This toolkit is meant for educational purposes only. The information within it should not be used to diagnose or treat brain injury in your clients.

Photo: Difficulties to Consider

Difficulties to Consider

Support workers can take key steps to accommodate the needs of survivors of IPV who may have a TBI.

The following is a list of impairments that can be caused by a brain injury. The list outlines how you might recognize these impairments in your clients, and how you can help.1,2

Impaired Functions:

Sleep

A survivor might experience:

  • Tiredness, particularly in situations requiring mental effort
  • Reduced tolerance, coping ability
  • Irritability
  • Other impairments becoming worse
  • Difficulty waking up in the morning and starting tasks
  • Difficulty going to school/holding a job
  • Difficulty accessing services

How you can help:

  • Encourage rest breaks
  • Encourage regular bed time and wake time
  • Prioritize demanding/important tasks to take place at the time of day she feels best (often morning)
  • Make activities shorter, with achievable goals
  • Help her fill out lengthy forms, make important phone calls, or other tasks requiring her to concentrate or pay attention for a long period of time

Information Processing

A survivor might:

  • Take longer to complete tasks, get ideas together to answer questions
  • Have difficulty keeping up with long conversations, or lengthy instructions
  • Have difficulty going to school/holding a job

How you can help:

  • Allow extra time to complete tasks
  • Speak clearly and evenly
  • Present information one piece at a time
  • Try to not interrupt or answer for her
  • Check that she is keeping up
  • Meet with her alone, unless she requests to have someone else present
  • Help her fill out forms, make important phone calls

Attention

A survivor might:

  • Appear to not listen
  • Miss details
  • Forget what was said
  • Struggle to maintain concentration
  • Be unable to cope with more than one thing at once
  • Be easily distracted
  • Change subjects frequently
  • Not finish what was started
  • Get bored easily
  • Have difficulty going to school/holding a job
  • Have difficulty accessing services
  • Have difficulty adapting to life in a shelter

How you can help:

  • Use short, simple sentences
  • Shorten activities so their completion is realistic
  • If safety allows, have her write down important information
  • Help her check her work
  • Encourage her to do one activity at a time
  • Reduce distractions such as noise, people
  • If she is distracted, interrupt and help her refocus
  • Alternate activities to keep interest
  • Meet with her alone, unless she requests to have someone else present
  • Help her fill out forms, make important phone calls


Memory

A survivor might:

  • Have difficulty learning new things
  • Forget what was said, forget names, appointments
  • Lose things
  • Have difficulty recalling what was learned
  • Have difficulty making and remembering safety plans
  • Have difficulty going to school/holding a job

How you can help:

  • Check to be sure she understands, repeat information if needed
  • Encourage rehearsal of new information
  • If it is safe, encourage use of memory aids – diaries, calendars, time tables
  • Decide on specific places for storage of belongings
  • Provide reminders/prompts to help with recall
  • Develop checklists
  • Help her fill out forms, make important phone calls

Problem Solving

A survivor might experience:

  • Difficulty working out solutions to problems
  • Difficulty generating new ideas
  • Disordered approaches to solving a problem
  • Difficulty going to school/holding a job
  • Difficulty leaving abusive partner, living independently

How you can help:

  • Help identify achievable goals, clarify the purpose of tasks
  • Avoid open ended tasks
  • Help her approach tasks in an ordered way
  • Help her break down tasks into smaller parts
  • Reduce the demands put on her, have her do one thing at a time, start simple
  • Help her fill out forms, make important phone calls

Flexibility

A survivor might:

  • Be unable to adapt to change
  • Be stuck in a rut, unable to develop new strategies
  • Continue to perform tasks the same way, even when they don’t work
  • Repeatedly refer to the same topic, return to that topic when doing something else, i.e., perseverate
  • Have difficulty going to school/holding a job
  • Have difficulty leaving abusive partner, independent living
  • Have difficulty accessing services
  • Have difficulty adapting to life in a shelter (stress, anxiety, confusion, disruptiveness, difficulty following rules)
  • Have difficulty keeping custody of children

How you can help:

  • Help her recognize early signs of frustration so that she can stop what she is doing and refocus
  • Help her find different ways to complete tasks, so there is choice
  • Distract her with another activity if she is continually making errors
  • If she is repeatedly off topic, get her back on track by asking specific questions

Planning and Organizing

A survivor might experience:

  • Difficulty preparing for tasks
  • Difficulty working out steps or sequences to tasks
  • Difficulty organizing thoughts and explaining things to others
  • Difficulty assessing danger and defending herself against assaults
  • Difficulty going to school/holding a job
  • Difficulty leaving abusive partner, independent living
  • Difficulty accessing services
  • Difficulty adapting to life in a shelter (stress, anxiety, confusion, disruptiveness, difficulty following rules)
  • Difficulty keeping custody of children
  • May not consider consequences of her actions

How you can help:

  • Encourage her to consider what she is going to do before starting an activity
  • Point out possible short- and long-term consequences of decisions
  • Provide written guidelines outlining steps in a task
  • Give prompts to keep her on track
  • If safe, help her develop a timetable to establish routine for activities

Reasoning

A survivor might:

  • Exhibit rigid, concrete thinking style
  • Take statements literally
  • Have difficulty putting herself in other people’s shoes
  • Resist change
  • Have a simplistic understanding of emotions
  • Show poor judgement and decision-making skills
  • Have difficulty going to school/holding a job
  • Have difficulty leaving abusive partner, independent living
  • Have difficulty keeping custody of children

How you can help:

  • Use simple, direct language, avoid abstract terms
  • Explain changes to routine in advance, provide a reason for the change
  • Avoid arguments and emotional undertones
  • Provide real life examples that she can relate to, when explaining something
  • Point out possible short- and long-term consequences of decisions

Self-Monitoring

A survivor might:

  • Not follow rules
  • Not pick up on errors because she does not check her work
  • ‘Hog’ conversations
  • Carry on talking even when others are no longer interested
  • Have difficulty going to school/holding a job
  • Have difficulty accessing services
  • Have difficulty adapting to life in a shelter (stress, anxiety, confusion, disruptiveness, difficulty following rules)

How you can help:

  • Reinforce the requirements for an activity
  • Encourage her to check her work
  • Provide immediate feedback to indicate when am error occurs or she is talking too much
  • Encourage taking turns in conversations

Insight

A survivor might:

  • Be unaware of cognitive and physical limitations
  • Set unrealistic goals and expectations
  • Resist help from carers and staff
  • Have difficulty leaving abusive partner, independent living
  • Have difficulty accessing services
  • Have difficulty adapting to life in a shelter (stress, anxiety, confusion, disruptiveness, difficulty following rules)
  • Have difficulty keeping custody of children

How you can help:

  • Explain the reasons for tasks, or steps in a plan
  • Identify realistic, achievable goals, which may be smaller steps in a larger plan
  • Point out possible short- and long-term consequences of decisions
  • Provide respectful feedback on problem areas that affect her safety

Mood

A survivor might:

  • Experience sudden changes in mood
  • Laugh or cry at inappropriate times

How you can help:

  • Identify triggers for mood swings
  • Have an alternative approach planned in case of changes

Motivation

A survivor might:

  • Experience lack of motivation
  • Not complete tasks that she knows how to carry out
  • Not act on something until prompted

How you can help:

  • Encourage her to get started on an activity
  • Give prompts in the early steps of a task
  • Reward initiative and persistence
  • Accept that less activity may be best for her well-being

Social skills

A survivor might:

  • Struggle to interact with others because of the aforementioned problems
  • Struggle to relate to others
  • Be less aware of social cues

How you can help:

  • Practice maintaining eye contact, asking questions when they come up, holding a conversation
  • Practice awareness of reactions and cues when interacting with others

References

1NSW Agency for Clinical Innovation, “Working With People With Traumatic Brain Injury,” TBI Staff Training. [Online]. Available: http://www.abistafftraining.info/Content/5_Strategies_T4.html

2New York State Office for the Prevention of Domestic Violence, “Traumatic Brain Injury and Domestic Violence”. [Online]. Available: https://opdv.ny.gov/professionals/tbi/tbidifficulties.html