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.

January is National Human Trafficking Awareness Month, and state public health officials said it is important to recognize the warning signs and risk factors of exploitation.

According to the U.S. Department of Health and Human Services, there are more than 25 types of human trafficking spanning numerous industries, from sex trafficking within escort services to the labor trafficking of farmworkers.

Tobi Adeyeye Amosun, assistant commissioner for the Tennessee Department of Health, Division of Family Health and Wellness, said the economic and social distress caused by the pandemic has exacerbated risks and vulnerability.

"From a statistics standpoint, through mid-December 2021, Tennessee had received 1,185 tips for human-trafficking concerns," Amosun reported.

She pointed out those numbers are up from 2020. To report a possible case of human trafficking or suspect someone may need help, call the Tennessee Human Trafficking Hotline at 855-558-6484 or text "BEFREE" to 233722.

Amosun noted increased computer time from online school and staying at home has increased the online exploitation of children.

"Tweens in particular get lured into unsavory situations through multiplayer gaming," Amosun asserted. "That's one thing that parents need to be aware of, just constantly checking in with your kids for their social media and internet exposure."

She added red flags for human trafficking include lack of identifying documents such as a drivers' license, excessively long or unusual work hours, and signs of fear, paranoia and depression. She emphasized the pandemic-driven recession has put more individuals in dangerous situations.

"They believe that there's been an increase in forced and coercive labor for some people who can't afford food and rent," Amosun stated.

She stressed staffing shortages in law enforcement and social services have decreased the capacity of state agencies to respond, investigate and prosecute these cases. Last month, the Biden administration released an updated National Plan to Combat Human Trafficking.

Modern-day slavery exists in the form of human trafficking, and Ohio is among the top states with high rates of the crime.

Traffickers use force or fraud to compel both children and adults to provide commercial labor or sexual services.

Rosa Beltré, president and CEO of the Ohio Alliance to End Sexual Violence, explained five major highways with easy access to Canada and the Midwest position Ohio as a hub for human trafficking. She noted the state is also vulnerable because it has both large urban centers and rural areas, as well as a large immigrant population.

"It does happen in our backyard," Beltré emphasized. "We can all help by being in-tune, looking at the signs of physical abuse, of fear. They can also only be empathetic, and just being intentional about being catalysts of change."

Beltré works with the Ohio Human Trafficking Task Force, a collaboration of 14 state agencies working to prevent exploitation, support survivors and ensure offenders are brought to justice.

Today is National Human Trafficking Awareness Day, and Beltré encouraged Ohioans to wear blue to support the cause.

According to the Ohio Attorney General's Office, in 2020 there were 148 total potential victims of sex trafficking and 94 potential traffickers. Beltré stressed it is a myth all cases involve kidnapping or physical force, since many offenders use psychological manipulation to trick or groom the victim.

"It is not always the white van that is circling around the neighborhood that is abducting people from their homes," Beltré pointed out. "Sometimes we are so focused on the wrong things that we miss the things that are real and are occurring."

Human trafficking is not only prominent among women and young girls, but there is evidence LGBTQ+ individuals and people of color are more likely to be targeted.

Beltré added bystander intervention is important, and encouraged people to report suspected human trafficking by texting 233733 or by calling the National Human Trafficking Hotline at 1-888-373-7888.

Nicole Bialko of Columbus is among the one-in-six women who've experienced stalking. And she's sharing her story to encourage other victims to stand up to stalking.

When a relationship that started online turned emotionally toxic, Bialko tried to end it. She said her former boyfriend started harassing and following her, even entering her apartment when she was out of town.

Despite her efforts to ignore him, including blocking hundreds of email addresses and phone numbers, he persisted. So Bialko contacted authorities.

"Trust your instincts, never excuse a red flag," said Bialko. "And if you find yourself making excuses for this individual, feeling unsettled, feeling isolated, maybe what you could do you're not doing anymore, things you enjoyed - there's a problem."

Bialko said she hopes to help other abuse victims free themselves from the fear of stalking. Her advice includes setting firm boundaries, collecting evidence, seeking legal advice about getting a Civil Protective Order, being vigilant about personal safety and maintaining a support system.

Bialko said the police took her seriously, but feels her case was diminished in the courts. In a plea deal, her former partner's charges of felony menacing by stalking; burglary and a protective order violation were reduced to a misdemeanor of criminal mischief.

Bialko said just like physical abuse, emotional and mental abuse is terrifying.

"If you're scared, you're scared out for a reason," said Bialko. "So there's something that individuals doing that's causing you that fear, but there's no tangible evidence. Because I can't show you a picture of a black and blue eye, I don't think it's taken as seriously. "

Caroline Anderson is the communications coordinator with the Ohio Domestic Violence Network. She encouraged friends and family members of survivors to be as supportive as possible and understand that it's difficult for a victim of abuse to simply walk out the door.

"Why didn't you leave sooner? I hate that question," said Anderson. "Why did she stay? I hate that question as advocate. She stayed because she didn't know she was in an abusive relationship. She didn't know how to leave. And leaving is the most dangerous time in a relationship. "

Anderson said most domestic-violence fatalities in Ohio occur when a survivor is in the process of ending the relationship or has already left.

The Ohio Domestic Violence Network can direct stalking survivors to local resources. There also is an easy-to-use chat feature at odvn.org for assistance.

January is National Stalking Awareness Month.