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.

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 judgment 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 an 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:
- Practise maintaining eye contact, asking questions when they come up, holding a conversation
- Practise awareness of reactions and cues when interacting with others