An Understudied Area of TBI

Although this blog primarily focuses on mild traumatic brain injury (mTBI) – concussion – and the ramifications on adolescents there are many segments of society that deal with brain injury. The most severe of this is traumatic brain injury (TBI); the difference at its basics is that there is actual physical findings of damage to the brain itself – a bleed, skull fracture, hematoma, etc. I am sure there may be a better way to put it but for the sake of being simple that is the difference.

The morbidity rate of TBI is extremely high and thusly we should be very cognizant of this.

A silent portion of the TBI problem comes from domestic abuse, silent because many of the suffers of the brain injury often don’t speak up. There are no actual numbers on this due to the many reasons one would not report incidents. Take car accident TBI’s for example, we have a very definitive number on them because most if not all are seen in emergency rooms but the silence in the domestic abuse realm makes us guess, at best.

This looks to change with a new study on this, below is the press release of a first-of-its-kind;

Sojourner Center Launches First-of-its-Kind Effort to Study Link Between Domestic Violence and Traumatic Brain Injury

Sojourner BRAIN Program to develop innovative screening, deliver treatment and share best practices


PHOENIX – Sojourner Center, one of the largest and longest running domestic violence shelters in the United States, announced plans to develop the first world-class program dedicated to the analysis and treatment of traumatic brain injury (TBI) in women and children living with domestic violence, a largely unrecognized public health issue.

With its Phoenix-based partners The CACTIS Foundation and Conquering Concussions, LLC, the Sojourner BRAIN (Brain Recovery And Inter-professional Neuroscience) Program will serve as a center of excellence, leading the domestic violence field in developing a body of knowledge regarding the incidence, short- and long-term effects, and treatment of TBI in a domestic violence population. The strategic alignment catalyzes an inter-professional, multi-institutional team uniquely suited to address this issue. Other collaborating institutions include the University of Arizona College of Medicine –Phoenix and Barrow Neurological Institute at Phoenix Children’s Hospital.

Much like professional football players and U.S. combat troops, women and children impacted by domestic violence are far more likely than the general public to have sustained a TBI. Of the published studies that do exist, the findings are telling. According to one survey of women in domestic violence shelters, an estimated 92 percent of women had been hit in the head by their partners, 83 percent had been both hit in the head and severely shaken, and nearly eight percent had been hit in the head over 20 times in the previous year[1].

“Accounting for the incidence of TBI in victims of domestic violence could potentially result in 20 million women exhibiting signs and symptoms of TBI each year— a number that is 12 times greater than any published incidence of TBI in the general population,” said Hirsch Handmaker, M.D., Chairman and Chief Executive Officer of The CACTIS Foundation. “Additionally, it is estimated that in 50 percent of households where domestic violence occurs, a child is also at risk for TBI. The Sojourner BRAIN Program will bring to light this rarely reported public health epidemic and guide evidenced-based  ‘best practices’ by producing effective, quantifiable outcomes.”

In addition to creating a meaningful database and assessing and treating TBI at Sojourner Center, the Sojourner BRAIN Program will inform and share standards of care, procedures, protocols and clinical practices with other domestic violence and social service providers, neurologists, psychiatrists, psychologists, physicians, pediatricians and other professionals. Clinical internships and residency opportunities will further extend the impact of the collaborative beyond the walls of Sojourner Center.

“Despite the alarming statistics, domestic violence facilities and service providers are not, in large part, addressing the needs of women and children experiencing TBI. It is not standard practice to screen participants for TBI, and shelter staff are not trained to manage, intervene or treat TBI when they encounter it,” said Maria E. Garay, M.S.W., Ph.D., Sojourner Center Chief Executive Officer. “We want to evolve our understanding of TBI in domestic violence, so that we can provide a supportive environment that promotes healing and direct change with solutions that can end domestic violence not just here in Phoenix, but nationwide and globally.”

As part of its initial roll out, the Sojourner BRAIN Program is conducting a study of women in residence to assess the incidence of TBI in this population. Sojourner Center and its partners will use the study results to begin screening all participants for TBI during intake at the shelter’s main campus beginning in late 2015.  In doing so, it will be the first domestic violence shelter to systematically screen its participants for TBI with domestic violence-specific tools. Robert Knechtel, M.D., J.D., Sojourner Center Chief Operating Officer will serve as the interim director of the Sojourner BRAIN Program.

“Most domestic violence research skims the surface of TBI and its associated problems,” said Knechtel. “Sojourner Center seeks to dig deeper, listen to our participants, and gather empirical data to inform hypotheses on how we can better assess and treat the specific and long-lasting trauma domestic violence imparts on women and children. We will do this not only through the program, but also through several focus areas aimed at strengthening direct services and translating evidence-based best practices to the wider public health and social services fields.”

The Sojourner BRAIN Program is a key strategic initiative supporting a robust Circle of Care approach launched in 2014 to strengthen Sojourner Center’s core programs and services to provide more effective treatment for women, families and unique populations who are affected by domestic violence. The long-term goal moves beyond shelter toward prevention and seeks to engage all sectors of society to bend, break, and end the cycle of abuse and domestic violence in society.


I just thought this was a good time to explain that brain injury is just about everywhere. See if you can help out!

One thought on “An Understudied Area of TBI

  1. June 3, 2015 / 04:13

    Dustin – Thanks for posting this. I have spent this past Spring meeting with domestic violence groups to see what screening tools and procedures they are using in their intake process. And while aware of head injury, they are not screening for it. As interest in all areas ebb and flow as we have seen in the last hundred years with concussion, it seems head injury and domestic violence is no different. This topic had a great champion in Sarah DeWard whose 2010 podcast and training materials seem to be the best I have found so far. I recently contacted Sarah and she is no longer working in TBI/DV but gave me links to the other resources she developed.

    If anyone else is interested in working on the issue of domestic violence or would like to have links to resources I have gathere, please contact me.

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