After the Webinar: Invisible Epidemic Part 1. Q&A with Rachel Ramirez

Webinar presenter Rachel Ramirez answered a number of your questions after her presentation, Invisible Epidemic: The Intersection of Traumatic Brain Injury, Strangulation, and Domestic Violence (part 1).   Here are just a few of her responses.


Audience Question: Do you need to have a degree in criminal justice to be able to work with domestic violence victims? 

Rachel Ramirez: A degree in criminal justice, to work with domestic violence victims. Absolutely not. The vast majority of people who work in domestic violence don’t have any type of degree. There are different agencies that have different requirements for their jobs. So, there are lots of people who are trained in social work. We have lots of social workers. We have people who do criminal justice. We have people who do have experience in mental health and substance use. We have many people, college students who work in domestic violence. We have advocates that have lived experience that have experienced domestic violence. So, we know that the justice system, response to domestic violence is one piece of that. But there’s also lots of work in domestic violence services in shelter places, we’re doing more and more work, particularly around this brain injury issue in health care, though agencies, each agency is going to have its own requirements for whatever jobs they have available. But, I don’t have a degree in criminal justice. I am a social worker, social workers help me. Social workers help you be better at everything. I’m a little biased, but I learned very, very little social where domestic violence is not a significant part of any kind of college curriculum. So, a lot of the learning is on the job through training like this, and in those kinds of things.


Audience Question: The problem is, is when there is not any physical evidence, the victims don’t go to the doctor. I recommend they see a doctor, but what else can we do? 

Rachel Ramirez: Well, and I think the other thing, one of the important things to understand about brain injury. Brain injury is also not one of those things. When you talk about there’s not a brain injury doctor. Brain injury, as we were talking about those chronic versus acute conditions, it’s not something that you can go to the doctor, they can give you a shot, they can give you a cone, they can just kind of fix it. A lot of brain injury treatment is actually very symptoms, specific or symptom-based, so if you have a survivor that you’re working with that is having balanced problems. They’d see a different kind of doctor than someone who’s having vision problems than somebody who might be having headaches. But I do think that one of the things I want, everybody who works with domestic violence victims, and we will talk about this in the next Webinar to understand is that this is our job too. And one of the very, very important pieces we can do we’ll talk about some of our resources in our next session is to raise awareness on this. I mean, and you just think about, as Paula said like how if somebody had told her after her strangulation, do you know that when you’re strangled? There are some things that can end up happening in your life and you might end up having problems with your vision and you might end up having problems with your balance. It might not show up now. It might show up later, but we want you to have some more information about that and be aware of that. So, if any of this does come up that might be something you want to reach out to someone about and when you’re if you’re seeing a medical provider about that you might want to share that you’ve experienced brain injury. I had a survivor that had reached out to me. We’re trying to help them get connected to them some services, and she had been seeing her primary care doctor for a long time and had never disclosed her abuse. She was out of her abusive relationship, her abuser actually passed away. But she was in a ten-year abusive relationship, with an estimated 70 or 80 incidents of head trauma, but she had never shared it with her provider. Even though it was prior to that, she trusted, it’s often something that’s very hard and very difficult to share. But I encouraged her and, of course, provide her with that support around that and just kind of encouraged her to think about sharing that with her provider. And when she told her, doctor, her doctor said, “All this stuff makes sense now.” It’s not something where a doctor will go, and it’s not where a patient or a survivor will go. We’ll be thinking about the impact on the brain. But you being able to talk about this, you being able to provide some information and some resources about it. And you also being able to think about those accommodations, which is what we’ll talk about in the last session. Thinking about, how are we providing services in a different way to someone who might be impacted by brain injury? How are we maybe if they’re having problems with the lighting in your room, can we adjust our lights or turn the lights down? Can that help them? If they’re having problems with concentration and focus, is there a way we can meet somewhere that isn’t so stimulating that there isn’t so much going on? So, that’s the other thing I really want people to remember, is that this is not to send someone to the doctor, and they’ll fix this. And we’re over here doing our domestic violence work because it’s also thinking about how we are assisting people with forms when they are having problems, and understanding them. How are we structuring our services so that they are accessible to what we know about how brain injury can impact people. Particularly repetitive, severe, unidentified brain injury. Hope that was helpful, but we’ll talk about that more. And anybody can always e-mail me and follow up if they have any additional questions. I will absolutely schedule time to talk with you.


Audience Question: How can we teach law enforcement officers to recognize the signs and listen for the symptoms of strangulation, and head injuries? Many of my survivors report that law enforcement officers didn’t believe their story because, “I can’t remember,” and “I don’t know,” was said by the survivor and the LEOs simply did not believe them.

Rachel Ramirez: I wish I had a great, easy answer for that. I encourage you to reach out. I think a part of doing training like this for the law enforcement system is really important. I also think how our law enforcement professionals who are responding to domestic violence cases, I mean, I think one of the very first things that they should be thinking about and asking about. Sometimes it’s, again, obviously there was there any type of head trauma, was somebody’s head hurt. One of the things if anybody has ever seen the concussion protocol that’s happened in NFL games, is where someone gets hit in the head, they stop everything, and someone goes up and talks to them. Literally, the things that they are doing with the NFL players, there’s actually a list of questions. They’re asking them what are you doing right now? They’re asking them, what’s the score of the game, what quarter are we in? Who did you play last week? And they’re really trying to access that cognition and figure out if there’s evidence of disrupted brain function. And if there is, those players are immediately taken off the field and evaluated and are not allowed to participate in sports until they’ve cleared the concussion protocol. So, I think really, really putting this on the radar of law enforcement officers and also just recognizing that they might be dealing with people who have acute concussions, like that football player who was just hit on the head and has been taken off the field because they’re not understanding what their athletic trainer is telling them. That it’s a neurological brain function that happens to your brain. That happens to my brain. That would happen to any of our brains if we were hit or hurt in the head like that. And nobody thinks when a football players says, “ I’m not sure what the score is,” that they’re lying, or they’re making it up, or they don’t know, or they’re trying to be dishonest. So, I think that marking head injury is something that could be something that could be significant, could impact absolutely. Your interaction is really important. But it’s lots of training and lots of resources. I also think law enforcement has an amazing opportunity to be that right person, with the right information, to share some of that information, to share some of the resources we’ve developed with survivors. And just give them a little bit of information. So, it doesn’t take them 11 years to realize what is impacting them, as it did, Paula.


Click Here to Watch a Recording of Invisible Epidemic: The Intersection of Traumatic Brain Injury, Strangulation, and Domestic Violence (part 1).  


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