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.

The giving season offers Ohioans an opportunity to reflect on the importance of supporting community services.

For survivors of sexual violence in rural Ohio, donations are critical in maintaining vital resources. In 2023, donations made up about 1% of incoming funds to the Ohio Alliance to End Sexual Violence.

Taylr Ucker-Lauderman, chief engagement officer of the alliance, explained rural areas face unique challenges.

"We've known for a while that there are service gaps there," Ucker-Lauderman pointed out. "We still need to provide crisis services like legal aid, like housing, medical services, and we don't want to lose any momentum. We want to keep our work going."

Rural areas often lack the resources available in urban centers, creating barriers to critical services such as transportation and crisis support. The coalition emphasized the importance of believing survivors and supporting them on their journey toward healing. Ucker-Lauderman acknowledged while grants and foundation resources fund most of the coalition's efforts, there are still remaining areas requiring additional support.

The organization has also prioritized empowering survivors through storytelling workshops, offering tools to help them reclaim their narratives.

Shelby Lieber, survivor coordinator for the alliance, emphasized the importance of such efforts, especially in rural communities, where stigma often silences survivors with notions like, "It doesn't happen here" or "If it does, it stays behind closed doors."

"We want to make sure that you're hearing survivor voices," Lieber stressed. "That way, other survivors can come forward and say, 'This happened to me and I'm ready to start healing.'"

The Alliance recently concluded a three-year project focusing on rural Ohio, addressing service barriers and increasing local capacity. These efforts underscore the resilience of Ohio's rural communities and the ongoing need for resources to foster healing and change.

More than 60% of sexual assaults are never reported to police, due to concerns like fear of retaliation or negative social interactions. But Nebraska advocates say there are resources to help with confidentiality issues.

These reminders come amid heightened concerns about threating behavior women experience online.

Katie Welsh is the vice president of programs for Omaha's Women's Center for Advancement - which works with survivors of domestic violence, sexual assault, human trafficking and stalking.

She said advocacy groups and law enforcement are learning more about the overlap between online harassment and physical abuse.

"It's kind of a new frontier in many ways," said Welsh. "While it may start where the victim and abuser are geographically separated and are communicating online, that it often leads to them meeting up so that the abuser can assert power and control."

Welsh said in its worst form, this can include sexual violence.

No matter the situation, she said anyone targeted can call the Women's Center's 24/7 crisis hotline (402-345-7273) where a confidential advocate works with the survivor ready to report what happened.

The Women's Fund of Omaha also stresses that reporting can happen anonymously, and the website sexualassaulthelp.org is another resource.

The website notes the survivor isn't required to provide any identifying information to law enforcement.

In other situations, Welsh acknowledged the challenges that sometimes come up when a survivor reports an assault or harassing behavior, and is bombarded with threatening online messages afterwards.

"Those online interactions are hard to shut off, you know," said Welsh. "They can from a lot of different sources - email, social media."

She said taking down social media profiles and changing email addresses might help ward off online harassment.

Welsh added that taking screenshots of online threats and daily notes about interactions can help when reporting them to authorities.

Sexual violence remains a significant concern in Ohio, and specialized teams, such as Sexual Assault Response Teams and Coordinated Community Response Teams, are designed to provide critical support to survivors. Now, a new study aims to assess the effectiveness of these teams and identify gaps in service.

Nicole Kass Colvin, director of coordinated community responses with the Ohio Alliance to End Sexual Violence said this research is essential.

"We are really hoping to get some information on what teams exist and what we can do to make our teams really effective across the state of Ohio. It takes all of us to end sexual violence," she explained.

While the teams aim to provide holistic support, there is limited Ohio-specific data on their effectiveness. The survey tied to this research seeks to gather information about how these teams are structured and where they could improve. Some question whether this approach alone can address all the challenges faced by survivors without more resources.

Anna Ressler, assistant professor at Miami University is leading the research, and explained that while the teams are known to be valuable, the details of how they operate effectively are still unclear.

"There's a lot of research that shows that these teams are necessary. But we don't know what constitutes an effective team," she said.

The study's results are expected to inform improvements in services for survivors across Ohio. Those involved in these response teams, or those interested in starting one, are encouraged to participate in the survey, contributing to this important research and Ohio's ongoing efforts to address sexual violence.