Kivalliq Intimate Partner Violence Traumatic Brain Injury

Background

Intimate partner violence (IPV) is a global public health concern characterized by physical, sexual or emotional abuse or controlling behaviors inflicted by a current or former spouse or intimate partner. In Canada, IPV is strikingly prevalent and heavily impacts women living in Nunavut. In Nunavut, the rate of violent crime experienced by women is nearly 13 times higher than the national average, with women representing almost two-thirds of police-reported crime victims (Pauktuutit Inuit Women of Canada, 2019; Statistics Canada, 2018). Among the most common yet often under-recognized injuries sustained by survivors of IPV is traumatic brain injury (TBI), which can range from concussion to more severe structural injuries (e.g. skull fractures, intracranial hemorrhage). Survivors of IPV can experience episodes of non-fatal strangulation that can result in hypoxic-ischemic brain injuries. In addition to TBI, survivors of IPV can also experience injuries to the face including complex orbital, maxillofacial, and mandibular injuries as well as injuries to other parts of their body. Those who experience IPV are also at risk of developing mental health conditions such as anxiety, depression, post-traumatic stress disorders as well as other medical conditions.

Optimizing clinical outcomes following acute IPV TBI requires timely access to emergency medical care and multi-disciplinary healthcare professionals including those with expertise in neurosurgery, plastic surgery, ophthalmology, orthopedic surgery, psychiatry, and neuropsychology. It is also important that patients receive coordinated access to shelters and temporary housing as needed as well as victim, family, criminal justice, legal, and culturally-based mental health and wellness services that can support patients and their families. Without access to this standard of care, patients are at risk of developing persistent and untreated symptoms or returning to environments where they are at risk of recurrent abuse that can result in additional and potentially life-threatening injuries. Unfortunately, those living within the Kivalliq region of Nunavut currently do not have access to multi-disciplinary physicians and allied health professionals with expertise in IPV TBI within their home communities. To access this care, patients must leave their families and communities to travel to cities hundreds of kilometres away placing an enormous financial burden on the healthcare system.

To address this significant gap in care, this pilot project aims to improve access to specialized care for survivors of IPV TBI living in the Kivalliq region of Nunavut.

Kivalliq Intimate Partner Violence

Traumatic Brain Injury Pilot Program

Patients must meet the following inclusion criteria to receive care through this pilot program:

Referral criteria include:

1.) Youth or adults who sustain IPV-related head trauma including head injury, concussion, structural brain injury (e.g intracranial hemorrhage, skull fracture) or suspected hypoxic ischemic brain injury secondary to strangulation, that is directly caused by intimate partner violence;

2.) Patients who live within one of the participating communities within the Kivalliq region of Nunavut.

To refer a patient, physicians and nurses working in a healthcare centre within the Kivalliq region of Nunavut must fax a completed Kivalliq Intimate Partner Violence Pilot Program Referral Form to the Pan Am Concussion Program at 204-927-2678. Referral forms will be shared with the healthcare centres and will also be made available on the Pan Am Clinic website.

Healthcare providers who require assistance determining whether patients are eligible for referral through the pilot program may contact a neurosurgeon during office hours (9:00 am-4:00 pm CST), Monday to Friday through the Kivalliq IPV TBI Program Rapid Access to Clinical Expertise (RACE Line) at 204-927-2766.

Patients evaluated at a healthcare centre within the Kivalliq region of Nunavut and who are transferred via medivac to Winnipeg for emergency medical assessment will ideally undergo in-person assessment at the Pan Am Concussion Program following discharge from hospital. Future follow-up care will be arranged primarily via telemedicine (in-person video-conferencing).

Patients evaluated at a healthcare centre within the Kivalliq region of Nunavut and who do not require emergency medical transfer to Winnipeg will be offered the opportunity to undergo elective in-person consultation by the neurosurgeon during periodic clinics held at the Kivalliq Health Centre in Rankin Inlet. Clinics will be scheduled three times per year. The neurosurgeon will be responsible for performing medical assessments of IPV TBI patients and providing recommendations regarding diagnostic tests (e.g MRI) and multi-disciplinary consultations (plastic surgery, ophthalmology, psychiatry, physiotherapy etc.). Following the initial assessment, patients may be offered the opportunity to undergo additional follow-up appointments via telemedicine.

For all patients, future in-person assessments in Winnipeg or Rankin Inlet will be scheduled as needed and be coordinated with other visits for diagnostic tests or multi-disciplinary consultations. All patients managed through the pilot program will be referred to local rehabilitation and mental health professionals as needed and available as well as to other supportive services (e.g. victim services, criminal justice outreach). Patients will continue to receive follow-up based on the patient’s needs and at discretion of the neurosurgeon.