It must seem a bit exasperating to set aside time to read an article only to discover that the authors conclude that little is known about the subject. What on earth are researchers doing with their time and our money? Systematic reviews are generally at risk of concluding ‘more research is needed’; if this is so then what is the point of them all?
This article addresses a subject where there is public and political interest in a social problem and so practitioners could turn to it for information and guidance. However, the authors warn that there is little evidence of how to successfully prevent violence against disabled people.
Like most reviews the first part of the article tells us what research the authors read on our behalf by defining the terms they selected and the electronic data bases they searched. I am always reminded of the World War II poem, ‘Naming of Parts’ by Henry Read when we are told what is included and what is not in such reviews. Here, for example, ‘persons with disabilities’ include children and adults, while ‘violence’ is a broad term covering areas commonly associated with physical mistreatment but also financial abuse. What the authors focus on are studies of interventions that prevent or respond to such violence.
They searched English language databases for reports of studies published between 2000-11; seeking further evidence from 12 international experts to supplement their search. This resulted in 736 possible articles to review – of which only 10 met their criteria for being about an actual intervention – where its purpose and design are clearly explained; the participants’ characteristics are reported, and the outcome measure (what was used to measure any change) is specified.
Social work is not a profession that is used to reading tables in my view – there is greater emphasis on narrative accounts and boxes or tables in publications are often used as illustrations, e.g for quotes. I’ve found that many social workers freely admit to skipping the tables in an article – not for lack of intelligence but because they are unfamiliar ways of presenting the world. Things may change but this article is an example of one where there is a lot of information in the tables and they repay reading and thinking about. What is immediately obvious from the 10 studies when put next to each other in a table form (Table 2) is that they are hugely different, as the findings section below illustrates.
The review identified:
- 10 separate studies evaluating the effectiveness of prevention or victim support schemes (mitigating the consequences) of violence against disabled people.
- In 8 of the 10 studies participants had intellectual disabilities or developmental disabilities.
- Most of the studies did not involve many participants – sizes ranged from 7 to 329.
- The interventions varied widely, ranging from respite care or short breaks for family carers to survivor groups.
- 4 studies concerned sexual abuse, 3 different types of abuse, 1 each physical abuse/child maltreatment/non-specified.
- The evaluations covered randomised controlled trials (RCTs), non RCTs, as well as before and after tests.
- The measures of prevention were rather general – not real measurements of violence.
- The researchers considered that after taking into account the risk of bias of the studies (meaning that they made judgements about the quality or rigour of the research) then claims that any of the interventions are effective are not strong.
Strengths and limitations
The review does what most of us will never have the time or the inclination to do. It has waded through a huge amount of material and read it in depth. It has compared like with like – as much as possible. If we work in one part of services or undertake research about interpersonal violence, domestic violence, elder abuse, or so on we often know one area well and don’t have much idea about others.
One strength of this review is that it has a lengthy discussion in which it explains the limits of current evaluations and the sustained tradition of researchers’ interest being in sexual abuse of people with learning disabilities. Rather than simply calling for just ‘more research’, the discussion is further helpful in pointing to the ways in which such research should involve disabled people by being more emancipatory – not seeking just to understand but to change social harms.
The authors also suggest that effective interventions related to interpersonal violence affecting disabled people might be rather similar to interventions related to general populations.
What works in preventing violence against people with disabilities is not really known. There is no ‘magic wand’ to wave; no research waiting to be discovered; no clear and obvious commissioning options.
Practitioners should be cautious in accepting claims that services are evidence based; instead they should encourage, participate or lead well-organised studies to work out what works and for whom, where and when, and why or why not.
Mikton and his colleagues’ findings may come as a surprise, given that there are many services and professionals supporting victims and survivors of violence. If you want to read a summary of fairly recent research this is a good overview and if you want to find out which of the hundreds of articles to read about the subject then the 10 reviewed here would be a good starting point.
Like good systematic reviews this one has done some helpful sorting and sifting for us.
Mikton C, Maguire H & Shakespeare T (2014) A systematic review of the effectiveness of interventions to prevent and respond to violence against persons with disabilities Journal of Interpersonal Violence 29 (17) pp.3207-3226 [Abstract]