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Every year thousands of Canadian women experience intimate partner violence (IPV) potentially causing disabling permanent traumatic brain injuries (TBI). This connection, and its implications, is still left largely unexplored.
Worldwide, IPV is a leading cause of non-fatal injury experienced by women.
The head, neck, and face are the most common sites of injury in victims of IPV. Such assaults can result in brain injury, and they often do.
It is estimated that between 19-75% of IPV survivors sustain a brain injury as a result of the abuse they endure at the hands of their partner.
Yet IPV survivors with brain injury repeatedly fall through the cracks when navigating support services while attempting to leave their abuser and after.
IPV survivors are often unaware they have sustained a brain injury.
Frontline workers caring for them may likewise be unaware of the interrelationship of IPV and brain injury, complicating initiation of necessary services.
Abused and Brain Injured: A Toolkit
Intimate Partner Violence
Traumatic Brain Injury
Abused & Brain Injured was created to draw attention to the widely unrecognized intersection of intimate partner violence and traumatic brain injury. In order to improve the lives of survivors as well as the working environment for frontline workers, this toolkit serves to provide information, resources, research and practice recommendations for providing trauma-informed service delivery. This toolkit is an evolving resource and as such, is constantly changing.
We acknowledge that not all situations are encompassed by this resource as it exists currently. While we strive to make the resources presented as universal as possible, we recognize that not all groups will find the toolkit applicable to their context.
Since its launch in 2019, this Toolkit has received overwhelmingly positive feedback. We’ve seen and heard how it is being implemented as an invaluable resource and can continue to grow and evolve. We’re constantly adding new information and features to support service providers and survivors.
Use arrow keys or click on the circles at the bottom to see recent additions:
Employment is a crucial aspect of a survivor’s health and well-being and has a significant impact on their quality of life. Having a stable job means survivors have access to basic needs, such as safe accommodations, food security, and disability supports. Employment also promotes survivors’ physical safety, improves their self-esteem and social connectedness, and provides mental respite and a purpose in life. In this module you can find information about Seeking Employment, Keeping Employment and relevant legislation in your province. There is also a section that provides suggestions on what employers can do to support survivors.
Mental Health Module
The relationship between brain injury and mental health is complex. Though we know people who sustain a brain injury are at an increased risk of experiencing mental health concerns, it can be difficult to disentangle whether the symptoms a survivor is experiencing are a consequence of a pre-existing mental illness, possibly made worse by the brain injury, or a consequence of the brain injury alone. In this section, you can find more detailed information about the common mental health challenges faced by survivors and some resources for supporting them.
Communication is an interactive process involving two or more people. We use communication to develop and maintain relationships; it is how we achieve our social and vocational goals, how we make group decisions, and how people access, receive, and provide support.1,2,3 In this module, you can learn about how brain injury can affect communication, tools to aid communication with brain-injured survivors, and resources to support survivors.
Because we intended this resource to educate IPV support providers and survivors about traumatic brain injury, we did not include information about IPV specifically. What we learned since launching it is that other people are using the site and they often are not informed about IPV and would like to be. It is important to us that this site is useful and provides access to information that is valuable to support professionals in any capacity, so we have added some introductory information about IPV and provided some links to other sources of information that we thought might be helpful. We have come to believe that in order to provide the best care possible for survivors of IPV-related TBI, we need to share information and expertise with each other, build bridges between traditional silos, and adopt a multi-disciplinary approach to care.
Many stakeholders have been consulted in the making of this toolkit and they often request concrete resources. In order to provide this, we’ve added a new Resource Library section where you can go to find a variety of informational and practice resources. We’ve included a new video library where you can see short films on the intersection of IPV and TBI, how to recognize it, how to support it, and what kinds of challenges survivors cope with. We’ve also added some new infographics for you to download and share in your organizations, with your clients, friends, and family in order to raise awareness about this important health concern.
We’ve always included the voices of survivors as they shared their experience so others can learn, but we’ve recently given this section a remodel and added some new information. Visit our Snowball Section to see how survivors experience various systems of care and what can be done to support women navigating these systems.
One of the questions we hear a lot from support staff is ‘who can I refer a client to for help?’ We thought it was time to add an introduction to some of the healthcare professionals who are trained to offer support to people living with a brain injury. We’ve started this list with five of the most commonly used support professionals, who they are, and how they can help people living with traumatic brain injury.
The Intersection of Intimate Partner Violence and Traumatic Brain Injury
Intimate partner violence (IPV) is a significant social issue. It is a leading cause of non-fatal injury experienced by women globally, and women are more at risk from their intimate partners than anyone else.1 The impact of IPV is even greater when it is combined with another major public health concern – traumatic brain injury (TBI). Prevalence rates of possible brain injuries in women survivors of IPV range from 19 to 100%, depending on sample characteristics.2
We call this the intersection of TBI and IPV.
The head, neck, and face are the most common sites of injury in IPV,3-5 with up to 92% of IPV incidents involving hits to the head and face, and strangulation.3 Such assaults can result in brain injury, and they often do.6
In Canada, IPV accounts for over one fourth of all violent crimes reported to police. Most of these incidents involve physical assault such as pushing, hitting, and choking (77%), and most of the physical assaults target women (76%).7 These numbers are likely underestimates, due to the sensitive nature of reporting abuse by an intimate partner. In fact, it is reported that less than one third of women disclose incidents of IPV.8
Intimate partner violence is characterized by a repeated pattern of abuse over time. It is rarely an isolated event. As a result, women are at serious risk of permanent disability caused by repetitive injury to the brain, if they are hit or strangled regularly.9 Because survivors are often unaware they have sustained a brain injury, they are unlikely to seek care. It is reported that up to 75% of women do not seek medical care for suspected brain injury.6Survivors and care providers can also mistake brain injury symptoms for the emotional distress brought about by the abuse itself.10
Brain injury has been referred to as a silent epidemic, and this is especially true for women survivors of IPV. It is difficult and sometimes impossible to see the injury with the naked eye. Understanding the connection between IPV and TBI is essential. This knowledge will help frontline workers meet the specific needs of clients who may have sustained a brain injury and ensure they receive appropriate care.
Who is this toolkit for?
Survivors and their friends and families
If you are a survivor, or a survivor's friend or family member, use this toolkit to learn about:
- Traumatic Brain Injury (TBI)
- Survivor stories
- Regional service providers
- Mental health & TBI
- Communication & TBI
- Strategies to cope with TBI
We want to help make your job easier. If you are a service provider, use this toolkit to learn about:
- Communication challenges & how to adapt
- Strategies for working with TBI/IPV clients
- Barriers & facilitating factors
- To screen or not to screen
- Care guidelines
- Referral resources
The purpose of this toolkit
This toolkit is provided as a source of information, not training.
Educate front line workers and survivors about the impact of brain injury in women survivors of IPV.
Help identify survivors with possible brain injury.
Give service providers suggestions to help them support women survivors with a TBI.
Provide referral resources.
NOTE: This toolkit is meant for educational purposes only. The information within it should not be used to diagnose or treat brain injury in your clients
Commonly Asked Questions
Where can I go to get treatment for my brain injury?
If you have recently been hit on the head, neck, or face, have been forcefully shaken, or strangled and are experiencing symptoms such as neck pain, loss of consciousness or are going in and out of consciousness, confusion or irritability, a bad or worsening headache, vomiting, behaviour changes, seizures or convulsions, double vision, weakness or tingling/burning in the arms or legs, it is imperative that you receive emergency medical care – call 911 or go to the nearest emergency department.
If you believe you may have sustained a brain injury at some time in the past, and are not experiencing the red flag signs and symptoms listed above but have concerns about your health, make an appointment to visit your family doctor or other healthcare provider for assessment and referral to a brain injury specialist.
It has been years since I sustained a brain injury. Is it too late to seek treatment or support?
It is never too late to seek treatment if you believe you sustained a brain injury and are experiencing symptoms that are affecting your quality of life. While years down the line it may be difficult to link your symptoms to a brain injury, an assessment by a doctor can answer important questions and get you the help you need.
There are also programs offered by agencies and advocacy groups that provide support such as peer mentoring programs.
Are there programs in my community to help women with brain injury?
There exist regional brain injury associations in ten provinces in Canada (AB, BC, MB, NB, NL, NS, ON, PEI, QB, SK), whose mission is to advocate for survivors of brain injury, educate about brain injury and its consequences, and to provide support to survivors and their families and caregivers. These associations may run support groups, peer support programs, recreational activities and workshops, among other services for survivors, their families, and caregivers. For a list of the nearest brain injury associations and other programs, visit the ‘Community Resources’ page.
Can I apply for special funding to help me to cover the costs of treatment?
Community programs such as support groups and activity clubs offered by brain injury associations can be free to access. The cost of medically necessary treatment at publicly funded inpatient rehabilitation centres is free for Canadian citizens and permanent residents, covered by public health insurance, which may also cover care at an outpatient clinic, home- or community-based care. Additional coverage for services that would not otherwise be covered by public health insurance is provided to certain groups, such as seniors, children, and low-income residents.
How common is it for women who have experienced violence to have a brain injury?
There are no reliable numbers available at this time on the incidence of brain injury in survivors of intimate partner violence. This is due to a number of reasons, among them the sensitive nature of reporting of intimate partner violence by survivors, as well as the lack of awareness about the risk of sustaining a brain injury in an abusive relationship. Up to 92% of incidences of intimate partner violence involve hits to the head, neck, or face, or strangulation, all of which can result in brain injury.
How long does a brain injury last?
The impact of a brain injury varies from person to person and depends on a number of factors related to the person (e.g., genetic vulnerabilities, previous head injury), their circumstances (e.g., living situation, economic status), and the details of their injury (e.g., severity, mechanism). When a person sustains a first-time concussion, a mild traumatic brain injury, the recovery period can be relatively short, lasting a few days or weeks before the person is back to their pre-injury self. However, in some cases, symptoms of a concussion can persist. Symptom persistence depends on the factors listed above. A person who has had a previous head injury, or has a history of neurological or psychiatric problems or physical limitations, who is older, or is dealing with life stressors at the time of injury, can experience a longer recovery from concussion than is typical. With more severe traumatic brain injury, the recovery period can last even longer, and reflect more significantly on the person’s health and well-being, and they may not be able to return to their pre-injury level of functioning.
Traumatic brain injury was at one time regarded as an event, but is now recognized as a disease process, with the course and recovery determined by factors unique to each person. Visit the ‘Long-Term Effects’ page for more information.
How do I get a medical diagnosis for a brain injury?
Diagnosing brain injury can be challenging, particularly in survivors of intimate partner violence, as a woman may not be aware that she has sustained a brain injury, or that the symptoms she is experiencing are symptoms of brain injury. She may likewise choose not to seek immediate medical attention for her injuries for a number of reasons, and so may carry on without proper care, with possibly debilitating symptoms. The only way to receive a diagnosis is to see a doctor for assessment. In cases where time passes before a survivor seeks medical care, a diagnosis can still be established. Oftentimes, in the case of concussions, the most common type of traumatic brain injury affecting survivors of intimate partner violence, assessment and diagnosis relies on the account of the event and symptoms experienced by the person. If you believe you sustained a brain injury recently or at some time in the past, it is important that you see a doctor to be assessed and to receive treatment if needed.
Where can I go to find the appropriate resources?
Are there other women out there that have experienced something similar?
You are not alone. Visit our ‘Stories’ page to hear the stories of women survivors of intimate partner violence.
What is a traumatic brain injury?
Traumatic brain injury is a brain injury that results when a significant force is applied to the head, face neck, or body, disrupting brain function.
How can I tell if I may have had a traumatic brain injury?
If you have been hit on the head, neck, or face, been violently shaken, or strangled, and are experiencing any of the signs and symptoms listed here, you may have sustained a brain injury. If such an injury is recent and you are experiencing red flag signs and symptoms,it is imperative that you receive immediate medical attention. If your injury happened some time ago and you are not experiencing red flag signs and symptoms, you should still see a doctor for assessment to determine whether you have sustained a traumatic brain injury and need treatment.
What happens after a traumatic brain injury and in what ways can it impact my life?
The aftermath of a brain injury will differ from person to person, and will depend on a number of different factors that are unique to each individual. These include factors related to the person (e.g., genetic vulnerabilities, previous head injury, etc.), their circumstances (e.g., living situation, economic status, etc.), and the details of their injury (e.g., severity, mechanism, etc). Traumatic brain injury can affect many different aspects of a persons life, including but not limited to memory and other thinking skills, physical functioning, ability to communicate, to control feelings, and a person’s sense of self.
Thank you to our partners, funders and supporters
Members of the research team:
Halina (Lin) Haag, Wilfrid Laurier University & University of Toronto, ABI Research Lab
Nneka MacGregor, WomenatthecentrE
Silvia Samsa, Women’s Habitat
Geoff Sing, The Cridge Centre for the Family
Dr. Nora Cullen, West Park Healthcare Centre
Danielle Toccalino, University of Toronto, ABI Research Lab
Noel Natalia Smith, University of Toronto, ABI Research Lab
Shirin Mollayeva, University of Toronto, ABI Research Lab
Dr. Angela Colantonio, Principal Investigator, University of Toronto, ABI Research Lab
We would like to thank the following individuals for their material contributions:
Candace Stretch, The Cridge Supportive Housing & Family Services
Janelle Breese Biagioni, The Cridge Centre for the Family Brain Injury Services
Reema Shafi, Krembil Research Institute
Jennifer Estrella, ABI Research Lab