Domestic Violence and Brain Injury
Domestic violence (DV) also referred to as Intimate Partner Violence (IPV) continues to be a public health issue that affects far too many Americans. With one in four women and one in ten men experiencing domestic violence in their lifetime, tens of millions in the United States experience DV. Within the context of domestic and sexual assault, brain injury usually results from a hit to the head or face (traumatic brain injury-TBI), strangulation (which leads to loss of oxygen to the brain), or a combination of both. Ongoing efforts to measure the prevalence of brain injury in instances of DV show between 50-90%, of individuals seeking medical services related to DV had symptoms associated with brain injury. This means that of those 30 million women who experience domestic violence in the United States, 20-27 million likely show signs or symptoms of brain injury. The prevalence of TBI in the context of domestic violence is estimated at 11–12 times greater than the published incidence of TBI from occupational, athletic, military, recreational, and accidental events. Thus, domestic violence intensifies the impact of TBI as a healthcare epidemic.
Illinois Coalition to Address Intimate Partner Violence-Induced Brain Injury
Unfortunately, the intersection between DV and brain injury is not well known to survivors, nor to those who provide services and assistance. Services to assist survivors typically do not address the brain injury symptoms, nor adapt their services to accounting for the neurological challenges that accompany brain injury. In 2018, we formed the Illinois Coalition to Address Intimate Partner Violence-Induced Brain Injury to address this issue. We collaborate with groups and individuals in Arizona, Ohio, Massachusetts, and New York and partner with area organizations such as The Network: Advocating Against Domestic Violence, Between Friends, Apna Ghar, and the Brain Injury Association of Illinois and others to address this issue. The four main areas of focus and activity of our organization are education, research, services, and advocacy.
Educational material for survivors and their families starts the conversation about how violence may have resulted in brain injury. Many times, for the first time, survivors recognize their symptoms as a consequence of brain injury, which include a loss of focus and memory, depression, and anxiety to name a few. Most importantly, the survivors are informed that brain injury symptoms are treatable. The education extends beyond survivors to include those who serve survivors, such as shelters, social workers, psychologists, legal professionals health care workers broadly defined, and police officers and paramedics who first respond to victims’ calls of distress. To this end, our group has raised awareness among hundreds of individuals who have attended symposia, training, and grand rounds. Our goal is to create and distribute a set of printed and digital materials and trainings that can be delivered to the community and the professionals who serve survivors.
The field of Intimate Partner Violence-Induced Brain Injury is a fairly young one, where knowledge still needs to be gathered and research conducted. Two of our members (Dorothy Kozlowski and Sonya-Crabtree-Nelson) are academics and DePaul faculty members, conducting research in this area. In fact, they co-edited a two-volume special edition on this issue in the Journal of Violence, Aggression and Trauma in 2019. We are partnering with groups in other cities on broader impact research projects. One project in particular examines the epidemiology of DV induced brain injury in Chicago/Illinois and whether the incidence of DV induced brain injury has increased during social isolation due to COVID (preliminary examinations suggests this is the case). We’re also interested in learning more about resources agencies would need to properly address brain injury in their clients.
Services for Survivors
Currently few, if any, survivors of IPV are evaluated for brain injury and therefore have limited access to services and treatment. While systems to attend to traumatic brain injury are in place for the military and athletics, few models address the particular needs of domestic violence survivors. A notable exception are our colleagues in Phoenix who have established a system of care specifically for survivors, in collaboration with Barrow Neurological Institute at Phoenix Children’s Hospital, the Maricopa County Attorney’s Office, Mesa and Tempe Police Departments, the University of Arizona College of Medicine – Phoenix, and The CACTIS Foundation. There survivors of interpersonal violence identified via police reports and shelters are offered an evaluation and health care from neurologists and therapists and supported by social workers throughout the process. We are working to establish such a system of care in Chicago, starting locally with the Pathways Program at Swedish Hospital, part of North Shore, with the hope to create a model that can be replicated by other health systems throughout the city and state.
We know that survivors of IPV are navigating multiple service delivery systems on a regular basis: domestic violence and sexual assault services and criminal justice, child welfare, public assistance, health care, and immigration systems. In order to make these systems accessible to survivors, we need to raise awareness of how having a brain injury can create barriers and fear around navigating these systems. In addition, we must advocate for accommodations and adaptations that account for the high prevalence of undiagnosed, untreated brain injury among the individuals trying to access these services. We need to work together with individuals and organizations across the nation to bring awareness and educate those that are trying to serve this population. Currently our educational and research efforts are the first step in changing systemic structures that have cultivated a culture where violence against intimate partners is still often thought of as a private matter. As our coalition grows, we will continue to advocate for policy changes on a local and national level.