Special Collection
Special Collection: Intimate Partner Violence Intersections With Traumatic Brain Injury, Trauma, Mental Health, and Substance Use
INTRODUCTION
The impact of severe physical violence, particularly against women, is fairly well-known. More has become known about traumatic brain injury, the neurobiology of trauma, mental health impacts, and substance use in the context of intimate partner violence (IPV). Included in this Collection are a number of organizations doing exceptional work in these various fields.
Although there is awareness of the connections between brain injury, trauma, mental health, substance use, and IPV, advocacy that adequately addresses these intersections is lacking within law enforcement, criminal justice systems, mental health, and medical fields. Too often, survivors are given no information or inaccurate information about what they are experiencing. Many survivors have been labeled as “untruthful,” “uncooperative,” “non-compliant,” “neglectful parents,” and “difficult.” Inadequate advocacy can cause confusion, misdiagnosis, neglect, and revictimization of IPV survivors – and the resulting impact can be devastating. The ability of survivors to get safe and heal is extremely compromised without accurate information, appropriate support, and the collaboration and coordination of the professions they may depend on for help.
This Special Collection intends to provide information in the context of IPV and traumatic brain injuries, including strangulation, and intersections with trauma (emotional and neurobiological impact), mental health challenges, and substance use experienced by survivors of IPV to advance intersectional work and collaborations, to strengthen advocacy, care, and assistance that prioritizes the safety and recovery of all survivors. This Collection also offers brochures, fliers, and other resources for survivors to increase their understanding of what they are experiencing, access resources, and enable them to make informed decisions.
Advocates are encouraged to use these articles, webinars, policy recommendations, public education materials, and resources in their work with survivors and to build initiatives for in-services, public education, cross-training, collaboration, and coordination with the allied professions working with IPV survivors.
This Special Collection is intended for advocates and allied professionals in law enforcement, criminal justice, medical, mental health, and substance use fields. Survivors and community members are also invited to explore it.
Advocacy for survivors of Intimate Partner Violence (IPV) requires an understanding of the dynamics and tactics of IPV. This understanding is also necessary for advocacy for social change to end domestic violence. This webinar provides an overview of the root causes of domestic violence in Indigenous communities. It also explains the dynamics and tactics of IPV from a survivor’s perspective. Highlighted in this webinar is the importance of traditional cultural practices in strengthening and building our capacity to provide effective, respectful advocacy with our relatives surviving IPV and other forms of violence.
Violence Against American Indian and Alaska Native Women and Men Fact Sheet
This fact sheet provides a statistical summary of the Violence Against American Indian and Alaska Native Women and Men, Report by the National Institute of Justice (2016).
Intimate Partner Violence Triangle
Intimate Partner Violence /Battering is the purposeful use of a system of multiple, continuous tactics to maintain power and control over another. As described in this Triangle, intentional violence results from and is supported by unnatural, misogynistic, sexist societal and non-Indigenous cultural belief systems. This tool describes the types of physical and psychological abuse that may be used to maintain power and control over a current or former intimate partner.
Intimate Partner Violence: Unnatural Power & Control Descriptions
This brochure provides an overview of intimate partner violence/battering as an institutionalized system of overlapping, continuous, purposeful, violent tactics used to maintain power and control.
The work to end violence against Native women and recreate peaceful, harmonious communities is based on reclaiming our traditional values, belief systems, and life ways. As shown in this Wheel, the key values of this life way are compassion, respect, generosity, mutual sharing, humility, contributing, industriousness, courage, love, and being spiritually centered. At the center of this tool is equality, which recognizes that everyone has the right to follow their path, power-sharing, and not hold power over. It is also at the center of all healthy relationships.
Respect Wheel: Natural Life-Supporting Power Descriptions
Our work to end violence against Native women and recreate peaceful, harmonious communities is based on reclaiming our traditional values, belief systems, and lifeways. This brochure briefly describes the values of compassion, respect, generosity, mutual sharing, humility, contributing/industriousness, courage, love, and being spiritually centered.
Domestic Violence and the LGBTQ Community
This fact sheet from NCADV reports that because the majority of the domestic violence awareness movement has focused on heterosexual relationships, members of the LGBTQ community have been largely left out of the movement. However, as cited in this fact sheet, recent research shows that LGBTQ members fall victim to domestic violence at equal or even higher rates compared to their heterosexual counterparts.
What is Trauma Informed Work, and Why Should We Care?
Kathy Wanpovi Sanchez from TEWA Women United, and Carole Warshaw, MD from the National Center on Domestic Violence, Trauma & Mental Health. The term “trauma-informed” refers to services and organizations that take into account the pervasiveness, neurobiology, and impact of trauma on people who access our services, on ourselves as providers, and on our organizations and communities. Understanding the range of ways we can be affected by trauma and what we can do to help counteract those experiences, mitigate their effects, and transform the conditions that produce them are key aspects of a trauma-informed approach.
What Do We Mean by Trauma-Informed?
This 3-page document by NIWRC provides a brief overview of the definition and elements of the concept of “trauma-informed” based largely on the work of the National Center of Domestic Violence Trauma and Mental Health.
Trauma happens when we experience a violent event or continuing situation that threatens our life or mind, and we’re so overwhelmed we can’t cope or regain our balance. For people experiencing domestic violence, trauma can be pervasive and ongoing. Further, historical and intergenerational trauma can affect individuals and communities across generations. This brochure provides a culturally-based overview of what trauma is, how people respond differently to trauma and Indigenous ways of healing.
CREATING TRAUMA-INFORMED SERVICES: Tipsheets and Information Sheets
- Practical Tips for Increasing Access to Services—Tipsheet—This tipsheet provides questions to consider how your services might be experienced by someone who has experienced trauma. Its goal is to ensure that the program is accessible to all survivors, including those experiencing the mental health effects of trauma or psychiatric disability.
- A Trauma-Informed Approach to Domestic Violence Advocacy – Tipsheet - This document will discuss five core components of a trauma-informed approach to domestic violence advocacy. These include (1) providing survivors with information about the traumatic effects of abuse; (2) adapting programs and services to meet survivors’ trauma- and mental health-related needs; (3) creating opportunities for survivors to discuss their responses to trauma; (4) offering resources and referrals to survivors; and (5) reflecting on our own and our programs’ practice.
- Impact of Trauma on Interaction and Engagement: Information Sheet for Domestic Violence Advocates – This is a one-page outline of how trauma affects survivors and how their responses may look as a result and emphasize the need for connection and reflection skills.
- Self-Injury: Information Sheet for Domestic Violence Advocates – This brief document gives guidance on steps needed to support survivors who self-injure to cope with their trauma.
Trauma-Informed Care Manual—Ohio Domestic Violence Network
By understanding trauma as a normal response to an abnormal experience and learning effective ways to support survivors in recovering from their trauma, we can further improve and enhance the services we provide and the care we offer. This manual outlines 16 best practices to incorporate into your organization. Also, it offers detailed protocols for providing trauma-informed services such as answering hotline calls, doing intakes and exit interviews, facilitating support groups, safety planning (including emotional safety planning), and providing parenting support to survivors. It includes information on vicarious trauma and how to make sure that advocates are focusing on the important issue of self-care. The appendices include a trauma-informed checklist developed by the National Center on Domestic Violence, Trauma, and Mental Health, resources, a comparison between the trauma-informed care model and the empowerment model, and suggested best practices for child survivors of domestic violence.
A Trauma-Informed Approach to Domestic Violence Advocacy
Part of the Creating Trauma-Informed Services: Tipsheet Series available at ncdvtmh.org. This document discusses the five core components of a trauma-informed approach to domestic violence advocacy. These include (1) providing survivors with information about the traumatic effects of abuse; (2) adapting programs and services to meet survivors’ trauma- and mental health-related needs; (3) creating opportunities for survivors to discuss their responses to trauma; (4) offering resources and referrals to survivors; and (5) reflecting on our own and our programs’ practice.
Creating Accessible, Culturally Responsive, Trauma-Informed Services and Organizations
NCDVTMH offers a unique, integrated approach to creating accessible, culturally responsive, and trauma-informed (ACRTI) domestic and sexual violence services and organizations. This healing-centered approach draws on myriad perspectives: the voices and experiences of survivors, advocates, and clinicians; the insights of social and political movements; and qualitative and quantitative research on the needs of survivors and the programs that serve them. This approach has evolved into a framework for holding many of the key elements of work in the domestic and sexual violence field: grounded in advocacy, incorporates an understanding of trauma and its effects, creates accessible environments, recognizes the centrality of culture, and is committed to human rights and social justice. This is a link to the three resources, a description of the development of this approach, a toolkit to support programs adopting this approach through organizational self-reflection, and a core curriculum for training for capacity building.
This toolkit is one of three components designed to support organizations’ efforts to become more accessible, culturally responsive, and trauma-informed (ACRTI). It guides organizations to self-assess and plan for transformation into fully ACRTI organizations. NCDVTMH’s framework draws from many perspectives: the voices and experiences of survivors, advocates, and clinicians; the insights of social and political movements; and a growing body of research on child development and neurobiology. This approach is grounded in domestic and sexual violence advocacy, incorporates an understanding of trauma and its effects, creates accessible environments for healing, recognizes the centrality of culture, attends to the well-being of staff, organizations, and communities, and is committed to social justice and human rights.
Webinar: Case Management: Survivor-Centered Practices for Crisis Intervention and Long-Term Support
Key staff from Strength United and the New York City Mayor’s Office to End Domestic and Gender-Based Violence shared their experiences providing survivor-centered case management using a co-located service model at Family Justice/Multi-Agency Centers. They discuss the importance of collaborating with and creating spaces for different disciplines at FJ/MA Centers to provide intensive case management that serves clients with an array of needs. They reviewed how to connect and collaborate with different agencies to seek training in providing services, learn from each other, and focus on partnering with culturally specific, legal, and mental health organizations.
Neurobiology of Trauma by Dr. David Lisak
In this 15-minute presentation, Dr. Lisak discusses the impact of trauma on the brain, i.e., processing and the ability to recall what happened in sequence, and how this impacts law enforcement interviewing. It provides recommendations for effective interviewing, including allowing for a sleep cycle before the interview and asking sensory-based questions. It also addresses the issue of false allegations.
Neurobiology of Trauma by Dr. Jim Hopper
Brain chemistry is altered when someone experiences a traumatic event or extreme fear, and the brain begins to function differently. This is called the "Fear circuity,” a protective mechanism inside us. The neurobiology of trauma--essentially the effects of trauma on the brain--is important to understand because it helps break down common misconceptions and victim-blaming about gender-based violence. It helps survivors to understand their experiences and the aftermath in a new way. This link includes an in-depth presentation by Dr. Hopper on the definition of “trauma-informed,” victim experience, the effects of trauma on the brain, and its impact on memory, processing, etc. Articles linked provide an overview of neurobiology, myths and facts, and other effects.
Understanding Trauma and Mental Health in the Context of Domestic Violence Advocacy
Experiencing domestic violence and other multiple forms of abuse and oppression affects how we think and feel and sets the basis for our relationships with family, friends, community, and service providers. This webinar provides a holistic and integrated framework for responding to trauma and mental health in the context of domestic violence. It looks at the critical role of trauma-informed care in supporting healing and resiliency, both individual and community, and how a trauma-informed approach can strengthen and enhance advocacy work by increasing understanding of the psychological consequences of individual, collective, and historical trauma and how this understanding and awareness support survivors’ access to and experience of services. Presented by Carole Warshaw, MD, National Center on Domestic Violence, Trauma & Mental Health
Mental Health Treatment in the Context of Intimate Partner Violence
This document provides an overview of the impact of IPV on survivors’ mental health and a framework for treatment in the context of IPV, including IPV-specific treatment strategies and suggestions for incorporating an IPV- and trauma-informed approach. Recognizing the role of mental health and substance coercion and the ability of people who perpetrate IPV to leverage providers and systems against their partners is critical to addressing the complex realities that survivors face as they try to end the violence in their lives and heal from its traumatic effects.
These slides are from Part 1—Session 4, Trauma Impact and Effects from the NIWRC Advocacy Curriculum, which can be downloaded in its entirety. This set of slides addresses: What is Trauma? The Ongoing Impact of Trauma/ Violence, Connections: Domestic Violence, Mental Health & Substance Abuse, and the Impact of Witnessing Domestic Violence on Children.
Coercion Related to Mental Health and Substance Use in the Context of Intimate Partner Violence
This toolkit provides trauma-informed guidance on integrating questions about mental health and substance use coercion into routine mental health and substance use histories and in-depth intimate partner violence assessments in primary care and behavioral health settings. This toolkit is intended to be used in conjunction with comprehensive guidance on trauma-informed approaches to screening, assessment, and brief intervention for intimate partner violence in healthcare, mental health, and substance abuse treatment settings.
Responding to Trauma, Mental Health, and Substance Use in the Domestic Violence Field
Survivor-led advocacy starts with meeting people where they are while being prepared to offer holistic support that is inclusive for survivors experiencing trauma, mental health, and substance use. The trauma of domestic and sexual violence (DSV) can impact a survivor’s mental health and substance use; survivors who experience these traumatic effects then face increased targeting, abuse, and victimization by (ex-)partners. Given the complex interconnections between DSV, trauma, substance use, and emotional distress, it is essential that DSV programs and advocates are prepared to offer relevant and affirming support for survivors who experience these traumatic effects of abuse, as well as their families.
Responding to Domestic Violence in the Mental Health and Substance Use Fields
Being abused by an intimate partner can have traumatic mental health and substance use-related effects. People who abuse their partners deliberately use mental health and substance use-related issues to undermine and control their partners and to keep them from achieving their treatment and recovery goals. These forms of abuse—known as mental health and substance use coercion—not only jeopardize survivors’ well-being but also compromise the efficacy of mental health and substance use disorder treatment. Therefore, implementing policies and practices for addressing IPV is essential. Knowing how to respond appropriately when a person is in immediate danger or contending with an abusive, controlling partner is critical to supporting the safety and well-being of survivors and their children.
Shelter and Other Safe Space Information Packet
This Shelter and Other Safe Space Information Packet is a collection of articles, booklets, sample policies, and forms covering a range of topics about providing shelter and other emergency housing for survivors of battering/intimate partner violence. It also includes a number of sample policies, such as a Model Medication Policy for DV Shelters, Guidance for DV Programs on Supporting Survivors Who Use Substances, DV Shelters and the ADA (Americans with Disabilities Act), Refusal of and Limitations on Services, and an Accessibility Guide for DV and Sexual Assault Providers.
ACRTI Core Curriculum—Module 7—Trauma-Informed Advocacy and Substance Use
Domestic and sexual violence (DSV) can have significant effects on one’s health, including increased risk for substance use concerns. In addition to using substances to cope with experiences of violence, survivors may also be coerced to use substances, face increased violence if they do not use substances, and have their attempts to engage in treatment and recovery sabotaged by a partner or ex-partner – all tactics of substance use coercion. Many advocates feel unprepared to help survivors address concerns related to substance use and substance use coercion.
Making the Connection: Substance Use Disorder and Traumatic Brain Injury
This presentation introduces the role of domestic violence and other abusive tactics—specifically mental health and substance use coercion— as additional drivers of substance misuse and addiction. To add another layer of complexity, a critically important consequence of domestic violence has been hidden in plain sight for decades—brain injury. This presentation provides tools to assist in raising awareness and addressing partner-inflicted brain injury in services and help you better support the unique needs of people impacted by domestic violence, brain injury, and addiction. Rachel Ramirez, ODVN, presents for NASHIA with the Mid-America Addiction Technology Transfer Center and Mountain Plains Addiction Technology Transfer Center.
In addition to using substances to cope with experiences of violence, survivors of substance use coercion may also be coerced to use substances, face increased violence if they do not use substances, and have their attempts to engage in treatment and recovery sabotaged by an intimate partner or ex-partner. At the same time, many advocates feel unprepared to help survivors address concerns related to substance use and substance use coercion, resulting in increased barriers and risk of revictimization. This resource assists programs and advocates in supporting survivors who use substances by providing practical strategies embedded within an accessible, culturally responsive, and trauma-informed (ACRTI) approach.
Overview of Substance Abuse (SA) Connections and Intimate Partner Violence
This is a two-page outline of the connections between substance use and the tactics of intimate partner violence from NIWRC Advocacy Curriculum, Part 1. Session 4 -Trauma Impact and Effects.
This booklet intends to provide basic information in the context of IPV about traumatic brain injuries, including strangulation, and an overview of the intersections with trauma (emotional and neurobiological impact), mental health challenges, and substance use as experienced by survivors of IPV. Our goal is to advance intersectional work and collaborations to support changes in attitudes, policies, and procedures that strengthen advocacy, care, and assistance that prioritize the safety and recovery of all survivors. Another objective is to give information to survivors to increase their understanding of what they are experiencing, access resources, and make informed decisions.
While a small group of researchers has been sounding the alarm about the intersection of domestic violence and brain injury for almost 20 years, the knowledge is just beginning to be considered in direct service agencies, including domestic violence shelters. The Ohio Domestic Violence Network’s Center on Partner-Inflicted Brain Injury and other organizations are helping to ensure brain injuries are identified early so survivors can get the care they need.
Hidden in Plain Sight: Traumatic Brain Injury, Strangulation, and Domestic Violence Webinar
Brain injury caused by domestic violence is rarely identified and almost never immediately treated, resulting in short and long-term physical, emotional, and cognitive consequences that can impact every area of a person’s life--including their ability to access and participate in an agency's services successfully. This session provides an overview of how CARE (Connect, Acknowledge, Respond, Evaluate), an evidence-based framework that supports trauma-informed practices and survivor empowerment, was developed. Participants learn ways domestic violence victims acquire head injuries, the unique characteristics of those injuries, and ways to implement the CARE framework in their agencies.
What You Don’t Know CAN Hurt You Webinar
Domestic violence abusers frequently target a victim’s head, neck, or face with often terrifying repeated assaults and strangulation. These invisible injuries can cause lasting challenges and affect how the brain works now and in the future. The injuries can make it harder for a survivor to access and use needed services. This webinar shares tools to support advocacy, educate survivors, and equip advocates to respond to their unique needs. This and other Ohio Domestic Violence Network (ODVN)webinars are recorded and available to download in the Online Learning Academy at https://odvn.talentlms.com/
Tools and Tips to Address Partner-Inflicted Brain Injury in Your Organization
As a follow-up to the What We Don't Know Can Hurt Us webinar (it is recommended that you watch it prior to this webinar—basic information on the intersection of DV and brain injury will not be covered), this webinar introduces the CARE framework of delivering services, using accommodations to make services more effective and responsive, and free, downloadable educational materials and practice-based tools for service providers and survivors.
Ten Things to Know About the Connection Between Brain Injury and Violence
Violence directed at the head, neck, and face—including choking and strangulation—can have severe and long-lasting consequences. Often, people are hurt again and again without medical care, treatment, or time to heal. This is an easy-to-read list of things everyone should know about Traumatic Brain Injuries, with additional information about managing challenges brain injuries often cause.
Invisible Injuries: When Your Head is Hurt While Experiencing Domestic Violence Brochure
This four-page educational brochure describes traumatic brain injuries, including strangulation, that leave no marks but still have possible dire consequences. It answers the question: “What I might notice that could be a sign my brain was hurt?” “What should I do if I was recently hurt in the head?” “What are some strategies for dealing with common problems after a head injury?” “Can brain injuries heal?” and “What helps my brain get better after it was hurt?”
Invisible Injuries: When Your Head is Hurt—Survivor Booklet
This 16-page booklet from ODVN’s Center on Partner-Inflicted Brain Injury is a tool for survivors describing the causes, impact, and symptoms of brain injuries, providing safety planning and care logs, and information that can help survivors deal with the ongoing effects of TBIs.
This three-page guide is useful for survivors with non-obvious head injuries and advocates who work with them, providing brief questions about symptoms and signs of head injuries and resources for healing. It includes a brief guide for advocates to use CHATS to connect with survivors, identify and provide information about head injuries, and accommodate people’s needs. C stands for Choking (strangulation, suffocation), H stands for Hits/ Harm to the Head, A is effects After the injury, T stands for Troubles physical, emotional, and thinking, and S stands for survivor Saw a doctor or gotten help.
Partner-Inflicted Brain Injury: Promising Practices for Domestic Violence Programs
This document consists of three important components to help better serve survivors of domestic violence impacted by head trauma. The first section provides an overview of partner-inflicted brain injury. It assists advocacy efforts by raising awareness on the subject, informing how survivors may present or speak of potential brain injury, and increasing empathy for those who may have endured brain injury. The second section describes the CARE (Connect, Acknowledge, Respond, Evaluate) framework and provides promising practices and strategies for integrating CARE into your work. Section three consists of CARE organizational practices, policies, and procedures to address brain injury within domestic violence organizations.
Living with Traumatic Brain Injury
The Model Systems Knowledge Translation Center (MSKTC) works closely with researchers in the 16 Traumatic Brain Injury (TBI) Model Systems to develop resources for people living with traumatic brain injuries and their supporters. These evidence-based materials are available in various formats, such as printable PDF documents, videos, and slideshows. Topics cover a range of TBI-related issues, including chronic pain and anxiety, cognitive and emotional problems, headaches, fatigue, sleep, relationships, and more.
Living with Traumatic Brain Injury
This resource by MSKTC includes informational comics on a range of TBI-related issues, including chronic pain and anxiety, headaches, and sleep, as well as basic descriptions of the causes, impact, and results of TBI. It is intended for use in working with survivors and for community education.
Where Can I Locate Brain Injury Resources in My State?
This resource provides links to Brain Injury Associations in your state, as well as brain injury support groups and rehabilitation services in your area.
What is Hypoxic and Anoxic Brain Injury?
This resource explains hypoxic and anoxic brain injuries. They are acquired brain injuries that occur when cells in the brain do not receive enough oxygen. These injuries are very similar but have slightly different causes. A hypoxic injury occurs when the brain is still able to receive some amount of oxygen but does not get enough. An anoxic injury occurs when oxygen is cut off completely from the brain.
Traumatic Brain Injury and Domestic Violence
The Empire Justice Center, Building Bridges: A Cross-Systems Training Manual for Domestic Violence Programs and Disability Service Providers in New York, 2006
This document describes traumatic brain injuries and symptoms, provides recommendations for working with survivors of TBIs, and provides a HELPS screening tool for traumatic brain injuries for use by domestic violence advocates to support appropriate referrals. (H stands for Hit/ Head injuries, E stands for Emergency room/ other hospital care, L stands for Loss of consciousness, P stands for Problems after being hit on the head, and S stands for Sicknesses after being hit in the head.)
Traumatic brain injury (TBI) occurring during intimate partner violence (IPV) is a largely unrecognized but significant public health crisis. One in 3 women will experience IPV in their lifetime, up to 75% of whom will sustain a TBI as a result. This article reports on the systems-level findings from a national summit to address barriers, needs, and priorities related to healthcare and support services for women survivors of IPV-TBI. Objectives: (1) To identify key needs, facilitators, and barriers to care for women survivors of IPV presenting with TBI; and (2) to co-create ideas for resources and principles for identification, clinical care, and support for healthcare practitioners who treat women exposed to IPV and TBI. Note that their research includes Indigenous and LGBTQ populations.
This important article chronicles the stories of a number of women in their voices who sustained traumatic brain injuries at the hands of intimate partners and their struggles to find help. Several doctors and researchers address the lack of attention to TBI research, lack of diagnosis/ misdiagnosis, and treatment specifically focused on women. Though more attention has been paid in recent years, the overwhelming need for research, consistent, appropriate diagnosis and treatment, and providers educated in TBI continues.
PINK Concussions focuses on pre-injury education and post-injury medical care for women and girls with brain injuries, including concussions incurred from sports, violence, accidents, or military service. PINK organizes conferences for international brain injury experts and researchers to share data and further scientific discoveries. For Women and Girls, PINK Concussions Fosters online communities for young women isolated by concussions creates online support groups and educational resources for schools, sports, and medical clinics, and holds online support groups and weekend educational/inspirational retreats for PCS for women and girls.
Safety Planning for Persons with Disabilities
This guide covers the core beliefs and values for helping survivors with disabilities plan for safety, tips on how and when to use a safety plan for various situations experienced by a survivor and a safety plan template with local resources for support and safety. This booklet includes statistical information and a description of the dynamics and tactics of domestic and sexual violence used against persons with disabilities.
Abused and Brain Injured Toolkit
This toolkit was created to draw attention to the widely unrecognized intersection of intimate partner violence and traumatic brain injury. It provides information, resources, research, and practice recommendations for trauma-informed service delivery. This toolkit is an evolving resource and is constantly changing. It contains modules on Employment, Mental Health, Communication, IPV, Resources Library, and Survivor Experiences with care systems and guidance on how to help survivors navigate those systems.
VAWA 2013: Strangulation & Suffocation Webinar
Strangulation has been identified as one of the most lethal forms of domestic violence and sexual assault. This session will provide an in-depth examination of the mechanics of strangulation and suffocation from a legal and law enforcement perspective, presented by Leslie Hagen, National Indian Country Training Center.
What We Learned In 2023: Updates from the Training Institute on Strangulation Prevention
This captivating 90-minute webinar discusses lessons learned, best practices, new research, and resources. Topics include best practices for identifying, documenting, investigating, and prosecuting strangulation cases through medical, legal, law enforcement, and advocacy trends.
FIVE MYTHS ABOUT STRANGULATION
This one-page handout outlines common myths about strangulation and offers facts to counter those myths. It was created by Gerald Fineman, Assistant District Attorney, Riverside County, and Dr. William Green, Medical Director, California Clinical Forensic Medical Training Center/ CDAA.
The Long-Term Consequences of Strangulation webinar
There is mounting evidence in the medical literature that intimate partner violence, including strangulation, has long-term negative health consequences for survivors. This impact, what Dr. Ellen Taliaferro terms the "Pandora Effect," lingers long after the bruises fade, the bones mend, and the abuse is over. Still, many victims, their friends and relatives, and those who serve them in the domestic violence advocacy, medical, and law enforcement communities fail to understand how significantly this lingering footprint of violence is affecting their well-being and ability to carry on a normal life. In this webinar, Dr. Smock shares the top 25 long-term health consequences of strangulation, and Gael Strack discusses how professionals can mitigate their impact through advocacy and new tools.
Strangled Victims Need Imaging article
High-risk domestic violence victims experience high rates of non-fatal strangulation, between 68% and 80% (Wilbur, 2001; Campbell, 2017). Most victims suffer minimal or no visible external injuries with few symptoms, so there is a tendency to minimize non-fatal strangulation. Untrained medical professionals often underestimate the risk of internal injuries and often don’t order imaging for the alert patient who looks relatively fine. Yet, research proves that victims of strangulation and suffocation may experience a wide range of internal injuries, including injuries to the arteries and veins, fractures, swelling, and other injuries that may result in delayed stroke and death.
This article explains and advocates for the need for routine imaging of victims of strangulation.
2022 Imaging Recommendations for The Patient Who Has Been Strangled: Saving the Lives of Survivors
In this webinar, leading forensic experts cover recommendations for the patient who has been strangled, the top 5 FAQs about implementing the imaging recommendations, and updates and lessons learned since the recommendations were first published in 2016.
Medical Radiographic Imaging Recommendations
Advocates and survivors of strangulation can utilize this one-page handout (with a second page of references) to educate themselves about the appropriate steps for treatment for first responders and doctors in the emergency room. This is a tool to advocate for imaging of victims of strangulation, which is frequently not done, leading to failure to diagnose critical injuries that can result in later strokes and potentially death.
The Dear Doctor Letter was created in collaboration with the Physician’s Medical Advisory Board to address the lack of imaging for the strangled patient, explain the risks, and encourage hospitals to adopt Medical Radiographic Imaging Recommendations for non-fatal strangulation patients. The letter details how the imaging guidelines were created and how expert consensus was reached, includes a recent case study, and provides references for imaging. The letter also discusses the anticipated concerns for CTA imaging and possible liability for medical malpractice. It is recommended that this letter be shared with hospitals that have not developed a protocol for the strangled patient or are routinely denying imaging for non-fatal strangulation patients.
Adult Strangulation Brochure—Template 2020
Survivors can use this two-page tool to help identify and document strangulation injuries.
Training Institute on Strangulation Prevention series on signs and symptoms of strangulation
These links provide a series of fliers on the signs and symptoms of strangulation. They include Signs of Strangulation, Symptoms of Strangulation, a Strangulation Infographic, a Strangulation Pocket Guide, and a Physiological Consequences of Strangulation Timeline.
What Judges and Court Staff Need to Know About Strangulation webinar
This webinar shares new resource tools, emerging sentencing statutes, case law, and court considerations in handling strangulation cases. Casey Gwinn and Gael Strack discuss the impact of bail and jail reform and share sentencing considerations. Judge Lee Chitwood shares his bench card and “Judicial Checklist for Motions to Dissolve Protective Orders,” as well as lessons learned handling strangulation cases. Jim Henderson discusses using risk assessment tools and the role of probation/parole.
The website offers a collection of Tribal codes on strangulation by the Training Institute on Strangulation Prevention. As of May 2024, the collection includes 21 tribal codes that specify strangulation as a crime, acknowledging the potential lethality and long-term damage strangulation can cause.
The report card offers a 10-question self-assessment to gain insight into the best practices for strangulation cases in your Family Justice Center or criminal justice and law enforcement departments by the Training Institute on Strangulation Prevention.
Although intended to promote effective responses within the Uniformed Code of Military Justice, this article provides a useful, general overview of the occurrence of strangulation within the context of domestic violence, symptoms/impact of strangulation, historical legal status of strangulation, and proposed enumerated offense for strangulation within the military.
The goal of this protocol is to guide clinicians across a variety of healthcare settings in effectively providing medical forensic examinations to patients experiencing intimate partner violence (IPV), which may include strangulation. A medical forensic examination is defined as a comprehensive assessment that prioritizes the patient's health and well-being while also planning for or preserving information for potential use by the legal system.
American Indian and Alaska Native Patients & Medical Forensic Examination Considerations
The purpose of this guidebook is to enhance care delivery to American Indian and Alaska Native (AI/AN) patients, families, and communities affected by violence by providing resources and support to forensic healthcare providers serving in Indian Health Service (IHS), Tribal, and Urban Indian (I/T/U) settings. The guide does not provide coverage for all patient care situations or scenarios. This is a companion guide to the Forensic Health Care & Caring for AI/AN Patients guidebook below.
- Within the above I.H.S. document, it is recommended to utilize the International Association of Forensic Nurses (IAFN) Non-Fatal Strangulation Documentation Toolkit is recommended for detailed guidance on assessment techniques, documentation, and evidence collection—access sample documents such as discharge instructions and policies/procedures. The Toolkit is available at https://www.forensicnurses.org/page/STOverview/.
- Note: Within this Toolkit, it is recommended to utilize the Strangulation Training Institute’s Recommendations for the Medical/Radiographic Evaluation of Acute Adult, Non-Fatal Strangulation (September 2016.)
Forensic Health Care and Caring for American Indian and Alaska Native Patients
This guidebook references medical forensic examination best practices, culturally centered care, program readiness, and development, screening, and prevention efforts.
Indian Health Service Traumatic Brain Injury brochure
This brochure, a public education tool, briefly explains what traumatic brain injury is. Note that it does not include “acquired brain injury” resulting from strangulation or choking.
Tribal Injury Prevention Cooperative Agreement Program (TIPCAP)
The Indian Health Service provides funding for tribes through the Tribal Injury Prevention Cooperative Agreement Program (TIPCAP) to develop their injury prevention infrastructure to address the disparity in injury rates throughout American Indian and Alaska Native communities. TIPCAP grantees employ effective strategies in collaboration with key partners to target specific injury risks and hazards and receive technical assistance from the Centers for AI/AN Health, Colorado School of Public Health.
Traumatic Brain Injury Resource Bundle for American Indians
Around 176 Americans die from a TBI-related injury each day. Indigenous people throughout North America are at greater risk for TBI and poor TBI-related outcomes based on disparities in health, connections to poverty, violence, and systemic racism. TBI has long been a concern for American Indians, and there continue to be numerous barriers to receiving culturally appropriate, timely, and local short- and long-term treatment and services. In collaboration with American Indian partners, the American Institutes for Research has developed a Traumatic Brain Injury Bundle to support American Indians with TBI, their families, and communities. It contains free, research-based, and culturally tailored resources to help improve the rehabilitation outcomes of American Indians with TBI.
Traumatic Brain Injury (TBI) Surveillance among American Indians in Arizona, Nevada, and Utah
This surveillance report was prepared in response to traumatic brain injury-related concerns among Tribal communities within the Phoenix and Tucson Indian Health Service (IHS) Areas. This surveillance report highlights trends in traumatic brain injury among American Indian populations in Arizona, Nevada, and Utah. The underlying causes of TBI-related injuries were categorized as motor-vehicle collisions, falls, assaults, struck by or against, and other or unspecified. It does NOT include brain injury caused by choking or strangulation.
Indian Health Manual: Chapter 37—Trauma-Informed Care
This chapter provides guidance to Indian Health Service (IHS) hospitals, health centers, clinics, and health stations (hereafter referred to as facilities) in delivering Trauma-Informed Care services. It will also prepare our workforce to be trauma-informed and promote self-care to prevent and treat secondary traumatic stress, also known as vicarious trauma, which can lead to compassion fatigue and staff burnout.
NATIONAL INDIGENOUS WOMEN’S RESOURCE CENTER
Our mission is to provide national leadership to end violence against American Indian, Alaska Native, and Native Hawaiian women by supporting culturally grounded, grassroots advocacy. Our vision is the restoration of sovereignty and safety for Native women. NIWRC provides training and technical assistance to Tribes and Tribal domestic violence and sexual violence organizations. NIWRC also provides a Resource Library with numerous free materials, documents, and webinars.
OHIO DOMESTIC VIOLENCE NETWORK
Mission: The Ohio Domestic Violence Network (ODVN) advances the principles that all people have the right to an oppression and violence-free life; fosters changes in our economic, social, and political systems; and brings leadership, expertise, and best practices to community programs.
ODVN’s Center on Partner-Inflicted Brain Injury provides statewide, national, and international leadership to raise awareness on the emerging area of brain injury caused by domestic violence—including traumatic brain injury and brain injuries caused by strangulation or oxygen deprivation. The Center works to increase collaboration among systems and provide education, training, technical assistance, domestic violence program capacity building, research, reports, resource development, and promising practices for researchers and practitioners working with domestic violence victims impacted by brain injury.
THE TRAINING INSTITUTE ON STRANGULATION PREVENTION
This Training Institute is a program of the Alliance for HOPE International and was launched in October 2011. It was developed in response to the increasing demand for Intimate Partner Violence Strangulation Crimes training and technical assistance (consulting, planning, and support services) from communities worldwide.
The Institute, led by Gael Strack, JD, CEO and Co-Founder, and Casey Gwinn, Esq. and President, provides training, technical assistance, web-based education programs, a directory of national trainers and experts, and a clearinghouse of all research related to domestic violence and sexual assault strangulation crimes.
NATIONAL CENTER ON DOMESTIC VIOLENCE TRAUMA AND MENTAL HEALTH
Mission: The National Center on Domestic Violence, Trauma, and Mental Health promotes survivor-defined healing, liberation, and equity by transforming the systems that impact survivors of domestic and sexual violence and their families.
SYSTEMS KNOWLEDGE TRANSLATION CENTER
The Model Systems Knowledge Translation Center (MSKTC) is a national center operated by the American Institutes for Research® (AIR®). The MSKTC collaborates with Model System researchers to translate health information into easy-to-understand language and formats for people living with spinal cord injury (SCI), traumatic brain injury (TBI), and burn injury and those who support them. The center conducts knowledge translation research to make research meaningful to those with Spinal Cord Injury, Traumatic Brain Injury, and Burn Injury. It develops and disseminates free research-based resources to help improve rehabilitation outcomes and quality of life for people living with SCI, TBI and burn injuries.
BRAIN INJURY ASSOCIATION OF AMERICA
Mission: As the voice of brain injury, we improve the quality of life of people affected by brain injury across their lifespan through advancing prevention, awareness, research, treatment, education, and advocacy.
PINK Concussions focuses on pre-injury education and post-injury medical care for women and girls with brain injuries, including concussions incurred from sports, violence, accidents, or military service. They organize conferences for international brain injury experts and researchers to share data and further scientific discoveries. Publicizes current research on the differences between female brain injury and female experience of brain injury. For Women and Girls, PINK Concussions Fosters online communities for young women isolated by concussion. They create online support groups and educational resources for schools, sports, and medical clinics. They also hold online support groups and weekend educational/inspirational retreats for PCS for women and girls.
If you or someone you know has sustained a hypoxic or anoxic brain injury, contact the National Brain Injury Information Center at 1-800-444-6443 for support and resources.
