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Helping the Helpers: Addressing Knowledge & Service Gaps in IPV-related TBI

This article explores the issue of intimate partner violence (IPV)-related traumatic brain injury (TBI) and the impact it has on women. It provides information on common signs and symptoms of TBI, as well as the consequences and communication challenges that survivors may face. The article also highlights the importance of addressing knowledge and service gaps to better support survivors of IPV-related TBI.

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Helping the Helpers: Addressing Knowledge & Service Gaps in IPV-related TBI

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  1. Helping the Helpers: Addressing Knowledge & Service Gaps in IPV related TBI Nneka MacGregor, LL.B. Executive Director nneka@womenatthecentre.com Women’s Centre For Social Justice, o/a WomenatthecentrE

  2. What’s The Issue? • This IS a gendered issue – about male violence against women • Socially constructed, but individually willed • Canadian Femicide Observatory for Justice & Accountability 2018 Report https://femicideincanada.ca/callitfemicide.pdf

  3. Call It Femicide: Understanding gender-related killings of women & girls in Canada 2018 - CFOJA https://femicideincanada.ca/callitfemicide.pdf • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  4. Chilling Facts Did you know? 1 in 4 women in Canada will experience intimate partner violence (IPV) over their life time • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com IPV is the primary cause of injury to women aged 15-44 in Canada Did you know?

  5. Chilling Facts 35-80% of women survivors of IPV have possibleTBI • (Kwako et al., 2011) • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  6. ‘The Perfect Storm Effect’ • Area of Violence • Type of Injury • Resultant Damage Image source: econews.com This perfect storm results in women left vulnerable to continued violence, exponentially compounding the damage to the brain in an ongoing cycle • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  7. Key Takeaways: So How Can We Help You Help Survivors? • TBI 101: What is it & what does it look like? • TBI & IPV: How is it relevant to you in your work? • What are we doing about it? • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  8. Common Signs & Symptoms of TBI • Decision making / Judgement • Reasoning / Impulsivity • Multi-tasking • Concentration • Memory • Organization • Reduced processing speed • Inability to read facial expressions • Communication challenges 1. Cognitive: • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 8

  9. Common Signs & Symptoms of TBI • Depression • Anxiety • Suicidality • Anger • Emotional lability • Changes to personality 2. Psychological: • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 9

  10. Common Signs & Symptoms of TBI • Headaches • Ringing in the ears (Tinnitus) • Chronic fatigue (physical & mental) • Dizziness • Blurred vision • Hormone & endocrine system involvement 3. Physical: • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 10

  11. Consequences of TBI • Increased rates of mental illness • Higher amounts of unemployment and homelessness • Higher rates of divorce • Higher rates of substance use challenges • More likely to experience poverty • Higher rates of social isolation • Potential for challenges to credibility and capability based on being ‘disabled’ or ‘brain damaged’ • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 11

  12. Communication After Brain Injury • Individuals with TBI often report communication challenges • Not always obvious • More subtle (but debilitating) communication issues can be misconstrued as poor attitude, disinterest, disrespect, low intelligence or even substance use • (Wiseman-Hakes, C., 2017) • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 12

  13. What Changes? • Difficulty with concentration i.e. paying attention, especially in noisy environments and for sustained activities • Slow to follow and process information (reduced rate, reduced amount, reduced complexity) • Poor memory; inconsistent and inefficient recall • (Wiseman-Hakes, C.,2017) • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 13

  14. What Does It Feel Like For The Individual? • Dread and shy away from multi-person conversations, noisy environments and conversations with strangers • Difficulty blocking out stimuli • Internal: pain, mood • External: noise, visual sound • Attention is effortful and hard to sustain over time • Easily fatigued, feeling of ‘brain fog’ • Easily overwhelmed by too much information • Like someone following a conversation in a new language ... just give up and tune out • (Wiseman-Hakes, C., 2017) • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 14

  15. To Screen Or Not To Screen… • Complex issue…does diagnosis increase risk through vulnerability? • Can it be used against women in family law courts? • No validated TBI screen tool that is sensitive to the IPV context • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 15

  16. What Is Needed • Include prompts relevant to the events that can result in TBI in this population • Allow for safe and private endorsement of an event • Offer ease of administration by IPV knowledgeable staff, without the need for special training in TBI • (Goldin, Haag & Trott, 2016) • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 16

  17. What Is Needed • Can be used by front line workers who are untrained in TBI • Quick and relatively non-invasive • Suggests likelihood of potential TBI • Needs to be adjusted for safety and non-traumatizing • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 17

  18. Best Options From Available Tools • Brain Injury Severity Scale – Dr. Eve Valera • Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) • the HELPS Screening Tool (adapted) to determine possibility of brain injury • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 18

  19. Some Challenges, Supports & What We’re Doing The work is hard: • VAW sector & challenges • TBI professionals & challenges • Academics & researchers & challenges • Funding scrambling • Burnout & disillusionment It takes a village: • Of survivors • Of researchers • Of VAW support services • Of advocates • Of like-minded citizens • Of partnerships, of kindness and empathy and compassion, of dedication and allyship • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 19

  20. Key Challenges For Survivors: THE 6 Ss Shame Feelings brought on by societal pressures and feeling she’s to blame 6 1 Stigma Associated with being a victim of violence Safety The Survivor Fear of repercussions and further violence if she discloses 2 5 Silence Either because she may have told and not been believed or from fear of repercussions Solitude / Isolation Abusers dismantle her social support networks, including family & friends 3 4 Silos VAW support services disconnected from TBI support services • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 20

  21. Key Challenges For Sectors: SILOING Brain Injury Research & Support VAWResearch & Support Primary Healthcare Social Work Nursing Gender Studies 21 • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  22. Battered & Brain Injured Programme of Research • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  23. Allyship, Collaboration & Participatory Research • Battered & Brain Injured: Identifying and supporting brain injured women survivors of intimate partner violence • Haag H.L. (co-PI), Sokoloff, S., MacGregor N., Broekstra, S., Cullen N., (co-Is) & Colantonio, A. (co-PI) • Funded by Women’s College Hospital Xchange Grant Program & the Canadian Institutes of Health Research • Women Survivors of Violence and Traumatic Brain Injury: Addressing gaps in knowledge and support • Colantonio A. (PI), Haag H.L., Samsa S., Sing G., Cullen N., MacGregor N., Brayton B. (Co-Is) • Funded by the Department of Justice Canada

  24. Helping The Helpers: Listening to survivors Developing A TBI / IPV Toolkit 1 Listening to Programme Managers Listening to Executive Directors 2 Listening to Frontline Workers • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com 24 3 4

  25. Helping The Helpers: • Develop a TBI training / educational toolkit for use in agencies supporting women survivors of IPV • Design and content informed by women survivors of IPV / TBI, EDs, Program Managers and frontline staff • WomenatthecentrE & Women’s Habitat, Toronto, ON • The Cridge Centre for the Family, Victoria, BC • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  26. What Did We Do? • Stakeholder consultation in Phase I • Focus groups with direct service providers and survivors in Victoria & Toronto • Individual interviews with EDs & Program Managers • We asked: • What content do you want in the toolkit? • What format do you want it in? • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  27. Battered & Brain Injured Video

  28. Consultation Results: Themes Service Provision TBI 101 Practical suggestions on ways to support Some basic information on the issue Not diagnosing Risks Identify possible risks of having the diagnosis Frontline workers are not physicians Toolkit Format Education Needs Most effective ways to deliver the info Of survivors, workers and the community • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  29. Consultation & Design: Pivot Project Design: TBI Toolkit Compass Information Gathering • What we’re working on • What success would look like • What’s the product for / purpose • Who are the stakeholders • What do we already know – based on our consultations with survivors, frontline workers & EDs • Other considerations • Understanding the marketplace • Understanding the audience • Diversity of survivors: IPV experiences • Diversity of workers: experience, qualification, motivation • Diversity of Programme Managers: organisational capacity, etc., Team Design • Toolkit Content • Intro • Purpose of Toolkit • About Brain Injury • Acquired Brain Injury • Traumatic Brain Injury (TBI) • Hypoxic / Anoxic • Signs & Classifications of Injury • Mild / Moderate / Severe: Glasgow Coma Scale & # of Post Traumatic Amnesia days • E.g. Loss / Altered Consciousness LOC / AOC • Signs & Symptoms of TBI, especially if repeated injury & persistent symptoms • Effects, Signs & Symptoms of HAI • Initial / long-term • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  30. Consultation & Design: • Toolkit Content cont’d • Service Provision • How to accommodate survivors • TBI / IPV Screening Tools (lack of) • Quick Facts • Community Resources Impaired function Manifestation Management Sleep Help fill forms, making calls Tires quickly Memory Checklists / repeat things Forgets things • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  31. Toolkit Design Process: Journey Mapping

  32. Toolkit Design Process: Journey Mapping

  33. TA-DAH! https://tbi.pivot.design/ Abused & Brain Injured • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  34. ThanksforListening • Helping the Helpers - Addressing Knowledge & Service Gaps in IPV-Related TBI – 2019 • www.womenatthecentre.com

  35. Q&A

  36. Get In Touch +416-964-0892 nneka@womenatthecentre.com 18 Wynford Drive, Suite 502, Toronto, ON CONTACT US WomenatthecentrE www.womenatthecentre.com 36

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