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.

Kentucky's child-care crisis could get worse when federal assistance for child-care centers runs out, and that could increase barriers for survivors of intimate-partner violence. Federal data shows that when adjusted for inflation, families nationwide are paying between $5,000 and $17,000 per year per child for child care.

Meg Savage, chief legal officer with ZeroV, the state's coalition of intimate partner violence programs, said child care ranks as a top factor in survivors' decisions to leave an abusive relationship. She noted that survivors typically cannot obtain employment and move into a safe situation unless they have reliable child care.

"And so they may be moving away from whatever support system they have for child care, Once you are working, then obviously you are concerned that children who need child care are going to be in a safe and wholesome environment while you're at work, " she explained.

A 2021 needs assessment found 35% of survivors identified it as a basic need, with affordability and operating schedules being the biggest barriers.

Crystal, whose last name has been withheld for this story at her request, is a Jessamine County resident and survivor. She said she cannot find affordable child care for her son, making finding employment difficult.

"There's so little options for a single mother, especially one who's been through a lot," she said. "There's trust issues involved with certain things, too. It's hard to trust anybody when you have severe PTSD from things you've been through."

According to the Kentucky Center for Economic Policy, since 2020 Kentucky's child-care industry received around $1-billion in federal funding - preventing half of the state's centers from shutting their doors. But Savage said that money is expected to run out within a year and added that means child-care costs for families will significantly increase.

"If we can't find a way to step up to the plate and help out child-care providers and help out the Kentucky families that are dependent on child-care assistance," she explained, "then we're really going to be looking at moving backwards very quickly."

A recent report from the Annie E. Casey Foundation found that between 2020 and 2021, 12% of Kentucky children younger than six live in families in which someone quit, changed, or refused a job because of problems with child care.

A South Dakota academic program that enhances training for those who respond to child abuse and neglect cases is gaining momentum.

In the past couple of years, the University of South Dakota has seen its first groups of students earn certificates for Child and Adult Advocacy Studies. Participants get a deeper understanding of child maltreatment and how to respond.

Tifanie Petro is the advocacy and prevention programs director statewide for the Children's Home Society. She's among the first graduates and noted that it's not just for graduate students before they enter the field.

Professionals like her tout the program's emphasis on how to work with other entities on these cases.

"It's really about bringing the partners together, to wrap around the person that has had this experience," said Petro, "versus making the person try to go to different systems and try to navigate it on their own."

And learning more about the effects associated with abuse and neglect inspired Petro to push for a new state law that just took effect.

It allows for a trauma-informed courtroom experience for children who have to testify against an abuser.

An element of the studies program just received an honorable mention from the U.S. Public Health Service and Interprofessional Education Collaborative.

The University of South Dakota's Department of Social Work Chair Kelly Bass is the director of the new program. He said integrating realistic cases through simulation has helped USD's model see some early success.

Bass noted that not having any taste of "in-the-field" scenarios can sometimes be a challenge for case workers when they transition from the classroom to their professional career.

"You're attempting to provide standards of practice," said Bass, "but you're also overwhelmed by the circumstances that are in front of you. "

He said the classes not only help students learn how to respond to individual cases but also situations where there are multiple victims of abuse.

This broader approach also is being used at more than 90 academic institutions across 30 states. The Center for the Prevention of Child Maltreatment helped get South Dakota's program off the ground.

Sunday is World Day Against Trafficking in Humans, and in Iowa state officials are calling on residents to do more to help.

Reports of trafficking are up, and so is the prevalence of the crime. Iowa Secretary of State Paul Pate said Iowa isn't alone in seeing a dramatic increase in human trafficking cases. Pate's office started asking employers to get involved in identifying traffickers and their victims through the "Iowa Businesses Against Trafficking" program. But Pate added that no matter how vigilant officials are, it is hard to keep up with ever-changing online platforms.

"With the internet and social media, they can move around - with a lot of 'cloak and dagger,' if you will - because it's very hard for law enforcement to track them all down," he said. "But it's also the way they recruit the people into trafficking. They prey on these people. They convince some of these folks that they're their best friend."

Pate said he's encouraged that, while trafficking is a growing problem, the number of tips to state officials is keeping pace. He said calls to a
state hotline to report suspected trafficking cases increased 61% last year alone.

Pate said signs of trafficking include isolation, someone not showing up to work or school for long periods or becoming suddenly withdrawn. But he added that other signs are more subtle.

"It's not like Hollywood, where a van pulls up and a couple of guys jump out and kidnap somebody," he said. "They are grooming people and they're bringing them in, and trafficking is very complicated. Family members are sometimes trafficking other family members."

Cities and towns are training police officers to be more aware of the signs of human trafficking and what to do when they spot it. In addition to calling the state anti-trafficking tip line, Pate said someone can call 911 if they suspect an emergency. People can also dial 800-770-1650 or text "IOWAHELP" to 20121. Other resources are on the Iowa Attorney General's website.


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