Free Tool: Prescreening for Lifetime History of TBI and other Acquired Brain Injuries

OSU TBIID and ABI prescreen.pdf

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Pediatric Brain Injury Prescreener.pdf

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Brain injury doesn’t hide. Systems fail to look.

Acquired brain injury is one of the most common, consequential, and systematically missed conditions in health care. It is not invisible because it is undetectable. It is invisible because the systems tasked with identifying it (primary care, emergency medicine, behavioral health, school systems) are not designed to look for it in the people most likely to have had a head injury.

We know that screening works. A validated, free tool exists. And yet most providers never use one. The question is not whether we can screen for brain injury. The question is who gets screened, who doesn’t, and what systems produce that gap.

The Tool: OSU TBI Identification Method

We recommend the Prescreening for Lifetime History of TBI (adapted from the OSU TBI-ID), validated by the Ohio Valley Center for Brain Injury Prevention and Rehabilitation at Ohio State University (Corrigan & Bogner, 2007). The OSU TBI-ID is a structured interview that elicits lifetime history of brain injury in 3–5 minutes. It avoids relying on diagnostic terminology your client may not recognize, instead asking about specific injury events, changes in consciousness, and persisting symptoms. It has been validated across clinical settings including substance use treatment, corrections, domestic violence services, and aging populations (Bogner & Corrigan, 2009; Corrigan et al., 2012).

We have adapted this screener for pediatric populations, to be delivered to a child’s parent or caregiver. Both versions are available as free downloads above.

Deliver this screener during an annual exam, or add it to intake documents for patients presenting with persistent symptoms, complex trauma histories, involvement in the justice system, experiences of intimate partner violence, or histories of military service or contact sports.

It is validated, quick to administer, and easy to interpret. You may administer it verbally or give it in written form.

A Note on the Tool’s Limitations

The OSU TBI-ID was developed and primarily validated within U.S. academic medical settings. Its initial validation populations were recruited from substance use treatment programs (Corrigan & Bogner, 2007). While subsequent studies have extended its use to corrections, domestic violence, and veteran populations, there is limited published validation data with Indigenous communities, immigrant and refugee populations, or non-English-speaking populations. The tool’s reliance on self-report, while a strength in many ways, assumes a model of disclosure that may not account for cultural frameworks around injury, stigma, or different relationships to medical systems. Use it! It is the best validated screener available. And also know that it was built within a specific epistemological tradition that does not represent everyone it needs to reach.

Who Gets Missed—and Why

Screening gaps do not fall randomly. They track along the same lines of structural power that shape every other health outcome: race, gender, insurance status, geography, and mechanism of injury. Understanding who is most likely to go unscreened is the clinical and ethical foundation for why universal screening matters.

Intimate partner violence (IPV) as an undercounted source of brain injury. Dr. Eve Valera’s research at Harvard Medical School and Massachusetts General Hospital has documented that brain injury among women who experience IPV is pervasive, neurologically significant, and almost entirely unaddressed by existing systems. Her team has found that even among women living in the community, rates of partner-inflicted brain injuries are strikingly high, with persisting neurobehavioral consequences long after the most recent injury (Valera et al., 2019; Valera & Berenbaum, 2003). Strangulation assaults, a common feature of IPV, cause hypoxic-ischemic brain injury that is frequently unrecognized (Valera et al., 2022). IPV-related brain injury represents a distinct clinical phenotype that co-occurs with psychological trauma and requires trauma-informed, brain injury-informed approaches that most providers are not trained to deliver (Esopenko et al., 2024). Domestic violence screening rates in brain injury clinics have not been formally studied, and screening rates in other medical specialties remain low (Chan et al., 2024).

This is what Diagnostic Exile looks like: A survivor’s brain injury is never named because no one in the system was trained to ask about it in the context of violence.

Racial and ethnic disparities across the entire TBI continuum of care. The CDC documents that American Indian/Alaska Native people have the highest rates of TBI-related hospitalizations and deaths of any racial or ethnic group in the United States. Non-Hispanic Black and Hispanic patients are less likely to receive follow-up care and rehabilitation after TBI compared to White patients (CDC, 2025). A narrative review by Saadi et al. (2022) found that racial and ethnic disparities span the full spectrum of TBI care, from acute diagnosis through long-term outcomes, and that these disparities are not explained by injury severity. White patients are more likely to be discharged to inpatient rehabilitation; Black patients are more likely to be discharged home (Lorenz et al., 2023). Racial and gender minorities remain underrepresented in TBI clinical trials, producing an evidence base that does not reflect the populations most affected (Bah et al., 2023). Race is a social category, not a biological one, thus these disparities reflect structural racism in health care systems, not differences in bodies (Doan et al., 2025).

Insurance status as a gatekeeper for diagnosis. Uninsured patients with suspected TBI are less likely to receive neuroimaging, less likely to receive inpatient rehabilitation, and less likely to access the specialist referrals including neuropsychology and rehabilitation psychology, which constitute the standard pathway to diagnosis and treatment (CDC, 2025; Gao et al., 2018). Insurance-gated access to neuropsychological evaluation is a structural justice issue that disproportionately affects Black, Indigenous, Latine, rural, and economically marginalized survivors.

Geographic barriers. As many as 30 million Americans do not have access to Level I or II trauma care within an hour of where they live. People in rural areas are more likely to die from TBI (CDC, 2025). For those who survive, the specialist pipeline, again, neuropsychologists, rehabilitation psychologists, and brain injury-informed therapists, is concentrated in urban academic medical centers, leaving rural, reservation, and frontier communities without meaningful access to diagnosis or treatment.

Other under-screened populations. People who are currently or formerly incarcerated carry extraordinarily high rates of lifetime TBI—studies using the OSU TBI-ID in corrections settings have found prevalence rates between 36% and 88% (Bogner & Corrigan, 2009; Diamond et al., 2007). Veterans and service members experience TBI from blast exposure, training injuries, and military sexual trauma. Refugees carry high and largely unassessed rates of TBI from conflict-related violence. Children in systems of foster care or juvenile justice are under-screened despite elevated risk. Each of these populations is more likely to be Black, Indigenous, or from a Global Majority community, making the screening gap an expression of intersecting structural harms, not isolated clinical oversights.

What to Do With a Positive Screen

A positive screen is not a diagnosis. It is a signal that this person’s brain may have been injured, that the injury may be contributing to their current presentation, and that they deserve a system that takes that seriously. What you do next depends on what resources are available, and it is important to act regardless of whether the “ideal” referral pathway is accessible.

Clinical Referral Pathway

Refer to our Brain Injury Therapy clinci for:

• Symptom and adaptive functioning evaluation with a trauma-informed, culturally responsive, brain injury-informed lens, under Colorado Licensed Psychologists

• Group, individual, relationship, or family therapy focused on brain-based trauma, identity, and neurological function

• Cognitive skills retraining and adaptive support

• Collaborative care planning and resourcing with primary and specialty providers

Connect them with their local chapter of the Brain Injury Association of America for peer support, resource navigation, and advocacy.

Specialist Referral (When Accessible)

If the client has insurance that covers specialist evaluation, refer to a Neuropsychologist for comprehensive evaluation of the neuropsychological, adaptive, and functional consequences of the injury. Then refer to a Rehabilitation Psychologist for cognitive therapy and to address difficulties identified in evaluation.

If the injury occurred within the last 6 months, consider a DTI scan (Diffusion Tensor Imaging) if the client’s insurance will cover it. DTI can detect white matter disruption not visible on standard MRI or CT. However, a negative imaging result does not rule out brain injury. Many brain injuries, particularly from repetitive subconcussive impacts, strangulation, or blast exposure, produce functional impairment without findings legible on current imaging technology. Do not allow the absence of scan findings to override a person’s reported symptoms. The medical gaze that requires visible, scannable pathology to confer legitimacy is itself a barrier to recognition.

When Specialist Access Is Not Available

If your client does not have insurance, does not have access to neuropsychological evaluation, or lives in a community without specialist providers, this does not mean they do not have a brain injury. It means the system has failed to build a path to diagnosis for them.

In these situations, you can still:

• Document the positive screen and the clinical presentation in the person’s record

• Adjust your treatment approach to be brain injury-informed: Slower pacing, repetition, written supports, and environmental modifications.

• Connect them with peer support through the Brain Injury Association of America or local brain injury support groups

• Explore community-based, spiritual, cultural, and relational healing practices that the person identifies as meaningful. These healing pathways are clinically, neurologically, psychologically, and personally legitimate pathways, not alternatives to “real” treatment.

• Advocate for expanded access to brain injury services in your system, your community, and your state!

• Contact us at Brain Injury Therapy for consultation, collaborative care planning, and help navigating resource barriers

Screening Is a Justice Practice

Not sure where to start with a client? Having trouble connecting with a client and suspect a brain injury? Contact us. Let’s work together to help your client receive the recognition and services they deserve.

Screening is not just clinical due diligence. For survivors that systems have failed to see, survivors whose brain injuries were never named because they were poor, or uninsured, or Indigenous, or Black, or women, or incarcerated, or undocumented, or all of these at once, screening is the first step toward recognition. And recognition is the precondition for care.

Screen for brain injury without jumping to an MRI first.

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References

1. Bah, M. G., Naik, A., Barrie, U., et al. (2023). Racial and gender disparities in traumatic brain injury clinical trial enrollment. Neurosurgical Focus, 55(5), E11.

2. Bogner, J., & Corrigan, J. D. (2009). Reliability and predictive validity of the Ohio State University TBI Identification Method with prisoners. Journal of Head Trauma Rehabilitation, 24(4), 279–291.

3. Centers for Disease Control and Prevention. (2025). Understanding health disparities in traumatic brain injury (TBI) & concussion. https://www.cdc.gov/traumatic-brain-injury/health-equity/index.html

4. Chan, J. P., Harris, K. A., Berkowitz, A., & Valera, E. M. (2024). Experiences of domestic violence in adult patients with brain injury: A select overview of screening, reporting, and next steps. Brain Sciences, 14(7), 716.

5. Corrigan, J. D., & Bogner, J. (2007). Initial reliability and validity of the Ohio State University TBI Identification Method. Journal of Head Trauma Rehabilitation, 22(6), 318–329.

6. Corrigan, J. D., Bogner, J., & Holloman, C. (2012). Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Injury, 26(2), 139–150.

7. Diamond, P. M., Harzke, A. J., Magaletta, P. R., Cummins, A. G., & Frankowski, R. (2007). Screening for traumatic brain injury in an offender sample: A first look at the reliability and validity of the Traumatic Brain Injury Questionnaire. Journal of Head Trauma Rehabilitation, 22(6), 330–338.

8. Doan, V. G., et al. (2025). Racial and ethnic disparities associated with traumatic brain injury across the continuum of care: A narrative review and directions for future research. [As cited in Brain Injury Association of America, 2025.]

9. Esopenko, C., Jain, D., Adhikari, S. P., ... Valera, E. M., ... Wilde, E. A. (2024). Intimate partner violence-related brain injury: Unmasking and addressing the gaps. Journal of Neurotrauma, 41(19–20), 2219–2237.

10. Gao, S., Kumar, R. G., Wisniewski, S. R., & Fabio, A. (2018). Disparities in health care utilization of adults with traumatic brain injuries are related to insurance, race, and ethnicity: A systematic review. Journal of Head Trauma Rehabilitation, 33(3), E40–E50.

11. Lorenz, L. S., et al. (2023). [As cited in CDC, 2025; and BIAA, 2025.] White patients more likely to be discharged to inpatient rehabilitation compared to racial/ethnic minorities.

12. Saadi, A., Bannon, S., Watson, E., & Vranceanu, A. M. (2022). Racial and ethnic disparities associated with traumatic brain injury across the continuum of care: A narrative review and directions for future research. Journal of Racial and Ethnic Health Disparities, 9(3), 786–799.

13. Valera, E. M., & Berenbaum, H. (2003). Brain injury in battered women. Journal of Consulting and Clinical Psychology, 71(4), 797–804.

14. Valera, E. M., Cao, A., Pasternak, O., et al. (2019). White matter correlates of mild traumatic brain injuries in women subjected to intimate-partner violence: A preliminary study. Journal of Neurotrauma, 36(5), 661–668.

15. Valera, E. M., Daugherty, J. C., Scott, O. C., & Berenbaum, H. (2022). Strangulation as an acquired brain injury in intimate-partner violence and its relationship to cognitive and psychological functioning: A preliminary study. Journal of Head Trauma Rehabilitation, 37(1), 15–23.