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Special Collection: Traumatic Brain Injury and Domestic Violence: Understanding the Intersections

This Special Collection offers information about the intersection between domestic violence and Traumatic Brain Injury (TBI). It provides advocates and other professionals with tools to screen for TBI within the context of domestic violence as well as presentations, articles, and other relevant resources on the topic.

The purpose of this collection is to: 1) increase knowledge and understanding of TBI within the context of domestic violence, 2) provide tools to advocates and other professionals to screen domestic violence survivors for TBI, and 3) highlight best practices.

The NRCDV provides a wide range of free, comprehensive, and individualized technical assistance, training, and specialized resource materials and projects designed to enhance current intervention and prevention strategies. To suggest additional resources we should include in this collection or for ongoing technical assistance and other resources, please contact the NRCDV Technical Assistance Team at 800-537-2238, TTY: 800-553-2508, nrcdvTA@nrcdv.org, or via our online TA form.

Table of Contents:

   

Introduction | Back to top

A traumatic brain injury (TBI) is defined as a specific type of damage to the brain that is caused by external physical force and is not present at birth or degenerative. A blow (or blows) to the head, shaking of the brain, loss of oxygen (anoxia), colliding with a stationary object and exposure to blasts can cause a TBI. Based on this definition, the use of physical force by an intimate partner during incidents of domestic violence can cause traumatic brain injury as abusive partners often cause injury to a victim’s head, neck (including strangulation), and face. In one study, 30% of domestic violence survivors reported a loss of consciousness at least once and 67% reported residual problems that were potentially head-injury related (Corrigan, Wolfe, Mysiw, Jackson & Bogner, 2003).

However, TBI often goes undiagnosed amongst domestic violence survivors. One reason for this is that domestic violence survivors, who also have a TBI, may exhibit symptoms that could resemble those of a mental illness, such as depression, anxiety, tension and/or inability to adapt to changing situations. Additionally, DV/TBI survivors may appear to have behavioral issues, including problems with keeping appointments, following through, or completing tasks that require multiple steps.

Anecdotal information from survivors and advocates indicates that victims with TBI are often questioned in regards to their ability to parent. At a training for domestic violence advocates, a TBI survivor as a result of domestic violence shared how she would forget to pick up her daughter from school, which prompted a call to the Child Protective Services agency in her area. Others have talked about the difficulties they experienced while living in congregate settings where following rules was, at times, problematic. These kinds of behaviors are often not intentional and survivors may even appear to be uncooperative and oppositional. However, it is important to keep in mind that many of these perceived behaviors might be directly related to the TBI. Therefore, it is crucial for domestic violence service providers and health care professionals to understand the prevalence and effects of TBI within the context of domestic violence.

This collection offers screening tools for advocates in the field of domestic violence as well as other relevant information for recognizing when the person they are supporting has a TBI.

Understanding the Intersection: TBI and DV | Back to top

This section explores the intersection between TBI and DV. A screening tool for TBI adapted by domestic violence service providers is included, along with several other related resources available for download.

"Women who are abused often suffer injury to their head, neck, and face. The high potential for women who are abused to have mild to severe Traumatic Brain Injury (TBI) is a growing concern, since the effects can cause irreversible psychological and physical harm. Women who are abused are more likely to have repeated injuries to the head. As injuries accumulate, likelihood of recovery dramatically decreases. In addition, sustaining another head trauma prior to the complete healing of the initial injury may be fatal." - Excerpted from the HELPS Screening Tool for Traumatic Brain Injury adapted and developed by the New York Coalition Against Domestic Violence. Posted below with permission.
General Information
  • The Intersection of Brain Injury and Domestic Violence | PDF PDF (7 p.)
    by Sarah DeWard for the New York State Coalition Against Domestic Violence
    This guide offers information about brain injury and the possible complications that this disability can provide to domestic violence survivors. Suggestions for providing informed services to domestic violence survivors living with a brain injury are also included.
    + View Summary
  • Domestic Violence and Traumatic Brain Injury Tip Card | PDF PDF (1 p.)
    by Brain Injury Association of Virginia
    This tip card provides information on one of the most unrecognized consequences of domestic violence, encouraging family members, friends, and professionals to be aware of the causes and long-term consequences of TBI.
    + View Summary
  • Increasing Awareness about Possible Neurological Alterations in Brain Status Secondary to Intimate Violence | PDF PDF (30 p.)
    by Mary Car, Brain injury Association of America
    This paper explains the possible types and etiologies for traumatic injuries, neurochemical changes and structural alterations that may occur in the brain as a result of intimate violence, most of which are not being diagnosed.
    + View Summary
  • Traumatic Brain Injury and Domestic Violence Facts | PDF PDF (2 p.)
    by Alabama Coalition Against Domestic Violence
    This fact sheet provides frequently asked questions and answers about TBI and DV as well as screening tips.
    + View Summary
  • Traumatic Brain Injury and Domestic Violence: What do professionals need to know? | PDF PDF (17 p.) HTML HTML (1 p.)
    by New York State Office for the Prevention of Domestic Violence
    This document provides information and relevant resources for the early detection of TBI among domestic violence survivors. It also offers an analysis of the intersection between brain injury and domestic violence as well as other relevant information.
    + View Summary
  • Victimization of Persons with Traumatic Brain Injury or Other Disabilities: A Fact Sheet for Professionals | PDF PDF (5 p.)
    by Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS)
    This fact sheet provides statistics on the extent of the problem and factors that may make a person with a traumatic brain injury, or TBI, susceptible to victimization.
    + View Summary
Screening Tools
  • Brief Screening for Possible Brain Injury | PDF PDF (1 p.)
    by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) (August 2006)
    This document provides information about available instruments used for screening for TBI, as well as tips for screening individuals.
    + View Summary
  • Traumatic Brain Injury Screening: An Introduction | PDF PDF (9 p.)
    by Alabama Department of Rehabilitation Services, Alabama Head Injury Foundation
    This brief screening tool is used to determine if an individual has experienced a brain injury during the course of a domestic violence incident, or at any other time.
    + View Summary
  • Traumatic Brain Injury and Domestic Violence: HELPS Screening Tool for Traumatic Brain Injury | PDF PDF (7 p.)
    by New York State Coalition Against Domestic Violence (2006)
    This document discusses the intersection between DV and TBI, lists symptoms and recommendations for working with survivors with TBI, and offers a screening tool to aid in determining if survivors should be seen by a doctor for further evaluation.
    + View Summary
Training Materials
  • Traumatic Brain Injury As a Result of Domestic Violence: Information, Screening and Model Practices | PDF PDF (184 p.)
    by the Pennsylvania Coalition Against Domestic Violence (2011)
    The materials in this toolkit facilitate ways to better equip domestic violence program staff to recognize, understand and respond more effectively to the specific needs of those living with TBI as a result of domestic violence.
    + View Summary
  • Domestic Violence and Traumatic Brain Injury: Understanding the Intersections Webinar Materials | PDF PDF (47 p.)
    by presented by Judith Avner and Sarah DeWard for the National Resource Center on Domestic Violence (March 2010)
    This webinar held on March 24, 2010 explored the intersections between domestic violence and TBI. Presenters shared useful tips for how to best work with DV survivors who have sustained a brain injury.
    + View Summary
  • Podcast: Domestic Violence and Traumatic Brain Injury | MP3 HTML HTML (1 p.)
    by Sarah M. DeWard, Northeast Center for Special Care (November 2008)
    This podcast discusses domestic violence and its patterns and types of abuse with a focus on individuals who have a traumatic brain injury. Therefore, its intended audience is TBI service providers but this can still be a useful training tool.
    + View Summary
  • Traumatic Brain Injury and Domestic Violence Webcast | HTML HTML (1 p.)
    by Susan L. Vaughn, Sue Parry, and Blanca Kling, National Association of Head Injury Associations (August 2004)
    This webcast discusses safety planning, screening methods, coping strategies, intervention techniques, resources, services, and supports for victims of domestic violence with traumatic brain injury.
    + View Summary
  • Understanding Life with a Brain Injury: The crossroads of Traumatic Brain Injury and Domestic Violence | PPT PDF (43 p.)
    by Judith Avner, Esq., Brain Injury Association of New York State (February 2010)
    This PowerPoint presentation offers information related to the prevalence of TBI and discuses the intersections between TBI and DV. Additionally, it provides specific tips including a screening tool, for DV advocates working with survivors with TBI.
    + View Summary
Services & Accommodations
  • Traumatic Brain Injury and Safety Planning: Ideas for Domestic Violence Advocates | PDF PDF (2 p.)
    by Sue Parry and Judith Avner for the New York State Office for the Prevention of Domestic Violence and Brain Injury Association of New York State (2012)
    This handout provides background information on brain injury, assistance with identifying existing injuries, and details to provide appropriate help for victims of domestic violence who have sustained brain injuries.
    + View Summary
  • Safety Planning for Domestic Violence Victims Who Have Been Hit on the Head | HTML HTML
    by Sue Parry and Judith Avner for the New York State Office for the Prevention of Domestic Violence and Brain Injury Association of New York State (2012)
    This handout provides information for victims of domestic violence to protect themselves from further injury and allow brain injuries to heal.
    + View Summary
  • Working with Victims with Brain Injuries in Domestic Violence Shelters | PDF PDF (3 p.)
    by Sue Parry and Judith Avner for the New York State Office for the Prevention of Domestic Violence and Brain Injury Association of New York State (2012)
    This handout provides guidelines for assisting victims of domestic violence who have sustained brain injuries while they are staying in a shelter.
    + View Summary
  • Victims with Brain Injuries in Domestic Violence Support Groups | PDF PDF (1 p.)
    by Sue Parry and Judith Avner for the New York State Office for the Prevention of Domestic Violence and Brain Injury Association of New York State (2012)
    This handout offers helpful tips for assisting a domestic violence victim who has a traumatic brain injury within a support group setting.
    + View Summary
  • Supporting Crime Victims with Traumatic Brain Injury | PDF PDF (4 p.)
    by the National Center for Victims of Crime (NCVC) (2011)
    This handout discusses some common causes and symptoms of TBI. Information about screening for traumatic brain injury and recommendations for services providers working with crime victims with TBI is also included.
    + View Summary
  • Safety Planning for Victims with TBI | PDF PDF (44 p.)
    by Sue Parry, New York State Office for the Prevention of Domestic Violence (2009)
    This resource offers information related to safety planning tips for victims of domestic violence with a TBI, including a bibliography and a full PowerPoint presentation on TBI and domestic violence.
    + View Summary

Related Issues | Back to top

Domestic Violence and the Military

The intersection between domestic violence, TBI and the military is an issue of growing concern due to the increase in the number of veterans returning from the wars in Iraq and Afghanistan. As many as 20% of US combat troops leaving these war zones are affected by traumatic brain injury (RAND Center for Military Health Policy Research, 2008). For additional information on the connection between domestic violence, TBI and the military, please see our Special Collection: The Intersection of Domestic Violence and the Military: Working across disciplines. This collection examines co-occurring issues experienced by veterans (PTSD, TBI, MST) and provides information related to best practices when addressing these co-occurring issues through a multi-systems approach. Challenges experienced by female service members and veterans are explored through the lens of violence against women.

Share your experience with addressing the complexity that combat-related PTSD or TBI bring to domestic violence cases in our news blog: "How Can I Best Respond To Victims Of Domestic Violence Whose Partners Struggle With Combat-Related PTSD Or TBI?"

Issues affecting female veterans: Although significant gaps remain in our understanding of how domestic violence-related TBI affect women veterans, were are including the following article to highlight some of the overall issues affecting women veterans. This section of the collection is expected to continue growing as more information becomes available. However, based on the information contained in this article alone, it appears that for female veterans the challenges can be compounded by societal perceptions and stigma.

  • Back from combat, women struggle for acceptance | HTML HTML (3 p.)
    by Kimberly Hefling, Associated Press, AirForceTimes (December 2009)
    The article reports, "More than 230,000 American women have fought in those recent wars and at least 120 have died doing so, yet the public still doesn’t completely understand their contributions on the modern battlefield."
    + View Summary
TBI and Children

The topic of TBI and children goes beyond the scope of this collection. However, we acknowledge that exposure to domestic violence may result in trauma. In turn, trauma has a significant impact on the biochemistry of the brain particularly during developmental stages in childhood and adolescent years.

For more information about the impact of domestic violence on early brain development, see Developmental Effects of Exposure to Intimate Partner Violence in Early Childhood: A review of the literature by Georgia L. Carpenter and Ann M. Stacks from Volume 31, Issue 8 of the Children and Youth Services Review (August 2009). The article explains:

"Experiences in the first few years of life greatly influence brain development and the most influential ways a child's brain develops is through his or her relationships with caregivers. These experiences with caregivers and other aspects of the baby's environment, for example violence in the home, play an important role in social and emotional development and are imperative to investigate when working with infants and caregivers."

Children may also be victims of child abuse and suffer head trauma as a result. The most common form of head trauma suffered by children is known as Shaken Baby/Shaken Impact Syndrome or Abusive Head Trauma, caused by direct blows to the head, dropping or throwing a child, or shaking a child. Head trauma is the leading cause of death in child abuse cases in the United States (KidsHealth, 2009).

We have included below some resources that may be useful to the reader when exploring these issues:

The ChildTrauma Academy, a not-for-profit organization based in Houston, Texas is a unique collaborative of individuals and organizations working to improve the lives of high-risk children through direct service, research and education.

The Child Witness to Violence Project (CWVP) is a counseling, advocacy, and outreach project that focuses on the growing number of young children who are hidden victims of violence: children who are bystanders to community and domestic violence. It is run under the auspices of the Department of Developmental and Behavioral Pediatrics at Boston Medical Center.

The Institute for Safe Families (ISF) is a non-profit organization and a nationally acclaimed family violence prevention initiative under the auspices of Physicians for Social Responsibility since the early nineties. The mission of ISF is to prevent intimate and family violence and to promote the health and well being of each member of the family and the community in which they live. ISF also advocates for changes in systems and policies that affect families living with interpersonal violence.

Living Educational and Resources Network (LEARNet) is a project of the Brain Injury Association of New York State and includes a problem solving system to assist users in identifying useful procedures for helping students with brain injury at work and at school.

The National Center on Shaken Baby Syndrome (NCSBS) is a 501(c)(3) nonprofit organization and is the only worldwide organization that is dedicated solely to the prevention of this form of child abuse. The NCSBS focuses their efforts in two areas: professional training for those who work with SBS/AHT cases, and prevention education for parents and those who work to prevent child abuse.

The National Child Traumatic Stress Network was established to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events.

The National Center for Children Exposed to Violence's (NCCEV) mission is to increase the capacity of individuals and communities to reduce the incidence and impact of violence on children and families; to train and support the professionals who provide intervention and treatment to children and families affected by violence; and, to increase professional and public awareness of the effects of violence on children, families, communities and society.

ZERO TO THREE is a national nonprofit organization that informs, trains and supports professionals, policymakers and parents in their efforts to improve the lives of infants and toddlers. Neuroscientists have documented that our earliest days, weeks and months of life are a period of unparalleled growth when trillions of brain cell connections are made. Research and clinical experience also demonstrate that health and development are directly influenced by the quality of care and experiences a child has with his parents and other adults. That is why at ZERO TO THREE our mission is to promote the health and development of infants and toddlers.

Bibliography | Back to top

The following articles provide some of the framework and necessary information to better understand the intersections between TBI and DV. This is a bibliographic list that only includes titles and their sources. These articles are copyright protected therefore their contents are not included in this section. They appear as part of this collection to make the reader aware of these valuable resources and act as a supplement to the previous sections.

Arosarena, O. A., Fritsch, T. A., Hsueh, Y., Aynehchi, B., & Haug, R. (2009). Maxillofacial injuries and violence against women. Archives of Facial Plastic Surgery, 11(1), 48-52.

Corrigan, J. D., Wolfe, M., Mysiw, J., Jackson, R. D., & Bogner, J. A. Early identification of mild traumatic brain injury in female victims of domestic violence. American Journal of Obstetrics and Gynecology, 188(5), S71-S76.

Empire Justice Center (2006). Building Bridges: A Cross-Systems Training Manual for Domestic Violence Programs and Disability Service Providers in New York. Albany, NY.

Funk, M., & Schuppel, J. (2003). Strangulation injuries. Wisconsin Medical Journal, 102(3), 41-45.

Jackson, H., Philp, E., Nuttall, R. L., & Diller, L. (2002). Traumatic brain injury: A hidden consequence for battered women. Professional Psychology: Research & Practice, 33(1), 39-45.

Mechanic, M. B., Weaver, T. L., & Resick, P. A. (2008). Risk factors for physical injury among help-seeking battered women. Violence Against Women, 14(10), 1148-1165.

Monahan, K., & O'Leary, K. D. (1999). Head injury and battered women: An initial inquiry. Health and Social Work, 24(4), 269-278.

Picard, N., Scarisbrick, R., & Paluck, R. (1999). HELPS (Grant # H128A0002). Washington, DC: US Department of Education Rehabilitation Services Administration, International Center for the Disabled.

Videos & Products for Purchase | Back to top

Domestic Violence and Traumatic Brain Injury: Tool Kit Video (2004)
This is a toolkit video for domestic violence service providers. An explanation about the symptoms that DV/TBI survivors may display and some of the interventions to best support them are the main topics presented here.
Length: 7.50
Distributor:
Alabama Department of Rehabilitation Services
Attn. Maria Crowley
P.O. Box 19888
Homewood, AL. 35219-0888
Tel: 205.290.4590
Fax: 205.945.8517
mcrowley@rehab.state.al.us

Domestic Violence and Traumatic Brain Injury: Victims' Video (2004)
This video was designed for DV survivors. It portraits a DV/TBI survivor telling her story and sharing some of the symptoms and challenges she had to face during her recovery and for most of her life. This survivor also highlights how specific accommodations continue to have a positive impact in her life.
Length: 5.10
Distributor:
Alabama Department of Rehabilitation Services
Attn. Maria Crowley
P.O. Box 19888
Homewood, AL. 35219-0888
Tel: 205.290.4590
Fax: 205.945.8517
mcrowley@rehab.state.al.us

Traumatic Brain Injury and Domestic Violence Web Cast by the National Association of State Head Injury Administrators (2004)
This Web cast discusses safety planning, screening methods, coping strategies, intervention techniques, resources, services, and supports.
Length: 1 CD/120 minutes
Cost: $25

Organizations | Back to top

The following organizations provide services to individuals living with a brain injury and/or devote attention and resources to studying the intersections between Traumatic Brain Injury and Domestic Violence. This list is not inclusive by any means, and it is expected to continue to grow over time. If you can suggest an organization that is not currently included here, please feel free to contact the NRCDV's Technical Assistance Team at 800-537-2238, TTY: 800-553-2508, nrcdvTA@nrcdv.org, or via our online TA form.

The Brain Injury Association of America
Founded in 1980, the Brain Injury Association of America (BIAA) is the leading national organization serving and representing individuals, families and professionals who are touched by a life-altering, often devastating, traumatic brain injury (TBI). You may access TBI state specific organizations through this website.

National Center on Domestic and Sexual Violence: PTSD and TBI
The National Center on Domestic and Sexual Violence (NCDSV) designs, provides, and customizes training and consultation, influences policy, promotes collaboration and enhances diversity with the goal of ending domestic and sexual violence.

New York State Coalition Against Domestic Violence
The New York State Coalition Against Domestic Violence (Coalition) is a not-for-profit membership organization whose mission is to eradicate domestic violence and to ensure the provision of effective and appropriate services to victims of domestic violence through community outreach, education, training, technical assistance and policy development. The Coalition's principles and practices prioritize the safety and concerns of women who are abused, provide support and encouragement for the participation of women who are abused in the struggle to eradicate personal and institutional violence against them, and provide for a non-competitive atmosphere that fosters open communication, respect, and cooperation among advocates and women who are abused.

Brain Injury Association of New York State
The Brain Injury Association of New York State provides support services to brain injury survivors and their families, programs for those injured before age 22 and for school-age children with brain injury, an array of resources and publications, support groups, among other services.