The Differential Impact of Alcohol and Interpersonal Violence on the Severity of Violent Traumatic Brain Injuries among American Indians

Battered and Brain Injured: Traumatic Brain Injury Among Women Survivors of Intimate Partner Violence-A Scoping Review

OBJECTIVES

The objective of this scoping review is to examine the extent, range, and nature of literature targeting health-care professionals on the prevalence and outcome of intimate partner violence (IPV)-related traumatic brain injury (TBI). The purpose is to gain an understanding of prevalence, investigate screening tool use, generate IPV/TBI-specific support recommendations, and identify suggestions for future research.

METHOD

The review was guided by Arksey and O'Malley's five stages for conducting a scoping review. A comprehensive search of nine databases revealed 1,739 articles. In total, 42 published research papers that focused specifically on TBI secondary to IPV were included in the study.

SYNTHESIS

The literature reports inconsistencies in prevalence rates from IPV-related TBI. There are no current standardized screening practices in use, though the literature calls for a specialized tool. Frontline professionals would benefit from education on signs and symptoms of IPV-related TBI. Empirical studies are needed to generate reliable data on prevalence, experience, and needs of brain-injured survivors of TBI.

CONCLUSIONS

Findings from this study demonstrate the need for the development of an IPV-sensitive screening tool, more accurate data on prevalence, an interprofessional approach to care, and raised awareness and education on the diffuse symptoms of IPV-related TBI.

Health Determinants among North Americans Experiencing Homelessness and Traumatic Brain Injury: A Scoping Review

Traumatic brain injury (TBI) in those experiencing homelessness has been described in recent literature as a contributor to increased morbidity, decreased functional independence, and early mortality. In this systematically conducted scoping review, we aimed to better delineate the health determinants-as defined by Health Canada/Centers for Disease Control and Prevention (CDC)-associated with TBI in North Americans experiencing homelessness. BIOSIS, MEDLINE, CINAHL, EMBASE, SCOPUS, and Global Health were searched from inception to December 30, 2020. Gray literature search consisted of relevant meeting proceedings. A two-step process was undertaken, assessing title/abstract and full articles, respectively, based on inclusion/exclusion criteria, leading to the final 20 articles included in the review. Data were abstracted, assessing the aims, literature quality, and bias. Five health determinants displayed strong associations with TBI in those North Americans experiencing homelessness, including male gender, poor physical environment, negative personal health behaviors, adverse childhood experiences (ACEs), and low educational attainment. In those studies displaying a comparator population experiencing homelessness without TBI, the TBI group displayed trends toward increased disparity in Health Canada and CDC defined health determinants. Most studies suffered from moderate limitations. There are associations between male gender, poor physical environment, negative personal health behaviors, ACEs, and limited education in those experiencing homelessness and TBI. The results suggest that those experiencing homelessness with TBI in North America suffer poorer health consequences than those without TBI. Future research on TBI in North Americans experiencing homelessness should focus on health determinants as potential areas for intervention, which may lead to improved outcomes for those experiencing both homelessness and TBI.

Using Behavior Change Theory to Understand How to Support Screening for Traumatic Brain Injuries Among Women Who Have Experienced Intimate Partner Violence

Background: Women who experience intimate partner violence (IPV) are at a high risk for traumatic brain injuries (TBIs). Women's shelters may be an ideal location for TBI screening. Behavior change theory can help understand factors that influence screening at women's shelters and develop interventions to promote screening. Objective: To use behavior change theory to understand the local context of women's shelters, factors influencing screening for TBIs among staff who work at women's shelters, and co-develop intervention recommendations to promote screening of TBIs at women's shelters. Methods: The research was conducted in three phases in partnership with the Kelowna Women's Shelter. In phase 1, participants (staff at women's shelters across Canada) completed an online survey that assessed their current TBI screening behaviors, knowledge of TBIs, and factors influencing screening. In phase 2, participants (staff at women's shelters in the Okanagan) completed an interview regarding the factors that influence screening for TBIs. In both phases, factors were analyzed using the Theoretical Domains Framework. In phase 3, intervention recommendations were co-developed using the Behavior Change Wheel. Results: In phase 1, findings indicate that participants (n = 150) lack skills (mean = 2.1, standard deviation [SD] = 1.9) and knowledge (mean = 2.9, SD = 2.2) with regard to screening and are nervous to screen (mean = 3.0, SD = 2.4) for TBIs. In phase 2, 194 barriers to screening for TBI were extracted from 10 interviews with staff members. Prominent domains included knowledge (37%), beliefs about capabilities (16%), and environmental context and resources (15%). Finally, in phase 3, five intervention recommendations were co-developed for interventions aiming to promote TBI screening in women's shelters. Conclusions: This thesis was the first theory-based study to develop intervention recommendations for promoting screening of TBIs at women's shelters. The recommendations have the potential to increase TBI screening at women's shelters ultimately improving the quality of life of women who have experienced a TBI from IPV.

Traumatic brain injury and intimate partner violence: Addressing knowledge and service gaps among indigenous populations in Canada

Background

Traumatic brain injury (TBI) is a serious consequence of intimate partner violence (IPV) that is often overlooked. In the case of Indigenous women in Canada the challenges are broad, multidimensional, and left almost entirely unexplored. Given the elevated rates of violence and injury experienced by women exposed to IPV and the increased levels of physical assault among Indigenous women in Canada, it is important to understand the unique experiences and service needs of these women. This study sought to identify barriers and facilitating factors for TBI-sensitive service provision for Indigenous women experiencing IPV.

Method:

As part of a larger national stakeholder consultation process to develop a TBI educational toolkit for IPV service providers, input from Indigenous stakeholders was specifically sought to allow for insights into unique challenges and strengths related to this population. Interviews and focus groups were conducted with IPV direct-service providers, support professionals, and advocates working with Canadian First Nations and Inuit women.

Findings:

Findings suggest that multiple intersections of marginalization, shame and stigma, and colonization, coupled with significant barriers to service provision in remote communities are such that solutions generated for urban-based settler populations are ineffective.

Conclusions:

Recommendations include a widespread educational campaign to raise awareness of the seriousness of TBI among Indigenous women exposed to IPV. Education is particularly important among healthcare and direct service providers, survivors and their families and communities, legal professionals and child protection agencies, and Indigenous and settler government bodies. Future research should focus on expanding our understanding of this complex issue and developing culturally sensitive, community-based supports.