Traumatic Brain Injury in Criminal Justice
About the Project
Inmates living with traumatic brain injury (TBI) are an understudied, vulnerable population, and are overrepresented in correctional facilities. TBI has been linked to poor impulse control, aggressive behaviors, deficits in attention span, and higher risks for substance use disorders. Symptoms often negatively impact behavior within corrections and contribute to increased recidivism rates. The prevalence of TBI within corrections is very high; although rates vary among sites, our pilot data from the Denver County Jail Mental Health Transition Unit suggests that up to 96% of those inmates have a history of at least one complicated TBI.
Recognizing the scope of this problem, we developed a novel partnership with the State of Colorado. The overarching goals of that collaboration are to increase identification of brain injury in youth and adults involved with corrections through the development, implementation, and evaluation of a comprehensive and effective screening/identification and assessment protocol; to provide the professionals with the training and tools needed to successfully support these individuals; and to develop a seamless referral protocol to ensure that, once identified with brain injury, individuals and their families will receive information, resources, and resource facilitation support to increase access to rehabilitation and other services necessary to be successful outside of the corrections settings. The proposed research agenda includes a plan to manually code the data generated by the screening tools (brain injury and neuropsychological screening results) into the REDCap database for the purposes of program development and evaluation as well as the identification of population-based trends in vulnerability prevalence (traumatic brain injury [TBI] history, mental illness, substance abuse, cognitive deficits). These data are being used to determine the population prevalence of vulnerabilities including traumatic brain injury (TBI) history, mental illness, substance abuse, and cognitive deficits among Colorado offenders. Results will be used to determine the need for and, ultimately, the relative efficacy of interventions including self-empowerment training, correctional staff education, and expanded community re-entry resources (e.g., resource facilitation support).
GSPP is working with 28 justice sites from jails to specialty courts and Division of Youth Corrections with plans to expand throughout the Department of Corrections as well. We are in year 4 of a 4-year contract with the Colorado Brain Injury Program which secured grant funding from the Colorado Office of Behavioral Health (OBH) and the Health Resources and Services Administration (HRSA; CFDA # 93.234 and #NCRW1410033OBH respectively).
Our primary goals are to screen for identification of individuals with TBI, build a trained TBI workforce (including mental health and neuropsychological assessment service delivery), provide information about TBI to families and make referrals to appropriate service providers, and facilitate access to needed services. Secondarily, we are able to embed unique service learning opportunities into psychology graduate training at GSPP and have also created more than 30 field placement and work-study positions for students.
Background
Traumatic Brain Injury (TBI) is a significant public health problem in both the adult and pediatric populations, with 2.8 million TBI's each year resulting in more than 2.5 million Emergency Department visits, 282,000 hospitalizations, and 50,000 deaths (Taylor, Breiding, & Xu, 2017). By definition, a TBI occurs when an external force alters the functional integrity of the brain such that an individual is functioning differently following the injury, and can occur in mild (concussion), moderate or severe brain injuries. These functional differences can be temporary or permanent, and may contribute to many of the behaviors that create legal difficulties for an individual.
The many cognitive characteristics that can be seen following a brain injury, such as impulsivity, poor problem solving and decision-making, slow processing speed, poor judgment, inability to interpret social cues efficiently or accurately, inattention, and cognitive fatigue, can lead to the maladaptive behaviors for both children and adults, and can result in legal challenges and, perhaps, incarceration in the prison system for adults, and placement in a juvenile justice facility for children and adolescents (New York Model Systems, 2006).
More than 1.5 million individuals are in state and federal custody (Department of Justice, Bureau of Justice Statistics, 2014). The prevalence of TBI history in those settings has been consistently demonstrated to be disproportionately high. One of the first studies to investigate the rates of TBI in offender populations was conducted by Slaughter, Fann, and Ehde (2003) who reported the rate to be 87% in a county jail setting. Schofield et al. (2006) then reported the TBI prevalence in all offender populations to range from 25-87% and, later, Williams et al. (2010) documented the prevalence of TBI in those settings to be 65%. In a more recent study, Ferguson, Pickelsimer, Corrigan, Bogner, and Wald (2012) found that 65% of male inmates, and 72% of female inmates, reported at least one TBI resulting in a change in consciousness. Finally, some of the current authors studied the incidence of TBI in a mental health transition unit at a county jail and found the incidence of TBI among a sample of offenders with a co-morbid mental illness to be 96% (Gafford, McMillan, Gorgens, Dettmer, & Glover, 2015).
Individuals with a history of TBI also have lengthier and more frequent involvement with the criminal justice system. Williams et al. (2010) reported that individuals with a history of TBI enter the justice system earlier (up to 4 years) and have longer and more frequent stays in custody. Piccolino and Solberg (2014) found that persons with a history of TBI were more likely to use correctional medical and psychological services, were also more likely to commit prison rule violations and were less likely to complete substance abuse treatment programs. In their study, individuals with a history of TBI also had higher recidivism rates than those without a history of TBI (51% and 33% respectively; Piccolino & Solberg, 2014). Kaba et al. (2013) reported that detained youth with TBI were more likely to be users of mental health services. And, because brain injury can lead to impaired decision-making abilities, memory dysfunction, impaired executive functioning skills, including the ability to plan, assess behavior risk, organize, remember, and connect consequences to actions, youth with brain injury may have a reduced capacity to detect unsafe situations. As a result, they have greater vulnerability to victimization or being taken advantage of by peers or malevolent adults.