Domestic Violence: Improved Data Needed to Identify the Prevalence of Brain Injuries among Victims
Fast Facts
Brain injuries may be common in domestic violence victims, and such injuries may be under-diagnosed and under-treated. There is little federal data on the prevalence of this public health problem, so it’s uncertain whether federal resources are addressing it efficiently. We recommended that the Department of Health and Human Services improve data collection.
We also looked at nonfederal initiatives that focus on domestic-violence-related brain injury, including federal grants that support them. All of the initiatives and efforts provided education or training on the issue, while some provided screening and treatment.
The National Domestic Violence Hotline (thehotline.org)
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Highlights
What GAO Found
According to the Centers for Disease Control and Prevention (CDC), one in three adults have experienced domestic violence, also known as intimate partner violence. Intimate partner violence includes physical violence, sexual violence, stalking, and psychological aggression. Victims of intimate partner violence may experience brain injury, resulting from blows to the head or strangulation. To address this issue, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) provide grants to state and local entities that work with victims.
GAO identified 12 non-federal initiatives that provide education, screen for, or treat brain injuries resulting from intimate partner violence. All 12 developed and distributed education and training materials to domestic violence shelter staff, victims, health care providers, and others. Six of the 12 initiatives used screening tools to identify potential brain injuries among intimate partner violence victims, and two included a treatment component. Additionally, eight of the 12 initiatives received HHS or DOJ grant funding, although agency officials told us the funding had no specific requirements to address brain injuries resulting from intimate partner violence.
Excerpt of Educational Materials from Ohio Domestic Violence Network
Based on its review of the literature, as well as interviews with HHS officials and other non-federal stakeholders, GAO found that data on the overall prevalence of brain injuries resulting from intimate partner violence are limited. HHS officials acknowledged that the lack of data on the prevalence of these issues is a challenge in addressing the intersection of the issues. However, HHS does not have a plan for how it would collect better prevalence data. HHS agencies have some related efforts underway; however, the efforts are limited and generally do not examine the connection between brain injuries and intimate partner violence. Enhancing the health and well-being of Americans is critical to HHS's public health mission. As part of this mission, CDC, within HHS, uses its Public Health Approach, which includes collecting prevalence data to understand the magnitude of public health issues.
With better data comes a better understanding of the overall prevalence of brain injuries resulting from intimate partner violence. This, in turn, could help ensure that federal resources are allocated to the appropriate areas and used as efficiently and effectively as possible to address this public health issue.
Why GAO Did This Study
Research has found brain injuries to be common among victims of intimate partner violence, and that such injuries are under-diagnosed and under-treated.
House Report 115-952 included a provision for GAO to report on the relationship between intimate partner violence and brain injuries. GAO (1) describes efforts to provide education, screen for, or treat brain injuries resulting from intimate partner violence; and (2) examines what is known about the prevalence of brain injuries resulting from intimate partner violence, including HHS efforts to determine prevalence. GAO reviewed peer-reviewed literature, federal websites, and documentation from HHS and DOJ. GAO also interviewed officials from HHS, DOJ, and 11 non-federal stakeholders, such as domestic violence organizations. GAO identified 12 initiatives, though this list may not be exhaustive, and conducted site visits to three of them.
Recommendations
HHS should develop and implement a plan to improve data collected on the prevalence of brain injuries resulting from intimate partner violence and use these data to inform its allocation of resources to address the issue. HHS concurred with our recommendation and is coordinating with its agencies to augment data collection.
Recommendations for Executive Action
| Agency Affected Sort descending | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of HHS should develop and implement a plan to improve data collected on the prevalence of brain injuries resulting from intimate partner violence and use these data to inform HHS's allocation of resources to address the issue. (Recommendation 1) |
Open
HHS initially agreed with this recommendation. However, in April 2022, HHS reported that it subsequently determined it does not have the authority to collect the necessary data--including medical data--on the prevalence of brain injuries resulting from intimate partner violence. Additionally, HHS noted it does not receive additional appropriations to support research and evaluation initiatives. HHS also noted continuing efforts to address brain injuries among domestic violence victims, and we acknowledge the efforts HHS is making to support this important issue. For example, HHS noted that several of its offices and agencies intend to continue supporting training and technical assistance for states, tribes, coalitions, and local domestic violence programs to increase partnerships with medical providers and provide greater access to health care providers for domestic violence survivors. These actions, according to HHS, would provide opportunities for medical identification and treatment of traumatic brain injury resulting from intimate partner violence. In July 2023, HHS reported that the Office of Management and Budget had approved of an additional question to the Centers for Disease Control and Prevention's (CDC) National Intimate Partner and Sexual Violence Survey, which should improve what is known about the prevalence of traumatic brain injuries among victims of intimate partner violence. In our June 2022 report, we noted CDC was planning to add this question to better capture intimate partner violence victims who may have experienced mild brain injury. However, as we also described, the addition of the new question may not ensure a comprehensive estimate of the prevalence of brain injuries resulting from intimate partner violence. For example, the new survey question does not account for individuals with brain injuries caused by strangulation. As a result, we maintain that developing and implementing a plan to improve the department's understanding of the prevalence of brain injuries resulting from intimate partner violence is an important next step. Implementing this recommendation--which could involve HHS and its agencies working together to identify approaches within current authority to augment data collection through surveys or supporting targeted research--would improve the department's understanding about the prevalence of brain injury among intimate partner violence victims.
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