Rehabilitation Counseling Graduate Student Works to Make the “Invisible Epidemic” of Partner-Inflicted Head Injury (PI HI) Visible by Bringing Research to Practice
Meghan Chapman is working to raise awareness for 1.6 million women who are underdiagnosed and underserved for head injuries each year. “For every one military or football concussion, there are five women experiencing partner-inflicted head injuries,” says the Rehabilitation Counseling graduate student.
Rehabilitation Counseling Graduate Student Works to Make the “Invisible Epidemic” of Partner-Inflicted Head Injury (PI HI) Visible by Bringing Research to Practice
“The Invisible Head Injury Epidemic,” based on Chapman’s work with fellow graduate student researchers Mariellen Breton, Sean Downing, and Myra Pierce, was the National Association of State Head Injury Administrators (NASHIA) 2022 student poster award winner. Chapman and her colleagues found existing research shows an estimated 1.6 million women in the United States experience partner-inflicted head injury (PI HI) annually. This number grows when all people, including but not limited to women, who experience PI HI are counted.
All this, Chapman points out, indicates a great need for attention and resources. Despite the high estimated rates of PI HI, Chapman and her collaborators found “the overwhelming majority of research dollars, media attention, and other resources are directed towards studies and treatments” focused on military servicemembers and football players. “Most of the dollars goes towards veterans, which is a wise investment. Football players get attention because research found evidence of brain injury in more than ninety percent of National Football League players tested. When you look at the much larger number of women experiencing head injuries through partner-inflicted violence, it’s frustrating to see only a trickle of funding and attention,” says Chapman.
Chapman explains that emerging research shows head injuries present differently in women than in men: the impact can be more severe and tends to last longer. More research is needed, but one potential reason for why women are more likely to experience traumatic brain injuries than men when exposed to the same situations (for example, playing hockey, soccer, or basketball) is that men’s necks tend to be shorter and more muscular, provide greater stabilization and protection for the brain during impact. Another study shows that hormone levels may affect the poorer outcomes women experience: increased hospitalization, headaches, depression, etc. (1).
Unfortunately, Chapman explains, it can be difficult for clinicians and domestic violence worker to differentiate between symptoms of brain injury and posttraumatic stress disorder: decreased ability to concentrate; slower cognitive processing; poor memory recall; difficulty organizing thoughts and activities; quick changes in mood or affect; anxiety; depression; and increasing irritability or even aggressiveness (2).
In addition, women experiencing partner-inflicted violence are unprotected in particular ways. Chapman says, because of this, every injury comes with trauma. She emphasizes, “The perpetrator isn’t an enemy, it’s someone who says they love the survivor. Unlike service people or football players, they have no helmets, no padding, and no medics on the sideline ready to administer first aid or remove them if their injuries are severe. Their helmets are made of hair. Their field of engagement is supposed to be their safe space, their home.”
Another barrier Chapman notes: “PI HI and other forms of domestic violence are not often reported, nor do the survivors often seek care. This is why we encourage all health providers to include the appropriate questions that would identify partner-inflicted violence in their universal screeners.” Chapman cites a screener from the Ohio Domestic Violence Network (ODVH), an organization she describes as a “leader in national advocacy for survivors of partner-inflicted violence.” Unlike other health screeners, she explains, ODVN’s CHAT screener includes the often-overlooked categories of being “choked, strangled, suffocated, or [feeling] like you couldn’t breathe.” Chapman adds that The Office of Government Accountability recommended the U.S. Department of Health and Human Services include these categories in their screeners to collect better incidence and prevalence data, however this advice has not yet been implemented (3).
A first step could be to add the questions to universal screeners – or any medical intake form - at hospitals, urgent care centers, and domestic violence shelters, and provide training to workers on how to speak with survivors of partner-inflicted violence. “When speaking with someone suspected of having a PI HI, it is important to use the right language. If a woman seeks care at a hospital, which is rare, our research found that healthcare workers need to be more careful than they think they do. It’s not enough to make sure the suspected abuser is not in the room before asking about PI HI. The survivor might be accompanied by a parent or friend, but that person may not know about the abuse,” Chapman explains.
Chapman explains the significance of this point: It is important for those seeking care to know healthcare providers’ mandated reporter status, and for those providers to explain what this means and offer options, before those providers ask a person to disclose the circumstances of their injury. “Depending on the situation, it might be better [for a survivor] to tell someone who is not a mandated reporter. So, I would tell them ‘You can talk to me but there are also all these people I could introduce you to, if you would like to meet them.’” (4).
“It’s recommended that healthcare professionals create a safe space for the survivor, where no one else is present, establish trust, and then offer options for how healthcare workers can help, if the patient were to disclose, before [emphasis added] asking them to disclose,” she says (4). Chapman first learned about the “invisible epidemic” of PI HI on a public radio segment in January 2022 (5). Her awareness came at the same time she was also hearing reports of an increase in domestic violence during the COVID pandemic. Chapman says, “The combination disturbed me, and I felt a call to learn more.” She wrote a research paper on the invisible epidemic of partner-inflicted head injury her first semester.
That summer, she and her research colleagues developed a training curriculum to prepare rehabilitation counselors to screen for and support PI-HI survivors. Being focused on research-to-practice, Chapman called on an encouraging person she had met in the Massachusetts Rehabilitation Commission (MRC) grants office, Amana Tower. During that call, Tower suggested Chapman enter the NASHIA student poster competition to build awareness among statewide head injury program administrators.
“I’m like, ‘What’s a student poster?’ I had no idea,” Chapman says candidly. The deadline was that day. She contacted NASHIA, and they extended the application deadline through the weekend. Then she had a week and a half to make her poster. With her classmates in support but unable to collaborate at the last minute, Chapman prepared the poster for submission with guidance from Graduate Program Director Dr. James Soldner. She focused on communicating through clear information, illustrative graphics, and well-chosen resources. “I have a passion for applying research to practice. ‘Great, we have identified problems and potential solutions. Now what? Here are some tangible steps you can take to make a difference,’” Chapman says.
As for advice for other student-researchers, Chapman says, “Always think about how to apply research to practice and then word it in a way that is motivating to your audience.” “Your research is there as evidence...but what you really want is for them to use it,” she adds.
Chapman, who holds a bachelor's degree mass communication, brings a wealth of experience to her work in counseling rehabilitation. She is currently a Family Partnerships Specialist with the Federation for Children with Special Needs. She is also a mother of two neurodivergent teens and has been engaged in a years-long transition planning process with her oldest child, who is about to turn 18. She saw a need for more people to provide services to people with disabilities as they become adults and wanted to be part of the solution. She recalls thinking: "I have so much knowledge, but I don’t want to depend on my lived experience. I thought, ‘there must be a degree for this.’”
That search led her to her current program at UMass. As a U.S. Rehabilitation Services Administration scholar, Chapman receives funding towards tuition and fees for training that will lead to professional certification. Chapman says vocational counseling rehabilitation has many facets: “It really focuses on helping people with disabilities gain meaningful work, retain work, get promoted, and live as independently in the community as they want to,” she says.
A year after hearing the radio segment that started her on this path, Chapman reflects on the connections made. There are many: Following her poster presentation, a researcher at ODVN, which Chapman describes as “the heart and soul” in advocacy addressing PI HI, requested use of an original image from Chapman’s poster. Also, after attending the Brain Injury Association of Massachusetts conference as part of her research last year, she was invited to and presented at this year’s conference. She has already been invited back for 2024.
Chapman has several more presentations planned for this spring including presenting to the Disability Inclusion Leaders who advise MRC's Brain Injury Council and the Vocational Rehabilitation Technical Assistance Center for Quality Employment National Symposium on Rehabilitation Counseling. She will also be presenting at her college’s own showcase in May. She continues to explore ways to encourage more thorough PI HI screening at MRC. Beyond that, “If anyone has any ideas or connections, I am open,” says Chapman when asked about future collaboration.
Chapman says her focus is on increasing awareness and resources related to PI HI. At the same time, recognizes how what she has learned will shape her practice as a rehabilitation counselor. “From a trauma perspective and from a violence perspective, in both ways, I am far more sensitive now to thinking about my wording, not just how I talk to people but about people,” she says.
She says her research on PI HI has prompted her to ask more questions. “Who else is not being seen? There is so much need in the world that we do know about,” she says. She hopes a practicum and internship at MRC will bring her in contact with more people with a variety of needs, and, hopefully, access to more resources too. “That experience would enable me to be able to have a bigger impact and learn so much more,” says Chapman.
To view Chapman’s NASHIA poster and presentation “The Invisible Head Injury Epidemic” click here
Meghan’s recommendations for more information:
- Pink Concussions: A nonprofit for survivors of female brain injury from sports, violence or military service.
- The Center on Partner Inflicted Brain Injury: This project of the Ohio Domestic Violence Network provides statewide, national and international leadership to raise awareness of brain injury caused by domestic violence.
- Concussion Awareness Training Tool: Online training resources addressing concussion recognition, diagnosis, treatment and management.
- Brain Injury Association of Massachusetts: Providing support, prevention, education, recreation, and advocacy.
- BrainLine: Information and resources about treating and living with traumatic brain injury (TBI) and PTSD.
References:
(1) “Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women” from The Journal of Head Trauma Rehabilitation (October 2014)
(2) “The Hidden Epidemic of Brain Injuries from Domestic Violence” from The New York Times Magazine (March 1, 2022)
(3) “Domestic Violence: Improved Data Needed to Identify the Prevalence of Brain Injuries among Victims” from the US Government Accountability Office (Jaune 12, 2020)
(4) “Domestic Violence Advocacy Fundamentals Online” from the Ohio Domestic Violence Network
(5) “An ‘Invisible Epidemic’: Survivors of Domestic Violence on Living with Traumatic Brain Injury” from WBUR’s On Point (January 20, 2022)
from the Office of Research and Grants in Education, CEHD