Understanding Brain Injury in Child Welfare:

Supporting Children and Families in Iowa

Every day, child welfare professionals and caregivers work with children and families who have experienced trauma, instability, or other life-altering events. What’s less often recognized is how frequently a brain injury may be part of that story. Understanding brain injury—and how it can affect behavior, learning, and relationships—is essential to providing the right supports for children and families.

What Is a Brain Injury?

A brain injury occurs when the brain is damaged by an external force (known as a traumatic brain injury, or TBI) or by internal factors such as lack of oxygen, infection, or exposure to harmful substances (an acquired brain injury). These injuries can happen at any age—and often go undiagnosed, especially when the effects are subtle or mistaken for behavioral issues.

Why Brain Injury Matters in Child Welfare

Children and adults involved in the child welfare system are at higher risk of having a past brain injury. Causes can include abuse or neglect, exposure to violence, accidents, substance use, or trauma at any age.

Because these experiences often overlap with emotional and behavioral challenges, the effects of brain injury may be misunderstood. Behaviors like impulsivity, memory problems, emotional reactions, or difficulty following directions are sometimes seen as noncompliance or lack of motivation.

In many cases, these behaviors are connected to how the brain has been affected. Identifying possible brain injury helps child welfare professionals offer more appropriate support and improve outcomes for both children and caregivers.

The Impact on Families and Care Providers

When brain injury goes unrecognized, both children and adults may struggle, and families or caregivers may not understand why typical strategies aren’t working. Children may experience placement disruptions, school challenges, or strained relationships. Adults with brain injury may struggle with problem-solving, communication, or follow-through, which can affect their caregiving or engagement in services.

Recognizing brain injury allows caregivers and professionals to adjust expectations and approaches—emphasizing structure, consistency, and strength-based support to improve outcomes for the whole family.

How Professionals Can Help

• Screen for possible brain injury history. Ask questions about past accidents, hospitalizations, or unexplained developmental changes.

• Collaborate across systems. Partner with medical providers, educators, and brain injury specialists to develop coordinated plans of care.

• Use brain injury-informed strategies. Provide clear instructions, reduce distractions, and reinforce routines.

• Support caregivers. Help families understand that challenging behaviors may have a neurological basis and can improve with the right interventions.

Iowa Resources and Supports

Iowa offers several programs dedicated to brain injury awareness and support:

• Brain Injury Association of Iowa (BIAIA): Provides education, training and Brain Injury Resource Facilitation

• Iowa Department of Health and Human Services – Brain Injury Program: Offers information about screening, data, and state-funded services.

• Become a Brain Injury Informed Provider: Learn more about becoming a brain injury provider in Iowa. 

Brain Injury Trainings

(Added 8/6/25)