Women victims of intimate partner violence (IPV) are at high risk of traumatic brain injury (TBI). As many as 75% are thought to have sustained a TBI, though most remain undiagnosed and untreated, but nonetheless live with its lasting effects. Aligned with Quebec government policies targeting increased healthcare accessibility and intersectoral support for victims of IPV, our team’s ultimate goal is to create an ecosystem of care for these women in Quebec. This paradigm shift will integrate healthcare, community, and socio-legal services and provide an alternative to the current siloed organization of care. This community-based research project will initiate the first step of this ecosystem tailored to the complex physical, psychosocial, and judicial needs of victims of IPV and TBI.

Building on a solid partnership between the Second stage women’s shelters Alliance (Alliance MH2), a provincial association of shelters for survivors of IPV, university researchers with expertise in TBI and community-based rehabilitation, law, criminology, and occupational therapy, healthcare and socio-legal service providers, and members of the Quebec Consortium of TBI services, our team has led several initiatives on the intersection of TBI and IPV. Previous studies have shed light on the impact of TBI on women survivors of IPV’s socio-judicial pathway and culminated with 60 representatives from research, government, healthcare, law, and community sectors to explore the feasibility and need for new cross-sector approaches to care. Funding obtained from the Ministère de l’enseignement supérieur du Québec further allowed us to increase awareness of TBI and IPV for shelter workers and women victims of IPV, instigate TBI screening within shelters, and offer community-based rehabilitation services.

Building on the lessons learned, our four main objectives are to (1) co-develop and document the implementation of TBI screening protocols in shelters affiliated to the Alliance MH2 across Quebec – through codesign workshops with shelter coordinators; (2) document the incidence of TBI among women victims of IPV and its relation to social determinants of health, including socioeconomic status, age, ethnocultural identity, TBI related variables, legal proceeding and judicial services, involvement of youth protection, shelter length of stay – mainly using harmonized systems data already existing across Alliance MH2 shelters sites; (3) determine the impact of TBI-related symptoms on independence in everyday activities of women screened positive for TBI – through questionnaires and individual interviews; and (4) raise awareness among key stakeholders, and policymakers of the issue of TBI in the context of IPV – through several knowledge mobilization events targeted to specific audiences.

For women, this project will increase their awareness of the link between IPV and TBI, improve their understanding of the consequences of TBI on their daily lives and legitimize their request for help. Other expected effects include helping women regain greater autonomy, preventing homelessness and limiting the impact of TBI on parenting, all of which directly translate to societal cost savings. Finally, through this study we will raise public awareness of the prevalence of TBI in survivors of IPV, mobilize service providers and policymakers around this issue, change practices (screening earlier for TBI), and document the need for equitable and sustainable access to TBI services.

The constructive feedback from the panel significantly contributed to refining the project objectives, ensuring feasibility. Specifically, we removed the implementation of community-based rehabilitation within the shelters. We view this project as a crucial first step towards the goal of creating a sustainable ecosystem of care tailored to the needs of these women in Quebec. This approach has the potential to achieve long-term cost savings, particularly emphasized by the feedback panel, which underscores the potential economic advantages of addressing the intersection of IPV and TBI.