A Community Support Network Intervention in SOAR Project Intimate Partner Violence-Related Traumatic Brain Injury

Intimate Partner Violence (IPV) comprises physical, sexual and emotional abuse and controlling behaviors imposed by an intimate partner. It is estimated that up to 92% of women who survive IPV may have suffered one or more traumatic brain injuries (TBI) from blows to the head, face, and neck, and/or anoxia or hypoxia due to strangulation. Even mild TBI may manifest as alternations in consciousness, black out, dizziness, disorientation, anxiety, depression, post-traumatic stress disorder, muscles weakness or paralysis and deficits in memory, attention, planning as well as executive functions. These signs and symptoms of TBI and their consequences impact the quality of life of women surviving IPV. Furthermore, survivors experiencing multiple IPV may acquire larger extent of the injury. Though this is recognized as an urgent and serious issue worldwide, it has been remarkably understudied.

To improve the quality of life of women experiencing IPV-related TBI, and to prevent potential longer-term consequences, an evidence-based therapeutic treatment is an urgent need. The Supporting Survivors of Abuse and Brain Injury through Research (SOAR) Project at the University of British Columbia-Okanagan was designed to integrate TBI knowledge into community-based supports. This Michael Smith Foundation for Health Research (MSFHR) trainee application will focus on the evaluation of the effectiveness of a community support network intervention for women with IPV-related TBI. The outcomes will generate valuable evidence to inform potential new TBI-informed policies regarding community-based and health care supports for survivors of IPV.

Globally, about 35% of women experience intimate partner violence (IPV) over the course of their lives. The COVID-19 pandemic has resulted in a rapid increase of the incidence of IPV as vulnerable women are more likely to be trapped at home with their abusers. In Canada, IPV affects one in four women over their lifetime. In a study conducted in the United States, a heterogeneous (with respect to race, age, education level and employment status) sample of 99 community and shelter women, showed that about 75% sustained at least one IPV-related traumatic brain injury (TBI) and 50% of women sustained multiple IPV-related TBIs. Similar to post-concussive signs and symptoms, women with IPV-related TBI demonstrate cognitive impairments (e.g., deficits in memory, attention, reasoning, planning and executive functioning), psychopathological problems (such as depression, anxiety, fatigue and post-traumatic stress disorders), and/or sensorimotor problems (such as paralysis or paresis of facial or extremity muscles, numbness, loss of sensation, muscle spasms, facial droop, and unilateral weakness), due to blows to the head, face, or neck and/or strangulation which ultimately impacts quality of life.

The very few studies conducted in this population have reported the prevalence of IPV-related TBI, characteristic signs and symptoms, prevalence and primary sequelae of non-fatal strangulation, and brain network organization associated with TBI and its cognitive effects. A recent randomized trial on prevention of IPV and relationship problems focused on the parents of newborns demonstrated that prevention interventions for at-risk couples were not effective and rather showed iatrogenic effects for some couples. Therefore, therapeutic treatment for IPV-related TBI survivors is crucial, and any physical or cognitive impairment in these survivors require therapeutic interventions similar to non-partner related TBIs.

Effective therapeutic interventions would not only improve IPV-related TBI survivors' quality of life but also has the potential to prevent longer-term neurodegeneration if early detection is possible and timely treatment is provided. However, women rarely receive any therapeutic assessment or interventions after sustaining IPV-related TBI due to the lack of awareness regarding early detection and need of therapeutic interventions. On the other hand, evidence-based therapeutic interventions to improve the quality of life of survivors of IPV-related TBI are still lacking.

The Supporting Survivors of Abuse and Brain Injury through Research (SOAR) Project at UBC-Okanagan is a multidisciplinary, community-based partnership designed to i) investigate the incidence and characteristics of IPV-related TBI; ii) use integrated knowledge translation to co-create and disseminate knowledge products designed to increase knowledge and awareness of TBI in those who provide support for IPV survivors; and iii) evaluate the effectiveness of a community support network intervention for women with IPV-related TBI. This MSFHR trainee application will focus on this last aim.

This project will characterize quality of life, resilience, and neurocognitive and sensorimotor function prior to, immediately after, and 6 months after a 6-month community-based intervention incorporating executive function, physical activity, mindfulness/meditation, and health counseling components by comparing with a group receiving usual care and control participants. In addition, exploratory analyses will demonstrate the response to the intervention depending upon the severity of the IPV-related TBI, whether strangulation was part of the experience or not, and the extent of psychopathological comorbidities (e.g., post traumatic stress disorders, anxiety, depression, adverse childhood experiences, etc.).

This study aims to disseminate the findings not only through conference presentations and peer-reviewed journal publications but also through ongoing engagement with our local, regional, and national community partner organizations. We have already co-developed and implemented a knowledge product - the Women's Support Workers module of the Concussion Awareness Training Tool (CATT) to help raise knowledge and awareness of brain injury in those who provide support to survivors of IPV. We would envision incorporating some of the key takeaway findings from the SOAR project into an updated version of the CATT module.

The expected outcomes of this study will add strong evidence to the effectiveness of therapeutic interventions for, and strengthen our understanding of, this understudied experience. More broadly, this study will (i) enhance professional knowledge and research skills in understanding this underserved population, (ii) build up research knowledge on this topic, and (iii) increase knowledge on the efficacy of a novel intervention. Thus, clearly and objectively characterizing the potential for a community support network to improve resiliency, quality of life, and neurocognition will have far-reaching implications for social support policy and funding for this population and their caregivers.

Eligibility Criteria:
Inclusion Criteria:

* Participants who identify as women and are survivors of IPV-related TBI

Exclusion Criteria:

* Pregnancy; any diagnosed neurological disorder other than brain injury known to affect cerebrovascular, neurocognitive, and/or sensorimotor function (e.g., stroke, Parkinson's, Alzheimer's, cerebral palsy, multiple sclerosis, migraine, seizures, etc.); taking any medication that might alter your blood pressure; have an injury or illness which affects your joints like arthritis. Participants will be tested in the early follicular phase or, if on combined hormonal contraception, at the end of the week that is off this contraception.