Campus Service Use Among Students with Disabilities Who Have Experienced Sexual Violence: A Conceptual Model

Abstract

Students with disabilities (SWDs) are one student group with elevated risk of sexual violence (SV). Although they would benefit from streamlined access to campus support, little is known about their patterns of campus service use. This qualitative analysis includes data from semi-structured interviews with 51 SWDs who experienced SV focused on service use across campus. The resultant conceptual model shows that greater accessibility is associated with positive experiences, and lower accessibility is associated with negative experiences. SWDs who experienced or expected negative reactions (e.g., judgement) were less likely to use services and were less satisfied. Advocacy and support in connecting students with disability or SV services was associated with positive experiences and increased accessibility. These findings highlight key facilitators and barriers to campus service use for SWDs with SV histories and suggest key intervention points for increasing accessibility, reducing stigma, and improving student experiences with campus providers, staff, and faculty.

Introduction

Students with disabilities (SWDs; students with a psychiatric, neuropsychiatric/learning disorder, physical, or sensory impairment causing substantial impairment in functioning in at least one major life activity) represent up to one third of the college student population (American College Health Association, 2016; Auerbach et al., 2018; U.S. Department of Education & National Center for Education Statistics, 2016), a proportion that has been growing in recent years (Watkins et al., 2011). The Americans with Disabilities Act of 2010 (ADA) defines disability as a person who has, “A) a physical or mental impairment that substantially limits one or more major life activities, B) a record of such an impairment, or C) being regarded as having such an impairment” (“Americans with Disabilities Act,” 2010). Most SWDs have a psychiatric or neuropsychiatric condition (e.g., attention deficit hyperactivity disorder, learning disorder), with fewer having a physical or sensory disability (e.g., cerebral palsy, hearing impairment; American College Health Association, 2016). College years coincide with the typical age of onset for many psychiatric disorders (Kessler et al., 2005). Thus, this population often faces the co-occurring challenges of learning to cope with their symptoms, transitioning to higher education, and being away from home and established support systems.

In addition, and regardless of disability type, many SWDs have received a variety of supports prior to college, including academic accommodations made available through individualized education plans (IEPs) managed by their school. Some SWDs also benefit from support from parents (and other caregivers) in managing medical needs (e.g., scheduling and attending appointments, picking up prescription refills, insurance claims), though not all receive such assistance. These areas are critical for success in adulthood for young people (Vazquez et al., 2019). However, for many SWDs, the transition to college comes with a transition to different or more independent management of health and disability-related needs. Once on campus, SWDs are responsible for registering with the campus office for disability services and providing any required documentation to receive accommodations, something SWDs do not always pursue due to stigma or a lack of knowledge about the resources available to them (Coduti et al., 2016; Gronholm et al., 2017; Oliffe et al., 2010). The transition to adult medical care can also be disruptive, as SWDs may be required to change providers whether or not they leave their local area for school.

SWDs also have elevated risk in other areas which may complicate their transition to college, including increased anxiety and academic-related distress, along with elevated rates of suicidal ideation, suicide attempts, and non-suicidal self-injury (Coduti et al., 2016). SWDs are also 1.41–3.3 times more likely to experience sexual violence (SV) (Basile et al., 2016; Hossain et al., 2014; Snyder, 2015) and 1.71–2.25 times more likely to experience intimate partner violence (IPV) (Scherer et al., 2013, 2016) than those without a disability. The networks of support services on college campuses offer a unique opportunity to provide resources to SWDs to help them manage academic stress, and their mental, sexual, and physical health. However, for campus services to help reduce these disparities, SWDs must perceive services as accessible, acceptable, and supportive.

Unfortunately, college students who have a disability or have experienced SV report lack of accessibility as a major barrier to receiving campus support services. Specifically, students report that mental health counselors were unable to address their mental health needs due to long wait times to be seen (Nichols et al., 2018), a lack of training in treating their disability (Collins, 2000; DiPlacito-DeRango, 2016; Nichols et al., 2018), or the trauma of a SV/IPV experience (Holland & Cortina, 2017; Próspero & Vohra-Gupta, 2008; Stewart et al., 2020). In a qualitative study of barriers SWDs faced meeting their needs in a higher education environment, students described not knowing if they were eligible for disability services, what services they could obtain, how to access services, and lack of guidance in navigating the process of obtaining accommodations (Hong, 2015).

Students also lose trust in support services when they or their peers have had a negative experience seeking services (DeLoveh & Cattaneo, 2017; Holland & Cortina, 2017; Hong, 2015; Nichols et al., 2018). In Hong’s (2015) study, SWDs reported feeling “intensely uncomfortable” when visiting disability services on their campus (p. 220). Another qualitative study investigating service seeking experiences among SWDs who experienced SV/IPV found that students were deterred by counseling providers who focused heavily on their violence experience instead of the issues they had sought help to address, such as academic anxiety (Nichols et al., 2018). Such negative experiences with one service or resource are likely to influence students’ outlook on other services and can cause them to delay help-seeking in other areas (DeLoveh & Cattaneo, 2017).

Negative help-seeking experiences can also create or reinforce a student’s sense of internalized or social stigma. Embarrassment and perceived stigma around help-seeking, disabilities and traumatic sexual and relationship experiences are major barriers to students’ utilization of campus resources and support services (Collins, 2000; Davies et al., 2000; DeLoveh & Cattaneo, 2017; DiPlacito-DeRango, 2016; Eisenberg et al., 2009; Gulliver et al., 2010; Holland & Cortina, 2017; Hong, 2015; Nash et al., 2017; Próspero & Vohra-Gupta, 2008; Sabina & Ho, 2014). SWDs avoid or delay the use of accommodations due to concerns over being judged by both their peers and their professors as attempting to avoid their responsibilities, being less capable than other students, or a burden on the class (Collins, 2000; Hong, 2015). These concerns can be influenced by negative reactions from teachers in the past, in both college and high school (Hong, 2015).

While much of the literature on help-seeking behavior among college SWDs focuses on barriers to service utilization, a paucity of research has focused on facilitators for help-seeking or service use. Some studies have shown social support to be a key factor in combating the effects of pervasive stigma against help-seeking (DeLoveh & Cattaneo, 2017; Gulliver et al., 2010; Sabina & Ho, 2014). Students are more likely to use support services after receiving encouragement or a positive response from informal sources of support, such as friends or family (DeLoveh & Cattaneo, 2017; Gulliver et al., 2010; Sabina & Ho, 2014). A positive experience from a formal source of support can facilitate the use of further services, (Battalova et al., 2020; Gulliver et al., 2010; Wolitzky-Taylor et al., 2011) particularly since a service provider may provide useful referrals (Wolitzky-Taylor et al., 2011). However, none of the literature to date has focused on the role of campus advocates or support groups in help-seeking, nor the ways in which the major barriers and facilitators to service use for SWDs influence one another. Further, very little research investigates service use and help-seeking patterns among SWDs who have experienced SV. The purpose of this study was to investigate barriers and facilitators to help-seeking on campus among SWDs with SV histories to generate novel ideas or access points for improving service provision and accessibility for this minoritized student group.

Methods

Context for the Present Study

The current study took place within a larger parent study evaluating a brief intervention aimed at reducing alcohol-related SV and improving care seeking via a universally delivered brief intervention given as part of clinic visits at campus health or counseling centers on 28 college campuses in Pennsylvania and West Virginia (Abebe et al., 2018; Miller et al., 2020). Given the focus of the parent study on SV and care seeking, the study team only recruited participants with experiences of SV to complete qualitative interviews. Further, the parent study aimed to recruit 100 students to participate in interviews, which covered a broad range of health-related topics. Because the study team found that 68% of students with disabilities in the overall sample reported an experience of SV (Chugani et al., 2020), we found it imperative to better understand these students’ experiences. Therefore, targeted recruitment and interview questions to elicit the experience of SWDs on campus were included in this qualitative phase.

Procedures and Participants

The campuses involved in the parent study varied widely in size and environment: seven of the institutions were small (<5,000 students, n=21 participants), three were midsized (5,000–15,000 students, n=21 participants), and three were large (>15,000 students, n=17 participants). Eight campuses were in urban environments (n=40 participants), five in rural environments (n=11 participants) and five institutions had a religious affiliation (n=16 participants). All study procedures were approved by the Human Research Protection Office at the [University of Pittsburgh], and by the Institutional Review Boards at each participating institution when required. After completing surveys for the parent study over the course of one year, a subsample of students who reported any lifetime SV or IPV were recruited for semi-structured qualitative interviews. In the later phases of participant recruitment, the research team prioritized students who were less represented in the pool of participants, including men, individuals with physical or sensory disabilities, and sexual or gender minority students. In total, 60 students who reported a disability or health condition on their survey measures participated in interviews.

At the beginning of each interview, the student provided informed consent and was given a $50 gift card with the understanding that they could leave at any time without loss of payment. They were then presented with a list of common health conditions/disabilities and asked to identify any they had been diagnosed with or had experienced. Through this process, nine participants did not endorse any health conditions or endorsed conditions that had been resolved before entering college and were not relevant to their college experience. After excluding these participants, 51 participants were deemed to have been affected by their health condition/disability while in college and were included in the current study. Participant demographics, including disability type and type of SV experienced, can be found in Table 1.

Table 1.

Participant demographics at parent study enrollment (n=51)

	% (n)
Age
18	23.5 (12)
19	25.5 (13)
20	27.5 (14)
21–23	23.5 (12)
Race
Black or African American	3.9 (2)
White	78.4 (40)
Multiracial	17.6 (9)
Gender
Male	15.7 (8)
Female	83.4 (42)
Other gendera	2.0 (1)
Any sex with same gender partnerb	20.5 (9)
Year in school
1st year undergraduate	25.5 (13)
2nd year undergraduate	33.3 (17)
3rd year undergraduate	21.6 (11)
4th year undergraduate	11.8 (6)
Other	5.9 (3)
Disability type(s)c
Physical/sensory	23.5 (12)
Psychiatric/mental health	66.7 (34)
Neuropsychiatric/learning disorder	41.2 (21)
BRFSS Disability Screen Item Responses
Are you blind, or do you have serious difficulty seeing, even when wearing glasses?	8.6 (4)
Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?	40.8 (12)
Do you have serious difficulty walking or climbing stairs?	6.1 (3)
Do you have difficulty dressing or bathing?	6.1 (3)
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?	12.2 (6)
Type(s) of sexual violence students reported experiencingc
Unwanted sexual touching	90.2 (46)
Attempted unwanted sex	74.5 (38)
Unwanted vaginal sex	29.4 (15)
Unwanted oral sex	45.1 (23)
Unwanted anal sex	13.7 (7)
Unwanted penetration (e.g., with finger, object)	29.4 (15)

Percentages may not total 100 due to missing data.

^aIncludes transgender, non-binary, and other gender responses

^bFor students reporting sexual activity at baseline, (n=44)

^cResponse categories are not mutually exclusive

The interviews were conducted by four skilled interviewers with experience discussing highly sensitive subjects with young adults and adolescents. The interview guide focused on topics relevant to the parent study, including alcohol use, relationship history, experiences of SV/IPV, and thoughts about alcohol and SV prevention on campus – these data are explored in separate analyses. Interview questions relevant to the current analysis focused on: 1) students’ disabilities (e.g., diagnosis, effects on college experience), 2) SV and IPV experiences, 3) experiences using campus-based services and supports related to their disability/health condition and SV/IPV experiences, 4) patterns of service use or reasons care was not sought, and 5) campus-based services (or individual providers) with whom students would be most comfortable going to for help and reasons why.

Data Collection and Analysis

Each interview was audio-recorded and typically lasted one to two hours. Recordings were professionally transcribed, quality checked for accuracy with the audio recordings, and redacted of identifying information before analysis began. Transcripts were uploaded to the secure web-based qualitative analysis program Dedoose (Dedoose, Version 8.1.21) for coding.

The research team first approached the data using Braun and Clarke’s (2006) method of thematic analysis. The research team familiarized themselves with the data by reading through all the transcripts in their entirety during the processes of quality checks, redaction, and previous analyses conducted. The senior author worked with two research assistants to develop an initial codebook by reviewing excerpts pertaining to students’ experiences with and viewpoints on health and support services on campus (e.g., disability services, health services, counseling services, and the Title IX office). The codebook was applied to all transcripts by two coders who met regularly to discuss any discrepancies (to increase the dependability of the code applications), necessary alterations to the codebook, and emerging patterns.

Once the codes had been applied, the researchers wrote summaries of each code with illustrative examples from the interviews. The researchers then worked both individually and as a team to identify patterns and sort the codes into potential themes. The patterns identified related to ways in which services were more or less accessible to students, ways in which experiences engaging with services were positive or negative, how stigma created barriers in service utilization, and how advocacy and support facilitated service utilization. After establishing these initial themes, the research team then applied them as codes to the data. Although these patterns appeared relevant to the content of the interviews, the researchers began to see an interplay between SWDs’ access to services, experiences with services, perceptions of stigma, and support from advocates. Consequently, the research team allowed their analytic technique and the thematic areas to inform a conceptual model to demonstrate these interactions, informed by a constructivist grounded theory approach.

Constructivist grounded theory allows for more flexibility in conceptualizing the results in a way that demonstrates the relationships between multiple influential components (Charmaz, 2008). This method of analysis has been used successfully by other authors (Bonomi et al., 2011) in research related to the interpersonal process of coercive conversations involving perpetrators of intimate partner violence and their victims. Constructivist grounded theory posits that reality is context-dependent and the result of negotiating interpretations (Sandu, 2018). Accordingly, our conceptual model and coding demonstrated the ways in which students’ access to services and their experiences with those services affected each other, and how they were additionally affected by perceptions of stigma related to accessing those services or the advocacy and support they received in the process.

Results

Overview of conceptual model

The accounts of SWDs in our sample provided a rich understanding of how they experience and use campus services. Students’ access to services and experiences using those services influence one another, with greater access being associated with positive experiences, and lower access associated with negative experiences. These factors are additionally affected by the stigma students perceive around disabilities, mental health, sexual activity, SV, and help-seeking. Students who experienced or expected negative reactions (e.g., judgement, annoyance, or indifference from friends, family, professors, and health providers) were less likely to use services and were not as satisfied with those services. Advocacy and support in connecting students to needed disability or SV services increased service usage and improved students’ experiences of services and their emotional well-being. Although previous studies have examined how a variety of these elements (access to services, experiences with services, stigma, and advocacy/support) are related, (Collins, 2000; DiPlacito-DeRango, 2016; Eisenberg et al., 2009; Gulliver et al., 2010; Holland & Cortina, 2017; Logan et al., 2004; Nichols et al., 2018) none have modeled the ways in which they all interact to hinder or facilitate utilization of support services. Figure 1 presents the conceptual model developed from our analysis. We next provide descriptions of each of the key relationships in the model with participant quotes to illustrate each.

Figure 1.

Conceptual Model of Barriers and Facilitators to Campus Service Use in SWDs with SV

Figure 1. The conceptual model includes two mirrored maps of interactions. Top of the model displays the concept “Stigma” (types of stigma include disability, mental health disorders, sexual violence, help-seeking) connected by a two-way arrow pointing downward and to the right to the concept “Challenges and Limitations in Accessing Services” (e.g., unaware of services available, limited resources, long wait times, difficult process to obtain services. The concept “Challenges and Limitations in Accessing Services” is connected by a two-way arrow pointing horizontally to the left to the concept “Negative Experience of Service Use” (e.g., judgmental attitudes, not well trained to address needs). The concept “Negative Experience of Service Use” is connected by a two-way arrow pointing upward and to the right back to the concept “Stigma.” The bottom of the model displays the concept “Advocacy and Support” (e.g., resource connection facilitation, accommodation coordination, emotional support, peer network creation) connected by a two-way arrow pointing upward and to the left to the concept “Positive Experience of Service Use” (e.g., caring, non-judgmental attitude; promotes students health and well-being). The concept “Positive Experience of Service Use” is connected by a two-way arrow pointing horizontally to the right to the concept “Accessibility of Services” (e.g., knowledge about services, timely help, easy to obtain services, provide useful referrals). The concept “Accessibility of Services” is connected by a two-way arrow downward and to the left back to the concept “Advocacy and Support.”

Accessibility Affects Experience

When counseling, physical health, or disability services were perceived as easy to access, SWDs with an SV history perceived the service as more helpful to their well-being. This had the effect of not only benefitting the individual, but also reducing stigma as students shared their positive experiences with peers and encouraged them to seek services if needed. Students expressed a greater sense of agency when they were aware of the services available because of outreach efforts to promote these services on campus, including messaging, educational booths and drop-in events in central locations on campus, and handing out free items with information about the service attached. Knowing help was readily available when needed was associated with greater confidence and ease of connection to services, which reduced students’ stress:

It was really weird for me because in [the last place I lived] you go to a doctor’s office, and you wait 40, 50 minutes. You go in, and you spend five minutes with the doctor, and they’re, okay, done, bye. Here I came in expecting the same thing. Within five minutes I was in a doctor’s office, and they spent an hour just running all these tests because they genuinely wanted to know what was wrong.

I know even when I was trying to get myself to go, I was like. “Oh, well, I don’t know if they’ll be open.” I got one of the emails and it had the phone number right there. I was like, “Well, I’ll just call them and see”…it definitely helps.

When campus services were difficult to access, it negatively impacted SWDs’ experiences with those services. Long waits for appointments, limitations on services, arduous processes (e.g., doctor’s validation of disability to school officials), and lack of knowledge about available services left students feeling disappointed and frustrated. Students expressed feeling defeated by counseling services that were time limited or appeared to be designed to stabilize someone in a serious mental health crisis, rather than problem-solving and cultivation of healthy coping skills to manage their issues:

I also don’t like that it was you get three sessions, and then you’re done.…if I’m going to tell someone the massive amounts of crap that have come in my life, then I can’t just leave. I already have enough abandonment issues.

Say I’m going through something, unless it’s an emergency and you declare it as an emergency like you want to kill yourself or you want to hurt somebody else, they won’t take it seriously…. The soonest they can get you in is three weeks…. I mean, it would help, but what’s really going on to work through the issue is not as important anymore.

Experience Affects Perceived Accessibility and Use

The quality of SWDs with SV histories’ experiences using campus services, in turn, influenced how likely they were to use services in the future. Positive experiences were associated with participants feeling cared about and understood by campus staff and that the service or provider was helpful and supportive, that they could use the service without difficulty, and that they would want to return in the future. A positive connection with a campus service provider facilitated access to other services, including connections to other campus resources or resources outside the university when needed:

The [counselor] I went to was really great…. She referred me to [an outside counseling agency]. Even then I’m like, “Hey, I have a question about insurance. I don’t know who to go to….” Or, “I have a question about just mental health in general.” She would answer the question or say, “Here’s a reference,” or something.

I felt really uncomfortable about it, but when I was dealing with that thing from [Europe] I like forced myself to go talk to somebody, and like, get tested and stuff. And that particular person… was like very understanding with me and tried to help me set up therapy with [counselling center]. Which was like really great… they were like, “do you mind if we call [counselling center] right now and set up an appointment with them?” And I was like, “yeah, like let’s just do it.” I didn’t want to, but like I did it anyway. And that was pretty cool. I think it’s just hard to take the first step. Like the initiative to start things.

Conversely, negative experiences with a campus support service deterred students from using other services in the future. SWDs with SV histories critiqued service providers for being judgmental, invalidating, insensitive, and even incompetent when addressing their needs. Negative experiences also included push back from providers or professors who did not think disability accommodations were necessary, limiting their access to reasonable accommodations and the effect this had on future attempts to use accommodations.

Then, they were just like, “Maybe you wanna practice better hygiene.” I was just like, “Okay, you can get staph from other things.” Plus, I work on a farm. I was just like, “Okay, I could’ve told myself that. Why did I come see you?” They were just really rude…. I was just like, “What the hell? I don’t need this from you. I need medicine, which is why I came to you.” I dislike the whole system, from the nurses to the doctors, is just a no.

But Title IX at [college]’s kind of like trash…. It takes a really long time for cases to process. Like it takes months and months and you don’t wanna be thinking about how you were sexually assaulted for months and months…. I know one of my friends got like sexually assaulted and her case just ended almost like a year later…. And like why would I want, like what does that even—nothing is gonna come of it…. Nothing but like it’s gonna like cause me more inner turmoil than it is going to be worth it I feel like.

It just comes down to the way that Title IX handled it, the being lied to, the being misled, simply not doing their job…. They did all these different steps and put a whole file together, but they didn’t actually do anything with it so it was just like what’s the point of—you don’t even—what’s your job?

I talked to one of my professors. She shut me down. Then after that, I felt bad talking to any of the rest of them. I just tried to deal with it. At first, I wasn’t even getting extended testing time, which was bad.

The Role of Stigma

SWDs with SV histories did not always readily seek disability services, mental health counseling, health services, and Title IX services due to concerns about how they would be perceived and treated by university professors and staff, health care providers, future employers, and peers, as well as internalized stigma of their disability. We have presented these results by service category because student experiences of stigma, both internal and external, varied widely and were often dependent on the type of services they sought.

Disability Services

SWDs shared fearing that if they sought accommodations, they would be viewed as problematic and trying to avoid their academic responsibilities. Many did not seek accommodations due to concerns about how they would be perceived by others, including concerns that peers or teachers might perceive them as getting away with doing less work, or concerns about how receiving accommodations might be perceived by future employers. These concerns led to internalized stigma, where students felt embarrassed for needing extra help or that they should not need the accommodations. These challenges were compounded by unhelpful or unsupportive experiences with service providers, who must provide documentation in order for students to access accommodations on campus:

I also didn’t wanna create that relationship with my teacher of like, me being some sort of problem child so…I was just like “This isn’t helpful.” So, I just never mentioned it to my teachers.

As far as learning disabilities go, kids feel they’re pretty much on their own. Because if you go and you try to get accommodations made, you almost feel like you’re doing half the work. You feel kind of embarrassed that you should need that extra help.

Someone else said that they were taking the exam through Disability Services, so I looked at the website. You had to have a doctor write a note for you. I was really—I was at the point where I was between all the doctors ‘cause they couldn’t get anything together. Then the one I had wasn’t very pleasant, and she didn’t wanna help. So, I felt like I was reaching for something that I didn’t quite deserve.

Counseling Services

SWDs with histories of SV also experienced internalized stigma related to accessing mental health treatment. Students who accessed counseling services discussed challenges with the physical location of the building (i.e., being seen entering the counseling center), explaining where they were going to peers, and stigma related to needing a therapist as opposed to managing independently:

Having to go there, and walk in, and other people knowing why you’re there, and just the idea of having to tell my friends, “Hey, I have to go do this thing,” and just not wanting to tell them where I was, or why I was there.

Health Services

Having an experience with a provider who was perceived as judgmental increased stigma when students were left feeling that they had been chastised for not having made different choices to avoid needing the care they sought in the first place. SWDs who perceived providers as lecturing or patronizing about medical issues questioned the usefulness of the service and this created a barrier to future access:

I just don’t wanna feel like an adult being like, “Well you should’ve been better, to like use condoms” blah blah blah blah. And I’m like, I get it. I should use condoms. But [sighs] I hate condoms. They’re painful, for me. And like I dunno, I don’t want to feel patronized. I just want to be understood.

Title IX

Students also shared the ways in which social stigma was a part of their experience when reporting SV to Title IX offices. SWDs had fears about how others, including friends, student organizations, or even the Title IX office, would respond to reports of SV, including fears about whether the report would be taken seriously as well as social exclusion:

Seriously, sexual assault is people you know. That’s part of the problem, you don’t wanna get them mad at you. They’re your friends. People know who you are. If you do something, the other people are gonna find out about it and they’re gonna hate you, so you don’t do anything.

Advocacy and Support Increases Access and Positive Experiences

SWDs with SV histories described ways in which they were supported in accessing help and campus services through advocacy groups on campus, programs specifically for SWDs, and providers who advocated for students by helping them access disability services or other campus and community resources. Specialized programs (e.g., to help SWD navigate higher education systems) or services on campus created supportive networks to assist students in the accommodations process and reduced the stigma of their disability or SV experience:

It was really simple. They really streamlined it ‘cause it’s kinda combined with [my specific disability program], which is student support services, which accepts people with disabilities, first-gen college students.…that just made it easy being in both. One helps the other… I think it kinda helped you more being in there with [my specific disability program] ‘cause you’re in with other students like you who have a learning disability or they’re a first-generation college student not used to the learning culture… I really never felt excluded or isolated on campus much from that.

I spoke with some people at [the campus women’s center]….They were incredibly helpful….They provide some informal counseling for victims of sexual assault or harassment or whatever. They provide redirection to resources, counseling, they help with things like reaching out to professors and explaining, for you, explaining why things need to be late or taking care of dropping classes for you so you don’t have to worry about it, things like that.

Discussion

This study illustrates how barriers and facilitators to help-seeking for college SWDs influence one another to affect campus service use and adds to the literature related to campus service use among marginalized student populations. Common barriers to service use such as, inaccessibility due to waitlists or complex assessment procedures or judgmental providers, are well-known issues facing campus-based service providers (Collins, 2000; DiPlacito-DeRango, 2016; Eisenberg et al., 2009; Gulliver et al., 2010; Holland & Cortina, 2017; Logan et al., 2004; Mennicke et al., 2019; Nichols et al., 2018). With regard to facilitators to service use, we found that SWDs with SV histories tend to have more positive experiences when services are perceived as accessible and helpful when they receive support and advocacy in tandem with other campus services. Such supports increase access by assisting students in navigating systems of care, reducing stigma by validating students right to and need for services, and providing helpful resources or referrals, thereby increasing the likelihood of a positive experience. The logistical and emotional challenges of seeking help for a disability and/or traumatic experience make such groups and advocates extremely important to supporting student success. SWDs are adjusting to all changes typical when starting college, with the additional difficulty of navigating new accommodation processes and seeking to prove their capabilities in a higher education system, where stigma towards disabilities persists. Challenges in support service availability, such as counseling service staff, resource limitations, or lack of expertise in serving victims of sexual assault, might be addressed through collaboration with community partners. These community partnerships can provide useful “warm” off-campus referrals to cut down the wait to receive care and provide more consistent and ongoing care (Javorka & Campbell, 2019). Establishing formal disability advocates within each campus service unit, referral networks, and peer groups on campus could provide SWDs with valuable sources of knowledge, assistance and a sense of belonging in an environment that often leaves them feeling marginalized. These models of care and support are based off of trauma-informed care models practiced in other settings such as HIV care and primary care to minimize barriers to holistic care for individuals (Brooks et al., 2018; Machtinger et al., 2015).

Student knowledge of services and positive interactions between providers and students seeking assistance are two additional key facilitators to service use. With regard to knowledge of services, our findings suggest that typical methods of informing students of available campus services such as during welcome week or in official statements on all course syllabi (e.g., Title IX policy, disability accommodations policy, counseling center) may not be sufficient. More effort, strategic marketing, and targeted education may be needed to help students understand the variety of services available on campus, the process for accessing such services, what to expect when accessing them, and what to do if those services are not helpful. Marketing and educational efforts should also be planned with attention toward accessibility. For example, resource lists on the university should be easily found via internet search rather than from the search function within the school’s webpage as this is the most common method used by college students to search for information (Kirkwood, 2008). Further, information presented digitally should adhere to ADA (2007) best practice for presenting accessible content, including reading level (e.g., posting complex legal policy documents related to Title IX are not likely to be accessible for most students), and font size/color (Americans with Disabilities Act, 2007).

Based on our findings, having positive, supportive interactions with service providers, faculty, and staff plays an important role in SWD’ willingness to seek help and support on campus. Since negative help-seeking experiences or perceptions can deter students from seeking help again in the future, even with a different service or professor, (DeLoveh & Cattaneo, 2017; Hong, 2015; Mushonga et al., 2020) all campus employees should receive trauma-informed training (Davidson & Northwest, 2017; Hubach et al., 2019; Walsh et al., 2010) to help them understand the role they play in perpetuating or dismantling stigma that limits SWDs’ access to the academic accommodations they are entitled to, the healthcare they need, or the justice they deserve.

Finally, all of these efforts must be backed by systemic and structural support for SWDs and those who have experienced violence. Protocols and policies should be available and accessible to students and other stakeholders (e.g., parents) and written in plain language such that those affected can understand the contents. Campus culture influences how comfortable students feel disclosing their disability and using supportive services on campus (Chen et al., 2016; Trammell & Hathaway, 2007). Systems that provide explicit support for students and faculty throughout these processes (e.g., normalizing confidential and formal reporting structures for SV, aiding students and faculty each semester as they navigate accommodations, support for faculty in creating accessible course materials, etc.) may also facilitate more inclusive, positive experiences and interactions. A campus culture that models inclusivity of disability and explicitly values help-seeking as an act of strength and commitment to academic success and personal well-being can serve to combat stigma (i.e., that someone who has experienced trauma and/or is receiving accommodations or mental health services is weaker or less capable than their peers).

The present study has some limitations. Participants were recruited from a geographic area with low racial and ethnic diversity and consequently there our sample did not have sufficient representation of individuals from minoritized backgrounds. Considering that many people have multiple minoritized identities including race, ethnicity, disability status, and violence exposure, it is important to examine the experiences of students for whom these factors may all intersect to make it particularly difficult for them to access the supports they need. Disability status was measured by reporting qualifying health conditions rather than a clinical assessment of functional impairment, as would be required to receive accommodations under ADA. Although this allowed us to capture a wider range of students affected by a variety of health conditions regardless of whether they were formally registered to receive accommodations, this sample may have included students who would not be eligible for formal accommodations. A clinical assessment of functional impairment conducted by a medical or health professional was beyond the scope and resources available for the present study. In addition, while we actively recruited for people who were hard of hearing/deaf, we were not successful in reaching this group of students who likely experience additional barriers to seeking and receiving relevant services. Further, though a novel aspect of this work is the focus on facilitators to service use, we found more barriers relative to facilitators in our data. It is likely that this finding reflects the lived experiences of SWD who have experienced SV are currently having on campus.

Despite these limitations, this study offers important insights into the experiences of SWDs who have experienced SV and can be used to guide campus services. Our conceptual model shows that greater access is associated with positive experiences, and lower access associated with negative experiences. As well, the model shows that SWDs who experienced or expected negative reactions (e.g., judgement, annoyance, or indifference from friends, family, professors, and health providers) were less likely to use services and were not as satisfied with those services. Advocacy and support in connecting students to needed disability or SV services is imperative. Taken together, these findings suggest that colleges and universities may be able to better support SWDs with a history of SV through attention to fostering inclusivity and easier access to specialized services.