Integrating Brain Injury-Informed Practices into the Child Welfare System

By Drew Nagele, PsyD, ABPP, FACRM, CBIST, CESP

Brain injuries are often undiagnosed or misdiagnosed, creating challenges for child welfare providers, as well as families. Brain injury can bring with it cognitive challenges for parents within the system, including difficulty remembering information and appointments, slowed information processing speed, and increased impulsivity. Brain injuries can also lower a parent’s frustration tolerance, making parenting more difficult.

Impulsivity can present as an inability to control their negative emotions or influence their patterns of misusing substances. Changes in processing speed may impair a parent or caregiver’s ability to understand the information provided by courts and the child welfare system. Increased memory loss can cause parents and caregivers to forget court dates, lose track of time, or arrive late to meetings, along with having difficulty remembering information from these court dates or meetings.

Long-term symptoms of brain injury may negatively affect a parent or caregiver’s ability to follow directions and succeed within the child welfare system. Executive functioning challenges may impact a parent or caregiver’s ability to prioritize and organize to meet their children’s basic needs. This difficulty can ultimately lead to legal substantiations of neglect. When we understand the reasons behind the actions of these parents and caregivers, better accommodations can be provided to improve outcomes for children and families.

In children, brain injuries increase the risk of impaired executive functioning and cognitive ability, decreased self-esteem, and increased peer victimization. These factors can potentially affect how children respond to new environments. For example, children removed from their homes may appear defiant or unable to form healthy attachments. The presence of an unknown brain injury may help explain and/or exacerbate these common symptoms. Along with difficulties in adjusting to environments, brain injury can have long-lasting cognitive effects. These impacts might be noticed in the child’s academic performance or in symptoms that could lead to placement disruption or a mental health concern. The full impact of a brain injury occurring in childhood may not be known until young adulthood and may be a risk factor for homelessness, substance use, or involvement in the justice system. Early identification and interventions for brain injury can help decrease the likelihood of these long-term effects.

Without screening for possible brain injuries, it is not feasible to provide comprehensive support to families involved in the child welfare system. Recognizing the symptoms of brain injury will enable child welfare professionals to provide appropriate support for children and parents/caregivers with a brain injury.

The Administration for Community Living State Partnership Program’s Child Welfare and Brain Injury Workgroup has developed the “Brain Injury and Child Welfare Best Practice Guide: Information and Tools for State Agencies.” The guide focuses on promising practices to help state child welfare systems identify brain injury in parents and children. The guide also provides ways to accommodate any functional changes to improve success within the system and to help families thrive.

The guide outlines a Child Welfare System Engagement Model, revealing opportunities to evaluate entry points to provide brain injury screenings, training, technical assistance, and referrals to brain injury services, programs, and resource facilitation. It provides a support and referral protocol and explains how to modify programming for brain injury and how to accommodate impairments. The guide provides resources for all steps, as well as school-specific resources.

The guide explains a training approach for child welfare personnel and provides links to educational resources for parents/caregivers and children.

Members of the ACL workgroup are available to provide training on the overall approach and resources to state brain injury and child welfare programs and to answer questions.

If you are part of a state brain injury program interested in coordinating a training on the guide with your child welfare program, contact Jim Pender at the Iowa Department of Health and Human Services at jim.pender@hhs.iowa.gov or Wendy Ellmo with Brain Links at wendy_e@tndisability.org.

Access the Brain Injury and Child Welfare Best Practice Guide: Information and Tools for State Agencies and Supplemental Materials by visiting: nashia.org/child-welfare-guide-supplements