A study found that a focus on addressing common brain injuries of domestic violence survivors leads to improved care.
Domestic violence survivor advocates and researchers at The Ohio State University developed a new approach to trauma-informed care.
CARE is a trauma-informed approach that considers brain injury in the complex circumstances to be addressed and accommodated for domestic violence survivors to access safety, health, and social services.
It was created in response to 2019 work by Ohio State researchers and the Ohio Domestic Violence Network that found 8 in 10 survivors seeking help have suffered head injuries and strangulation by their abusers.
“Given the pervasiveness of the problem, agencies should be ruling brain injury out, as opposed to ruling it in, and approaching their work with tools to appropriately support these survivors,” said Julianna Nemeth, the study’s lead author and an assistant professor in Ohio State’s College of Public Health. “These injuries are contributing to common struggles experienced by survivors, including engaging and following through with services and planning for significant life changes. And they are contributing to mental health, substance use, and other health concerns.”
The CARE model is based on four cornerstones:
- Connect with survivors by forming genuine relationships and learning what survivors value, want, need, and expect.
- Acknowledge that head trauma, strangulation, and related challenges are common, including brain injury, mental health struggles, substance use, and suicidal ideation.
- Respond by collaborating with survivors to develop accommodations for challenges related to suspected brain injury caused by violence and provide effective, accessible referrals and advocacy.
- Evaluate services provided by establishing a strong feedback loop with survivors to see how and to what extent the support, accommodations, resources, referrals, and services are meeting their needs.
“CARE tools are intended to be used flexibly by domestic violence program staff to open conversations and provide information about head trauma, strangulation, and mental health struggles – and help survivors identify short-term and long-term consequences of brain injury and trauma,” said Nemeth.
The research team interviewed 53 staff members, including some volunteers, at five Ohio domestic violence organizations before the implementation of CARE, and 60 staff members a year after the organizations implemented the approach. The majority of staff indicated that after CARE implementation, they felt more confident and comfortable and had more conversations with survivors about head injuries and strangulation.
“These tools help staff proactively recognize these injuries, which can manifest themselves in a variety of ways that present challenges in the daily lives of survivors and in their ability to access lifesaving services,” said Nemeth.
Though there is growing evidence of brain injury among domestic violence survivors, agencies that serve survivors largely still have a long way to go to effectively address brain injury, Nemeth said. The CARE tools are free for download, were designed to be used by people with no formal health training, and now have evidence to back them up, she said.
Nemeth said she and her colleagues are hopeful that the CARE framework can help not only staff who work in domestic violence shelters but those who come in contact with survivors elsewhere and play a role in their health, safety, and life circumstances – including the justice system, health care providers and social service organizations.
“Trauma-informed care, including the CARE model, is marked by the entire organization’s ability to be flexible with people and recognize that their current situation may have to do with both traumatic incidents that have happened directly to them and intergenerational trauma and community trauma,” said Nemeth. “If we want to help them, we have to be flexible with people and realize that their behavior may also be the result of coping with the troubles arising from an invisible injury.”