Domestic Violence and TBI

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Washington State Domestic Violence Information and Referral

TBI Domestic Violence Informational Handout

 

Screening and Information Tools

Domestic Violence and Traumatic Brain Injury Information

Domestic violence (DV) is a common cause of a traumatic brain injury (TBI) among the population. While a disproportionate amount of these individuals are adult women, both adult men and children can be victims of the severe physical violence that cause these injuries in a domestic setting.

What is a Traumatic Brain Injury?

Traumatic brain injury (TBI) is:

  • An intracranial injury that is the result of an external physical force striking the head or neck.
  • Classified based upon causative forces, pathophysiology, and severity of the injury.
  • Caused by bumps/jolts, rapid acceleration and/or deceleration, lack of oxygen (i.e., strangulation), severe shaking, or penetration of the skull, which results in damaged brain tissue.
    • Penetrating head injuries are due to a foreign object (i.e., knife, bat, bullet, etc.) that pierces the skull. This type of injury leads to localized brain damage.
    • Closed head injuries are due to blows to the head or neck that do not fracture the skull; this also includes injuries caused by severe physical shaking. This type of injury is common for those that are classified as sustaining a mild-TBI (aka, concussion).
      • Common causes of closed head injuries among DV victims:
        • Objects striking the head or neck.
        • Pushed against a wall or other surface.
        • Pushed down a flight of stairs.
        • Violent physical shaking or strangulation.

A victim of DV may sustain a TBI without their knowledge, especially if there are no signs of obvious trauma or other TBI-related symptoms. Due to this, many individuals may receive no medical care or intervention, thus dramatically increasing the likelihood of recurrent TBI(s), which may result in more severe neurological damage over time.

The Potential Effects of Traumatic Brain Injury

The potential effects resulting from a TBI can range from mild to severe among several categories. These categories include Thinking (i.e., memory and reasoning), Sensation (i.e., sight and balance), Language (i.e., communication, expression, and understanding), and Emotion (i.e., depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).
An individual that has sustained a TBI may not recognize they are experiencing issues related to brain damage 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.

Other problems experienced by individuals that have sustained a TBI are:

  • Impairments in executive functioning, such as difficulty making decisions, considering long-term consequences, taking the initiative, feeling motivated, and starting and finishing actions; disinhibition and impulsiveness.
  • Impairments in cognition, such as a decreased ability to concentrate, problem-solve, remain attentive, and appropriately communicate.
  • Impairments in personality and behavior that leads to chronic irritability, frustration, and stunted emotional expressions.

There is also a potential for physical impairments, such as hearing and vision problems, insomnia, loss of coordination, and the development of seizures.

Service Providers and Trauma-Informed Care

Every victim of DV will have a unique history, background, and traumatic experiences. Adopting a trauma-informed approach can aid in the healing process and allow for the best possible outcomes. For a service provider to be trauma-informed in practice means establishing a pathway that will not further re-victimize the women, men, and children seeking their services. In accomplishing this goal, the service provider will be holistically supporting victims of DV in their recovery and healing trajectories.

Tips for service providers:

  • Collaborate with the individual in establishing a safety and treatment plan.
  • Establish a connection based on respect and focus on the individual’s strengths.
  • Promote emotional safety by reducing potential trauma-inducing triggers.
  • Help the individual understand the nature of their trauma symptoms.

The service provider would also benefit from incorporating active listening and validation of the individual’s emotional state. This strategy enables the service provider to foster trust and guide the DV victim through strategies to diminish extreme stress, everyday obstacles, and recurrent trauma. The goal is for the service provider to acknowledge the individual first and foremost, and not any potential diagnosis (i.e., behaviors and symptoms).

Service Providers and Screening Tools

Individuals living with DV may find it difficult to recover from a TBI. The high probability of recurrent physical injuries without any medical intervention facilitates a situation where individuals are more likely to experience severe TBI-related symptoms over a prolonged period. Screening for TBI among individuals that experience DV can potentially reduce the physical, behavioral, and cognitive consequences of a TBI by identifying those individuals that require more extensive medical care. However, service providers need to remember that there are several obstacles for an individual that has sustained multiple TBI(s) as a result of DV.

A TBI can make it harder for a victim of DV to:

  • Remove themselves from an abusive environment.
  • Create and sustain a safety plan.
  • Assess potential dangers and react appropriately.
  • Gain and/or retain employment and financial stability.
  • Engage in educational opportunities.
  • Access service providers that can enable independent living.
  • Adapt to living in a DV shelter.
    • The victim may become anxious and confused or disruptive or have trouble understanding or remembering shelter rules and procedures.

TBI Screening Assistance

Screening for TBI among victims of DV is essential. A brief assessment that was designed to be used by professionals who are not TBI experts is known as HELPS Screening Tool.

HELPS is an acronym for:

H = Have you ever Hit your Head or been Hit on the Head?

E = Were you ever seen in the Emergency room, hospital, or by a doctor because of a head injury?

L = Did you Lose consciousness? (Not everyone who suffers a TBI loses consciousness)

P = Are you having cognitive or social Problems in your daily life? (List provided on screener)

S = Did you experience a significant Sickness following your head injury?

A HELPS screening is considered positive for a possible TBI when the following three items are identified:

  1. An event that could have caused a brain injury (yes to H, E or S), and
  2. A period of loss of consciousness or altered consciousness after the injury or another indication that the injury was severe (yes to L or E), and
  3. The presence of two or more chronic problems listed under P that were not present before the injury.

If an individual has been considered positive for a possible TBI, then they need to be referred to a medical provider for a diagnostic evaluation.

Screening Tool

HELPS - TRAUMATIC BRAIN INJURY (TBI) SCREENING TOOL

Working with Victims of Domestic Violence Post-TBI

Adopting the following strategies can aid a service provider in navigating an individual’s impairments in cognition, behavior, and executive functioning to optimize their well-being.

  • During meetings, reduce unnecessary distractions, such as bright lights and noise.
  • Break safety planning into sequences of smaller steps.
  • Review safety planning frequently.
  • Aid in the development of checklists, goal creation, and time management.
  • Allow extra time for them to complete tasks (e.g., forms, phone calls, decisions-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 individual 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.

Local / Regional / State Resources

Citations

  • Carmo, R., Grams, A., & Magalhães, T. (2011). Men as victims of intimate partner violence. Journal of Forensic and Legal Medicine, 18(8), 355–359. doi: 10.1016/j.jflm.2011.07.006
  • Haag, H. (L., Sokoloff, S., Macgregor, N., Broekstra, S., Cullen, N., & Colantonio, A. (2019). Battered and brain injured: Assessing knowledge of traumatic brain injury among intimate partner violence service providers. Journal of Women's Health, 28(7), 990–996. doi: 10.1089/jwh.2018.7299
  • International Center for the Disabled, HELPS Screening Tool, 1992
  • Ko, S. J., Ford, J. D., Kassam-Adams, N., Berkowitz, S. J., Wilson, C., Wong, M., Brymer, M. J., & Layne, C. M. (2008). Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice. Professional Psychology: Research and Practice, 39(4), 396–404. https://doi.org/10.1037/0735-7028.39.4.396
  • Potential Effects. (2019, February 25). Retrieved from https://www.cdc.gov/traumaticbraininjury/outcomes.html
  • Zieman, G., Bridwell, A., & Cárdenas, J. F. (2017). Traumatic brain injury in domestic violence victims: A retrospective study at the barrow neurological institute. Journal of Neurotrauma, 34(4), 876–880. doi: 10.1089/neu.2016.4579