Published February 19, 2026
Maggie Ferguson, project director for the Disability and Injury Prevention Programs at the Iowa Department of Health and Human Services, is shining a light on brain injury in Iowa – a common, often undiagnosed chronic condition that can cause lifelong challenges without an individual’s awareness.
Brain injuries affect thousands of Iowans each year and often result from falls, motor vehicle crashes, sports injuries, or strokes. Many of these injuries go unreported, especially mild traumatic brain injuries which are commonly referred to as concussions. Some people recover quickly, while others live with lasting effects from a brain injury.
“Living with chronic brain injury can mean unpredictable symptoms that can affect work, relationships and daily life,” Ferguson said. “Symptoms may stay the same, or they can get better or worse. An individual’s symptoms may seem to go away but come back later, especially if the individual experiences stress or fatigue.”
Iowa HHS is training and educating partners around the state to screen for lifetime brain injury. According to the 2023 Iowa BRFSS survey, approximately 570,000 adult Iowans (26%) ages 18 and older have experienced a brain injury. The survey asked participants to recall previous head or neck injuries, including experiences in which they were knocked out or lost consciousness as a result of injury.
The majority of participants sustained their first brain injury during early to late adolescence, and many continued to feel its effects later in life. For example, 22.5% of first-time brain injuries occurred between ages 15 and 18 years old, and 20% of 65 to 74 years old were still experiencing symptoms from a brain injury during that stage of life. Iowans with a history of a brain injury were also more likely to report mental distress, depression, and binge drinking compared to those without such a history.
Here, Ferguson discusses why lifetime brain injury screening is important, why proper treatment and prevention are critical for young people, and how Iowa is creating stronger brain injury programming across the state.
How are Iowans affected by brain injury?
Brain injuries affect thousands of Iowans each year, often resulting from falls, motor vehicle crashes, sports injuries, or strokes. These injuries can lead to long-term challenges with memory, behavior, and physical health, impacting employment, education, and family life.
The economic burden is significant, with increased healthcare costs and lost productivity. Prevention and proper treatment improve quality of life and reduce these costs, making brain injury a critical public health issue for all Iowans.
Why is it important to screen for a lifetime history of brain injury, including mild concussions?
Many brain injuries go undiagnosed, especially mild traumatic brain injuries, yet the injury can have lasting effects. Screening for a lifetime history helps identify significant and cumulative injuries that may contribute to mental health issues, substance use, or chronic disability. This information allows providers to tailor treatment plans and connect individuals to appropriate supports.
For the individual, this may be the first time they have made the connection between the experiences they have had, such as surviving domestic violence or a drug overdose, and cognitive challenges they are currently experiencing. While screening is not diagnostic, it is a tool that can start a conversation which can lead to better outcomes and reduce long-term complications.
While managing a chronic condition, like brain injury, can be challenging, many individuals are able to have an engaging and meaningful life. Screening and ongoing support can help identify needs early and improve quality of life.
Why is brain injury prevention and proper treatment so important for young people?
Brains continue to develop through our early twenties, so injuries during this key developmental period scan affect learning, emotional regulation, and behavior. Proper treatment and prevention are essential to avoid long-term consequences. Parents and schools should implement concussion protocols, encourage helmet use, and support safe sports practices.
For example, schools can adopt return-to-learn and return-to-play policies to ensure students are supported and monitored throughout all phases of return to activity. Iowa schools can access resources like the Teacher Acute Concussion Tool by emailing brain.injury@hhs.iowa.gov.
What is the relationship between brain injuries, substance use disorders, and mental health conditions?
Brain injuries often intersect with substance use disorders and mental health issues, creating complex challenges. Alcohol and drug use may increase the risk of injury, while brain injury can lead to depression, anxiety or suicidal thoughts. Integrated care that screens for brain injury in behavioral health settings is key to breaking these cycles and improving recovery by tailoring approaches to support the needs of individuals after brain injury.
How is Iowa HHS incorporating lived experiences and partnering on this work?
Iowa HHS actively includes individuals with brain injury and their care partners in the Iowa HHS Brain Injury Advisory Committee. In 2025, the Iowa HHS Brain Injury Program conducted nine listening sessions across Iowa and fielded surveys to gather information about individual lived experiences to ensure programs support real needs.
For example, information gathered was used by the Advisory Committee to draft Iowa’s 2026-2030 State Plan for Brain Injuries. This plan serves as the roadmap for the Iowa HHS Brain Injury Program and statewide partners to implement strategies for systems change as well as prevention and awareness efforts.
A key partnership is with the Brain Injury Association of Iowa (BIAIA). Through a contract with BIAIA, Iowa HHS disseminates information statewide to service providers and individuals about brain injury. BIAIA also provides a service called Brain Injury Resource Facilitation, which is provided at no cost to the individual, their family, or other supports to give information and support related to navigating community, medical and general life challenges after brain injury.
If you would like to talk to a Brain Injury Resource Facilitator, please contact BIAIA by calling 855-444-6443 or emailing info@biaia.org.
How has brain injury programming evolved over time?
Brain injury programming has shifted from focusing primarily on acute care to emphasizing long-term support and community integration. We now have better screening tools, stronger prevention strategies, and greater inclusion of lived experience in program design. Partnerships across health, education, and social services have expanded, creating more holistic, person-centered approaches. This evolution reflects a growing understanding of brain injury as a lifelong, chronic condition requiring comprehensive support.
Some resources:
This new document communicating about brain injury was developed by brain injury advocates and individuals with brain injury as a resource to help with de-stigmatizing brain injury.
NASHIA has a number of resources about supporting individuals with brain injury at Resources List — NASHIA | National Association of State Head Injury Administrators
Evaluating youth concussion recovery in Iowa (UI IPRC blog post)