Intimate partner violence (IPV) is extremely common, with estimates of nearly 1 in 3 women reporting violence from a partner. IPV is stigmatizing and can feel embarrassing, and it traverses all socioeconomic, ethnic, and political boundaries. Unfortunately, it is also true that the majority of injuries reported by women are to the neck and higher (Wu et al, 2010). Abusers will often hit their victims on the head to conceal bruises. An estimated 36% of domestic violence survivors have sustained injuries to the head, neck, or face. Women seeking medical attention for these injuries are 7.5 times more likely to be survivors of domestic violence than women with other bodily injuries. Traumatic brain injury (TBI) may also be associated with sexual assault with or without the experience of domestic violence. Along with blows to the head, domestic violence victims often experience trauma-inducing, terrifying strangulation (most victims refer to it as “choking”), chokeholds, or attempted drowning – all which can affect the brain.

 

Here are some actionable tips as you work with people experiencing brain injury that might also be experiencing domestic violence:

1. 1.  Incorporate domestic violence screening into your regular business practices. It’s important for client-facing personal injury service providers to a) universally assess for domestic violence, and b) establish an ongoing working relationship with local domestic violence program advocates to streamline a referral process where provider partners personally know and trust each other’s staff, agencies and services.
   2. Directly ask about how people are doing at home. During this time of heightened stress and isolation, ask about how people are managing during these trying times. We know that many domestic violence victims don’t disclose abuse immediately – for many reasons – but by asking about their home life, it shows you care. Also, there are many other things a person you are working with could be struggling with – including mental health, finances, job insecurity, or the stress of living in a pandemic – that could affect their wellbeing.
   3. Learn about local domestic violence services. While not every county in the United States has a shelter, every county is served by a domestic violence program that offers important supports — including a crisis hotline, advocacy services, safety planning, support groups, counseling, legal advocacy and support, and children’s programming. Because domestic violence programs offer different services in different communities, it’s important to learn what your local services have to offer. Click here for help identifying the domestic violence program(s) that serve your area, and be prepared to share information on your local domestic violence program.
   4. Provide information about domestic violence and other supports for challenges during COVID-19. You can reach out to your local domestic violence program to see if they have any posters, flyers, materials, safety planning cards, or other information that could be available in your office setting. Putting up signs in your office and having information available, combined with asking directly about how people are doing at home are powerful messages that your workplace cares about domestic violence.
   5. Be aware of the unique circumstances domestic violence victims face. Domestic violence victims often have additional barriers in living their daily lives and doing just about anything. A domestic violence victim is always living through a lens of trying to figure out the safest choice in the moment, which can often change and shift moment to moment or day to day. Circumstances might make it difficult for them to even come to get your services. They might show up late or miss appointments, aren’t able to comply with at-home instructions or therapy. With remote services being employed by many agencies, they might not have the safety or the space to engage in those services. Remembering that there are often reasons behind why things happen, and having flexible, low barrier policies that increase access can help your services be more effective for domestic violence victims.
   6. Recognize that masks could be triggering to survivors of abuse who have been choked or strangled, and help people develop strategies to make wearing masks less difficult. Like stay at home orders, a critically important public health strategy that works for the vast majority of the population – the new mask mandates across the country – are uniquely difficult for domestic violence victims who have experienced violence that has interfered with their breathing. With masks being an important strategy for controlling the virus and keeping people safe, service providers can also work with victims who have problems with masks to find a face-covering option that is the least triggering and most effective for survivors. Suggesting face shields, different types of masks, and encouraging survivors to develop regulation and coping strategies to increase mask tolerance will help them in all areas of their lives.

 

Conclusion

Domestic violence is ubiquitous and TBIs are invisible. It is helpful, when assessing for domestic violence, to first inform an individual that because injuries to the head are so common in relationships, you are now discussing these important issues with all patients. It may take time for a survivor to trust a provider enough to disclose how the TBI occurred. In fact, a provider may be the first and only person a survivor will have or may ever tell about the abuse. Domestic violence assessment questions must be asked, sometimes multiple times, and always with trauma-informed compassion. Never assess for domestic violence in front of a dating or marital partner, as this person may be the cause of the TBI and there may later be retaliation for the survivor.

Everyone has a role to play in supporting domestic violence victims during this difficult time, and during times of restricted movement, we need more allies than ever who are willing to support domestic violence victims. We hope you will join us as we weather this storm.

 

“PERSONAL INJURY LEGAL SERVICES WITH A PERSONAL TOUCH.”

A Schmidt Salita Personal Injury Lawyer can come to your home, the hospital, or a discreet public setting chosen by you for your initial visit. The Schmidt Salita Law Team strives to provide personal injury legal services with a personal touch to help the victims of personal injury through a very difficult time in their lives.