Black Women’s Experience with Brain
Injury and IPV
Monique R. Pappadis, MEd, PhD
Assistant Professor
Division of Rehabilitation Sciences
University of Texas Medical Branch at Galveston
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Learning Objectives
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• Summarize the risk factors and outcomes associated with brain injury and Intimate Partner Violence (IPV) among Black women.
• Describe the experiences with accessing IPV-related care and services among Black women.
• Encourage the use of cultural Humility to guide interactions with Black women and other diverse populations.
• Identify potential clinical and research implications to reduce IPV-related disparities among Black women with TBI
Intimate Partner Violence (IPV)
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• physical violence,
• sexual violence,
• stalking,
• or psychological
harm/aggression by
a current or former
partner or spouse.
Intimate Partner Violence (IPV)
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• Physical violence - hitting, kicking, or using another type of physical force;
• Sexual violence – forcing participation in a sexual act, sexual touching, non-physical sexual act (e.g., sexting) without consent;
• Stalking – unwanted attention that causes fear or threat to own safety or of a loved one;
• Psychological harm/ aggression – verbal or non-verbal communication with an intent to harm someone mentally or emotionally or through control
• Control over reproductive or sexual health –interference with birth control
Intimate Partner Violence
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• IPV is a serious, preventable public health
problem that affects millions of Americans.
• Annually, approximately 4.8 million women
experience IPV related injuries in the US.
• About 1:4 women experienced IPV in their
lifetime.
• Every minute, an average of 20 people are
physically abused by their intimate partner.
Black et al., 2011; Tjaden & Thoennes, 2000
Consequences of IPV
• Stalking – 66.2% from a
former or current intimate
partner
• Sexual Assault – 9.4%
raped by an intimate partner
• Homicide – 1:3 female
murder victims are killed by
an intimate partners
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https://assets.speakcdn.com/assets/2497/domestic_violence.pdf
Consequences of IPV
• Physical Effects - 34%
require medical care
• Emotional Effects– high
rates depression
• Economic Effects - 21-
60% of victims lose their
jobs
• Child Welfare – 15.5 million
children witness IPV
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https://assets.speakcdn.com/assets/2497/domestic_violence.pdfhttps://www.futureswithoutviolence.org/userfiles/file/Children_and_Families/Children.pdf
IPV Disproportional Effects on Certain Groups• Young women
• Socioeconomically disadvantaged women
• Women of color:
• American Indian women (51.3% lifetime
physical violence)
• Black/African American women (41.2% lifetime
physical violence)
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https://assets.speakcdn.com/assets/2497/domestic_violence.pdf
Black Femicide
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https://www.ebony.com/news/black-women-murdered/
IPV and Black Women
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• 29% of all women experiencing IPV
• 3 times more likely to experience death as a
result of IPV than non-Hispanic white women
• Make up 22% of IPV-related homicides
• Greater severity of violence (e.g., firearms)
Anderson et al., 2015; Grisso et al., 1999; Jenkins, 2002; McNutt et al., 2000; White, 1995
https://www.vpc.org/studies/wmmw2015.pdf
IPV and Black Women
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• Scant evidence regarding their unique experiences
• Less likely to report or seek help
• Less likely to seek mental health services
• Increased use of emergency departments
• Receive inadequate medical care
• Darker skin, injuries masked
• Discrimination and/or Victimization
Anderson et al., 2015; Grisso et al., 1999; Jenkins, 2002; McNutt et al., 2000; Sabri et al.,
2013; White, 1995
Diagnosis Disparities
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Nolen L. How Medical Education
Is Missing the Bull’s-eye. New
England Journal of Medicine.
2020 Jun 25;382(26):2489-91.
Theories underlying the AA women’s IPV experience
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• Institutionalized Racism &
Poverty
• “use of American systems,
governances, and other
practices to discriminate,
subjugate, and oppress
persons belonging to racially
marginalized groups.”
• Limited resources and
access to health care
Morrison, 2009
Theories underlying the AA women’s IPV experience
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• Black Male Masculinity (e.g., “tough guy” and “playa”)
• Possible causes:
• Individual (e.g., childhood experiences)
• Cultural (e.g., breadwinner, conquistador)
• Structural (e.g., systemic workforce discrimination, disproportionate experiences with incarceration)
Morrison, 2009; Smith, 2008
Theories underlying the AA women’s IPV experience
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• The “Strong Black Woman”
• “a mantra so much a part of the U.S. culture that it is seldom realized how great a toll it has taken on the emotional well-being of the AA woman. As much as it may give her the illusion of control, it keeps her from identifying what she needs and reaching out for help.” (Romero, 2000)
• resilient, independent, emotionally controlled, self-sacrificing and endure much without complaint.
Morrison, 2009
Theories underlying the AA women’s IPV experience
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• Adhering to the “Strong Black Woman”
cultural mantra might prevent Black women
from:
• recognizing TBI-related signs,
• seeking medical or IPV services,
• or engaging with the criminal justice system
against their perpetrators.
IPV and Brain Injury
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• 1.75 million diagnosed with TBI annually (Faulet al., 2010)
• Estimated that 31.5 million women receive at least one IPV-related TBI in the US (Valera et al., 2019).
• Many women are having brain injuries as a result of IPV and not seeking services (Monahan, 2019).
• No standardized screening tool (Haag et al., 2019)
Black/African Americans with TBI
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• Ethnic minorities are disproportionally
affected by TBI
• Less likely to be discharged to inpatient
rehabilitation
• Poorer functional outcomes
• Blacks and Hispanics have unique
perspectives on community integration
Intersection: DV/IPV, Brain Injury, and Black women
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• Severity of IPV/DV puts Black women at disproportionate risk.
• Victims of DV 7.5 times more likely to report head, neck, and facial injuries than other trauma patients (Perciaccante et al., 1999).
• 64 AA women in Bay Area shelters or battered women programs – the majority (n=51) had head injuries (Oden, 2000).
Intersection: DV/IPV, Brain Injury, and Black women
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• Black women with both probable TBI and
IPV were more likely to report central
nervous symptoms (e.g., memory loss,
blackouts, ringing ears, dizziness, vision
and hearing problems, and concentration
difficulties) (Campbell et al, 2018)
Experiences of Black Women with accessing IPV/DV services/shelters
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• Perceived as unwelcoming
• Predominantly White neighborhoods
• Predominately White staff
• Lack outreach efforts
• Lack of culturally aware/ competent/
humble staff and service delivery
Donnelly et al., 1999; 2005; Gillium, 2008
Experiences of Black Women with accessing IPV/DV services/shelters
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“The majority of people we serve are White…It’s almost like the Black take care of their own better. Either that, or they’re just more used to it [violence], tolerate it longer, or don’t see it as battering. The majority of the one [Black women] that we get through here are lower socioeconomic, not folks like you and me.”
“right now, we’re about 50-50, thank goodness. If I could keep it at that, I would be so happy, because what happened in [city] was it [the shelter] became totally Black, and the White women would not go . . . we had to close the shelter and move it to another community [so White women would use it].”
Donnelly et al., 1999; 2005
Experiences of Black Women with accessing IPV/DV services/shelters
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“They need to have more African American
women working in these programs.
Especially the domestic violence shelters. I
think . . . if more African American women
as therapists and counselors work in
these environments, they can help you,
you know? It would give us more of a relief
to discuss our problems and you know, make
it easier for us to talk to people.”
Gillum, 2008
Experiences of Black Women with accessing IPV/DV services/shelters
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• Microaggressions – intentional or unintentional subtle forms of racism
• Examples include:
• “you are just being too sensitive,”
• “how can someone as strong as you be abused,”
• “you are not like the Black women I typically see.”
Nnawulezi & Sullivan, 2014
Microaggressions
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“This is 2010.” You know, “We don’t call Black
people colored people anymore and it’s
offensive to, you know, some people.”
(Amber)
Nnawulezi & Sullivan, 2014
What is Culture?
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DIVERSITY WHEEL
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Cultural Humility
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• Three Principles
1. A lifelong commitment to learning and critical self-reflection
(self-evaluation and self-critique)
• Be humble and flexible
2. A desire to fix power imbalances within provider-client dynamic
• Shift the expertise to the patient/client regarding their
experiences, life, etc.
3. Institutional accountability and develop mutually-beneficial
and trusted partnerships
• “We cannot individually commit to self-evaluation and fixing
power imbalances without advocating within the larger
organizations in which we participate.” (Waters & Asbill, 2013)
(Tervalon & Murray-Garcia, 1998)
What is Cultural Humility?
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• Shift from trying to understand everything to a
focus on your own assumptions, biases, and
prejudices.
• Promotes respect, places the focus on not
only the other but also on self through self-
reflection/self-awareness making your biases
explicit, and results in flexibility and humility.
• It is OK to not know!
Tervalon & Murray-Garcia, 1998
Cultural Humility, IPV and Brain Injury
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• Community engagement strategies and programs must be culturally appropriate for Black IPV survivors (West, 2018).
• Use of an intersectionality framework.
• Appropriate assessment of behavioral health needs.
• Explore cultural barriers to seeking care
• Be attentive, compassionate, and humble!
More work to be done with Black Women with TBI and IPV
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• Qualitatively exploring their with TBI as well as with IPV
• Determining their specific access to care needs
• Development of culturally-appropriate and culturally-
sensitive assessments and testing
• Evaluating screening and treatment practices
• Increasing outreach services and working with community
organizations in the Black community
• Assessing diversity among staff and training related to
cultural humility
Brain Injury Professionals addressing the intersectionality of TBI, IPV aamong Black women
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• Increase outreach services and working with community
organizations in the Black community to increase
awareness of IPV and TBI.
• Create a transparent pathway to support their access to
IPV services.
• Create a safe, anti-oppressive and culturally humble
environment to assess for TBI, assess and disclose IPV,
and seek and receive needed services (e.g., behavioral
health) is essential for ensuring social justice for Black
women following IPV.
References
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Banksm ME, Ackerman RJ. Head and brain injuries experienced by African American women victims of intimate partner violence. Women & Therapy. 2002 Oct 29;25(3-4):133-43.
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Campbell JC, Anderson JC, McFadgion A, et al. The Effects of Intimate Partner Violence and Probable Traumatic Brain Injury on Central Nervous System Symptoms. J Womens Health (Larchmt). 2018;27(6):761-767. doi:10.1089/jwh.2016.6311
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References
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References
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