ABSTRACT

Traumatic brain injury (TBI) is a serious yet commonly under-recognised injury sustained by women as a direct outcome of family violence. Although healthcare and support services are critical, many women do not access support services following this injury. At present, there are few relevant qualitative studies that have elevated the voices of Aboriginal and Torres Strait Islander women. This article describes the barriers that prevent Aboriginal and Torres Strait Islander women from accessing hospital and support services after experiencing a TBI from family violence in one regional (Queensland) and one remote location (Northern Territory). Interviews and focus-group discussions were conducted with 28 community members and 90 service professionals. Thematic analysis identified four key factors influencing women’s access to health care: all women fear child removal; fear of escalating violence; prioritisation of other competing demands; and insufficient awareness of the signs of brain injury. Given child protection systems perpetuate cycles of discrimination based on poverty and structural inequalities that have generated fear and contributed to the reluctance of women to engage with services, child protection processes and practices need to be transformed to consider the impact of head injury on the everyday lives of women. Pathways need to be implemented to assist women to access healthcare and support services as well as strengthen families to maintain the care of their children.

IMPLICATIONS

• Aboriginal and Torres Strait Islander women living with a head injury experience severe trauma, coercive control, disadvantage, and poverty, which prevents them from accessing healthcare and support services.

• Communities should be resourced to design, implement, and evaluate TBI prevention and intervention solutions as increased awareness and insight into the long-term consequences for the brain that can result from violence, including education for school-aged children, community campaigns, and targeted education for community members.

• TBI should be incorporated into child protection frameworks, workforce training, and assessment tools, along with training and education for community members.

摘要

创伤性脑损伤 (TBI) 是一种严重但通常未被充分认识的伤害，女性因家庭暴力而遭受这种伤害。尽管医疗保健和支持服务至关重要，但许多女性在受伤后无法获得支持服务。目前，很少有相关的定性研究能够提高原住民和托雷斯海峡岛民女性的声音。本文介绍了在一个地区（昆士兰州）和一个偏远地区（北领地），原住民和托雷斯海峡岛民妇女因家庭暴力而遭受创伤性脑损伤后无法获得医院和支持服务的障碍。对 28 名社区成员和 90 名服务专业人员进行了访谈和焦点小组讨论。专题分析确定了影响妇女获得医疗保健的四个关键因素：所有妇女都害怕孩子被带走；担心暴力升级；其他竞争需求的优先顺序；对脑损伤迹象认识不足。鉴于儿童保护制度使基于贫困和结构性不平等的歧视循环不断，产生了恐惧并导致妇女不愿接受服务，因此需要转变儿童保护程序和做法，以考虑头部受伤对日常生活的影响的妇女。需要实施途径来帮助妇女获得医疗保健和支持服务，并加强家庭的力量以维持对子女的照顾。鉴于儿童保护制度使基于贫困和结构性不平等的歧视循环不断，产生了恐惧并导致妇女不愿接受服务，因此需要转变儿童保护程序和做法，以考虑头部受伤对日常生活的影响的妇女。需要实施途径来帮助妇女获得医疗保健和支持服务，并加强家庭的力量以维持对子女的照顾。鉴于儿童保护制度使基于贫困和结构性不平等的歧视循环不断，产生了恐惧并导致妇女不愿接受服务，因此需要转变儿童保护程序和做法，以考虑头部受伤对日常生活的影响的妇女。需要实施途径来帮助妇女获得医疗保健和支持服务，并加强家庭的力量以维持对子女的照顾。

影响

• 头部受伤的原住民和托雷斯海峡岛民妇女遭受严重创伤、强制控制、不利地位和贫困，这使她们无法获得医疗保健和支持服务。

• 应向社区提供资源来设计、实施和评估 TBI 预防和干预解决方案，以提高对暴力可能对大脑造成的长期后果的认识和洞察，包括学龄儿童教育、社区活动和有针对性的教育对于社区成员。

• TBI 应纳入儿童保护框架、劳动力培训和评估工具，以及对社区成员的培训和教育。