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Educating Staff and Conducting Screening Reveals High Incidence Of Brain Injury in Survivors of Domestic Violence

With funding from the Women Investing in Nebraska (WIN) Grant and Nebraska Dept. of Health and Human Services Office of Injury Prevention, Brain Injury Alliance of Nebraska and its partners is increasing brain injury recognition, assessment and management in programs serving victims of domestic violence. Previously, similar research was conducted in 2016. You can view the full reports from the 2019 and 2016 research below. 

Partners include:

  • Friendship Home in Lincoln
  • WCA in Omaha
  • University of Nebraska at Lincoln - Dr. Kathy Chiou, Kate Higgins
  • University of Nebraska Medical Center - Dr. Matt Garlinghouse and Dr. Shireen Rajaram

Staff working with victims of domestic violence programs gained 1) brain injury recognition and management training, 2) implementation of a modified HELP screening tool, 3) referral instructions for victims with positive BI screening to a neuropsychologist for assessment, if the victim was interested. Post-assessment, victims received BI management recommendations.  Additionally, a sample (10) of the victims were interviewed regarding their experience with the screening and the assessment.

BIA-NE and partners also provided BI and domestic violence awareness and training to community-based health and legal providers which serve domestic violence victims.

Research identified:1

  • 58% of the 171 women who were screened, tested positive
  • Among women who were screened 91% indicated that they had been hit in the head or strangled
  • 31% of these women reported that this happened more than six times in their life
  • 65% of women received no medical treatment due the hit to the head or strangulation
  • 64% reported losing consciousness or experienced a period of being dazed and confused
  • 43% believed the problems were due to the head injury
  • Most commonly experienced the following symptoms related to brain injury: anxiety, depression, headaches, insomnia, changes in relationships and difficulty concentrating.
  • 33% of those screened also completed the neuropsychological assessment which demonstrated notable weaknesses in the areas of verbal memory and clinically significant impairments in the areas of visual reasoning and visual memory. 

Together, these findings suggest that cognitive functioning is negatively affected by domestic-violence related brain injury.

Women had varied reactions when they learned that they might have a brain injury from the trauma of their domestic violence. Despite being angry, scared, and embarrassed, they were thankful that they now had an explanation for some of the cognitive symptoms they were experiencing.

Most of them experienced memory loss and had problems with their concentration. These symptoms disrupted their daily activities, social relationships with family and friends and their overall quality of life. Most participants found the neuropsychological assessment to be challenging and difficult, but the experience also made them aware of the deficits in their cognitive functioning.

Several participants followed up and took steps to seek more information on their condition. They stated that they would like more information on how they fared on the neuropsychological assessment and steps that they could take to help them better manage some of their symptoms. These included helpful tips and information on community resources that will help them improve their quality of life.

Community based training participants were overwhelmingly positive about the impact of the training on their understanding of brain injury and their knowledge of the challenges facing individuals with brain injury.

Recommendations:2

  • Community based agencies that provide services to women (and men) who have experienced gender-based violence such as domestic violence, human trafficking, and sexual assault should screen for brain injury using an established tool such as the modified HELP screen tool.
  • Following BI screening provide:
    • Results of the screening to women.
    • All information in writing since many of the women with a BI experience memory and concentration lapses.
    • Women with free- to low-cost assessment services such as neuropsychological assessment, brain scans, etc. for women who score high on a brain injury assessment.
    • Offer timely free- to low-cost intervention programs in the community, based on best/promising practices to help women better manage their symptoms resulting from a BI, through interagency collaboration.
      • Such classes could be offered as a group or individual classes in the community, preferably by DV serving organizations in collaboration with BI organizations to provide women with tips to manage their symptoms to help women improve their quality of life.
    • Information on community resources that women can access at free- to low-cost for follow up on the results of the screening process.
  • Develop, implement and evaluate protocols for screening and management of BI in DV serving organizations.
  • Develop, implement and evaluate programs to educate and train all employees to screen for BI in DV serving organizations.
  • Include the voices of survivors in all stages of program development, implementation and evaluation to help survivors better manage their brain injury and improve their quality of life.
  • Develop, implement and evaluate referral protocols for support services for domestic violence survivors who have experienced a brain injury.  

Click below for the full report. 

[1] Rajaram, S., New-Aaron, M., Ojha, T. & Smith, L. (2019). Brain Injury Screening: Survivors of Domestic Violence in Nebraska. Submitted to the Brain Injury Alliance of Nebraska.

[2] Rajaram, Shireen (2019). “Knowing what is wrong is like a million bucks.” Perspectives of Survivors of Domestic Violence on Brain Injury Screening/Testing -- A Qualitative Study. Report Submitted to the Brain Injury Alliance of Nebraska.