Brain Injuries and Homelessness

Stephanie Chassman, PhD ’22, LCSW, was struck by the vast disparities visible in her hometown of Los Angeles, California. “Within 10 miles in one city people could be living in a tent or in a mansion,” says Chassman, who wanted to do something to help. 

As an MSW student at the University of Southern California, she started to work closely with unhoused individuals during her internship at the Los Angeles Center for Alcohol and Drug Abuse. After graduation, her clinical work continued at St. Joseph Center, where she worked with individuals experiencing chronic homelessness and severe mental illness. Chassman then decided to pursue a research career to address homelessness at a systemic level. 

As a doctoral student at the University of Denver Graduate School of Social Work (GSSW), Chassman has collaborated with Professor Daniel Brisson, executive director of GSSW’s Center for Housing and Homelessness Research, and Kim Gorgens, a professor in the University of Denver Graduate School of Professional Psychology, to examine the prevalence of traumatic brain injuries (TBIs) among individuals experiencing homelessness. 

It was already known that the rates of TBI are higher among individuals experiencing homelessness compared to the general population. “We wanted to figure out if acquiring a TBI led one to experience homelessness or if the dangers of living on the streets led to TBI,” Chassman says. 

The team collected data from 115 individuals in Fort Collins and Colorado Springs, Colorado. What they found was striking: 71% of the individuals in their sample had at least one TBI, compared to 2%–8% of people in the general population. Of those with a TBI, the vast majority (74%) acquired the injury prior to becoming unhoused; 24% had a TBI before the age of 15 (signaling damage to developing brains) and 50% had multiple TBIs (compounding the damage). 

TBIs can have long-lasting physical and mental health consequences, affecting memory and cognition, emotional regulation, pain, vision and hearing, and more. Life on the street can put individuals at greater risk of acquiring TBIs, but as this new research shows, past TBIs can also increase risk for homelessness. Brain injuries are associated with lower employment rates, chronic pain may cause someone to self-medicate, cognitive issues may make it difficult for someone to manage money or remember appointments, and challenges with emotional regulation can lead to conflicts with landlords and neighbors. 

Despite the high rates of TBI among those who are unhoused, interventions and prevention strategies for individuals experiencing homelessness usually don’t screen for TBIs. Chassman says that needs to change. “Once you can screen for a TBI, you can refer people to specialty care. It’s a first step to uncovering the type of mental health and health care they need.” 

For her dissertation, Chassman examined the role of social support in the relationship between traumatic brain injury and homelessness, finding that a lack of social support contributes to housing instability for those with brain injuries. “When you have a TBI, it’s a huge impact on your family … it’s very costly, time consuming, and the burden often falls on the family,” Chassman explains. 

Chassman emphasizes the need for routine TBI screening and public health interventions that prioritize placing people in permanent housing and then focusing on treating the issues that may have contributed to housing instability. “Lowering barriers helps everyone,” she says. Even while individuals are still on the streets, screening for TBIs, helping people enroll in health insurance and providing services such as low-barrier transportation to medical appointments can improve outcomes, Chassman says. 

Chassman has relocated back to Los Angeles, where she will work as a program specialist for the VA Mental Illness Research Education and Clinical Center. There, she’ll work with veterans experiencing homelessness and mental illness as part of a research team working to generate new knowledge about the causes and treatments of mental disorders. 

“TBI impacts individuals from many different walks of life, and the consequences of TBI may lead one to experience homelessness,” Chassman says. “You want to help, and there are ways that we can. It gives me hope. There are things we can do.”