Program Profile: A Safety Awareness Program (ASAP) for Women with Disabilities

This program is designed to increase safety awareness, knowledge, skills, self-efficacy, and behaviors as well as increase social support among women with disabilities. The program is rated Promising. The program was shown to produce a statistically significant increase among participants’ scores on measures of safety planning, safety knowledge, and safety-promoting behaviors, compared with non-participants. The groups did not differ on measures of safety awareness following the intervention.

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals/Program Components

A Safety Awareness Program (ASAP) for women with disabilities was designed to increase abuse and safety knowledge, safety skills, safety self-efficacy, social support, and safety promoting behaviors of women with diverse disabilities (including physical, visual, mental health, cognitive, or developmental disabilities or other health conditions) who are residing in centers for independent living (CILs).

Drawing largely on SafePlace Disability Services’ Stop the Violence, Break the Silence: A Training Guide (Hughes, 2003), the program consists of eight weekly, 2.5-hour educational and interactive classes. The program includes weekly action planning with group feedback and problem solving. Affirming messages and relaxation training are included at the closing of each class. Class sessions incorporate information and activities that are theorized to improve safety behaviors and ultimately prevent and reduce physical and sexual abuse.

Key Personnel

Each CIL director selects two female staff members with disabilities to serve as leaders for the ASAP program. At least one leader from each CIL completes an in-person, 2.5-day training program (Hughes et al. 2010). Training is provided on the curriculum, recruitment and enrollment procedures, documentation, protocol fidelity, the consent process, and mandatory reporting of abuse. Trained CIL leaders then return to their sites to initiate recruitment and enrollment.

Program Theory

ASAP for women with disabilities is based on self-efficacy theory (Bandura 1997), feminist disability theory (Garland-Thompson 2003), feminist psychology (Jordan, Walker, and Hartling 2004), trauma and recovery theory (Herman 1992), and independent living philosophy (Nosek and Fuhrer 1992). Based on social–cognitive theory (Bandura, 1997), ASAP seeks to build safety awareness and knowledge, skills, self-efficacy, and social support, all of which help to increase safety behaviors and ultimately influence physical safety. The program also addresses how women with disabilities are more likely to experience interpersonal violence in their lifetimes than their non-disabled counterparts (Hughes et al. 2011).

Study

Robinson-Whelen and colleagues (2014) used a randomized controlled trial to determine if A Safety Awareness Program (ASAP) improved safety protective factors among participants. Each of the 10 centers for independent living (CIL) leaders were responsible for recruiting 20 to 22 women for the study. Women participating in the study had to be at least 18 years old; have a physical, visual, mental health, cognitive, or developmental disability or other health condition for at least 1 year that caused a limitation in one or more major life activities, or deafness or hearing loss; a demonstrated ability to give informed consent; and fluency in English or American Sign Language. Women were also required to correctly answer at least four of the five questions on a comprehension of consent test, which all study participants passed. 

The women were randomly assigned to either the treatment group (ASAP plus regular CIL services) or the usual care (regular CIL services only) condition. Safety-related variables were assessed at pretest (prior to the intervention), at 2 months (immediately after the intervention), and at 6 months (4 months after the intervention). A total of 109 women were assigned to the treatment group, and 104 women were assigned to usual care. Among all participants, the average age was 48 years old. Most of the overall study sample (72 percent) was white, with 18 percent African American and 9 percent mixed race or multi-race. For 56.8 percent of the overall study sample, the primary disability was a physical disability or health condition, while 23.5 percent had a mental health disability, 11.3 percent had a cognitive or learning disability, and 8.5 percent had a visual disability. Most participants (71.4 percent) had experienced some abuse in their lifetimes. The most common abuse reported was physical abuse (66.5 percent), followed by sexual abuse (45.1 percent). Comparing women assigned to the two conditions, no group differences were observed on any of the demographic, disability characteristics, or prior abuse experience. 

At all three testing times, participants completed an abuse-awareness scale, as well as measures of 1) abuse and safety knowledge, 2) safety skills, 3) safety self-efficacy, 4) social network, 5) social support, and 6) safety-promoting behaviors.

• Lifetime abuse experience was assessed using the Abuse Assessment Screen Disability (AAS-D; McFarlane et al. 2001).
• Abuse awareness was measured by the five-item Abuse Awareness Scale (Robinson-Whelen et al. 2010). Abuse and safety knowledge was measured using the ASAP Knowledge Test.
• Safety skills were measured with six items, asking respondents to indicate, along a 5-point scale, how much they had learned certain safety skills such as self-defense.
• Safety self-efficacy was assessed with two measures. The first was the six-item Safety Planning Self-Efficacy Scale (SPSES; Taylor, Hughes, Mastel-Smith, Howland, and Nosek 2002). The second measure was the nine-item Safety Self-Efficacy Scale (Robinson-Whelen et al. 2010).
• Social network was assessed using the six-item Friendship subscale of the Lubben Social Network Scale-Revised (LSNS-R; Lubben, Gironda, and Lee 2002).
• Social support was assessed using the eight-item Emotional/Informational Support subscale of the Medical Outcomes Study Social Support Survey (MOS-SS; Sherbourne and Stewart 1991).
• Lastly, safety-promoting behaviors were assessed using a seven-item, 5-point scale. More information on the development of these items can be found in Powers and colleagues (2009) and Robinson-Whelen and colleagues (2010).

A general linear mixed-model analytic plan was applied. Least square means were calculated for both intervention and control groups at all three measurement times. No subgroup analysis was conducted.

Centers for independent living (CIL) leaders participated in regular conference calls with research staff to discuss issues that might arise in the recruitment process. Project staff also provided individual consultation and broader supervision. Conference calls were used to review attendance, disability related accommodations, time management of class sessions, engagement of participants, group management challenges, and the importance of research fidelity (Robinson-Whelen et al. 2014).

Moderator Analysis

No subgroup analysis was conducted; however, a moderator analysis was conducted to assess whether abuse experience and presence of a cognitive disability moderated the impact of the intervention. Abuse experience was related to many of the protective factors examined in the study. Abuse awareness, abuse and safety knowledge, and safety skills were all positively related to abuse experience, such that those with more abuse experience reported higher scores at the follow-up period. On most outcomes, women with cognitive disabilities had significantly lower safety self-efficacy scores overall than women without cognitive disabilities. In addition, there was some evidence that women with cognitive disabilities experienced fewer gains in safety self-efficacy over time (Robinson-Whelen et al. 2014).

These sources were used in the development of the program profile: