January 5, 2022 – Brain injury is very common among survivors of intimate partner violence (IPV), and these risks have been further heightened during the COVID-19 pandemic, reports a qualitative study in the January/February special issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America, JHTR is published in the Lippincott portfolio by Wolters Kluwer.
In addition to increasing the risks and severity of violence, the pandemic has had important implications for service delivery and service providers supporting women survivors of IPV, according to the new research, led by Halina (Lin) Haag, MSW, PhD(c), of the Acquired Brain Injury Research Lab at the University of Toronto, and the Faculty of Social Work at Wilfrid Laurier University, Waterloo. Ont., Canada. The article is part of a special issue of JHTR focusing on Brain Injury and Intimate Partner Violence.
Key themes in overlap of IPV and brain injury during COVID-19
As described in previous reports, the emergence of COVID-19 has led to a "shadow pandemic" of increased violence against women. "With over 90 percent of physical IPV altercations focusing on hits to the head, face, and neck or strangulation, brain injury is startlingly common among survivors," Haag and coauthors write. Despite this combined impact – heightened by the challenges of COVID-19 – there are continued gaps in research, policy, and practice on IPV and brain injury and their impact on survivors.
To address these gaps, the researchers conducted interviews with women survivors of IPV and brain injury, as well as with organization directors/managers, direct service providers, and representatives of employers or labor unions involved in supporting survivors. (Although people of any gender identity can be affected by IPV, the study focused on women, who account for the majority of survivors.)
Analysis of the interviews identified three main themes at the intersection of IPV/brain injury and COVID-19:
- Implications of COVID-19 for survivors. The pandemic placed women at increased risk of IPV and brain injury, as well as risk for increased severity of violence. "Participants referred to COVID-19 as an 'amplifier' of violence," Haag and colleagues write. "Service providers reported a quiet period in the first months of lockdown, followed by a surge in calls, housing applications, and requests for peer support and counselling once communities began reopening." COVID-19 had a major impact on survivors' mental health, due to increased isolation and loneliness. Women were also faced with new challenges in caring for themselves and their children as a result of pandemic-related employment changes.
- Implications for service delivery and service providers. While most shelters remained open during the pandemic, many were operating with reduced capacity and increased barriers to access, including challenges in legal services and housing. Support services had to become more adaptable and flexible, as organizations worked to overcome barriers to virtual care and incorporate new public health measures required for in-person care. Some providers felt that increased rules and decreased client autonomy " mimicked abusive behaviours and risked re-traumatizing women survivors." Providers also reported increased stress and mental health challenges due to COVID-19.
- Key priorities: outreach and technology. Organizations faced new challenges as they raced to meet the demand for increased online programs. "Participants identified need for widespread outreach and technological support during the pandemic," Haag and colleagues write. Barriers to technology-based care were identified as a major priority, including funding for technology, software, internet access, brain injury related accessibility challenges, and support training for providers. Community outreach programs were another key focus.
"The COVID-19 pandemic has intensified IPV/brain injury, increased challenges for women survivors and service providers, and accentuated the continued lack of IPV/brain injury awareness," Haag and coauthors conclude. They note that the complex intersection of IPV/brain injury has been overlooked far too long, leaving survivors exposed to ongoing violence and at increased risk of significant impacts to their mental and physical health and social integration. While there is still much work to be done, the researchers hope their findings will increase understanding of how COVID-19 affects the risks and well-being of survivors of IPV and brain injury, as well as the organizational and personal effects on those providing care and support. The authors would like to recognize and thank the participants who shared their expertise. This research was funded by the Ontario Neurotrauma Foundation and in part by the Canada Research Chairs Program.
The twelve papers in the special issue highlight the widespread but neglected issue of brain injury in the context of IPV. Other topics include the characteristics and outcomes of survivors of strangulation, neurobehavioral symptoms of survivors and perpetrators, neuroimaging findings, worldwide prevalence of IPV and brain injury, and new developments in programming and knowledge transfer.
Eve M. Valera, PhD, and Angela Colantonio, PhD, OT, Reg. (Ont.), are Guest Editors of the special issue. In a preface, they write: "We are optimistic this issue will further the field and prepare the way for additional future research that will be able to expand knowledge of IPV-related brain injury to other and marginalized groups (eg, transgender women) that are yet to be examined."
DOI: 10.1097/HTR.0000000000000751
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About The Journal of Head Trauma Rehabilitation
The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America.
About the Brain Injury Association of America
The Brain Injury Association of America is the country’s oldest and largest nationwide brain injury advocacy organization. Our mission is to advance awareness, research, treatment and education and to improve the quality of life for all individuals impacted by brain injury. Through advocacy, we bring help, hope and healing to millions of individuals living with brain injury, their families and the professionals who serve them.
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Journal of Head Trauma Rehabilitation