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When Home Isn’t Safe: Domestic Violence and Brain Injury in the Era of COVID-19

Categories: Professionals

By Rachel Ramirez, LISW-S, R.A.

The unexpected COVID-19 pandemic has radically altered everyone’s life – but some people have suffered in extraordinary ways. As a longtime professional in the domestic violence field, my heart and thoughts have been uniquely attuned to the devastating way in which shutdowns, social distancing, and increased isolation make an already complicated and difficult situation that much worse for domestic violence victims. These conditions could be so easily manipulated by an abuser to prevent a victim from escaping the abuse, calling a domestic violence hotline or seeking help, talking with friends and family, or reporting the abuse.

As the country continues its rocky reckoning with COVID-19, new challenges for domestic violence victims emerge. Along with reports of more people seeking help for domestic violence, the field is seeing more severe physical abuse to police, hospitals, and shelters. This severe abuse very often includes violence directed at the head—a widely recognized target for domestic violence. Along with blows to the head, domestic violence victims often experience trauma-inducing, terrifying strangulation (most victims refer to it as “choking”), chokeholds, or being sat on in ways that make breathing difficult-all which can affect the brain.

Understanding the impact of COVID-19 on victims of domestic violence for those who work in brain injury is critically important in several ways. Here are some tips for you as you work with people experiencing brain injury that might also be experiencing domestic violence:

  1. Directly ask about how people are doing at home. During this time of heightened stress and isolation, ask about how people are managing during these trying times. We know that many domestic violence victims don’t disclose abuse immediately – for many reasons – but by asking about their home life, it shows you care. Also, there are many other things a person you are working with could be struggling with – including mental health, finances, job insecurity, or the stress of living in a pandemic – that could affect their treatment.
  2. Learn about local domestic violence services. While not every county in the United States has a shelter, every county is served by a domestic violence program that offers some type of shelter and also many other important supports, including a crisis hotline, advocacy services, safety planning, support groups, counseling, legal advocacy and support, and children’s programming. Because domestic violence programs offer different services in different communities, it’s important to learn what your local services have to offer. Click here for help identifying the domestic violence program(s) that serve your area, and be prepared to share information on your local domestic violence program with your patients.
  3. Provide information about domestic violence and other supports for challenges during COVID-19. You can reach out to your local domestic violence program to see if they have any posters, flyers, materials, safety planning cards, or other information that could be available in your office setting. Putting up signs in your office and having information available, combined with asking directly about how people are doing at home are powerful messages that your clinic is a place that cares about domestic violence.
  4. Be aware of the unique circumstances domestic violence victims face. Domestic violence victims often have additional barriers in living their daily lives and doing just about anything. A domestic violence victim is always living through a lens of trying to figure out the safest choice in the moment, which can often change and shift moment to moment or day to day. Circumstances might make it difficult for them to even come to get your services. They might show up late or miss appointments, aren’t able to comply with at-home instructions or therapy. With remote services being employed by many agencies, they might not have the safety or the space to engage in those services. Remembering that there are often reasons behind why things happen, and having flexible, low barrier policies that increase access can help your services be more effective for domestic violence victims.
  5. Recognize that masks could be triggering to survivors of abuse who have been choked or strangled, and help people develop strategies to make wearing masks less difficult. Like stay at home orders, a critically important public health strategy that works for the vast majority of the population – the new mask mandates across the country – are uniquely difficult for domestic violence victims who have experienced violence that has interfered with their breathing. With masks being an important strategy for controlling the virus and keeping people safe, service providers can also work with victims who have problems with masks to find a face-covering option that is the least triggering and most effective for survivors. Suggesting face shields, different types of masks, and encouraging survivors to develop regulation and coping strategies to increase mask tolerance will help them in all areas of their lives.

Everyone has a role to play in supporting domestic violence victims during this difficult time, and during times of restricted movement, we need more allies than ever who are willing to support domestic violence victims. We hope you will join us as we weather this storm. 

This article was contributed by Rachel Ramirez, Founder and Director of the Center on Partner-Inflicted Brain Injury at The Ohio Domestic Violence Network. For more information on the intersection of brain injury and domestic violence, please contact Rachel at


If you or someone you know may have suffered a brain injury as a result of intimate partner violence, please first ensure their safety, then reach out to the National Brain Injury Information Center at 1-800-444-6443.