People with no formal health training may be able to spot signs of brain injury in domestic-violence survivors, using a set of tools called CARE, which stands for Connect, Acknowledge, Respond and Evaluate. Severe intimate-partner violence is often targeted at the head and neck, and in the airways.

Julianna Nemeth, assistant professor, college of public health, The Ohio State University explained since these injuries often are invisible, staff at domestic-violence service organizations and medical providers may not be aware of how best to meet a survivor's needs, and added brain injuries impact a person's cognitive function, decision-making skills and planning ability.

"The other impact of brain injury can be things like seizures, constant headaches, balance problems, anger and rage, ability to control emotions," she said. "Those are all things that impact survivors' daily function."

Nemeth recently co-authored a paper on the effectiveness of the CARE model. She said its four cornerstones include connecting with survivors; acknowledging that head trauma, strangulation and related challenges are common; responding by collaborating with survivors to develop accommodations for challenges related to suspected brain injury caused by violence; and evaluating services by establishing a strong feedback loop with survivors to ensure their needs are being met.

Nemeth added that memory problems, depression and suicidal thoughts can also be affected by trauma to the brain.

"Emerging literature really is suggesting to us that brain injury from domestic violence is not only prevalent, but it's really having neurologic psychologic cognitive and behavioral impacts," she continued.

Ohio's domestic-violence shelters provided emergency housing to nearly 10,000 people last year.




Brain injury from domestic violence is an unrecognized public health challenge, and new research shows how a set of tools called "CARE" can help staff at domestic-violence service organizations recognize signs of traumatic brain injury. Comments from Julianna Nemeth (nuh-em-ith), assistant professor, college of public health, The Ohio State University.

People with no formal health training may be able to spot signs of brain injury in domestic-violence survivors, using a set of tools called "CARE," which stands for Connect, Acknowledge, Respond and Evaluate. More from Nadia Ramlagan (ROM-la-gone).

I'm Nadia Ramlagan.

Reach Nemeth at 614-247-7142. CARE research: https://bit.ly/43DO8c5. Ten thousand (in caption): https://bit.ly/3KLog5g.

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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