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.
Challenge-Specific Strategies
Support workers can take key steps to accommodate the needs of survivors of IPV who may have a TBI.
The following is a list of impairments that can be caused by a brain injury. The list outlines how you might recognize these impairments in your clients, and how you can help.1,2
Impaired Functions:
Sleep
A survivor might experience:
- Tiredness, particularly in situations requiring mental effort
- Reduced tolerance, coping ability
- Irritability
- Other impairments becoming worse
- Difficulty waking up in the morning and starting tasks
- Difficulty going to school/holding a job
- Difficulty accessing services
How you can help:
- Encourage rest breaks
- Encourage regular bed time and wake time
- Prioritize demanding/important tasks to take place at the time of day she feels best (often morning)
- Make activities shorter, with achievable goals
- Help her fill out lengthy forms, make important phone calls, or other tasks requiring her to concentrate or pay attention for a long period of time
Information Processing
A survivor might:
- Take longer to complete tasks, get ideas together to answer questions
- Have difficulty keeping up with long conversations, or lengthy instructions
- Have difficulty going to school/holding a job
How you can help:
- Allow extra time to complete tasks
- Speak clearly and evenly
- Present information one piece at a time
- Try to not interrupt or answer for her
- Check that she is keeping up
- Meet with her alone, unless she requests to have someone else present
- Help her fill out forms, make important phone calls
Attention
A survivor might:
- Appear to not listen
- Miss details
- Forget what was said
- Struggle to maintain concentration
- Be unable to cope with more than one thing at once
- Be easily distracted
- Change subjects frequently
- Not finish what was started
- Get bored easily
- Have difficulty going to school/holding a job
- Have difficulty accessing services
- Have difficulty adapting to life in a shelter
How you can help:
- Use short, simple sentences
- Shorten activities so their completion is realistic
- If safety allows, have her write down important information
- Help her check her work
- Encourage her to do one activity at a time
- Reduce distractions such as noise, people
- If she is distracted, interrupt and help her refocus
- Alternate activities to keep interest
- Meet with her alone, unless she requests to have someone else present
- Help her fill out forms, make important phone calls
Memory
A survivor might:
- Have difficulty learning new things
- Forget what was said, forget names, appointments
- Lose things
- Have difficulty recalling what was learned
- Have difficulty making and remembering safety plans
- Have difficulty going to school/holding a job
How you can help:
- Check to be sure she understands, repeat information if needed
- Encourage rehearsal of new information
- If it is safe, encourage use of memory aids – diaries, calendars, time tables
- Decide on specific places for storage of belongings
- Provide reminders/prompts to help with recall
- Develop checklists
- Help her fill out forms, make important phone calls
Problem Solving
A survivor might experience:
- Difficulty working out solutions to problems
- Difficulty generating new ideas
- Disordered approaches to solving a problem
- Difficulty going to school/holding a job
- Difficulty leaving abusive partner, living independently
How you can help:
- Help identify achievable goals, clarify the purpose of tasks
- Avoid open ended tasks
- Help her approach tasks in an ordered way
- Help her break down tasks into smaller parts
- Reduce the demands put on her, have her do one thing at a time, start simple
- Help her fill out forms, make important phone calls
Flexibility
A survivor might:
- Be unable to adapt to change
- Be stuck in a rut, unable to develop new strategies
- Continue to perform tasks the same way, even when they don’t work
- Repeatedly refer to the same topic, return to that topic when doing something else, i.e., perseverate
- Have difficulty going to school/holding a job
- Have difficulty leaving abusive partner, independent living
- Have difficulty accessing services
- Have difficulty adapting to life in a shelter (stress, anxiety, confusion, disruptiveness, difficulty following rules)
- Have difficulty keeping custody of children
How you can help:
- Help her recognize early signs of frustration so that she can stop what she is doing and refocus
- Help her find different ways to complete tasks, so there is choice
- Distract her with another activity if she is continually making errors
- If she is repeatedly off topic, get her back on track by asking specific questions
Planning and Organizing
A survivor might experience:
- Difficulty preparing for tasks
- Difficulty working out steps or sequences to tasks
- Difficulty organizing thoughts and explaining things to others
- Difficulty assessing danger and defending herself against assaults
- Difficulty going to school/holding a job
- Difficulty leaving abusive partner, independent living
- Difficulty accessing services
- Difficulty adapting to life in a shelter (stress, anxiety, confusion, disruptiveness, difficulty following rules)
- Difficulty keeping custody of children
- May not consider consequences of her actions
How you can help:
- Encourage her to consider what she is going to do before starting an activity
- Point out possible short- and long-term consequences of decisions
- Provide written guidelines outlining steps in a task
- Give prompts to keep her on track
- If safe, help her develop a timetable to establish routine for activities
Reasoning
A survivor might:
- Exhibit rigid, concrete thinking style
- Take statements literally
- Have difficulty putting herself in other people’s shoes
- Resist change
- Have a simplistic understanding of emotions
- Show poor judgment and decision-making skills
- Have difficulty going to school/holding a job
- Have difficulty leaving abusive partner, independent living
- Have difficulty keeping custody of children
How you can help:
- Use simple, direct language, avoid abstract terms
- Explain changes to routine in advance, provide a reason for the change
- Avoid arguments and emotional undertones
- Provide real life examples that she can relate to, when explaining something
- Point out possible short- and long-term consequences of decisions
Self-Monitoring
A survivor might:
- Not follow rules
- Not pick up on errors because she does not check her work
- ‘Hog’ conversations
- Carry on talking even when others are no longer interested
- Have difficulty going to school/holding a job
- Have difficulty accessing services
- Have difficulty adapting to life in a shelter (stress, anxiety, confusion, disruptiveness, difficulty following rules)
How you can help:
- Reinforce the requirements for an activity
- Encourage her to check her work
- Provide immediate feedback to indicate when an error occurs or she is talking too much
- Encourage taking turns in conversations
Insight
A survivor might:
- Be unaware of cognitive and physical limitations
- Set unrealistic goals and expectations
- Resist help from carers and staff
- Have difficulty leaving abusive partner, independent living
- Have difficulty accessing services
- Have difficulty adapting to life in a shelter (stress, anxiety, confusion, disruptiveness, difficulty following rules)
- Have difficulty keeping custody of children
How you can help:
- Explain the reasons for tasks, or steps in a plan
- Identify realistic, achievable goals, which may be smaller steps in a larger plan
- Point out possible short- and long-term consequences of decisions
- Provide respectful feedback on problem areas that affect her safety
Mood & Emotional Regulation
A survivor might:
- Experience sudden changes in mood
- Laugh or cry at inappropriate times
- Get angry quickly
How you can help:
- Identify triggers for mood swings
- Have an alternative approach planned in case of changes
- Avoid reacting emotionally yourself
- Acknowledge the survivor's feelings and create space for them to talk about it if they would like to
Motivation
A survivor might:
- Experience lack of motivation
- Not complete tasks that she knows how to carry out
- Not act on something until prompted
How you can help:
- Encourage her to get started on an activity
- Give prompts in the early steps of a task
- Reward initiative and persistence
- Accept that less activity may be best for her well-being
Social Skills
A survivor might:
- Struggle to interact with others because of the aforementioned problems
- Struggle to relate to others
- Be less aware of social cues
How you can help:
- Practise maintaining eye contact, asking questions when they come up, holding a conversation
- Practise awareness of reactions and cues when interacting with others
Decision Making
A survivor might:
- Make decisions too quickly, without considering the impacts
- Get stuck on one solution without considering other options
- Be unable to make decisions
How you can help:
- Create lists of pros and cons
- Brainstorm multiple potential solutions
- Provide respectful feedback on problem areas that affect her safety