Involving Police Departments in Early Awareness of Concussion Symptoms during Domestic Violence Calls

ABSTRACT

Police officers around the world respond to and investigate calls regarding domestic violence (DV) daily. Police departments operate with standard protocols, particularly when engaging in investigations that involve allegations of strangulation or sexual assault. Operating under advisement of the Maricopa County Attorney’s Office, the Mesa Police Department (Mesa, AZ) has established protocols for detecting, recording, and prosecuting DV cases that involve strangulation and sexual assault. Allegations of strangulation (defined as impeded breathing) or sexual assault prompt officers to offer a forensic nursing exam (FNE) combined with strangulation treatment by forensic nurses at the Mesa Family Advocacy Center. Recognizing the potential for head injury to the assault victim in all DV situations, including intimate partner violence (IPV), the police department has added concussion-awareness training, as well as a point-of-incident investigative tool for its officers to record neurological function of the victim. Officers were instructed to use the ConQVerge device to measure and record the Near Point of Convergence (NPC) as a test of neurological impairment in suspected head injuries. In this article, we discuss the challenges and opportunities for assisting victims of DV strangulation and sexual assault (including non-DV sexual assault) with on-site assessment and consent for further medical assessment and treatment. Additionally, rates of domestic assault victims that report a crime, but decline to follow through with forensic medical tests, are reported for the first time. Lessons learned from the project that inform strategic operations in this space are offered to other agencies prior to the implementation of similar procedures.     

Rethinking Traumatic Brain Injury from Intimate Partner Violence: A Theoretical Model of the Cycle of Transmission

ABSTRACT

Despite growing evidence of the repeated nature of traumatic brain injury (TBI) in women experiencing intimate partner violence (IPV), there is no theoretical model depicting TBIs as a cyclical process throughout a lifetime. Situational analysis methodology was used on interviews with 10 women who self-reported passing out from being hit in the head during an episode of IPV to create a theoretical model depicting the cycle of transmission of TBI. We define the cycle of transmission of TBI as the way that women experience multiple TBIs over the course of their lifetime and how TBI can be perpetuated in a family or community. The cycle begins in childhood or adolescence, when women receive a TBI from abuse, sports, or motor vehicle accident. They enter into abusive relationships with men who are also described as living with a TBI and the women receive other TBIs during this relationship. With repeating head trauma, women described increasing TBI symptoms: problems with memory, cognition, executive functioning, depression, and concentration. If they do seek help, they must choose between healthcare and protective shelter. With either choice, the element of instability could be introduced and the cycle of transmission continues. This theoretical model shows that it is necessary to move beyond individual behaviors to think about how TBIs are transmitted through communities and how untreated symptoms can impact help-seeking behavior and perpetuate other risk factors for receiving a TBI.     

Two Kinds of Brain Injury in Sport

Abstract

After years of skepticism and denials regarding the significance of concussions in sport, the issue is now front and center. This is fitting, given that the impact of concussions in sport is profound. Thus, it is with trepidation that one ventures to direct some attention onto brain injuries other than concussions incurred through sport. Given a closer look, however, it may be that considering various kinds of brain injuries, with different causes, will help us better understand the range and seriousness of brain injuries in sport. My focus is on emotional trauma in sport. I argue that severe emotional pathology is evidence of underlying brain injury. Any attempt to minimize the significance of emotional disturbance that results from emotional trauma as ‘merely’ psychological in nature is thus misguided.     

Psychological distress associated with domestic violence in Northern Ireland

Several studies have noted an association between domestic violence and psychological distress. However, little empirical work has examined behavioral and psychological difficulties, especially with reference to dissociation and guilt, in victims of domestic violence in Northern Ireland. In addition, childhood abuse history has tended not to be assessed in studies conducted in the Province. Using measures designed to assess behavioral and psychological difficulties that are problematic to self and/or others (that is, Brief Symptoms Inventory, General Health Questionnaire, Guilt Inventory), dissociation (that is, Dissociative Experiences Scale, Peritraumatic Dissociative Experiences Questionnaire) and trauma (that is, Traumatic Experiences Checklist), the current study assessed Northern Irish victims of domestic violence from shelter-type accommodation (N=33) and a comparison sample of women from the general population (N=33). The domestic violence group displayed significantly more psychological difficulties, including higher depression, anxiety and dissociation scores. Dissociative episodes at the time of an assault were related to higher on-going dissociative experiences. Finally, the domestic violence sample reported more emotional, physical, and sexual abuse in childhood than the comparison group. Despite the difficulty generalizing from victims of domestic violence in shelter-type accommodation to all victims of spousal abuse, the current results highlight the increased levels of psychological distress in those exposed to abuse by their partner.     

Analysis of early representations and personality among victims of domestic violence

IntroductionThis exploratory study analyses the individual elements of the victims of domestic violence through life events, early dysfunctional representations and personality.ObjectivesThis research aims, firstly, to show the existence of early traumatic experiences for the victims of domestic violence. Secondly, it aims to measure the prevalence of early maladaptive schema and identify personality traits in these subjects. Finally, our aim is to highlight that depending on the violence carried out within the couple (reciprocal/unilateral), activated schemas and personality traits are different.MethodOur sample consists of 80 female subjects, non-abused women (n = 40) and victims of domestic violence (n = 40), of which 22 victims of unilateral violence and 18 victims of reciprocal violence. Participants filled out an initial questionnaire as well as the scales and self-report questionnaires as follows: Life events (Amiel-Lebigre, 1984); TCI (Cloninger et al., 1993); YSQ-S3 (Young et al., 2005). The data were subject to statistical analysis and were processed using the software SPSS 22.ResultsThe results show that the victims have experienced more early traumas than non-victims, that schemas (emotional deprivation, mistrust and abuse, subjugation, self-sacrifice) are more active. We note also different personality traits according to the different groups (victims/non-victims) and subgroups (reciprocal violence/unilateral violence).ConclusionOur study sheds light on the role of the individual elements of the victims on the perception of the relationship and on the process of engagement and disengagement of women in abusive relationships. Limits and expectations of the study are discussed.     

« Docteur,pourrais-je avoir une copie du certificat ? » Étude pluricentrique concernant l’application des décrets du 31 mars 2021 et du 23 novembre 2021

On 31 March 2021, a decree was published in the Official Journal concerning the procedures for the delivery of medical certificates to victims of violence. These victims can now obtain a copy of the certificate drafted by the doctor required by the judicial authorities, particularly as regards medical examiners.PurposeThe aim of our study was to assess the impact of the March 31, 2021 decree on victims’ requests to the medical examiner for a copy of the medical certificate.MethodsThis prospective study was conducted among three forensic services receiving victims in consultation, using a paper questionnaire linked to Medlé data, over a three-month period.ResultsOf the 1,492 consultations conducted during the study period, a copy of the certificate was only given to the victim in 13.1 % of the consultations. It was requested spontaneously by the victim in 15.2 % of cases, most often to exercise his right (46.4 %). These were primarily consultations following an accident, psychological abuse, and assault. This copy was requested spontaneously by less than 3 % of victims of domestic violence. There was some disparity between the three centres regarding the minor victim.ConclusionThis study is a small sample over a short period. The information of the victims, especially of domestic violence, on access to the copy of the medical-legal certificate seems still insufficient, and the principle of surrender, when it can help the victim in his efforts, can also be a source of confusion.     

Neuropsychological Issues in the Assessment of Refugees and Victims of Mass Violence

Brain injury, stressor severity, depression, premorbid vulnerabilities, and PTSD are frequently intertwined in trauma populations. This interaction is further complicated when the neuropsychologist evaluates refugees from other cultures. In addition, the observed psychiatric symptoms reported in refugees and victims of mass violence may in fact not be the primary features of PTSD and depression but psychiatric symptoms secondary to the effects of traumatic brain injury. This paper reviews the occurrence of starvation, torture, beatings, imprisonment, and other head injury experiences in refugee and POW populations to alert treators to the presence of chronic and persistent neuropsychiatric morbidity, with implications for psychosocial adjustment. The concept of fixed neural loss may also interact with environmental and emotional stresses, and a model of neuropsychological abnormalities triggered by traumatic events and influenced by subsequent stress will also be considered. Neuropsychologists working with refugees play an important role in assessing the possibility of traumatic brain injury with tools that are relatively culture-fair.     

Co-Occurring Traumatic Brain Injury,PTSD Symptoms,and Alcohol Use in Veterans

Traumatic brain injury (TBI) has been identified as a significant health problem among veterans. Recent research demonstrates the potential interaction and magnification of symptoms of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) in veterans with a history of TBI; however, there is very limited research on the co-occurrence of the three conditions. Veterans (N = 115) with comorbid PTSD and SUD completed a baseline assessment for enrollment into a larger treatment study. As part of that assessment, participants completed a TBI screener as well as self-report measures for pain and physical health, affective symptoms, and substance use. Almost half of the sample (48 %) endorsed a history of a previous head trauma with loss of consciousness (LOC). Participants with and without head trauma with LOC were compared across various measures of functioning. Increased severity of physical health complaints and affective symptoms were reported by the TBI group compared to controls. However, the increases in affective symptoms were relatively small. No group differences were observed for alcohol use. Together, the findings suggest that treatment-seeking veterans with a history of head trauma with LOC may present with roughly equivalent symptoms of PTSD and SUD to those without said history.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

The Power of Shame

Abstract

The reality of lesbian partner violence has been long under-recognized and misunderstood. Treatment protocols based solely upon work with heterosexual batterers and victims are inadequate when working with lesbians. In fact, without recognizing the specific needs of lesbians, treatment may compound rather than cure the problem. This article explores lesbian battering as a response to and reenactment of cultural oppression, internalized homophobia, and religious/psychological shame. The cycle of domestic violence can be the acting out of the traumatization of homophobia/heterosexism, compounded by sexual and religious shaming. A theology of liberation and the psychology of healing from trauma are explored as critical ingredients to treating victims and perpetrators.     

Domestic Violence Screening in Medical and Mental Health Care Settings

ABSTRACT

Health care providers and patients agree that domestic violence presents a serious health issue that falls within the purview of medical care. The patient-physician encounter has the potential to assist domestic violence victims in considering their options of living without violence and playing a critical role in preventing future violence. Despite this possibility, many persons evaluated in the health care system do not experience the benefits of such interactions. This article reviews current research that evaluates physician, patient, and systems barriers to providing care to patients experiencing domestic violence as well as gaps in the current research and suggestions for how these barriers might be overcome. Educational initiatives, implementation of protocols, and increasing environmental cues that prompt patients and physicians to discuss domestic violence may all increase the likelihood of screening and the success of interventions.     

Intimate Partner Violence (IPV) and Neurological Outcomes: A Review for Practitioners

ABSTRACT

Thirty-eight million women will experience intimate partner violence (IPV) during the course of their lifetime. Many of these women will experience brain injuries as a result of IPV and may not seek medical attention. Several types of practitioners who work with IPV survivors consistently, e.g., first responders, advocates, and clinicians, may be unfamiliar with brain functioning, screening, assessment, and treatment. This article reviews the dual traumas of IPV and TBI, the impact on neurological processes and symptomatology, and short and long-term outcomes. Recommendations for screening, intervention, interprofessional collaboration, and research are outlined.     

The Neuropsychology of Heading and Head Trauma in Association Football (Soccer): A Review

Association Football (soccer) is the most popular and widespread sport in the world. A significant proportion of the injuries suffered in football are head injuries involving trauma to the brain. In normal play, head trauma frequently arises from collisions, but some researchers have claimed that it also may arise as a consequence of heading the ball. Although assessments based on biomechanical analyses are equivocal on the potential for brain injury due to football heading, a growing literature seems to support the claim that neuropsychological impairment results from general football play and football heading in particular. However, this review suggests a distinction is required between the neuropsychological effects of concussive and subconcussive head trauma and that all of the neuropsychological studies conducted so far suffer from methodological problems. At best, a few of these studies may be regarded as exploratory. The review concludes that presently, although there is exploratory evidence of subclinical neuropsychological impairment as a consequence of football-related concussions, there is no reliable and certainly no definitive evidence that such impairment occurs as a result of general football play or normal football heading. The neuropsychological consequences of football-related subconcussive effects await confirmatory investigation.     

Attentional Skills in the Acute Phase Following Pediatric Traumatic Brain Injury

Only a limited number of studies have investigated attention following pediatric head-injury. The present study examined sustained attention and processing speed in a group of children who had sustained a mild (n = 27), moderate (n = 33) or severe (n = 16) traumatic brain injury (TBI). No significant differences were evident between the TBI groups on reaction time measures. Results did show that the severe TBI group exhibited greater deficits in the area of sustained attention, in comparison to children with mild and moderate injuries, in the acute stage following traumatic brain injury. This difficulty may impact on the future development of skills dependent on intact attentional capacity.     

Effects of Race and Victim Drinking on Domestic Violence Attributions

This research examines the mutual influence of race and victim drinking on college students' domestic violence attributions. Participants were 200, predominately White, middle-class college students. They read a vignette depicting a domestic violence incident. Manipulated within the vignette were batterer race, victim race, and victim drinking. After reading the vignette, participants completed a questionnaire concerning their perceptions of the domestic assault. Results indicate batterers in interracial relationships are attributed more guilt than batterers in same-race relationships. In addition, when domestic violence victims drink alcoholic beverages before a domestic assault, more responsibility for the assault is attributed to Black victims than to their White counterparts. Furthermore, domestic violence victims who drink alcohol are ascribed more blame and derogation in comparison to abstinent domestic violence victims. We examine these findings in relation to stereotypes and gender-role violations. Implications for actors involved in domestic violence are also discussed.     

Attentional skills in the acute phase following pediatric traumatic brain injury.

Only a limited number of studies have investigated attention following pediatric head-injury. The present study examined sustained attention and processing speed in a group of children who had sustained a mild (n = 27), moderate (n = 33) or severe (n = 16) traumatic brain injury (TBI). No significant differences were evident between the TBI groups on reaction time measures. Results did show that the severe TBI group exhibited greater deficits in the area of sustained attention, in comparison to children with mild and moderate injuries, in the acute stage following traumatic brain injury. This difficulty may impact on the future development of skills dependent on intact attentional capacity.     

Childhood Trauma,Criminogenic Social Schemas,and Violent Crime

ABSTRACT

Utilizing a sample of 400 homeless street youth, the study draws on the social schematic theory of crime to examine if childhood trauma (physical abuse, physical neglect, emotional neglect, and sexual abuse) is linked to the development of a criminogenic knowledge structure (CKS) that mediates its relationship with violence. Results indicate childhood trauma is directly associated with the CKS. They also show that it is indirectly related through violent peers. The CKS in turn is directly linked to violence as are childhood trauma and violent peers. The CKS also mediates the relationship childhood trauma and violent peers have with violence. Violent peers likewise mediate the association between childhood trauma and violence. The link between childhood trauma and violence is also serially mediated through violent peers and the CKS. Findings suggest the social schematic theory offers a valuable explanation for the link between childhood trauma and violence.     

Occupational Therapy's Role with Victims of Domestic Violence

ABSTRACT

Occupational therapists encounter individuals who are victims of domestic violence in many different settings. The role of the occupational therapist with each client depends on that client's specific needs, the treatment setting, and the skills and beliefs of the therapist. This article presents a theoretical argument for why the occupational therapist should choose to be involved in the treatment of domestic violence. The Model of Human Occupation provides a framework for understanding functional issues related to domestic violence. Methods of assessment and treatment are presented using this model. A continuum of levels of involvement including referrals for resources or treatment, direct and indirect treatment and program consultation is offered. Each level is illustrated with case vignettes demonstrating the therapist's role. Issues related to the challenge of working in domestic violence and reasons that women may refuse intervention are also discussed.     

An Uphill Climb

Abstract

The Community Partnership Team (CPT) was created to more effectively address the problems of child sexual victimization and domestic violence in the rural, northeast corner of Connecticut. A multi-disciplinary team was formed to improve collaboration between agencies serving victims of violence. Observations of meetings and confidential interviews suggested that most participants felt quite positively about the process; however, serious conflicts emerged between agencies serving different types of victims. Results indicated that it is important to identify barriers to collaboration, to recognize and use differences to build relationships across agencies, and to maintain a formal mechanism for resolving conflict.     

Children Exposed to Domestic Violence and Child Abuse: Terminology and Taxonomy

Three definitional issues regarding children exposed to domestic violence are examined. First, the multiple ways in which a child can be exposed to violence is discussed. A taxonomy of 10 types of exposure is proposed. Nine key characteristics of domestic violence, as they relate to children and children's exposure, are then outlined. The third issue addressed concerns why children who are exposed to domestic violence can be considered victims of child maltreatment. These children, by nature of their experience in the home, are psychologically maltreated and are also at high risk for physical abuse and some risk for sexual abuse. Empirical questions concerning these definitions and taxonomies and their interrelations are discussed.