Social work and acquired brain injury: insights from research 

by Daniel Earnshaw former Assistant Psychologist (Research) at Brainkind

 

This month we explore the research investigating the impact that social workers can have on the lives of people with acquired brain injuries (ABI). Here are some things that we have learned from the literature published in the last few years. 

A recent review by Freymüller and colleagues [1] explored the role of social workers in rehabilitation settings internationally. The review identified core activities in social work such as assessment, counselling, and education, and it highlighted the essential role of social work in interprofessional teams. It also identified a need for more rigorous research, especially in underrepresented regions, such as much of Africa and South America. Five of the 66 studies included in this review were based in the UK (8%). All focused on people with ABI and mostly referred to social work practice in a community setting.  

Another review, by Linden and colleagues, [2], a team of UK researchers, sought to identify and synthesise research in social work and its relation to acquired brain injury (ABI). Findings of the 17 studies that were included in the review revealed four common themes: 1) advocacy, 2) training and multi-disciplinary team working, 3) inclusion of social networks, and 4) societal barriers. Let’s look at these in more detail. 

Advocacy, training, and multi-disciplinary team working 

Linden and colleagues described the role social workers can have in advocating for survivors of ABI as well as in helping them with self-advocacy. However, the authors also pointed out that the ability to advocate for those with an ABI requires training and knowledge of the relevant legislation. Social workers who are equipped with that knowledge can then educate clients about their rights to ensure that they are able to advocate for themselves in the future.  

In order to advocate effectively for their clients, social workers need to be able to recognise the presence of an ABI in a person they support when necessary. But identifying ABI is complex as it is not always a visible condition. Many people with an ABI do not display obvious signs, such as a scar on the head, and some are not aware of their own cognitive, physical, or social difficulties. Spotting signs of brain injury can be especially difficult in those who present with what is called the ‘frontal paradox’. This is where someone with damage to the frontal lobe networks of the brain may appear to perform well in structured assessments and standardised tests but then experience difficulties in applying knowledge in their daily life [3]. 

Understanding this ‘hidden’ aspect of the disabilities that many people with ABI experience, can help to ensure that that their needs are reliably assessed and that they are provided with appropriate care and rehabilitation.  

Linden and colleagues’ review concluded that there was a lack of basic knowledge of ABI amongst some social workers and difficulty in recognising comorbidities of ABI in order to signpost appropriate services to their clients. One example that the authors provided was the lack of training in mental capacity legislation, with some social workers failing to conduct mental capacity assessments altogether. This can have implications for safeguarding risks, as many people who lack capacity to make a certain decision may not be offered the support that they need. They may also lack the ability to self-advocate. In those presenting with the ‘frontal paradox’, assessing mental capacity can be even more complicated. This is because the difficulties in understanding, remembering, or weighing-up information relevant to making a decision, may be hidden during structured assessments, and only become apparent when observing the person’s daily functioning. The authors suggest that allowing more time for these assessments, and involving multi-professional teams, can contribute to ensuring a greater accuracy of the assessment and better quality of care for the client. 

Inclusion of social networks 

Linden and colleagues also discussed the importance of social networks for people with ABI and how having a good support network can help with their process of rehabilitation. This social network specifically refers to non-health professionals (e.g. family and friends), and social workers can support members of this network by educating them about ABI and how to support those with an ABI. The researchers also highlight the importance of communication between social workers and members of the client’s social network in order to make sure that the needs of the individual are being met. However, the authors found that some of the studies reviewed observed a lack of awareness in social workers of the impact that ABI can have on families and of the importance that a social circle can play in helping ABI survivors overcome the feelings of stress and anxiety that they may experience.  

Social barriers 

Social barriers were identified as significantly impacting the support that someone with an ABI will receive. As an example, Linden and colleagues described how in the United States, insurance restrictions and lack of provision for disability supports can lead to many people with an ABI not receiving the support they need. They also raised concerns about the assessment of needs for those with disabilities within the UK, which can lead to people being denied essential support. Achieving greater public awareness and understanding of ABI, its prevalence and impact, especially amongst those in government and the public sector, but also as a society, were suggested as possible solutions to these problems. 

The role that adequate education and training around brain injury could play in equipping social workers to better support people with brain injury was a recurring theme in these studies. To address this, the Heads Together team who conducted the   review of the current evidence base on social work and brain injury [2] also created a platform that was designed to enable social workers to grow their knowledge and develop their skills in this area.  

The Brain Injury Social Work Education Platform can be accessed on biswg.co.uk/courses-home. It incorporates various resources, including the Brain Injury Needs Indicator (BINI), developed by Brainkind to complement social workers’ assessments of care needs in the context of the frontal paradox [4]. For those wishing to take the opportunity to learn more about brain injury and social work, we cannot but recommend the forthcoming  BISWG Annual Conference 2026 – The Intersection between Marginalised Groups and People with Acquired Brain Injury | The Brain Injury Social Work Group on 10th September 2026 at The Foundry, Victoria Hall, in Sheffield. And those with a special interest in research in this area, might wish to join Heads Together the NIHR funded incubator to support research capacity on brain injury and social care: www.linkedin.com/company/heads-together-braininjury. 

References 

[1] Freymüller, N., Knoop, T., & Meyer-Feil, T. (2024). Social work practice and outcomes in rehabilitation: a scoping review. Frontiers in Rehabilitation Sciences, 5. https://doi.org/10.3389/fresc.2024.1348294 

[2] Linden, M. A., Holloway, M., Cooper, C., Amadiegwu, A., Bald, C., Clark, M., Mantell, A., Norman, A., & Bateman, A. (2023). Social workers and acquired brain injury: A systematic review of the current evidence-base. PLOS ONE, 18(11), e0292128. https://doi.org/10.1371/journal.pone.0292128 

[3] George, M., & Gilbert, S. (2018). Mental Capacity Act (2005) assessments: Why everyone needs to know about the frontal lobe paradox. The Neuropsychologist, 1(5), 59–66. https://doi.org/10.53841/bpsneur.2018.1.5.59 

[4] Copstick, S., Ramos, S. D. S., Griffiths, T., & Wallace, A. (2021). The Importance of Considering Functional Outcome and Self-awareness in the Assessment of Care Needs: Initial Evaluation of the Brain Injury Needs Indicator. The British Journal of Social Work, 52(2), 682–699. https://doi.org/10.1093/bjsw/bcab026