Exploring the dynamics between homelessness and healthcare access for Aboriginal and Torres Strait Islander women with traumatic brain injury from family violence: a qualitative study.

backgroundHomelessness is a significant issue in the context of violence, particularly for Indigenous women in settler colonial countries, as are the long-lasting impacts of violence such as traumatic brain injury (TBI) including concussion. Understanding of the relationship between homelessness and healthcare access for TBI from violence among Indigenous women is critical for informing service delivery; however, research in this area remains limited. Situated within the broader experiences of accessing healthcare following violence-related TBI, this study aimed to explore the relational dynamics between violence, homelessness, healthcare access, and the implications for long term recovery and wellbeing.

methodsUsing purposive and snowball sampling, semi-structured interviews and focus groups were completed with 18 Indigenous women who have experienced TBI from violence, 28 community members, and 90 community-based frontline workers to gather insights into the experiences of living with TBI family violence or supporting someone with this injury. All data were transcribed verbatim and analyzed using thematic analysis.

resultsTwo themes were identified regarding how responses to family violence-related homelessness created barriers for Indigenous women to access healthcare for TBI: (1) Housing service barriers affect access to healthcare and TBI management, and (2) The (in)visibility of TBI within crisis accommodation and housing services. The dominant experience for Indigenous women who had experienced violence and homelessness was characterized by complexity, uncertainty, and distress, largely due to service delays and barriers encountered across housing pathways. Some Indigenous women were required to relocate away from their home region to secure temporary accommodation. While crisis accommodation services were widely viewed as places of safety, many did not consider TBI in environmental design or service delivery. Multi-agency case management and outreach were identified as valuable approaches for improving healthcare access.

conclusionsThe findings illustrate the importance of TBI-informed policy and practice within housing and homelessness services, especially for Indigenous women in rural and remote regions, alongside strengthened workforce training. Stronger linkages between women's shelters, housing services, and healthcare systems - including concussion clinics - are critical for supporting both immediate and long-term care. Needs-based funding is required to ensure regional and remote housing systems can support women-led responses, including more streamlined transitions from crisis or short-term accommodation to secure housing.