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Brain Injury in Vulnerable Communities and the Case for Neurologic Informed Care

Categories: ACBIS Insider

By John D. Corrigan, PhD, National Research Director, Brain Injury Association of America

A recent survey commissioned by the Brain Injury Association of America suggested that almost 40 percent of adults in the U.S. have had a traumatic brain injury (TBI).1 This conclusion is consistent with other recent findings. Researchers at the Centers for Disease Control and Prevention (CDC) reviewed population-based surveys of lifetime history of TBI and observed prevalence rates ranging from 19 percent to 29 percent.2 A metanalysis of population-based surveys concluded that 18 percent of the U.S. adult population had experienced at least one TBI in their lifetime that resulted in loss of consciousness.3 An AARP poll found that 30 percent of adults over the age of 50 had experienced a TBI in their lifetime, and more than 70 percent of them had at least two TBIs.4

Having sustained a TBI is common. If all sources of acquired brain injuries are taken into account, it is quite clear that brain injury is highly prevalent in the general population.

I was recently asked, “If it’s so common, why don’t we see the effects of it?” My answer was simple: “Because society is not looking.” Specifically, the question ignores the incredible prevalence of a history of TBI in vulnerable populations. Rates of a positive history are higher than those found in the general population, and when indicators of more severe TBIs are assessed, the prevalence rates are often tripled among vulnerable populations. Here are a few examples:

  • More than half of persons unhoused have had a TBI in their lifetime, and more than one in five have had a TBI resulting in at least 30 minutes of loss of consciousness.5
  • More than 80 percent of service-seeking survivors of domestic violence report a brain injury following intimate partner violence.6
  • More than half of male prisoners – and two-thirds of female prisoners – have a history of TBI.7
  • A review of studies on mental health and substance use disorder clients observed that nearly half found rates over 50 percent.8
  • A single TBI increases the risk of later life dementia by 70 percent.9

To fully appreciate the public health burden of brain injury requires a systematic strategy for surveillance of both incidence and prevalence that captures both TBI and other causes of acquired brain injury in the general population as well as among vulnerable groups.

At the same time, service delivery systems that work with populations at greater risk of brain injury must adopt a “neurologic informed care” approach to the persons they serve who are living with consequences of brain injury. As described in the American Society of Addiction Medicine’s ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, Fourth Edition, 10 neurologic informed care is an approach to treatment, but not a treatment regimen itself. This is similar to trauma informed care that has been widely adopted to accommodate persons with a history of psychological trauma.

Neurologic informed care calls for a workforce educated about the effects of brain injury with the skills to accommodate cognitive, emotional, and behavioral effects when working with a client with a history of brain injury. Neurologic informed care also includes a treatment environment adapted to minimize negative effects on persons with brain injury, including screening all persons served for lifetime history of brain injury. Screening assures that staff are aware of all clients who might need accommodations, not just those with obvious impairments. While the ASAM criteria are for substance use disorder treatment programs, similar approaches have been proposed for programs in the criminal justice system,11 as well as agencies serving victims of intimate partner violence.12

A neurologic informed care approach is not a burdensome expectation for service delivery providers. This approach includes:

  • Ensuring that staff are educated about brain injury and its effects
  • Adopting policies and procedures that minimize barriers to the use of services by persons with brain injury
  • Screening all those served for history of brain injury
  • Based on the needs of the individual, using strategies to mitigate the effects of cognitive, emotional, and/or behavioral deficits due to brain injury

Having a history of brain injury is common, and is even more common – and more consequential – in certain populations. It was not that long ago that we ignored the needs of persons with psychological trauma when they used healthcare or social services. Those systems learned to recognize and accommodate trauma. It is within our reach to attain neurologic informed care for persons with a history of brain injury seeking care in healthcare and social service systems.

References

  1. Brain Injury Association of America. New National Survey Finds Most Americans Unaware Concussions are Traumatic Brain Injuries. Published March 6, 2025. Accessed November 26, 2025. https://biausa.org/public-affairs/public-awareness/news/new-national-survey-finds-most-americans-unaware-concussions-are-traumatic-brain-injuries.
  2. Daugherty J, Peterson A, Black L, Waltzman D. Summary of the Centers for Disease Control and Prevention’s Self-reported Traumatic Brain Injury Survey Efforts. J Head Trauma Rehabil. 2025;40(1):E1-E12. doi:10.1097/HTR.0000000000000975
  3. Seifi A, Karamian A, Lucke-Wold B, Seifi A. Prevalence of Traumatic Brain Injury in the General Adult Population of the USA: A Meta-Analysis. Neuroepidemiology. 2025;59(5):558-567. doi:10.1159/000540676
  4. AARP. Older Adults’ Experience with Traumatic Brain Injury. Published June 2, 2025. Accessed November 26, 2025. https://www.aarp.org/pri/topics/health/brain-health/traumatic-brain-injury-older-adults/#:~:text=A%20sizable%2043% 20percent%20of,%2C%20emotional%2C%20and%20behavioral%20health.
  5. Stubbs JL, Thornton AE, Sevick JM, et al. Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis. Lancet Public Health. 2020;5(1):e19-e32. doi:10.1016/S2468-2667(19)30188-4.
  6. Nemeth JM, Decker C, Ramirez R, et al. Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults. Brain Sci. 2025;15(5):524. Published 2025 May 19. doi:10.3390/brainsci15050524.
  7. Schneider BS, Arciniegas DB, Harenski C, Clarke GJB, Kiehl KA, Koenigs M. The prevalence, characteristics, and psychiatric correlates of traumatic brain injury in incarcerated individuals: an examination in two independent samples. Brain Inj. 2021;35(14):1690-1701. doi:10.1080/02699052.2021.2013534
  8. Davies J, Dinyarian C, Wheeler AL, Dale CM, Cleverley K. Traumatic Brain Injury History Among Individuals Using Mental Health and Addictions Services: A Scoping Review. J Head Trauma Rehabil. 2023;38(1):E18-E32. doi:10.1097/HTR.0000000000000780
  9. Gardner RC, Bahorik A, Kornblith ES, Allen IE, Plassman BL, Yaffe K. Systematic review, meta-analysis, and population attributable risk of dementia associated with traumatic brain injury in civilians and veterans. J Neurotrauma. (2023) 40:620–34 doi: 10.1089/neu.2022.0041
  10. American Society of Addiction Medicine. The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 4th ed. Waller RC, editor-in-chief; Boyle MP, managing editor; Hazelden Publishing; 2023.
  11. Davidson M, Reed K. Mind Matters: Building a Justice System That Is Inclusive and Responsive to Brain Injury. New York, NY: The Council of State Governments Justice Center; 2024.
  12. CDC National Center for Injury Prevention and Control. Hidden Harms: Supporting Survivors of IPV with Brain Injuries. Published September 26, 2025. Accessed November 26, 2025. https://vetoviolence.cdc.gov/apps/tbi-ipv-hidden-harms/.

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