Brain injury can lead to cognitive defects that include diminished executive function, the ability to actually do something the brain injury survivor may know intellectually they need to do, such as seek shade or water.

The unrelenting heat of the Arizona summer is just around the corner. For most of us that means higher power bills as we crank up the air conditioning, but for Arizona’s homeless the heat means a grueling slog to the next shady spot or cooling station. Summer for the state’s homeless often means full shelters, heat exhaustion, blistering sunburns, and, too often, death or injury from exposure.

Events that lead to homelessness are myriad and complex. Still, it can’t be coincidence that over half of all homeless men in a 2014 study conducted by Neuroscience Research Program for St. Michael’s Hospital in Toronto, Canada were found to have sustained a traumatic brain injury, or TBI.

The implications of the study’s findings are huge and indicate the danger of being homeless with a brain injury are two-fold. Brain injury can lead to cognitive defects that include diminished executive function, the ability to actually do something the brain injury survivor may know intellectually they need to do, such as seek shade or water. This can add to litany of reasons life on the street and in the elements is already dangerous for anyone.

Secondly, once shelter has been secured a homeless person can lack the ability to maintain themselves in a housing program the way their counterparts without brain injury can. The inability to keep track of important paperwork, attend appointments, or follow directions in sequential order due to brain injury can lead to being disqualified from programs which seek to address chronic or temporary homelessness.

It’s also important to note the study’s findings that the majority of homeless men who were also brain injury survivors sustained their injuries prior to becoming homeless, meaning before the brain injury they were able to maintain housing. Brain injury may very well be a risk factor for homelessness.

The causes of the brain injury that lead to homelessness are varied. A 2011 Wisconsin study found that out of 3,000 homeless people at least half had sustained their injuries as children and teenagers as a result of domestic or family violence.

But many other homeless brain injury survivors sustain their injuries through nonviolent means, such as car accidents or tumors, sometimes decades before they experience actual homelessness.

The road leading from a head injury to homeless is a bit nebulous and hard to quantify because so often information about the injury is not gathered. But common sense offers a guide of sort. The abilities that allow one to avoid homelessness — executive function which tells one to pay bills on time, emotional regulation that helps avoid conflict or strife with loved ones, the absence of neuro-fatigue or memory issues that allow for productivity at work — are can be severely impacted by head injury.

Fortunately, the solutions are far clearer. Those who work with the homeless population should integrate brain injury assessment and screening into their initial intake procedures. Once identified as a brain injury survivor, the person needs access to specialized services that help to mitigate cognitive and emotional defects so that they can meet the requirements of the shelter program and have a real shot at safety and success. This requires consistency and time and, it should come as no surprise, both can only be offered alongside that most basic of needs, shelter. It is not enough to simply be informed that those we may be serving have sustained trauma, we must help those who have been through trauma succeed on their terms and timeline.

Carrie Collins-Fadell is the executive director of the Brain Injury Alliance of Arizona.