How CARE Tools Are Being Used to Address Brain Injury and Mental Health Struggles With Survivors of Domestic Violence

Abstract

Introduction: CARE (Connect, Acknowledge, Respond, and Evaluate) is an advocacy framework developed for domestic violence service organization (DVSO) providers to address and accommodate domestic violence (DV) survivors with brain injury and mental health struggles. The CARE tools were designed for use by advocates and include the Just Breathe booklet, the Head Injury education card, and the Invisible Injuries booklet. Objective: The purpose of this study was to report findings on how CARE tools are being used by DVSO providers as well as their impact on DVSO advocacy practice. Methods: Post-CARE retrospective process evaluation online surveys (n = 60) and focus groups (n = 10 groups; 57 advocates) were conducted with consenting staff at 5 DVSOs in Ohio who partnered with the state coalition to develop and evaluate CARE, overseen by a university research partner. Rigorous, iterative coding qualitative analysis methods, endorsed by the Centers for Disease Control and Prevention, were used (Cohen's κ = 0.903 [stage 1] and 0.810 [stage 2]). Results: The use of CARE tools has been integral to DVSO providers' implementation of the CARE advocacy framework. DVSO advocates are using CARE tools to Connect with self, survivors, and other systems; to Acknowledge that head trauma and mental health struggles are common among survivors and that ongoing education and self-care are necessary for advocates. Advocates have been able to provide a more holistic Response through accommodation within DVSOs and referral to other providers, often by using the CARE tools, including the Head Injury education card. Conclusion: CARE tools were designed for lay use to address head trauma, strangulation, and mental health struggles with DV survivors and are free for download at the Center on Partner Inflicted Brain Injury website: https://www.odvn.org/brain-injury. More widespread use of these tools by advocates has the potential to improve services for DV survivors and address what have historically been invisible injuries and mental health struggles in the population.

The CARE Health Advocacy Intervention Improves Trauma-Informed Practices at Domestic Violence Service Organizations to Address Brain Injury, Mental Health, and Substance Use

“…Next DV programs A CKNOWLEDGE that head trauma and strangulation, and related challenges, are common—including BI, mental health struggles, other medical issues, substance use, and suicidal ideation. DVSO staff can use CARE tools ( Invisible Injuries and Just Breathe booklets, The Head Injury education card, CHATS needs identification, accommodation, and referral tool) to provide information and education about and identify short- and long-term consequences of BI and trauma 15. The DV programs then R ESPOND by collaborating with the survivors to develop accommodations for challenges related to suspected BI caused by violence and provide effective, accessible referrals and advocacy for individuals who need additional services or support.…”

“…DVSO staff can use CARE tools (Invisible Injuries and Just Breathe booklets, The Head Injury education card, CHATS needs identification, accommodation, and referral tool) to provide information and education about and identify short-and long-term consequences of BI and trauma. 15 The DV programs then RESPOND by collaborating with the survivors to develop accommodations for challenges related to suspected BI caused by violence and provide effective, accessible referrals and advocacy for individuals who need additional services or support. Finally, staff EVALUATE their services by establishing a strong feedback loop with survivors to see how, and to what extent, the support, accommodations, resources, referrals, and services are meeting their needs.…”

“…Prior to this study, current TIC approaches had not yet acknowledged the impact of BI on survivors of DV and trauma. 6,7,15 CARE is the first program that is a trauma-informed, BI-aware advocacy model that acknowledges BI (including from head trauma and strangulation) as central to many survivors' experiences and one of many causes of current struggles that has to be addressed and accommodated. This study demonstrates how the CARE framework and materials can benefit DVSO trauma-informed services by acknowledging the prevalence and impact of BI within the DV community.…”

“…6,7,9,11,15 Currently, the different sectors that address survivors' needs (DVSOs, healthcare, justice system, social service, etc) do not have an established framework that is both BI-aware and trauma-informed. 6,15 Furthermore, these systems do not have established protocols, referral systems, or care pathways to seamlessly address survivors' needs across systems if survivors require specialized services for safety, recovery, justice, or stability. 15 Through expanded interdisciplinary collaboration, CARE may provide the foundation upon which to develop a cohesive, cross-system model to support the implementation of BI-aware, trauma-informed practices across service settings.…”

Brain Injury and Intimate Partner Violence

“…Finally and critically, this issue highlights the impact of a promising health advocacy intervention, CARE (Connect, Acknowledge, Respond, and Evaluate), 20 revealing improvements in agencies' and advocates' provision of instructional and functional social support to survivors of IPV-related BI. Survivors increased their knowledge, personal validation, and agency.…”