To Örebro University

People with cognitive disabilities are often excluded from research due to the inaccessibility of methods and assessment tools. Critical challenges include ensuring self-determination, developing inclusive recruitment methods, and enabling effective communication, all of which are essential to inclusive research. This article describes the use of graphic vignettes-illustrating various forms of violence-combined with semi-structured interviews as a multimodal approach to promote sensemaking and reflexivity related to violence against persons with cognitive disabilities. This methodological study is based on a reflexive thematic analysis conducted with 17 participants with cognitive disabilities (18 years or older). It describes the development of the vignettes and interview strategies designed to elicit participants' own understanding of violence while supporting their decision-making and sense of control over the interview process. The article also discusses the implications and value of using vignettes and interviews as a multimodal research approach that not only maximizes accessibility and flexibility but also enhances self-determination and actively builds trust; key aspects that support sense-making of sensitive topics, such as violence. In doing so, this study provides key methodological insights that uniquely facilitate reflection and the direct participation of this population in research about their lives.

Summary: Dialogues between professionals and clients in social work are central to identifying and providing support for violence in close relationships. How professionals approach dialogues about violence in close relationships with clients with cognitive disabilities, and associated challenges to making them accessible, are understudied. Semi-structured interviews with 18 professionals in disability services, domestic violence shelters, social services, and health services in Sweden were conducted. Previous findings and gaps in theory motivated an inductive content analysis which generated four categories that illustrate challenges to accessible violence in close relationship dialogues.

Findings: The four categories comprise challenges about : understanding and reasoning about violence; self-determination and protection; adapting assessment tools and approaches; and urgent and long-term approaches. These challenges entail difficulties in creating shared understandings and handling conflicting rights of clients. Furthermore, they included the need to adapt and maintain the validity of assessment tools, as well as organizational restrictions on the use of long-term approaches.

Applications: The findings shed light on how professionals must simultaneously handle various aspects of violence in close relationship dialogues. Verbally adhering to a given description of a situation was restricted by the need to maintain a professional-client relationship. When motivating the need to accept support, professionals had to avoid manipulating clients. Furthermore, the findings indicate several weaknesses in current practice that professionals struggle to address individually, such as, overly extensive assessment tools and little guidance on identifying less overt forms of violence in close relationships. Professional guidance is required in social work practice and related fields.

People with disabilities have a higher risk of exposure to violence than people without disabilities. Although dialogues between professionals and clients hold potential for improving the response to violencei n close relationships against persons with cognitive disabilities (PwCD), the necessary and favorable conditions for these dialogues to have a positive effect have received little attention.

Purpose: This thesis explores dialogues about violence in close relationships from the perspectives of professionals and PwCD, thus identifying the conditions needed to achieve co-constructed understanding through such dialogues by integrating scientific theory on dialogue, disability, and violence.

Methods: An explorative design was applied in two studies, using qualitative methods to gain insight into perspectives from professionals and PwCD. In parallel, an abductive approach was used to construct a theoretical framework for analysis.

Conclusions: This thesis emphasizes that dialogues are shaped by processes at multiple levels, extending beyond interpersonal dynamics to include ableist structures, normative expectations, and disability-related experiences of violence. Strengthening violence literacy among professionals and PwCD can improve the conditions for dialogue. To facilitate the co-construction of shared understanding in dialogue, professionals should acknowledge the dimensions of trust and powerbalance, provide access to adapted communication, supported decision-making, and enable the individual choice of communicators.       

Future Research: The use of vignettes, and expansions to the proposed theoretical framework, are promising topics for future research.

The risk of violence in close relationships is higher for people with cognitive disabilities than in the general population. This is due to social isolation, and physical or financial dependence on others in everyday activities. To enable adequate protection for these victims, social workers need to take decisions and provide support that is based on knowledge about both violence and disability-related needs. By contrast, people with cognitive disabilities are de facto less likely to be provided with support adapted to their needs. Therefore, this study explores how social workers navigate barriers and facilitating aspects to support victims of violence with cognitive disabilities.Data were collected in individual interviews with 18 social workers, and analysed using content analysis. The inclusion criteria were 3 years or more experience in identifying and/or assessing exposure to violence in close relationships among people with cognitive disabilities.

The emerging categories illustrate how social workers face dilemmas when navigating the balance between individuals’ rights for self-determination and complex needs for protection and support. The policies that frame social workers' practice in Sweden are discussed in relation to the need for flexible interventions and accessible support based on interprofessional collaboration related to violence and cognitive disability. The categories also problematize the power dynamics involved and how different actors’ experiences, values, and power influence the support process. The different actors involved add to the complexity that social workers need to navigate.

This presentation focus on how social workers' practice is governed and hindered by policy, a focus on individuals' rights for self-determination, and the need to support and protect a group that may have difficulties to identify both violence and their needs for support.

Background: In Sweden, social workers are responsible for identifying, assessing, and supporting victims of violence among people with and without disabilities. Research has shown that people with cognitive disabilities are more likely to become victims of intimate partner violence (IPV) than non-disabled people. Some reasons for the high rates of victimization that people with cognitive disabilities have reflect a dependence on others in everyday activities, limited access to adapted communication, and lack of education about the victimization of IPV for this group among professionals and social workers. Yet, there are no official disability-adapted assessments to support this work. Very few studies explore the type of adaptations needed to identify and assess the risk of violence against this group. Therefore, this study aims to explore how social workers identify and assess victims of IPV with cognitive disabilities.

Method: An explorative and qualitative design using focus group interviews with five groups of social workers was conducted. Each group contained three to five social workers employed either at a municipality’s social services or NGO and having experience working with people with cognitive disabilities or IPV. Group discussions were led through six topics prompting participants to describe their experiences working with people with cognitive disabilities who are victims of IPV.

Results: Preliminary results point to both challenges and good examples of the practices concerning identification, assessment, and support of victimization among people with cognitive disabilities focusing on the resources at different types of organizations to meet the needs of this group. Local adaptions of government-recommended assessment tools such as adding picture support or verbally elaborating definitions of IPV were common. Some difficulties in cooperation between and within institutions were also described.

Conclusion: Final results and conclusions will be presented at the NNDR research conference in May 2023.