Strangulation, Brain Injury & Survivor Safety with April Flores-Brayton | Ep. 122

Welcome And Why WINGS Matters

SPEAKER_01 0:00

Hi, Warriors. Welcome to One and Three. I'm your host, Ingrid. We first learned about the WINGS program based in Chicago back in January when Anthony Pisquini joined the show. Today, April is here to take us deeper into the work they do with a special focus on their hospital-based program. In this conversation, April provides valuable insight on traumatic brain injuries, a topic that is often misunderstood. As she explains, traumatic brain injuries do not just involve visible head trauma, which leads us to the conversation surrounding strangulation. We also talk about lethality risk assessments and why understanding these warning signs can quite literally save lives. Here's April. Hi, April. Thank you for joining me and welcome to One and Three.

SPEAKER_00 0:51

Thank you.

SPEAKER_01 0:52

You are affiliated with an organization, and we're going to talk all about that organization. But before we get into that, do you mind just sharing some background so everyone gets to know you just a little bit?

SPEAKER_00 1:03

Absolutely. My name is April Brayton. I am the director of community-based services for the WINS program. We're a domestic violence agency, actually, the largest domestic violence agency in the state of Illinois. We have two shelters, one in the Northwest suburbs and one in Chicago. We have outreach programs

What WINGS Provides Beyond Shelter

SPEAKER_00 1:27

such as a hospital program, which I'll talk a little bit more about in depth as we go through. We have a survivor lifeline mentoring program, which pairs survivors of intimate partner violence that are kind of on the other side and have done the work to get themselves in a better place and they want to give back. And they're paired with somebody who is either in the process of leaving or still with the person that causes harm. And those are our survivor lifeline mentors. And then we also have our housing program, and that is a vast program, both city and suburbs. And then we have a counseling program in both city and suburbs and a children's program, city and suburbs. So it is a very large organization. And our hospital program is mostly what I'm going to talk a little bit more about today. I've been working for Wings for about 16 years now. Prior to that, I worked in legal advocacy out of the courthouse in the Northwest suburbs. And prior to that, finance. My background is I have an MBA. And with the 16 years that I've worked for this nonprofit, I say I'm kind of like an armchair therapist at this point with all the trainings that I've done. But uh yeah, so that is uh a little bit about my background.

SPEAKER_01 2:52

Yeah, that's huge for an organization to take on that. How long has Wings been around?

SPEAKER_00 2:58

Wings has been around for 40 years. Um, our our CEO, Rebecca Darr, has been with us for about 27 or 28 years at this point. She is an amazing leader for this organization. She has taken it from a very small organization. I think when it started, it was just like they had a house that they were utilizing as kind of a make like like a shelter. They could have maybe a few families in there, did a little outreach to the point where now we have two 45-bed houses and uh uh the one of the largest housing programs um also for transitional. So, in other words, you could come in from any touch point. So maybe you're a survivor that comes through the mentoring program, or you're one of our survivors that comes through one of our hospitals. Um, and and as most people know, if once you leave um the person that causes harm, that's just the beginning, right? That's just the first step. It takes time, it takes a lot of support. Um, and it takes a community uh to actually help that family get from one place to the next. So, you know, getting the assistance, living in a safe house possibly, then going potentially to a transitional housing program, and then two, two and a half years later, going back into the community. And that's where one of our mentors would come in because oftentimes people that have gone through our program, which is about a two and a half year program, when they go back into the community, sometimes they have a support system re-established, oftentimes they don't. And so having that mentor is kind of that extra step for somebody that's that's getting, you know, re-embedded into their community. You know, maybe it's just about just processing their day or, you know, can you help me? I I I lost my job, help me with my resume. Um, it, you know, it starts off oftentimes just on the phone and then sometimes texting. But then down the road, what ends up happening is, you know, they'll meet in person, they'll develop a relationship, and it's really up to them. This is not counseling, this is this is more of a big sister, big brother role. Um, we pair them, uh, we pair the mentors specific to their needs.

SPEAKER_01 5:26

That is amazing that you encompassed that entire timeline because everyone's heard the statistics of how victims often return to their abusers on average seven times. And little side note, if you've gone back to your abuser nine times, that doesn't mean you're a failure. It it varies, it's an average. But one of the reasons is because of lack of housing or financial difficulties or just that that difficult time adjusting, like you said, to the community, because in these relationships, you're beat down to where you are so dependent on this other person. That's what they do, and you're so isolated. Like you again, you mentioned the lack of support system. So that's really incredible that you guys take on that that long of a role.

SPEAKER_00 6:16

Yeah, it and it is. It definitely takes a lot. I mean, we obviously refer out for different services or things that they may need that we don't provide. Um, but when they come in to our program, especially our our housing or safe house, um, they get a counselor. They get a child advocate, which is a master level counselor that will work with mom or dad in parenting and then work with the child one-on-one. And then we also have uh they'll have a caseworker that works with them on anything from what's your next step to finding a job. Um, you know, everything is is worked out with them and they they can have a, you know, if they're have something involved with the hospital, they could get a medical advocate. Or if there is the potential, we also do assessments for potential brain injuries. And so if one of the advocates or counselors is like, hey, I think there's something here, I'm gonna refer them to the hospital program to a medical advocate, and then we'll do an assessment just by asking some questions. Um, and then, you know, we it they could either come into the program through an internal program of one of ours, or most of the time they come to us through a hospital, one of our partner agencies.

SPEAKER_01 7:34

That's just absolutely incredible. I love that because I just I never had to use a domestic violence agency for myself, but with doing this podcast, I've talked to so many survivors, so many advocates, and a lot of the the programs that are there to help victims are very condensed into let me just help with this immediate need that you have. And then after this immediate need, you need to move on to to someone or something else.

SPEAKER_00 8:04

Right, right. But what we've found, especially with our um, it's kind of like a co-location uh program, which would be we're provide we're bringing the service to the hospital, right? So our advocates, we'll get a call from any touch point in the hospital. Could be the ED, could be, you know, uh P I O P, it could be you know, pre-surge, uh post,

Inside The Hospital Advocate Model

SPEAKER_00 8:29

they come from everywhere. You'd be surprised. Most people are like, oh, they all come from the ED. No, not the not all of them come from the ED. Um, and so once we get that call, um, because the questions were asked in the hospital and and that that patient has said, you know what, I don't feel safe or I have been hurt, um, they're given the option to have a medical advocate come to their bedside and actually talk to them. So um with our partner hospitals, that is that's one of the things that we do with them. We do a lot of, you know, medical training for their physicians, their nurses, their social workers, their EMTs, because they're all the people that are doing the first, you know, that they have that first contact with that patient. And what we keep telling them is if you want to stop recidivism, you don't want them to keep coming back, right? But if you're not addressing those underlying issues that they're coming in back, coming in and they're saying, you know, I can't sleep, or I I have headaches constantly, or they're constantly saying, you know, they're coming to the ED and I'm clumsy, I broke my arm, I did this, I did that, whatever. And they're not asking the questions, or they're asking the questions with the person that causes harm in the room, which is another issue, right? Because who they're not gonna feel safe telling you, oh, I don't feel safe at home. They're not gonna say that if the person that's doing it is right next to them. So we do a lot of education on that as well. We talk to them about just because they say, This is my sister, or this is my mother, my brother, my mother, my father. Don't assume that that could not be the person causing harm, because oftentimes it is.

SPEAKER_01 10:15

Right. And I I'm gonna be honest, I think this is the first time I've ever actually heard of an organization having a hospital program within their organization. I know that there are people who want to educate more in those systems, but that's not all you do.

SPEAKER_00 10:35

Oh no, no, no, we we we provide the we we talk to the nurses and the physicians and the you know assistant nurses and the LPNs. Uh we talk to them about because I understand being a nurse, my mom was a nurse, my son started studying to be a nurse, and what I always was told, you are expected to to care for so many patients, right? And you nurses get into this industry because they're cared to they they they care, right? And so it when I'm asking, when they ask those those uh safety questions when the per patient comes in, um, and every hospital has their set of, you know, because it's it's mandated, when they ask those questions, they're asking them and they're not making eye contact. And as we all know, like if, and I get it, you're in a hurry. So I tell nurses, I get it, you're over here, you're like, you know, and what brought brought you in today? Do you feel safe at home? And they're not making the patient feel, you know. So I say to them, stop, take a break, make eye contact. Oh, now the patient's like, whoa, she's she's looking at me. This she's gonna ask me something serious. And and that's when, you know, you can say, I'm gonna ask you some questions. And I know that they may you might not feel comfortable talking to me about it, but I just want to make sure, and make sure that no one else is the in the room when you ask those questions, right? So I talk to them about because I'm like, you may be the only person that they are able to disclose this to. This is their one shot, one shot. And uh oftentimes patients they'll say, like they there's so much research around this, they'll say, if I would have been asked more than one question, because maybe that first time you asked me, I I still didn't feel comfortable, but then you ask it to me in a different way. D has anything ever happened to you or your children? Oh, okay, now you're talking about my kids, so yeah, maybe I am gonna disclose something there. You see what I'm saying? Like asking more than one question, because just one question may not be it. If you ask a couple by that third one, I'm gonna, oh, I I might answer that then. And then if you investigate a little more, you might find out a little more. And what I tell the nurses is I I get it, because once they disclose a nurse feels like, oh, now it's my responsibility, what am I gonna do? Right. And I tell them that's why we're there. That's the whole reason we're there. Now you can say, We have a medical advocate that can come talk to you. If you don't want to talk to them now, I can give you their phone number, you can talk to them later. And guess what? Boom, you're done. See? So now it's no longer about now, this is on me. Now I've got to find out, you know, I got to make sure she's safe. I've got it, no, no, no, no, no. You're giving them the opportunity to talk to a professional, somebody who this is what we do, right? And and then, you know, most of the time they do want us to come to their bedside. You know, we went through COVID, which was a whole other ordeal. And that's when we started doing virtual meets and and that kind of opened a door because sometimes people don't feel comfortable with somebody coming to their bedside, or sometimes it's not safe in the moment because the person causing harm is constantly there. So that could be in a case where there's uh a baby in the NICU, right? And so she'll come to see the baby in the NICU, and so will the the the father or or the person that causes harm. And so we have to get real creative, and we work real well with the healthcare professionals on, you know, she's gonna say she's gonna go talk to a lactation specialist, she's gonna say she's gonna go talk to this other person, get her alone, and then we can meet with her there. And we can talk to her, talk about, you know, there are the the main thing is safety planning. One, we do a lethality assessment because we wanna we wanna determine how safe is the situation? Are there guns at home? Has he in, you know, strangled or or hit her in the head in the past? How often? How long has this been going on? Were you ex, you know, pregnant during the time that this abuse was happening? There's all these different questions that we go through with the patient, um, or if she's discharged, you know, the mom, uh after the fact, and then we'll determine how safe or unsafe she is. And from there we talk about other resources. The key is to let her know she's not alone. Because oftentimes uh survivors of D of domestic violence feel no one understands, no one's gonna believe me. Um, because especially if they've been um with this person for many years, probably at the beginning they were reaching out to their friends and family. They were asking for help. But as you previously stated, seven times on average they go back. Well, many times friends are gonna be like, I'm not gonna do anything because you're just gonna go back. So why am I gonna get all invested? Take

Safety Questions That Unlock Disclosure

SPEAKER_00 15:38

your calls at two in the morning, pick you up, get you to the hotel, do whatever. You're just gonna go back. So they lose all of their support system. What ends up happening is exactly what the person that causes harm wants: isolation for them to feel there's no one that's gonna believe them, no one's gonna help them. So that's the other main key for us to let them know you're not alone. We're here, we believe you. Um, and and then, you know, we go from there. But we want to make sure, I mean, it's completely patient-driven. Whatever it is that they want to do, often the case that they are they they're not ready to leave, and that's fine. So, but they do want to talk, they want to get this out, they want to have somebody they can vent to talk to, feel like they're not alone. Um, and so our medical advocates, once they're discharged from the hospital, what's good is that in the majority of our hospitals, we actually have an office on site. So they can say, Oh, I'm just going to the hospital. I have a follow-up, or I have this, or I have that, or I'm taking the baby to the hospital for a follow-up. And then they can actually meet with their medical advocate in a private location within the hospital setting. In other instances, if they can't get to the hospital, because we we do have some patients that are of older, um, you know, and so they'll go to their senior home. So we have a good relationship with some senior locations, and they'll go there and they're, oh, I'm going for my chair yoga. And they're really meeting with their medical advocate in a side, you know, office. And again, because somebody who's been in a marriage for 50, 60 years, they're not ready to just up and leave, right? There's a lot of fear of financial insecurity. Where am I gonna live? My children are turning the back. I mean, and some of the kids, you know, which often is the case with the person that causes harm, they're not this bad person in public. Often the case is that everyone thinks they're amazing, and you know, they're there's they they do all these amazing things, and I they've never, I've never seen them be aggressive and all this stuff. And so they have so many people, you know, bamboozled on who they really are. Because when that door closes, that partner, the person that is the survivor, is the one that really sees what's going on and is experiencing this. And so it is definitely a very difficult situation to maneuver. But our medical advocates are so good at making sure that the patient or the survivor is getting their needs met and that we're going at their pace. It is all patient-driven. Whatever their the key is, showing them their options, letting them know we're there, and then they drive where we go.

SPEAKER_01 18:27

That is incredible. I are you guys gonna expand out of Chicago? I mean, it's gonna be everywhere.

SPEAKER_00 18:35

Oh, yes. I'm so glad you said that because we actually are um Miami. Um, yes, Miami. Um, we are uh we've been well, Rebecca and Latanya have been working on this for about two to three years at this point. Um, they brought me in last year. Um, I presented to the University of Miami Hospital. They were like, when can you start? And I remember sitting on the end, I was like, uh, you know, and uh, you know, in as with all things, uh, when you are a nonprofit, you have to raise enough money to be able to support the program, um, not just for this first year, but we have to think long term because we're gonna hire people on the spot there, right? And so um we're getting closer to launch. Um we uh the we're getting very close. I I know we're getting very close, having the MOU at the hospital, and then we'll start with um the hiring, and that would be to have a medical advocate on site there in Miami to do the same things that we're doing here, and then as we continue to uh raise additional monies, we will be able to expand that program. It is an amazing program, and it the impact is um i I I can't even express it. I mean, when you think about 80 to 83, and

Miami Expansion And Alarming Statistics

SPEAKER_00 20:00

this is not just our numbers, this is kind of across the board. 80 to 83 percent of survivors of domestic violence indicate being hit in the head or strangled by their partner. 80 to 83. Okay. Why do I why do I say hit in the head or strangled is because a person who has been strangled by their partner is 70 750% more likely to be murdered by that partner.

SPEAKER_01 20:30

Yeah.

SPEAKER_00 20:31

I mean, that's why that statistic is so important. And that's why it's so important to catch these things because those questions often are not asked, right? If I'm a survivor and I go to the ED because maybe I got pushed down the stairs and you know, my arm, you know, got broke. So um, survivors don't go to the ED just because they had a bad fight, maybe got slapped, hit in the head, even strangled oftentimes. If they if they get up and they're like, well, I'm fine. Yeah, I've got some bruising, maybe a little patikia on my eyes, but I'm okay. You know, what they don't realize is they don't know what's going on internally. And when there's been a potential um head trauma or or brain injury potential, that person, it could become lethal for two weeks after. And in 50% of the cases where a um person um died as a result uh uh of a brain injury, strangulation, there was no signs. There were no signs. So what does that say? That says that and and and and another thing you gotta take in consideration again, usually survivors are not, like I said before, they're not gonna go to the ED just because, you know, they they were strangled if they're okay now. They will go if their arm is broke or If they need stitches and and and what happens, right? When you go to the ED, they're looking, what brings you in today? Well, I've got this broken arm. I fell down the stairs. They're not going to ask them, were you, you know, did anything else occur? How did it, you know, oh well, actually I was strangled. Okay. That's not what's taking precedence is this arm that was broke, right? Well, if we get involved, we're going to ask those questions. And if they say, oh yes, I have been strangled, our next question is, has this happened before? You know? And then we once we determine that they screen positive for a potential head injury, then we go through a different screening process. Because we want to be able to know how to best help them tell their healthcare providers so that they get the correct assessments, whether that's a CT scan, a CTA scan, an MRI, whatever it is, because we need to be able to see, right, what is there something going on internally besides this broken arm, right? Um, and and they're not even thinking about that. Because what brought them in is the broken arm.

SPEAKER_01 23:11

Right. Okay, so one thing that you said that kind of I wanted to address is brain injury or head injury. When people think of a head injury or brain injury, they're thinking their head is getting smashed into something or something is smashing into their head. But strangulation is included in that.

SPEAKER_00 23:31

Yes. And I'm glad you said that because oftentimes a myth is that a brain injury can't be caused by strangulation, right? Because it's here. People are like, oh, it's your neck, it's not your brain. But what's happening, if you think about it, when a person is being strangled, they're losing oxygen. Blood flow is no longer going. Well, if it's not going and oxygen is not getting to the brain, that's a potential brain injury. Um, and then oftentimes another thing that we, you know, a patient will say, Well, yeah, I was choked, but I I'm fine, right? And that's another misconception, right? You choke on food. That's an ex, that's an internal issue where you can't breathe, something's choking, it's internal. When somebody is strangling you, that is external. They are causing, they're they are causing damage to um this part of your neck, which you

Why Strangulation Damages The Brain

SPEAKER_00 24:30

have blood going up and down, you have oxygen going up and down, there are um, you know, blood vessels there, you know, there are uh capula, you've got all these things going on that people don't think about, right? Um, and you could get a carotid artery, like there is just so many things that can occur when that strangulation is occurring. And when and people are like, well, you know, really, I I I don't think anything happened. Um, or or I passed out for just a short period of time. Um, what we then do is we talk to them about stud their studies on depending on how long you were unconscious or you're being strangled for. So like the first 15 seconds is when like you potentially could go unconscious, you could seize, um, you could lose uh loss of bladder at about 15 seconds, loss of bowel movements at 30 seconds. So that's how when we are talking to somebody and we're trying to help them, you know, remember, because oftentimes yeah, I don't remember. I I I remember coming home or I remember pulling in the driveway, and then I don't remember anything. I woke up on the floor and it's like, okay, and I know it's personal, but we'll talk about did you have a loss of bladder? Did you have a loss of bowel? Because that will determine how long you were being strangled for, right? Like how long that that was the that was occurring, right? Um, seizing uh could again up to one minute, and then you know, after that, death can occur. So I tell people, when you're, you know, when you you're being strangled, it's either death or near miss. That's the reality. That is really the reality. It's death or a near miss. And so depending, you know, um, going back to um documenting, um, when we talk to people about this, because oftentimes they're like, oh, I I I I don't want to get police involved, I don't, I don't want to get an order protection. And and we can say that's fine, but let's talk about this from a standpoint of when the medical uh provider, when your doctor is asking you how long, I'm let's talk about this so that you can have a better idea of how long this happened. We'll talk to them about like, well, when you woke up, if you get home at five, right? So let's assume that you were probably strangled somewhere between five and then when did you wake up? Well, I don't really remember. Oh, but my son got home and he gets off of work at seven. Okay, so somewhere between five and seven is when it occurred, right? So now you have a time frame. Um, did you lose the bowels? Did you lose you know control of your black? So those kinds of things. It's helping them try to remember because there is nothing more a feeling of hopelessness than not knowing what happened to you during a period of time. That loss, it's it's a loss of control, right? And and so you're helping them try to re-recollect. And then you're helping them with journaling. All right, we're gonna write that. We think it happened five and seven. You know, if this happened, then we know it probably happened for about 30 seconds, right? Um, did you have patekia? You know, you know, if if they're present with you, and they don't always have that, not everyone. You have to also remember that not everyone's skin color is the same, you're not gonna see the same things. Bruising looks different on people. Um, and sometimes there's no you know, signs whatsoever. Physical. Now, maybe there are other signs. Do you are you having trouble sleeping? Oh my gosh, yeah, ever since it happened, I I I'm like I feel dysregulated, like I'm up all night, and or um, I don't feel myself like there's just something that's not right. Um, or maybe um I normally don't get this frustrated or agitated. I'm I'm losing my temper all the time, and this is so dysregulating, and I don't know what's happening. You know, you start talking to the when do you notice these symptoms happening? Well, it happens when I'm around loud noises, or it happens when I'm in a room with very bright lights. So all of these things are symptoms that are triggering the survivor, and they're going back into they're being re-triggered. And so it's helping them learn to cope because the reality is we're not doctors, we can only help with the symptoms to a certain extent, right? There really is no way of getting, I mean, once those, you know, arteries are dissected, it it's it, you know, they're they're gone. Like, and and so to get them to re and if you've been a survivor who's been strangled multiple times for years and years, it's it's a lot, it's a lot different. If you think about a football player, the average time that they're gonna be, you know, with head impacts, I mean, it's three, four years, right? And we see what happens when they go longer than that. Um, well, imagine a survivor who's been in this relationship for years and years and never got help, never just felt like, I don't know what's wrong with me. My, my, uh cognitively, I I mean, I'm intelligent. We, you know, you have a people that are like, you know, I've got a degree. I'm a smart person. I cannot think of my memory, is gone. These are all symptoms, right? That they're not recognizing one for the other. They're not associating the two. There is such a correlation, but they don't know that.

SPEAKER_01 30:22

So are you also teaching? I know like the medical staff is going to do their questionnaire, and if they answer positive to certain things, they're going to call you guys in. But if somebody is there and they've determined that there is a possible strangulation, do they are they educated to look beyond the external symptoms of bruising or the patiki eye?

SPEAKER_00 30:46

Or is that something that you guys will We advocate, we advocate on behalf of our client, our our patients. Like we'll once we we've determined, we we help them advocate for themselves and we advocate as well. So, and and you run into issues, right? Because let me think of it. Okay. So if a person is, let's hypothetically say in the behavioral unit, okay, so it's not a physical thing, right? They're in there because of cognitive issues and da-da-da-da-da-da, right? So the advocate may advocate, hey, I think we need to look deeper and have let maybe do a CTA scan, see where these, you know, um uh what do you call it, dissected iron arteries possibly could be. Let's see, you know, like the doctors are gonna figure it out, we're not, but at least look there. Well, that psychiatrist who is the prescribing doctor is like, I really can't order that. You know what I mean? So we would we would advocate and and say, this is why we think this is happening, right? And um, and and most of the time we can get through, you know, especially if it's in the medical side of the hospital, behavioral health, it's a little more difficult because again, they're looking at other things, right? But if we explain to them that obviously when there is damage to the different parts of the brain, and depending, it could be they were strangled and banged up against the wall. So now it's the back of the head. And so other things could be happening. They're cognitively, they're they're not, you know, it's emotional and it's physical. So there's all these things going on. Um, and that's what we will then help the patient and and help them advocate for those things and we'll advocate for them as well because we're part of the, you know, we're in the hospital. Um, we we we have good relationships with the social workers and the nurses. Um, I mean, they call on us for a reason because they know we're gonna be able to work with this patient, and we're we wanna get them from A to B. We want to get them to from there to a safe house if that's the case, or to another place, whichever they deem safe for them. Because we understand it's a continuum of care. It's not just you're a patient, here's yeah, let's do some safety planning, good luck. No, this is gonna take time. This is gonna take a lot of time. Um, because depending on how severe the potential head injury is, um it that's you know, that's how much of support they're gonna need. And so it's so important that the medical advocate works with them. You know, journaling, uh, because another thing, one of the main things that we see is memory issues. Um, and so what's unfortunate for people with a potential head injury is because they have these memory losses and because they're cognitive issues, they miss appointments, they seem disengaged, they lose opportunities that they, you know, they'll make an appointment, but then they'll forget they had the appointment or they won't remember. And so one of the things that we've done even for our own safe house staff is we talk to them about compassion before critique. We talk to them about this person is gonna need a little more support. So when you meet with them weekly, it's gonna take sending them an email after you met with them. Here's all the things we talked about today, right? And these are the things that you're gonna do this week, and and then here's some stuff I'm gonna work on, and we're gonna make sure that we we we both will touch base, you know, in the middle of the week, and I'm gonna remind you

Symptoms, Memory Gaps, And Coping Tools

SPEAKER_00 34:45

that we're gonna see each other again Tuesday at 10. Um, and so they have a record of it and then giving them that reminder, helping them like many people have have uh these smartphones where you can set alarms, set alarms for things that you, you know, so you don't forget, oh yeah, 10 o'clock, you know, because people be like, oh my gosh, I staff will be like, she forgot to go pick up her kids. Do you really think that that was really what you wanted to do? Right? Like helping them with, okay, I'm going to set my alarm at 3 15 so I remember I've got to run out. I'm gonna go pick up the kids, right? Um, giving them sunglasses. So we have like um these little head injury kind of kits. And so if somebody discloses in one of our safe house or housing program, they will get this kit to give to that uh client. And it has like little hydration packets for water, it has a little pair of glasses, noise canceling, earphones, because that's another thing that could be re-triggering is loud noises, um, and and a journal. Um, and then, you know, we we talk to them about the importance of keeping a journal, talking about the, you know, remembering that's how you can keep a thing, having a calendar, um, because even though you make an appointment, maybe even on your phone, but some people having that hard copy and being able to open it up and look at it, or that that uh fact of actually writing it out, um, those are all things that we we we work with them on coping, breathing, grounding techniques, um, anything that will help the person get back to regul be regulated once again, you know. And and then one of the main things I I tell advocates and counselors, like if or anybody who's working with a survivor of a head injury, be patient. And if the person is triggered, you'll know. And don't continue the interview or the discussion or the meeting because they are not in a place any longer that is going to be beneficial to them. Or you. You're not gonna get anything done because they are so right, you know, dysregulated. So um it's it's it's a lot of that kind of work that we're doing right now within the hospital and outside of the hospital.

SPEAKER_01 37:04

That's a lot. So I was looking at my notes here, and when we spoke last time, I wrote down, and correct me if I didn't write this down correctly, but I wrote the highest rate of traumatic brain injury is due to domestic violence or intimate partner violence.

SPEAKER_00 37:21

That is 100% correct. It is a misconception that it is military or it is the sports, you know, because who else do you always hear, right? You you hear about it in the military, all the PTSD, and you hear about it in our sports, right? And if you think about, I always I love telling this, if you are watching a football game or even a baseball game, because those pitches come at you know 90, 100 miles an hour, somebody gets hit in the head, whatever, boom, the game stops. You know, you've got medical personnel coming out to the field, they're checking, they're getting immediate medical, and they're rushed off the field, right? And they are not allowed back in the game until they're cleared. Now, think about a survivor of intimate partner violence or of DV. There's no person sweeping into that house going, whoop, that's it. She's no longer gonna be able to go to work, take care of kids, or do anything until she is fully cleared, right? Survivors of domestic violence do not get the medical attention as quickly or as often. So most of the time, when by the time we've gotten to them, this has happened more than once, and oftentimes for years. Um, and so they've not gotten the

Why DV Is The Top TBI Driver

SPEAKER_00 38:44

medical assistance that they've needed. They haven't associated one with the other, right? They're just thinking I'm stressed, and this is a this is a common issue with counselors and medical providers, is because they think it is related to the domestic violence that they've been over years and years and years. They're just depressed because of the domestic violence, or they're anxious because of the domestic violence, or they're paranoid, or PTSD, or all this? They're not thinking that there could potentially be, you know, the issue is because of a head injury. They're not, they don't know that, right? And so, um, and most of the research that is done, you know, even as of today, is for the military and for sports, because there's money there. Who wants to study, you know, intimate partner violence survivors, right? And then add on, uh, you know, um, because domestic violence occurs in in the unhoused population as well, right? And that definitely is another very much at-risk population that is not researched. And so you cannot apply the research that's been done on how to have a healthy male, young male, um, be treated for a head injury versus a put a woman that has endured head injuries and strangulations multiple times. It's not going to be the same because she has other strenuous circumstances as well. She still has to suit up and show up for those kids. She still has to go to work. She is not getting the medical attention that this military person or this sports person is getting. So the research is based over here. It's not over here. It's not it that that's why it's a very understudied and it so needs the attention that that the medical or that the uh military and the sports are getting. But it's not. It doesn't.

SPEAKER_01 40:45

And for those who minimize the head injury, and and I'm including victims, you mentioned how a lot of victims won't seek medical attention if they've been strangled. Hey, that's me. And you know, I'm a medical professional, so I know better. But I did not. If I were bleeding, I would have, probably. But but I did not. But just for those who minimize the effects, the and you've listed a number of effects of bringing injury, those are not reversible. So every time it's happening, you're stacking on and you don't get that back.

SPEAKER_00 41:18

No, you don't. And that's why for us, we work with how can we help them cope with, right? What are some techniques that we can help them so that they can continue to live, you know, and and thrive as best they can within, you know, with everything that's going on, right? Um, but it's like I said, it's compassion before critique. And it's hard, right? Because um you think of uh a survivor that is like losing, yeah, but she's she's irate and she's angry and she's blaming you for everything. And and you're like, you don't know what's going on. She's not able to regulate. So instead of, you know, saying that's it, you're no longer in our program. No, let's talk about, let's get her the help and let's figure out when is she being triggered? What is the trigger? There's, you know, because another thing you think about if somebody comes into a safe house, I mean they're there with 45 other people. It's not a quiet place, right? And it's full of kids running everywhere. Um, and so if somebody is triggered by that, you we need to work on that, right? If you're meeting with somebody that is triggered by the lights, dim the lights, right? Um, maybe putting them in a room that's not so close to the kitchen or the living room where there's all this noise going on. Um, it's really thinking about in putting that survivor first. And but you wouldn't know any of these things if you didn't do the assessment, if you didn't find out that she had been strangled multiple times or had been hit in the head multiple times for years and years, and never associated the two, right? And never got medical attention for it either. Um, so yeah, yeah, it's definitely um understudied. And um our goal is that we want this, we want studies to to to continue and to um not just on survivors of DV, but also survivors um uh that compounded with strangulation, head injuries, um, and then I haven't even talked about the LGBTQ and transgendered community, right? Like those communities even less studied, right? Like, so there's just so much. But yeah, those are um those are definitely big areas that um we are focusing on right now. And we've been very fortunate that the pilot program that we once started. Two years ago, through um an amazing grant through the Michael Reese Foundation that started all of this, and we were able to start the pilot toolkit program. So and and you know, brain injury, and and from that came the development of the uh TBI toolkit, which is going to launch this fall. And what that is going to do is it is going it is a program, it's a toolkit that we have developed. Um, and is so if you're an uh intimate partner violence agency looking to start a hospital program with the focus on brain injury or head injury, this is going to be your toolkit. Everything from how to start in a hospital, developing those relationships, and moving forward, like how do you start that? You know, having the advocate, when do you, you know, have a counselor or a child counselor? How who are the key people that you want to bring to the table? Um, because the other thing that we do within our partner hospitals is we have a task force. And so it's not just a social worker or a nurse. No, we need people from all parts of that hospital to have the buy-in, right? Because we need them to understand that this is affecting all aspects. If you want to stop recidivism in your hospital, you don't want them to come keep coming to your hospital, right? Then we need the buy-in from everyone. We need everyone because often we we would, you know, I we do what we call rounding. So we'll walk around to the different departments. Hi, you know, I'm April, I'm with the Wings program. You know, you know, let me leave you my cards. You know, we'll do bedtime, we talk a little bit about everything. And of course, we'll bring

Building A TBI Toolkit For Agencies

SPEAKER_00 45:48

bagels because nurses need food. They don't get food. So we've got to bring them some food. They're always on the run. Yeah, you gotta fuel them. And plus they'll remember who's that girl that brought those bagels? Um, and so, you know, those are the things we're doing so that they they remember us, right? They remember that we're there to help them. Um, and so yeah, that's that's that's what we're doing.

SPEAKER_01 46:12

I love that. I so I thought of a couple of questions. Actually, one, I thought of I wonder how many of those medical staff, this medical personnel that you have come in promoting wings, have looked in at their own relationships. I bet there are quite a few that have learned about themselves and what's happening as they're learning about what you guys are doing.

SPEAKER_00 46:39

I'm yeah, I'm glad you said that because we actually, as all of everyone within our partner agencies, know we are not just there for their patients, we're there for their staff. And we have received referrals from our hospitals. Um, and it's very and usually what we try to do is have them go to a different one of our partner hospitals because you know, they don't people talk and so we don't want them going in and seeing, or we can meet with them virtually. But yes, um, we do get in fact it's another thing because I also go into like local colleges, uh nursing schools, and talk about what we do, right? And then after, inevitably, there's always one student that'll come up to me and say, Um I really need to talk to somebody, right? Um, and so I it it always it really moves me because I'm like, and you're coming into this profession, this is great that you're gonna address this before you're there, right? Because um, somebody who's going or is in those kinds of relationships or those situations are gonna have a hard time when they are working with somebody in front of them that is experiencing domestic violence. So um, yeah, so the often that does happen. It does. We get internal referrals.

SPEAKER_01 47:59

And and that just that's the importance of speaking out about this because you never know who's going to hear it. It just takes one time for the right person to hear it. Uh and actually, so that sort of leads into one of my questions is back to triggers. The you were talking about sound and light being potential triggers. Now, that doesn't necessarily mean that when the abuse was happening, that it was happening in a loud environment or a really bright environment. So it's not even something that a victim could potentially anticipate being a tri a trigger.

SPEAKER_00 48:34

No, it's due to the the damage to the lobes, different lobes in the in the brain, right? If I when I when I do my PowerPoint present, I have a picture of the brain and I'll say, and you know, and this lobe's the you know, the sight and hearing, and you know, the this part controls, you know, you know, your sleep patterns, cognitive, whatever. Um, and so depending on what part of the brain has been damaged or potentially damaged, um, that's why they're having these issues. It has nothing to do with they poked their eye or they did whatever. No, no, no, no. The brain control, I mean, people don't think about it. Your brain is such an important part of your body, and that's why it's protected by a skull, you know? And and so when there is a potential brain injury, um, even if it was a slight, you know, minor to moderate whatever, um, that causes them to have these side effects, these symptoms, and they don't associate it. They don't know, like, why am I constantly getting headaches? Why can I not sleep? You know, like I cannot, or I'm getting so emotional all the time and I don't understand it. Um, those are all symptoms of some sort of, you know, potential brain injury. But again, they won't know unless they are diagnosed by a medical professional and done through, you know, different scans that they could have done. But also it's not just different scans because the reality is you may not see it, right? Like even a CT scan, unless it just occurred, you're not gonna see like a brain bleed or something like that. Um, a CTA, yeah, you could probably see some of the dissected arteries. Um, MRI, you might see some, but I I'm in the research that I've done, from what I have heard if you lost consciousness, saw stars, have any moment of I don't remember, there's a potential for a brain injury there. There is, right? Something has happened for that to occur. And that is the part that people don't understand is that just because you may have only lost consciousness for 10 seconds, oh, I didn't, you know, lose my bladder bowel movements or anything. I I must have just, but yeah, I do have markings and I and I I do remember, you know, my eyesight going black a little bit, but but I'm fine. I'm fine. Look at me, I'm fine. Um two weeks after that, you potentially could still it could still be a lethal case, right? Like, because you don't know what's happened inside your brain. You don't know if there's anything that is if you know there's uh the lack of oxygen, if there's like uh any kind of issues with the air and the blood. Uh we don't know, right? And and I'm not a doctor. That's why I always say, please have a medical professional. And I tell them, let's talk about, let them know all the things, you know, talk to them about it's not just this incident that occurred, right? This has been going on. Um, and so then the you know, the medical professional will be able to know, oh, this could be something a little more serious, right? This could this could this could be something a little more serious. We need to really investigate this.

SPEAKER_01 52:01

So, I mean, you've talked about all these reasons why this is such a significant thing to pay attention to. And you also you already mentioned the statistic of increased lethality of 750% by someone who's been strangled by their partner. And you also you also mentioned the lethality risk assessment. And I can't remember if it was you that told me or if it was someone else, but that there's a bill on the floor that was it you obviously.

SPEAKER_00 52:29

HB4668. So here's the thing. When there's a domestic violence call, right? Like you, I'm sure you've always heard um that uh you know, officers will say, oh, that's the most dangerous call is going on a domestic, right? Um, and they're right, right? It is dangerous. But add to that if the person is a strangler. If they are a person that strangles, it's it's increased exponentially. Now, let's there um let's talk about when there is a domestic, they go out. Sometimes they're not gonna, they don't do lethality assessments. Sometimes they're gonna give information on a domestic violence agency. Sometimes they're gonna tell the person that causes harm to just go for a walk and cool off. Sometimes they're gonna tell the person that is the survivor what is there somewhere else you can go that you'll feel safe, you know, and they're not doing the assessment. So they don't really know how lethal the situation is. There is a bill on the floor, and I believe it passed last week, two weeks ago. Two, I think it passed two weeks ago. So it won't go into effect though until 2028. And so now what they're working on is what is gonna be in this lethality assessment that all police officers

Lethality Assessments And Illinois HB4668

SPEAKER_00 53:52

in the state of Illinois are gonna have to do. They're gonna have to ask these questions. So if they go on a domestic, they're gonna have to ask those questions. Are there guns on the in the home? Is does he have a FOID card? Have you been strangled? You know, how uh, you know, how often has this happened? You know, I I don't, it could be a vast array. Uh usually there's actually multi-lethality have like I want to say 15 to 20 questions. Um, and those questions will be asked. And depending on the lethality assessment, they then will be referred, right? And so that's so key. It is so key. And this is there's um, there's, you know, several states within our country that already have passed this. Um, that's why I was so excited to hear that it finally did pass. And they're actually bringing in, I believe, domestic violence agencies to help and assist and be a part of the development of the lethality assessment, what it should look like, right? Um and I know that for an officer is just one more thing that they have to do. But if they think about it, if they do this lethality assessment and they refer the person um to get the assistance that they really need, I am a true believer that that is going to impact the amount of survivors that actually get help and that actually escape, right? Um, so yeah, I'm I'm very excited about that.

SPEAKER_01 55:22

Well, and I agree with you. You you also mentioned this at the beginning of the episode, is how when the nurses or whatever medical staff are questioning people, they may be the only person that they say something to. And it's the same, same situation for these police officers who are going out to these calls. They may be the very first person that this victim is telling what happened. And their reaction is going to set the precedence of what that victim does going forward. Are they going to tell anyone anymore? Are you are they going to be believed? And, you know, yes, it may be more paperwork for a police officer to go through this this questionnaire. But I mean, think of all the paperwork that they could be saving themselves for down the line when they actually have to investigate a homicide because they didn't follow up on this.

SPEAKER_00 56:12

Exactly. Exactly.

SPEAKER_01 56:14

And another statistic that I heard, sorry, I'm getting very excited here, uh, is that police officers who are killed in the line of duty, 80% of those, I believe, are from someone who had previously strangled their partner.

SPEAKER_00 56:31

That's 100%. That is very, very true. I mean, that's why we say, yeah, domestics are dangerous, but 80% of them are people that strangled. I mean, the Pulse Nightclub, the guy that shot all those people at the Pulse Nightclub, he was a strangler. Um, the Petito case, uh, Gabby Petito, another one, uh, he was a serial strangler. Um and yeah, so there's just so many um mass shooting situations in those cases. Um, I can't remember the statistic, uh, but the majority of them were stranglers. Um it's it's it's the ultimate form of control. I can take your life, right? It's that God complex. Um, because remember what I said, it's you know, it's death and near misses. And um, and sometimes, you know, uh and another area that I definitely think is important, and and I really think that we need to address this with even the younger generation is um because you know, there's that sexual strangulation. Um there's a lot of root, they're they're doing a lot of research on that right now because people like, oh, you know, they get you to the point where you're you're about to pass out, and and they think that that's okay. They don't, they're damaging their brain. Um, and so you know, and the younger generation may not know this, right? Because they're they're not they're not privy to what could what is actually happening to their brain. Um, and so yeah, yeah, there's there's so many ways that this needs to continue to be studied and researched.

SPEAKER_01 58:13

And yes, I agree. And I think back to the the younger generation that is doing that sexual strangulation or whatever, I there's a term for it, it might be that. I can't remember exactly what they call it. But I'm curious that of how much of that is actual consensual. And I know that a lot of people are saying it is consensual, but if you are being coerced into saying yes, then that's actually not consensual.

SPEAKER_00 58:40

Exactly. Exactly. And 100%.

SPEAKER_01 58:44

Yes. And then I know I bring Gabby up all the time and God bless her. But if there was a lethality assessment that would have been done on that, I mean, not even a lethality assessment. I think just a little tiny bit more education in that that time when they pulled them over, there could have been a completely different outcome. But for sure, a lethality assessment would have addressed all of the concerns that they would have been able to recognize something. It wouldn't have been Gabby go take a shower somewhere. I mean, my God.

SPEAKER_00 59:20

Well, I mean, if you think of remember back to it, she was crying and and and the officers saying, you know, he said you I think you slapped him or you whatever. So instead of arresting you, we're just gonna put him up in a hotel and you're just gonna take the truck or whatever. And she's crying hysterically. And, you know, if you were looking at it and didn't didn't know, right? Uh people might be like, Oh, she's crying because she feels guilty. No, she can't regulate her emotions. She and if you think about it, she's been strangled so many times that there's this is just yeah. I it it it's it's so sad. If they really had done, if they would have asked her more questions, if there would have been a female on site, I personally think there would have been a female on site that could have, you know, gotten her to a regulation regulated state, like there's a person's crying, there's something wrong there. There's something wrong. He's cool and collected over there, right? Making jokes, making jokes, yeah. And he gets put up in a hotel. Yeah, no.

SPEAKER_01 1:00:25

Especially when the initial call was because of him doing something to her. Right. And how did they not know that? Right.

SPEAKER_00 1:00:34

It's it's the whole thing, yeah.

SPEAKER_01 1:00:36

Uh so I had another question, and I think that's my last official question. But uh, when you said that you were expanding to Miami, that actually made me think of human trafficking. And a lot of the same things that happen to domestic violence victims also happen to trafficking victims. And I I'll admit that when you said Miami, I went to the stereotypical version of trafficking, as in this is somebody gets kidnapped and they're quick shipped out. And Miami is a perfect hub for trafficking of international trafficking, but trafficking does exist within domestic relationships and it does exist within suburbs and cities and your neighborhood that you're living in. So realizing that that uh stereotype is is not necessarily accurate, but your questionnaire, I feel,

Sexual Strangulation And Trafficking Overlap

SPEAKER_01 1:01:30

would also address trafficking victims. Do you guys get trafficking victims as well?

SPEAKER_00 1:01:37

Or do you have yeah, oh yeah, we definitely have in the past. Um there are specific agencies that assist them specifically. Um, but we have had a few because there is that fine line, right? There's that very fine line because there's times that they're being trafficked, but they have children with this person. Because initially it's oftentimes it's it's they're being brought in by like, oh, he's my boyfriend, I'm gonna take care of you, I'm gonna move you over here, and you know, we'll have kids and you won't have to work. And then once you're there, you've been cut off from everybody. And if you're from a different country, they'll take your passport. If you have children, they'll threaten to say, Well, you uh I'll call, you know, immigration on you, they'll deport you. And guess what? I'm keeping the child. Well, what mother wants to do that? So, you know, there's a lot of um di you know intricacies with that. Um, we don't get it as much, but yes, there is that overlapping. Um, and and and also within the hospitals, um, when we do these task force, um, it's it's a combination of sexual assault, human trafficking, and DV. Because there's a lot of overlap. There is, right? Um, just because I I don't know how many times I've I've had discussions and and talks with clients over the years where you know different cultures believe that if I'm married to you, well, my body belongs to you. And so they feel like, well, I just I had to have sex or I was raped, but it wasn't really raped because I'm his wife. And he said that if I, you know, this is what I have to do. And and so it's a lot of education also for our clients.

SPEAKER_01 1:03:27

Yeah. And actually, I don't even know if marital rape is illegal in all of our states. It might I think there's a few who it is, but uh, you're right. I think there are a few loopholes and some. Okay. Do you think we covered everything you wanted to touch on? I think so. Okay. So if people wanted to learn more about wings or anything about you or whatever, how do you have any links or social media that you want to share with everybody?

SPEAKER_00 1:03:53

So um, if you go on our wings uh program.com website and then click on um, I think it's how we help, um, it there's a little tab that says um traumatic brain injury, I believe. So if you are a person that potentially thinks you could have a head injury, um, there's kind of a little questionnaire in there. You can go in there, you can take the questionnaire, it talks about different symptoms, um, or maybe you have a friend or relative that you you would love to talk to them about this. Um, go on our website, go on there, talk to them about it. There's a little tab where you can ask for additional help, and then somebody will reach back out to you. If you want to reach out to me personally, feel free. Um, I I definitely love talking about this. Um, if you have a program or a group that you think could benefit from knowing a little more about this, um, and I believe I gave my email address, but I can give it it's aprilf at wings program.com.

SPEAKER_01 1:04:59

Perfect. Okay. And then in closing, do you have any words of wisdom or advice that you want to specifically leave with listeners?

Where To Get Help And Closing Words

SPEAKER_00 1:05:06

You're not alone. We are here, wings is here. Um, and please know that we believe you. That is key. We believe you.

SPEAKER_01 1:05:18

Yeah, those are important words. Well, well, thank you, April. Actually, also thank you, Anthony Pisquini, because he's the one who introduced us. And if anyone is still listening, Anthony did an episode, I believe it was back in January, where he did speak a little bit about wings and he spoke mostly about men speaking out about domestic violence.

SPEAKER_00 1:05:39

So if you have so important, yes.

SPEAKER_01 1:05:41

Very important. And he did a fabulous job. So if you if you haven't listened to that, I believe it's a January 2026 episode that uh he was on. So thank you, Anthony, again. And April, thank you so much for your time. Thank you. All of your work you've been doing with Wings. This is absolutely incredible. I'm in awe. I hope you guys take off and become an international sensation because this is so needed.

SPEAKER_00 1:06:06

Thank you. Thank you, Ingrid.

SPEAKER_01 1:06:08

Thank you again, April, for joining me today and thank you, Warriors, for listening. You can find the links April was referring to, as well as her one in three profile in the show notes. I will be back next week with another episode for you. Until then, stay strong. And wherever you are in your journey, always remember you are not alone. Find more information, register as a guest, or leave a review by going to the website onein3podcast.com. That's the number one, I and the number three podcast.com. Follow one and three on Instagram, Facebook, and Twitter at one and three podcasts. To help me out, please remember to rate review and subscribe. One and three is a.5 Panoy production. Music written and performed by Tim Crow.