Child Abuse & the Foster System
Children in general are vulnerable to accidents simply due to their size and developing motor skills, but some children bear the added risk of intentional physical abuse by a caretaker or other close adult. In 2017, 18% of American children were reported victims of physical abuse.
Pediatric Abusive Head Trauma (AHT), formerly called “Shaken Baby Syndrome”, is abuse that involves any injury caused by violent shaking or blunt impact to a child under five. A parent’s or caretaker’s moment of unbridled frustration can have a lasting impact on the child’s brain for the rest of their life. As children grow older, their risk of abuse decreases, but children of all ages can still be subject to injury at the hands of their caretakers.
Sometimes, children are removed by Child Protective Services to stop or prevent this abuse. For example, a study from San Diego County showed 5% of the children who entered foster care during a 1-year period were there due to physical abuse. However, foster care is not always safe either. Some surveys indicate from 25% up to 40% of former foster children report having been abused or neglected while in foster care.
Foster children have higher likelihood of entering other vulnerable populations. 25% of foster children experience PTSD and tend to suffer high rates of depression and low self-esteem. Foster kids who experienced neglect or abuse are more likely to misuse substances, especially if they have a parent with a history of substance misuse. After “aging out”, 25% of foster teens will experience homelessness at least once. Within 2 years of leaving care, 25% of former foster kids become involved with the criminal justice system.
Interpersonal Violence Survivors
One study showed that 81% of women who seek help for Intimate Partner Violence (IPV) have suffered at least one head injury, while 83% have been strangled. This is important because if the brain is deprived of oxygen via strangulation, this can result in anoxic or hypoxic brain injury.
Another study found that only 21% of IPV survivors sought medical help at time of injury. When a person feels trapped in a violent relationship, they may not seek help, for fear of angering their abuser. They may also believe that the abuse is somehow their fault and that they don’t deserve help. Delaying diagnosis and treatment for a head injury can lead to worse outcomes than if the person got help right away.
While most information and resources available tend to center around female survivors of IPV, they are not the only ones who experience this type of abuse. People of all genders and in all types of relationships can endure abuse at the hands of those who purport to love them.
The CDC’s National Intimate Partner and Sexual Violence Survey found that 43% of lesbians, 61% of bisexual women, 26% of gay men and 37% of bisexual men report having been on the receiving end of IPV in their lifetime, compared to 35% of heterosexual women and 29% of heterosexual men.
It is possible that even more instances go unreported due to the fear of judgement and shame from the professionals they would turn to. Some abusers also threaten to “out” their victim as another layer of control. When they do seek help, it is not always there. The National Coalition of Anti-Violence Programs reported that nearly half of LGBTQ survivors of IPV have been turned away from a shelter, usually because of their gender identity.
Transgender and gender nonconforming people are especially at risk. One report found that 31% to 50% of transgender people have experienced domestic violence, compared to the 28% to 33% of the general population. Another survey found that 19% of respondents were subject to violence at the hands of family members because they were transgender or gender nonconforming.
Refugees & Asylum Seekers
People who flee their home country are often doing so to escape intense violence. Their journey to find safety can be fraught with danger, and many do not survive. Those that do can suffer injury, abuse, trafficking, and torture along the way. TBI is one of the most common injuries sustained by refugees and asylum seekers. One study found that out of 488 refugee survivors of torture, 69% reported sustaining a blow to the head, and 55% of those reported a loss of consciousness after the injury.
After injury, refugees and asylum seekers may not have the support or access to services they need to recover. An untreated TBI may make it more difficult to navigate their new life and home. It can exacerbate the many challenges they will face in their quest for safety and security, such as language barriers, cultural differences, and discrimination.
Traffickers use many methods to control the people they exploit, including violence. In one study, over 92% of sex trafficking survivors reported suffering from physical violence, with most from direct blows to the head or face. It is very likely that trafficked people will sustain multiple TBIs, and this “stacking” of injuries can not only disrupt their recovery but increase the likelihood of more severe symptoms and deficits. Recovery time after a brain injury is extremely important, but trafficked people rarely are allowed any rest, medical care, or even emotional support. They may also face additional challenges, such as malnutrition, substance misuse, and anxiety disorders.
Traffickers prey upon the vulnerable and create a situation of dependency and fear to control their victims. People who have suffered a brain injury can find themselves in a situation where they lack income, stable housing, and support from friends and family. This can make them easily exploitable, and their cognitive deficits can make it even harder to navigate out of an exploitative situation.
We cannot hope to make a significant positive change in the lives of brain injury survivors, nor hope to prevent many future brain injuries, without focusing on those who are most drastically affected and their unique issues.
The Brain Injury Alliance of Arizona and its Services for Vulnerable Populations Committee will continue to strive for equity and patient-centered care in the prevention and treatment of brain injury in our state. Please consider joining our committee to help us with this goal.
The true measure of any society can be found in how it treats its most vulnerable members.