COLUMBUS, Ohio -- Sometimes, the impacts of physical abuse run deeper than a scar, and researchers in Ohio are digging deeper into cognitive injuries caused by domestic violence.

Working with researchers from Ohio State University, the Ohio Domestic Violence Network's CARE project discovered that a majority of survivors have lived through extensive violence directed at the head, neck and face, and through strangulation.

At ODVN's Center on Partner-Inflicted Brain Injury, Director Rachel Ramirez said such injuries can be linked to brain trauma.

"So, when we think of the very first picture of a battered woman being a woman with a black eye, we now should be thinking that that woman very well could have had a concussion, and her brain could have been hurt," Ramirez said.

The project's work was featured in a recent federal report, which recommends improved data collection on brain injuries from intimate-partner violence.

According to Ramirez, with better data comes a better understanding, which will help providers better serve survivors.

Ramirez explained that brain injury often is not diagnosed and not well understood by domestic violence prevention programs or survivors. It can manifest in such cognitive challenges as problems with attention or memory; such physical problems as headaches and fatigue; and emotional issues, including depression and anxiety.

"When these issues are untreated and unidentified, things end up getting worse for the survivor," she added. "They aren't getting better; they don't understand what happened to them, and they blame themselves -- instead of understanding what happened to them as a result of an injury that wasn't their fault."

ODVN has developed a new conceptualization of brain injury, known as the CARE framework. CARE stands for "connect, acknowledge, respond, evaluate."

Ramirez described the framework as focusing on building positive relationships with survivors, and acknowledging and responding to the individualized needs of each person accessing services.

Ohioans who work, day in and day out, with some of the most vulnerable populations are struggling with major burnout, according to new data.

Program directors and staff in the Ohio Victim Services Compensation 2022 survey reported they don't earn what they see as a living wage, and 45% of staff said their salaries don't cover their basic needs.

Rosa Beltre, president and chief executive of the Ohio Alliance to End Sexual Violence, explained that these workers are first responders for survivors of violence and sexual assault. She agreed that they are overextended and underpaid.

"We are on the field of anti-oppression and anti-violence," she said, "and the way that we pay our staff, the way that we compensate our staff continues to fall into the cycles of oppressive methods."

In the survey, 57% reported having to work more than one job to make ends meet, which leads to fatigue and lower performance at their Victim Services job. Average Victim Services budgets fell 16% between 2020 and 2022, which means less funding available to pay employees.

Beltre said Victim Services workers often are expected to be well-versed in legal and medical advocacy as well as social work and psychology. She contended they deserve a compensation package that includes a competitive salary, health-care and retirement benefits, and reimbursement for out-of-pocket expenses, from gas to education.

"We're asking them to come in with a master's degree in social work or be a sociologist," she said, "and what we're paying them doesn't cover their expenses, or the years that it took them to obtain the degree or the experience."

The bulk of funding for victim-services organizations comes from the federal Victims of Crimes Act, which consists of fines and penalties paid by convicted offenders. Beltre said the funding has decreased more than 70% in Ohio in the past few years.

"That has trickled down to the programs, that has trickled down to the services, and we are not exempt from the exodus that all of the corporations or organizations are experiencing," she said. "We have been heavily hit, and it's not sustainable."

The VOCA Fix to Sustain the Crime Victim Funds Act of 2021 will provide more federal dollars to states. However, it will take time for the funds to be distributed.

Economic supports could be the key to reducing intimate-partner violence, which claims the lives of dozens of Ohioans each year.

Research from the Ohio Domestic Violence Network showed during times of financial insecurity, people are at a higher risk of violent behavior.

Rebecca Cline, director of prevention for the Network, explained individuals are targeted for intimate-partner violence, often because they are marginalized and made vulnerable by oppressive systems.

"High rates of poverty, high rates of unemployment, high rates of social disorganization," Cline outlined. "All of those things contribute to conditions that create additional risks for violence perpetration and victimization."

Cline also pointed to a new Centers for Disease Control and Prevention report which found a nearly five times greater firearm homicide rate in counties with the highest poverty levels, and it mentions economic supports as a pathway to gun-violence prevention. Data show 4.5 million women have reported being threatened with a gun by an intimate partner.

The research suggested strengthening economic supports for families by expanding access to affordable child care, health care, transportation and housing, making the Ohio Earned Income Tax Credit fully refundable, and raising wages.

Cline pointed out a minimum-wage worker in Ohio earns less than $20,000 a year, but a single parent of two needs nearly four times as much to earn a living wage.

"$76,000 a year," Cline asserted. "And that's to be able to afford housing, transportation, child care and all the other things a family needs to live sustainably and efficiently instead of in scarcity. "

She emphasized policies can be most effective with a holistic approach, bringing local and state partners together.

"The smarter we get about our prevention work, the more evidence that begins to emerge about where we need to go, the more promising our prevention work will be," Cline stated. "And it's long-term work."

Cline added measures to improve community connectedness can reduce violence, which can be as simple as picking up litter or planting flowers. Individuals can also talk to their elected leaders about policies to help reduce violence.

Kentucky will soon begin developing a coordinated, statewide system for reporting crimes related to intimate-partner violence. Gov. Andy Beshear's signature on Senate Bill 271 mandates data collection on domestic violence.

Advocacy groups say they have struggled for years to verify state records of these types of cases, and have relied primarily on media reports and information from local shelters.

Andrea Robinson, executive director of Oasis Women's Shelter in the Owensboro area, said homicides involving an intimate partner are likely underreported.

"By us collecting this data, it's going to potentially help shape laws that will better protect victims," Robinson stated.

The new law requires Kentucky State Police, Administrative Office of the Courts, State Medical Examiner's Office, and coroner's office to gather and report annual domestic violence-related data to the state's Criminal Justice Analysis Center.

According to the University of Kentucky's Violent Death Reporting system, between 2005 and 2017, Kentucky saw 462 documented deaths related to intimate partner violence.

Meg Savage, chief legal officer for the Kentucky Coalition Against Domestic Violence, said like any other public health issue, communities, advocacy groups and social-service agencies need accurate reporting in order to develop best practices and prevention strategies.

"Even to start looking at, you know, domestic violence homicides and what might be the underlying causes and trends and red flags, etc.," Savage outlined. "That could help us improve our systems."

Robinson believes inaccurate data is masking the prevalence of household violence in the Commonwealth.

"I think it's important for us to be able to recognize how many victims are murdered and losing their lives," Robinson emphasized. "Because it brings awareness to how real and serious domestic violence is."

If you or someone you know is experiencing abuse, call the National Domestic Violence Hotline at 800-799-7233 for help, 24 hours a day, seven days a week.