Brain Injury and Child Welfare Best Practice: 

A Guide and Tools for State Agencies

May 31, 2023

TBI TARC is supported by contract number 

HHSP233201500119I from the U.S. Administration for 

Community Living, Department of Health and Human 

Services, Washington, D.C. 20201

1
Welcome to Today’s Webinar

Terry

Camacho- Gonsalves

Director

Traumatic Brain Injury 

Technical Assistance 

and Resource Center 

(TBI TARC)

Maria Crowley

TA Lead 

TBI TARC

Judy Dettmer

TA Lead 

TBI TARC

2
3

Webinar Logistics

• Participants will be in listen-only mode during the webinar. 

Please use the chat feature in Zoom to post questions and 

communicate with the hosts. 

• During specific times in the webinar, we will have opportunity 

to respond to questions that have been entered into chat.

• The webinar will be live captioned in English and live 

interpreted in Spanish.

• Live English captions can be accessed by clicking the “CC” 

button at the bottom of your Zoom screen.

• Live Spanish interpretation can be accessed by clicking the 

“interpretation” button at the bottom of your Zoom screen 

(world icon). Once in the Spanish channel, please silence the 

original audio. 

• Se puede acceder a la interpretación en español en vivo 

haciendo clic en el botón "interpretation" en la parte inferior de 

la pantalla de Zoom (icono del mundo). Una vez en el canal 

español, por favor silencie el audio original.

• This live webinar includes polls and evaluation questions. 

Please be prepared to interact during polling times. 
Feedback and Follow-Up

• After the webinar, you can send follow-up questions 

and feedback to tbitarc@hsri.org

(Please note: This email address will not be monitored 

during the webinar.)

• A recording, including a pdf version of the slides, will 

be available on the ACL website (acl.gov)

4
Who’s Here?

“In what role(s) do you self-identify? Select all that apply.”

1. Person with a traumatic brain 

injury (TBI) or other disability

2. Family member or friend of a 

person with a TBI or other 

disability

3. Self-advocate / advocate

4. Peer-specialist / peer-mentor

5. Social worker, counselor, or care 

manager

6. Researcher / analyst

7. Service provider organization 

employee

8. Government employee (federal, 

state, tribal, or municipal)

5
Speakers

Jim Pender

Brain Injury Grant 

Manager

Iowa Department 

of Health and 

Human Services 

Kelly Miller

Project Manager

MINDSOURCE

June Klein- Bacon, 

Associate Director

Brain Injury 

Alliance of Iowa 

Dr. Drew 

Nagele

Chief Clinical 

Officer

TBGHealth

Wendy 

Ellmo

Brain Injury 

Specialist

Brain Links, 

Tennessee Disability 

Coalition

6
AGENDA

Background: Brain Injury & Child Welfare

The Child Welfare Ad Hoc Committee

Contents of the Best Practice Guide

Key Takeaways

Next Steps

8
Brain Injury and Child Welfare

• In 2014, more than 812,000 children and 1.7 million adults were treated for 

TBI.

• 25-42% are likely to go undiagnosed1

• This means there are both children and caregivers with BI in the CW system that are not 

identified

• Brain injuries are often misdiagnosed2 

• After BI, there are often cognitive, emotional and behavioral difficulties3

• Impulsivity, aggression, emotional reactivity, language deficits, impaired attention, 

processing speed and memory loss.

• In 2019, parental rights were terminated 71,335 times in the U.S.4

8
Parenting Issues After Brain Injury

• Change the way they care for and interact with the child

• Difficulty controlling emotions

• Influence patterns of misusing substances5

• Difficulty understanding court and/or child welfare information

• Forget court dates, lose track of time, arrive late to meetings, forget info 

from meetings

• Difficulty prioritizing and organizing to meet child’s needs

9
Challenges for Children After Brain Injury

• Impaired executive functioning

• Decreased self-esteem

• Increased peer victimization

• Difficulty adjusting to new environments

• Difficulty in school

• Challenges creating and maintaining friendships and forming 

healthy attachments

• May lead to problems with juvenile justice, mental health, 

substance abuse and more

The full impact may not be known until adulthood6

10
Removal 

from the 

Home

Feeling 

Apprehended

Feeling At 

Fault

Bewilderment

Loss

Feeling 

Unsupported

Abandonm

ent

Misunderstood

Helpless

See reference 7

11
Benefits of Keeping Families Together

Social/Emotional

• Separating a child from their parent(s) in some cases may be worse than leaving 

the child at home.

Financial

• Every year, ~ $124 billion spent on treatment and care of children in foster care 

system8

• Cost per child in placement services alone: $150,000 - $250,0009

12
Helping State Child Welfare Systems

• Identify brain injury in both parents and 

children, 

• Provide accommodations for them and 

• Monitor their progress 

...will likely improve outcomes for families. 

13
The Start of an Ad Hoc Committee

...Iowa gets the ball rolling

• 2020, Iowa Dept of Public Health asked the TARC 

• To conduct a literature search on adults with BI involved in the 

Child Welfare System

• To find out what other ACL grantees were addressing this issue

Results

• No states directly addressing

• Tennessee was providing training only

14
Inaugural Leading Practices Academy

Sponsored by NASHIA

Iowa proposes intersection of BI and Child Welfare be the focus of a 

NASHIA Leading Practices Academy. 

Iowa is the first member.

15
The Child Welfare and Brain Injury 

Ad Hoc Committee Begins

• The TARC facilitates calls with states interested in forming a workgroup on the issue.

• Iowa, Tennessee, Colorado, Connecticut, Pennsylvania and Alabama agree to participate.

• TN hosts a call with states and the TN Department of Children’s Services for more fact-finding.

• All states agree the intersection is underserved and the workgroup should be formalized.

• NASHIA and the ACL recognize the group as an Ad Hoc Committee.

• Jim Pender from Iowa and Wendy Ellmo from Tennessee agree to serve as co-chairs.

• The Ad Hoc Committee will continue to work over the 2021-2026 grant cycle to develop products in 

support of this intersection

16
Decision to Create a 

Guide & Toolkit

Three Subcommittees:

1. Guide Writing

2. Toolkit – Supporting Materials

3. National Training

https://www.nashia.org/acl-child-welfare

17
Brain Injury & Child Welfare 

Best Practice Guide

Judy Dettmer, BSW

Director of Strategic Partnerships

NASHIA

https://www.nashia.org/cj-bestpractice-guide-attachments-resourcescopy

18
Contents of the Guide (1 of 7)

Introduction to This Guide

Overview of Brain Injury as A Risk Factor

Overview of The Child Welfare System

Loss of Parental Rights & Financial 

Considerations

Child Welfare System Engagement Model: 

Possible Entry Points 

Components of a Brain Injury Screening 

and Identification Approach 

Training and Education for Child 

Welfare Personnel and People Served

Data Collection and Outcomes 

Evaluation

Sustainability and Funding Strategies

Key Takeaways

References

19
Child Welfare System

Brief Overview

• Complex systems with procedures 

varying by state

• Each state determines how child 

maltreatment is defined, what is 

required by child protective services 

and their interventions

• A group of services designed to 

promote the well-being of children by

 ensuring safety

 achieving permanency

 strengthening families

20
Child Welfare System

Services

Public agencies (department of social services, child and family services) often 

contract with community-based organizations to provide

In-home family services

Foster care

Residential treatment

Mental health care

Substance use treatment

Parenting skills

Domestic violence services

Employment assistance

Financial and housing assistance

21
Child Welfare System

Involvement

• Families become involved with the CW system when there are reports 

of alleged child abuse or neglect by a parent or primary caregiver

• Child maltreatment by a stranger or acquaintances are the responsibility 

of law enforcement

22
Child Welfare System

Typical Actions

• Typical Actions

• Assess & screen reports - determine response for further action

• Investigate reports

• Support Families

• Provide temporary safe shelter

• Return children to their families when safe or find other permanent 

arrangements

23
Contents of the Guide (2 of 7)

Introduction to This Guide

Overview of Brain Injury as A Risk Factor

Overview of The Child Welfare System

Loss of Parental Rights & Financial 

Considerations

Child Welfare System Engagement Model: 

Possible Entry Points 

Components of a Brain Injury Screening 

and Identification Approach 

Training and Education for Child 

Welfare Personnel and People Served

Data Collection and Outcomes 

Evaluation

Sustainability and Funding Strategies

Key Takeaways

References

24
Child Welfare Engagement Model

Evaluating potential entry 

points for

• Brain injury screening

• Brain injury related training

• Referral points for Resource 

Facilitation or brain injury 

services 

• Technical assistance

Inspired by the Sequential Intercept Model10

25
CW Engagement Model Entry Points (1 of 2)

26
CW Engagement Model Entry Points (2 of 2)

27

lepartof- Level of Safety and/or Risk 

Detennination 

Investigation and Assessment Intervention Planning Permanency 

State agency evaluates reports of 

suspected child maltreatment to 

determine if additional assessment is

required. *States must engage in the 

Indian Child Welfare Act (ICWA) 

federal requirements for individuals 

ith Native American heritage. 

The assigned agency completes an 

assessment to evaluate safety 

and/or risk factors. 

The assigned agency explores 

mitigation risk efforts for safety 

and/or risk. Families that do not 

present additional safety and/or risk 

concerns may be referred elsewhere.

Safety and/or risk mitigation efforts 

are recommended by the agency that

may include voluntary or involuntary 

services, possible removal of 

child(ren) from the family home. Court 

engagement when necessary will 

determine next steps with the goal of 

reunification of the family. These 

steps may include engagement with 

community based organizations. 

Goals in a child welfare system are to 

mitigate concerns related to safety 

and/or risk with child welfare have 

varying outcomes. Reunifying family 

units as a permanent solution is ideal,

when this is not possible other 

permanent solutions are evaluated. 

**Permanency options may include 

seeking placement for children with 

kin, fictive kin, foster or adoptive 

homes. 
Child Welfare System Engagement

28

Child Welfare System 

Engagement Model 

Natural supports Community based organizations specializing in: Judicial related services: 

(9161)1 49,8:~ 5001 

(ill 6) 498-5006. (FAX) 

(9161)1 49,8:~ 5001 

(ill 6) 498-5006. (FAX) 

(9161)1 49,8:~ 5001 

(ill 6) 498-5006. (FAX) 

• Birth families 

• Educational services and supports 

• Foster families 

• Permanency resources 

• Behavioral/ mental health 

• Foster/ Adoptive parent organizations 

• Human service agencies 

• Intimate partner violence 

• Parent skill development 

• Primary health physician or other health care 

• Substance use treatment 

• Attorneys 

• Court Appointed Special Advocate (CASA) 

• Family/Specialty court programs 

• Guardian Ad Litem (GAL) 

• Law enforcement 
Contents of the Guide (3 of 7)

Introduction to This Guide

Overview of Brain Injury as A Risk Factor

Overview of The Child Welfare System

Loss of Parental Rights & Financial 

Considerations

Child Welfare System Engagement Model: 

Possible Entry Points 

Components of a Brain Injury Screening 

and Identification Approach 

Training and Education for Child 

Welfare Personnel and People Served

Data Collection and Outcomes 

Evaluation

Sustainability and Funding Strategies

Key Takeaways

References

29
Components of a BI Screening & Identification 

Approach

Considerations for Screening

Screening for lifetime history of Brain Injury

• Ohio State University Traumatic Brain Injury Identification Method (OSU 

TBI-ID)

• Modified OSU TBI-ID

• Some states recommend their own 

Additional Screening Tools

• HELPS Brain Injury Screening Tool

• Brain Check Survey Colorado State University: Ages 5 to 21 

• SAFE CHild Screening Tool: Birth to 3 Years Old

• SAFE CHild Screening Tool: 3 Years Old to Kindergarten

• Brain Injury Screening Questionnaire (BISQ)

30
Components of a BI Screening & Identification Approach: 

Considerations for Screening

Symptoms Questionnaires

• Adult Symptom Questionnaire

• Juvenile Symptom Questionnaire

Both have an accompanying set of accommodations to address 

symptom to improve ability to engage in child welfare process

• Memory, concentration, delayed processing, etc.

31
Components of a BI Screening & Identification 

Approach: Temporary Approach

Temporary Alternative Screening Approach - For states reluctant to add another 

screening

Use their current intake

* Next to all items indicating a brain injury could have occurred

• Physical assault/abuse, domestic violence, anoxia from overdose, exposure to toxins, stroke, 

prior brain infections, serious injury, etc.

** Next to all items indicating possible after-effects of a brain injury

• Learning disability, developmental delays, behavioral issues, mental health challenges, 

alcohol/drug misuse, court actions, etc.

32
Components of a BI Screening & Identification Approach:

Temporary Approach - Key

Temporary Alternative Screening Approach

Place a Key on the intake form explaining the symbols:

* Indicates an incident where a brain injury may have occurred

** Indicates possible after-effects of a brain injury

Add a note stating: 

“Further brain injury screening, evaluation, education, 

treatment and/or accommodations may be necessary.”

33
Components of a BI Screening & Identification Approach:

Downstream Consequences

• Identification allows for immediate intervention, lifelong monitoring

to prevent undue stress and struggle and prevent common 

downstream consequences

 Common downstream consequences:

 Domestic Violence

 Homelessness/housing instability

 Pain

 Substance misuse

 Mental health issues, including increased risk of suicide

 Juvenile and criminal justice issues

34
Components of a BI Screening & Identification Approach

Neurocognitive Screening

The guide provides an explanation of Neurocognitive Screening

Link to Neuropsychological Screening Tests for Mental Health 

Clinicians: An Intensive Short Course by Kim Gorgens, PhD.

https://www.nashia.org/np-modules#!form/Neuropsych

35
Components of a BI 

Screening & 

Identification Approach

Service Coordination/Resource Facilitation

A main reason to screen is to guide targeted 

interventions to improve outcomes.

Resource facilitation is designed to provide 

services and supports.

RF has been shown to increase community 

participation and employment.11,12

36
Service Coordination/Resource Facilitation

• Resource Facilitation should be built into the protocol:

• By incorporating RF as a referral 

• By training Child Welfare staff so state RF is not overwhelmed

• Accommodations/strategies

• Referrals and resources within the community

• By training other existing infrastructure

• Schools

• Mental health providers

• Substance use facilities

• Vocational Rehab services

• Resource Facilitators may need to be trained in the basics 

of the Child Welfare system

37
Modifying Programming/Accommodating for 

Impairment

• Accommodations have to be feasible for the setting (home, 

school, work)

• Contextually relevant

• Easy to use

• Child welfare workers need to be trained

• How to adapt expectations

• How to identify what strategy to use

• How to teach people to successfully use strategies

38
Strategy and Accommodation Tools (1 of 2)

• Model Systems Knowledge Translation Center has videos and fact sheets that could be 

useful: https://msktc.org/tbi

• The Ohio Valley Center for Brain Injury Prevention and Rehabilitation, with contributions 

from the MN Department of Human Services, booklet called, “Accommodating for the 

Symptoms of Brain Injury”. https://heller.brandeis.edu/ibh/pdfs/accommodating-tbi-booklet-1-

14.pdf. 

• The Ohio Brain Injury Program developed an accompanying training: http://abouttbi.org/accommodating-tbi.html

• The Rehabilitation Hospital of Indiana extensive catalog of fact sheets:

https://resourcefacilitationrtc.com/fact-sheet-catalog.

39
Strategy and Accommodation Tools (2 of 2)

• Brainstorming Solutions Tool For direct service/support providers, Brain Links, TN

• Strategies and Accommodations Tool Links difficulty identified by the 

Brainstorming Solutions Tool (above) with potentially helpful strategies. Brain Links, 

TN

40
School Specific Resources

CDC

● Returning to School After a Concussion

● A Fact Sheet for School Nurses

● Heads Up to Schools Know Your Concussion ABCs Returning 

to School After a Concussion: A Fact Sheet for School 

Professionals

● Heads Up to Youth Sports

CBIRT, University of Oregon

● 504/IEP Accommodations and Modifications in the Classroom for a Student with 

Traumatic Brain Injury

● Sample IEP Goals

● Accommodations & Modifications in the Classroom for a Student with a Traumatic 

Brain 41
More School Specific Resources

Brain Links, TN

● Symptom Tracker

● Hospital to School Transition Protocol

● School Lingo

● Traumatic Brain Injury Supporting Materials for School 

Nurses

Colorado Department of Education

● Brain Injury in Children and Youth: A Manual for 

Educators Building Blocks of Brain Development

● Get Schooled On Concussions Symptom Wheel

42
MINDSOURCE Resources

• MINDSOURCE – Self-report symptoms questionnaire 

when a person screens positive for brain injury. This tool 

is completed by the individual, then child welfare 

personnel inputs answers into on-line portal. 

• Adult link: https://mindsourcecolorado.org/adult-symptomquestionnaire/

• Children’s Link: https://mindsourcecolorado.org/juvenilesymptom-questionnaire/

• Customized tip sheets with strategies which they can share with 

the individual. Microsoft Word - CMHBooklet WORD 

5.6.19.docx (squarespace.com)

43
Contents of the Guide (4 of 7)

Introduction to This Guide

Overview of Brain Injury as A Risk Factor

Overview of The Child Welfare System

Loss of Parental Rights & Financial 

Considerations

Child Welfare System Engagement Model: 

Possible Entry Points 

Components of a Brain Injury Screening 

and Identification Approach 

Training and Education for Child 

Welfare Personnel and People Served

Data Collection and Outcomes 

Evaluation

Sustainability and Funding Strategies

Key Takeaways

References

44
Training & Education

For Child Welfare Personnel & People Served

• Training could stand alone, but we recommend it as part of the overall protocol 

where possible

• Most CW personnel have had little Brain Injury training

• First part of the protocol

• Embed within existing training structures (for sustainability)

• Include all personnel, including juvenile justice

• 3 Levels of training:

• All CW personnel

• Those involved with implementing the protocol

• Train the trainer

45
Many Trainings Linked

• From several groups

• AlabamaTBI.org

• Brain Injury Association of America

• Brain Links, TN

• BrainSTEPS Brain Injury School Consulting Program

• Center on Brain Injury Research and Training

• Colorado Department of Education

• Model Systems Knowledge Translation Center

• Ohio State University Wexner Medical Center

46
Trainings on a Variety of Topics

• What Foster Parents Need to Know about Concussion

• TBI: Impairments and Strategies

• Substance Abuse and TBI

• Brain Injury Fundamentals Certified Brain Injury Specialist

• Brain Injury and Behavior

• Brain Injury and Executive Functioning

• Memory, Depression and Relationships After TBI

47
Education for Parents with a Brain Injury

It’s important to follow up finding a history of brain injury with education.

• Helps them understand themselves in a different way

• Convey that it does not mean they cannot parent effectively

• There are strategies and resources that can help

Tip sheets, guides, booklets, parenting groups, state resources, social 

media supports, referral options, supports for their children

48
Educational Materials

• Written at the lowest grade level possible

• In Spanish and English 

• Individualized as much as possible

• Tools to educate

• Child Welfare Personnel

• Parent with Brain Injury

• Parents of Children with a Brain Injury

49
Signs & Symptoms Handouts

• Young Children

• School-Aged

• Adults

• Identifying symptoms in 

people who communicate 

without words

• For School Nurses

• For student athletes

50
Guides

● R*E*A*P An interdisciplinary community-based concussion management approach

● Get Schooled On Concussions Schools, districts and states can purchase a 

subscription; includes Teacher Acute Concussion Tool (TACT) which provides full 

Return to Learn (RTL) supports.

● Guides on what to look for when concussion symptoms should have resolved, but 

have not. Young child - adult

● Guides used after discharge from the hospital, surgery, brain injury rehabilitation, to 

help families know what problems may still occur over the child or adult’s lifetime.

● Personal Guide for Everyday Living After Concussion/Traumatic Brain Injury

Explains typical cognitive challenges following mTBI and solutions, with room for 

personalization.

51
Fact Sheets & Tools

○ 6 Types of Concussion Infographic and Fact Sheet 

○ Concussion/Brain Injury Alert and Monitoring Form Assists with tracking the 

student with a brain injury through the school system so the injury is not 

forgotten. 

○ Brainstorming Solutions Tool

○ Strategies and Accommodations Tool

○ Concussions and Mental Health

○ Mental Health and Brain Injury Quick Guide

○ Concussion Fact Sheet for Parents

○ Brain Injury and Opioid Overdose: Fast Facts National Association of State 

Head Injury Administrators

● Cognitive Strategies for Community Mental Health Traumatic Brain Injury 

Factsheets A variety of subjects. Model Systems Knowledge & Translation 

Center

52
Social Media Support

● Traumatic or Acquired Brain Injury Support Private group. There 

may be other public or private support groups in the person’s

specific community or state.

● Post Concussion Support Solutions focused, not emotional 

support. Private group

● Pink Concussions Nonprofit for women with brain injury.

● Concussion Discussions Public group

● Also check county, State-specific Brain Injury Associations, 

State-specific Brain Injury Alliances 

53
Support for When Parent Has a Brain Injury

● Parenting After a Brain Injury Booklet

● Parenting a Second Time Around (PASTA) “PASTA is a 

parenting program for relative caregivers who are not the 

biological parents 

● The Association for Successful Parenting TASP is a national 

non-profit organization "dedicated to enhancing the well-being 

of at-risk parents with learning difficulties and their children." 

● Children’s Services Practice Notes for North Carolina’s Child 

Welfare Workers Article

54
Parent with an Injury

● Parents with Intellectual Disabilities Article 

● Connecticut Parents with Differing Cognitive Abilities 

Workgroup “Training to assist providers in identifying and 

working more effectively with parents with cognitive limitations 

and their children.”

● Job Accommodation Network

● Concussion Discussions Website Great interview series

● Brainline - https://www.brainline.org/

● Supporting Parents with Disabilities for Child Welfare 

Professionals: A Desk Reference Guide Oklahoma Department 

of Human Services 

55
Supporting the Child with an Injured Parent

● Supporting Children When a Parent Has Had a Brain 

Injury (Booklet)

● Children of a Parent with a Brain Injury

● Traumatic Brain Injury Law Blog: How does a Parent’s 

Brain Injury Impact the Children?

56
Educational Handouts with Referral Options

● General information about referring to a symptom-specific specialist

● Provide specific community-based referrals when possible

○ Six Types of Concussion Infographic and Fact Sheet Concussion 

Management Protocol

○ When Concussion Symptoms Are Not Going Away: A Guide for Parents of 

Children 5 and Under

○ When Concussion Symptoms Are Not Going Away – A Guide for Parents 

of School-Aged Children

○ When Concussion Symptoms Are Not Going Away – A Guide for Adults 

with Concussion

○ A Guide to Possible Changes After Brain Injury: For School-Aged 

Children and Adults

○ A Guide to Possible Changes After a Brain Injury for Young Children

57
Contents of the Guide (5 of 7)

Introduction to This Guide

Overview of Brain Injury as A Risk Factor

Overview of The Child Welfare System

Loss of Parental Rights & Financial 

Considerations

Child Welfare System Engagement Model: 

Possible Entry Points 

Components of a Brain Injury Screening 

and Identification Approach 

Training and Education for Child 

Welfare Personnel and People Served

Data Collection and Outcomes 

Evaluation

Sustainability and Funding Strategies

Key Takeaways

References

58
Data Collection & Outcomes Evaluation

● To ensure sustainability and to scale up the protocol 

system-wide, BI programs will have to develop data 

collection protocols and research methodologies to 

● Demonstrate effectiveness

● Improved outcomes

59
Outcomes

Work with the Child Welfare System to define outcomes

• Some areas to look at:

• Compliance with treatment

• Compliance with the conditions of child welfare

• Reduced out of home placements

60
At the Start

● Solicit a partnership with a university

● Develop research questions

● Identify data that will need to be collected

● Determine where data will be collected by sites

● Develop a consent/release of information form

● Obtain approval from the Institutional Review Board

● Keep your own database if no university partner

61
Examples of Data to Collect

● Number who screen positive/negative for history of brain injury

● Number screening positive/negative for impairment

● Co-occurring disorders: substance abuse disorder and mental illness

● Demographic data

● Treatment completion

● Compliance with conditions of child welfare

● Number out-of-home placements

● Length of stay in out-of-home placement

● Placement disruptions

● Re-engagement in the child welfare system 

● Connection to community-based service coordination/resource facilitation

● Goal achievement such as sustained employment, stable housing, independence 

with finances, stability in family or significant other domain, and stable 

health/medical status

62
Contents of the Guide (6 of 7)

Introduction to This Guide

Overview of Brain Injury as A Risk Factor

Overview of The Child Welfare System

Loss of Parental Rights & Financial 

Considerations

Child Welfare System Engagement Model: 

Possible Entry Points 

Components of a Brain Injury Screening 

and Identification Approach 

Training and Education for Child 

Welfare Personnel and People Served

Data Collection and Outcomes 

Evaluation

Sustainability and Funding Strategies

Key Takeaways

References

63
Sustainability & Funding

• Plan for sustainability right from the beginning

• Cost effective 

• Easy to administer

• Staff are well trained

• Training is built in for new staff

64
Establish Effective 

Partnerships

• Child Welfare Personnel

• CW Related Organizations

• People w/in the CW system

• Universities

• Brain Injury Advocacy Organizations

• State Agency Leadership

• State Policy Makers/Legislators

65
Formalize Partnerships

• Through a Memorandum of 

Understanding (MOU)

• Background/Justification for work

• Outline of expectations

• Outline of what state agency provides

• Expected outcomes

Guide includes an example MOU

66
Produce a Body of 

Evidence

Use your evidence to

• Publish in journals

• Develop policy statements

• Justify sustainability

• Justify funding

• Communicate results

• Further blend the protocol into the 

existing framework

67
Contents of the Guide (7 of 7)

Introduction to This Guide

Overview of Brain Injury as A Risk Factor

Overview of The Child Welfare System

Loss of Parental Rights & Financial 

Considerations

Child Welfare System Engagement Model: 

Possible Entry Points 

Components of a Brain Injury Screening 

and Identification Approach 

Training and Education for Child 

Welfare Personnel and People Served

Data Collection and Outcomes 

Evaluation

Sustainability and Funding Strategies

Key Takeaways

References

68
Key Takeaways

• State Child Welfare systems are all different

• Use this Guide to figure out ways to engage with your system

• Engage partners early

• Select screening tools/methods in partnership

• Provide sustainable training

• Train in accommodations

• Data collection & evaluation are important

• Disseminate Results

69
Where the Committee 

Goes From Here

Disseminate Guide and Supporting 

Materials

• Presentations

• ACL Portal/ACL Website

• Emails to the state BI agencies and to state child 

welfare departments

• Articles for newsletters (and other places)

• Social media – create pieces to be shared

• Child Welfare Information Gateway (DHHS)

• Kids Count Foundation – endorsement 

• State Child Welfare training academy

• BIAA and USA BIA – for them to endorse and 

market

70
NASHIA’s Website

To find the Guide on Nashia.org: 

• Resources

• ACL Grantee Library, scroll down

• Child Welfare, scroll down

71
References (1 of 2) 

72

1. Centers for Disease Control and Prevention. (2014). Surveillance report of traumatic brain injury-related emergency department 

visits, hospitalizations, and deaths. https://www.cdc.gov/traumaticbraininjury/pdf/TBI-Surveillance-Report-FINAL_508.pdf

2. Iverson, G. (2006). Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Archives of Clinical 

Neuropsychology, 21(4), 303–310. https://doi.org/10.1016/j.acn.2005.12.008

3. Finnanger, T. G., Olsen, A., Skandsen, T., Lydersen, S., Vik, A., Evensen, K. A., Catroppa, C., Håberg, A. K., Andersson, S., & 

Indredavik, M. S. (2015). Life after adolescent and adult moderate and severe traumatic brain injury: Self-reported executive, 

emotional, and behavioural function 2-5 years after injury. Behavioural Neurology, 2015, 1–19.

https://doi.org/10.1155/2015/329241

4. Children's Bureau, Administration On Children, Youth And Families, Administration For Children And Families, U. S. 

Department Of Health And Human Services (2020). The AFCARS 

Report.https://www.acf.hhs.gov/sites/default/files/documents/cb/trends_fostercare_adoption_10thru19.pdf

5. Wood, R. L., & Thomas, R. H. (2013). Impulsive and episodic disorders of aggressive behaviour following traumatic brain 

injury. Brain Injury, 27(3), 253–261. https://doi.org/10.3109/02699052.2012.743181

6. McKinlay, A., Grace, R.C., Horwood, L. J., Fergusson, D. M., MacFarlane, M. R. (2009). Long-term behavioural outcomes of 

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QUESTIONS

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Real-Time Evaluation Questions (1 of 2)

• Please take a moment to respond to these six 

evaluation questions to help us deliver high-quality 

TBI TARC webinars

• If you have suggestions on how we might improve 

TBI TARC webinars, or if you have ideas or requests 

for future webinar topics, please send us a note at 

TBITARC@hsri.org

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Real-Time Evaluation Questions (2 of 2)

1. Overall, how would you rate the quality of this webinar?

2. How well did the webinar meet your expectations?

3. Do you think the webinar was too long, too short, or about right?

4. How likely are you to use this information in your work or day-to-day 

activities?

5. How likely are you to share the recording of this webinar or the PDF 

slides with colleagues, people you provide services to, or friends?

6. How could future webinars be improved?

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MEET THE PRESENTERS

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Jim Pender

MSW, LMSW

Brain Injury Grant Manager 

Iowa Department of Health and Human Services 

james.pender@idph.iowa.gov

Jim Pender, MSW, LMSW, is a native Iowan who received his Bachelor degree in Human 

Services from Grand View College in Des Moines, Iowa and Master of Social Work degree 

from the University of Iowa (Iowa City, IA). He has been a licensed social worker since 1993. 

Jim has served as the grant manager for the Administration for Community Living’s Traumatic 

Brain Injury State Partnership Program at the Iowa Department of Health and Human Services 

since 2019. Prior to that he spent 20 years at the Iowa Department of Human Services in the 

Targeted Case Management (TCM) unit. In that role he served as a targeted case manager 

(working with individuals/families on the brain injury waiver). Jim also served as a trainer and 

policy analyst for the unit. His interest in this intersection began when he worked in the child 

protection field, early in his career, but was renewed after being encouraged by a child 

advocate to screen adult caretakers, involved in the child welfare system, for a lifetime history 

of brain injury. Jim and his wife adopted several foster children two of whom have a brain 

injury.

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Kelly Miller. M.S.W.

Project Manager 

MINDSOURCE

kelly.miller@state.co.us

Kelly Miller, MSW, is a Project Manager with MINDSOURCE, Colorado’s lead 

state agency on brain injury. Prior to joining the MINDSOURCE team Kelly was 

the Executive Director of Court Appointed Special Advocates (CASA) of the 

Continental Divide. Kelly spent the first ten years of her career in the field of 

child welfare as Child Protection Caseworker/Investigator in Casper, Wyoming 

and Supervisor of Youth In Transition and Placement Services teams in Denver, 

Colorado. Kelly also has ten years of experience as a Probation Supervisor, 

which included oversight of a juvenile preadjudication program in Colorado’s 5th 

Judicial District (western mountains). Kelly earned her Master of Social Work 

degree from the University of Wyoming in 2004. 

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June Klein-Bacon, BSW, 

CBIST

Associate Director

Brain Injury Alliance of Iowa

jklein@biaia.org

June Klein-Bacon, BSW, CBIST, joined the Brain Injury Alliance of Iowa in 2013 with 

experience in HCBS services, options counseling and case management. She currently 

serves as the Associate Director and Director of Programs and Services. June 

coordinates grant and contract activities that have included projects with concussion 

management, case consultation and technical assistance for programs serving under 

and unserved individuals with multi- occurring conditions including brain injury, mental 

health conditions, substance use disorders, high-risk populations involved with the 

criminal justice system and families engaged with the child welfare systems. June also 

supervises a nationally recognized Neuro Resource Facilitation program in Iowa. June is 

involved at multiple tables for systems and public policy advocacy including the Mental 

Health Disability Services Commission, County Social Services children’s services 

advisory board and the Iowa Provider Prevention Support Services advisory board. June 

is dual licensed with the state of Iowa as a foster and adoptive parent and is passionate 

about serving children and families in the community. 

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Drew Nagele, PsyD, ABPP, 

FACRM, CBIS-AP, CBIST, CESP

Chief Clinical Officer 

TBGHealth

drew.nagele.psyd@gmail.com

Dr. Drew Nagle, is a Board-Certified Rehabilitation Psychologist trained in 

NeuroRehabilitation with a 40-year career in creating and running brain injury 

rehabilitation programs for children, adolescents, and adults with acquired brain 

injury. He is Chief Clinical Officer for TBGHealth and chairs the Advanced 

Practice WorkGroup for the Brain Injury Association of America's Academy for 

Certification of Brain Injury Specialists (ACBIS). Dr. Nagele is Co-Principal 

Investigator on 3 federal grants working with brain injury in schools, prisons, and 

juvenile justice. He is Clinical Professor at the Philadelphia College of 

Osteopathic Medicine (PCOM) teaching Neuropsychology, Neuropathology, and 

Cognitive Rehabilitation.

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Wendy Ellmo 

MS CCC/SLP, BCNCDS, CBHP

Brain Injury Specialist, Speech Language Pathologist

Brain Links, TN Disability Coalition

Wendy_e@tndisability.org

Wendy Ellmo, MS CCC/SLP, BCNCDS, CBHP, is a speech-language pathologist and Brain Injury 

Specialist for Brain Links, a TN grant-based program supporting people with brain injuries. She is 

board certified by the ANCDS in neurologic communication disorders and was the Clinical Service 

Supervisor for JFK Johnson’s Center for Head Injuries’ Cognitive Rehabilitation Department where 

she worked with people with brain injuries for twenty years. Part of a national group that developed 

practice guidelines for TBI and stroke, Wendy also authored a book of group treatment activities and 

an assessment battery for mild and moderate TBI. Wendy was a member of the Joint Coordinating 

Committee on Evidence Based Practice and an adjunct faculty member at Kean University, 

developing and teaching their first class on traumatic brain injury. She has served in many leadership 

roles, including President of the NJ Speech Language Hearing Association, and ultimately received 

their Honors of the Association Award for her distinguished service. 

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Thank You

The Traumatic Brain Injury Technical Assistance and Resources Center (TBI TARC) is 

an initiative from the Administration for Community Living that helps TBI State 

Partnership Program grantees promote access to integrated, coordinated services 

and supports for people who have sustained a TBI, their families, and their 

caregivers. The Center also provides a variety of resources to non-grantee states, 

people affected by brain injury, policymakers, and providers.

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