TBI and Domestic Violence

Survivors, families, and providers can find clear information on how domestic and intimate partner violence can lead to traumatic brain injury, along with supportive resources, trauma‑informed guidance, and tools that help identify and respond to TBI.

Traumatic Brain Injury and Domestic Violence

If you or someone you know is in a domestic violence situation, and/or if you need immediate information and assistance:

 

Domestic Violence and Intimate Partner Violence

Domestic violence and intimate partner violence are common causes of traumatic brain injury. While a disproportionate amount of these people are adult women, both adult men and children can be victims of the severe physical violence that causes these injuries in a domestic setting.

Intimate partner violence includes any behaviors that one intimate partner (current or former) uses over another to establish power and control. This can include:

  • Physical or sexual violence
  • Financial
  • Emotional and psychological
  • Cultural and spiritual
  • Reproductive
  • Other controlling behaviors

Some forms of intimate partner violence can be perpetrated electronically through mobile devices and social media sites, as well as in person. Intimate partner violence can occur regardless of whether people live together or not. This is usually what separates intimate partner violence from domestic violence.

Domestic Violence usually refers to violence occurring between residents within a single location. It is a pattern of controlling behavior used by one partner to maintain power in a relationship over the other.

 

What is a Traumatic Brain Injury?

A traumatic brain injury is an injury to the brain caused by physical trauma, including physical assaults. A TBI can result in changes to one or more of the following areas: cognition, language, memory, attention, reasoning, abstract thinking, judgment, problem solving, sensory, perceptual, and motor abilities, psychosocial behavior, physical functions, or information processing.

A victim of domestic violence or intimate partner violence may sustain a TBI without their knowledge, especially if there are no signs of obvious signs of trauma or other TBI-related symptoms. Many people may receive no medical care or intervention. This dramatically increases the likelihood of recurrent TBI(s), which may result in more severe neurological damage.

Common causes of closed head injuries among domestic violence or intimate partner violence victims:

  • Objects striking the head or neck
  • Pushed against a wall or other surface
  • Pushed down a flight of stairs
  • Violent physical shaking
  • Choking or strangulation

A person who has sustained a TBI may not recognize they are experiencing issues related to a TBI because many of the associated symptoms are common in everyday life. The most widely reported TBI-related symptoms are headaches, severe neuro-fatigue, working memory issues, anxiety, depression, and impairments in social communication.

 

TBI Screening

Screening for TBI among people who have experienced or are experiencing domestic violence can potentially reduce the physical, behavioral, and cognitive consequences of a TBI by identifying and supporting proper treatment and resources. 

The high probability of recurrent physical injuries without any medical intervention facilitates a situation where a person is more likely to experience severe TBI-related symptoms over a prolonged period. Screening for TBI among survivors of violence is essential.

Some screening tools include (but are not limited to): 

CHATS: Head Injury Identification and Accommodation Tool

Ohio Domestic Violence Network

Download PDF

This is a three-page resource that's part of the CARE framework, which includes guidance on supporting IPV survivors and providing accommodations. Advocates and survivors can use this tool to share past history and current concerns with health care providers. 

HELPS Brain Injury Screening Tool

National Association of State Head Injury Administrators

View HELPS Brain Injury Screening Tool 

This is a one-page tool that uses five "YES" or "NO" questions. 

The Ohio State University Traumatic Brain Injury Identification Method

The Ohio State University 

Visit Ohio State University TBI Method

This two-page tool provides steps for conducting a structured interview. It provides a chart for documenting possible causes of TBI and severity of the injury. 

Online Brain Injury Screening and Support System

National Association of State Head Injury Administrators

Visit Online Brain Injury Screening and Support System

This online screening system determines if someone has had a brain injury in their lifetime. It screens for specific symptoms and provides tip sheets to shelter staff and survivors on how to accommodate those challenges. It requires buying a 12-month plan to use. 

Brain Injury Screening Questionnaire

Icahn School of Medicine at Mount Sinai 

Visit Brain Injury Screening Questionnaire

This questionnaire evaluates experiences and severity of head trauma and traumatic brain injury.

Brain Injury Severity Assessment Interview

University of Illinois

Download Brain Injury Severity Assessment Interview (PDF)

This is a six-page tool. It uses a series of "YES" or "NO" questions with prompts for probing more information. 

 

Providers and Trauma-Informed Care

Service providers with a trauma-informed approach can aid in the healing process and allow for the best possible outcomes for survivors of domestic violence and intimate partner violence. To be trauma-informed in practice means establishing a pathway that will not further re-victimize the person seeking services. In accomplishing this goal, the service provider will be holistically supporting victims of domestic violence and intimate partner violence in their recovery and healing trajectories.

A TBI can make it harder for a survivor to:

  • Remove themselves from an abusive environment.
  • Assess potential dangers and react appropriately.
  • Engage in educational opportunities.
  • Access service providers that can enable independent living.
  • Adapt to living in a domestic violence shelter. The victim may become anxious and confused or disruptive or have trouble understanding or remembering shelter rules and procedures.

 

Working with survivors after a TBI:

  • During meetings, reduce unnecessary distractions, such as bright lights and noise.
  • Develop safety planning in smaller and more frequent steps.
  • Aid in the development of checklists, goal creation, and time management.
  • Allow extra time to complete tasks (e.g., forms, phone calls, decision-making, etc.).
  • Be factual, realistic, and concrete in your statements.
  • Break information down into small pieces.
  • If safety allows, write important information down in a journal or calendar, such as court dates, contact numbers, directions, order of protection information, to-do lists, etc.
  • Coordinate with the person to optimize the management of their lives, in terms of accessing benefits, rehabilitation and support services, assistive devices (voice recorders, timers, PDAs, post its, etc.), service animals, and independent living.
  • Provide respectful feedback on problem areas that affect the safety and possible consequences of long-term/short-term decisions.

Visit I am a Provider and Person-Centered Care and Practices for more information and resources.

 

Additional Information and Resources

Learn more about:

  • RCW 74.31.070 on the statewide response to traumatic brain injuries suffered by domestic violence survivors.
  • How it supports RCW 10.99.030 on peace officers’ powers and duties when responding to domestic violence calls (under 4b).

Access eLearning Network training and downloadable materials from the Ohio Domestic Violence Network Resource Center, like:

Access our Building Capacity: Brain Injury Workshop Library and register for upcoming learning opportunities

Access our TBI Capable Caregiver training manual and other useful learning materials

Access research, learning, and advocacy resources:

 

Traumatic Brain Injury graphic