brain injury in minnesota correctional facilities: changing the system dr. charlotte johnson...
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Brain Injury in Minnesota Correctional Facilities:Changing the System
Dr. Charlotte Johnson Psychologist, MN Department of Corrections
Mary Enge Regional Resource Specialist, MN DHS, Disability
Services Division
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Types of Brain Injury
Traumatic Brain Injury (TBI) is an injury to the brain caused by an external force after birth
Acquired Brain Injury (ABI) is an injury to the brain which is not hereditary or congenital, occurs after birth, & includes all types of TBI
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Centers for Disease Control (CDC) Traumatic Brain Injury (TBI)
Statistics
TBI is a contributing factor to a third of all injury-related deaths in the United States
About 75% of all TBIs each year are concussions or other form of mild TBI
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Centers for Disease Control TBI Statistics
Each year there are a reported 1.7 million TBIs in the United States
An estimated 5.3 million Americans - 2% of the U.S. population - live with a long-term or lifelong need for help due to TBI
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Demographics of MN
US Census population for the state of MN estimated in 2010 as 5,303,925
85.3% White
5.2% Black
4% Asian
1.1% American Indian/Alaska Native
White89%
Black6%
Asian4%
Am. Indian/
Alaskan Na-tive 1%
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TBI in State of Minnesota
2011 Dept. of Health TBI Registry Data
5,713 Hospital Admissions 10,429 ER/ED Visits 853 Deaths
2011 Population of Minnesota: 5,303,925
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Chronic TBI in Minnesota
Estimate:
90,000 to 100,000 Minnesotans live with
a disability that is caused or made
worse by a traumatic brain injury
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Traumatic Brain InjuryGrant 2006-2009 Goals
Measure prevalence rates of TBI in state correctional facilities
Provide training & education to Department of Corrections employees & partners
Identify / develop release planning & community resources for offenders & ex-offenders
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Minnesota Department of Corrections Prison Facilities
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Minnesota State Prisons
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What Did We Learn?2006-2009: TBI Prevalence
998 adult male offenders were successfully interviewed to determine TBI History (MCF-St. Cloud)
100 adult women offenders were successfully interviewed (MCF-Shakopee)
52 adolescent male offenders were successfully interviewed (MCF-Red Wing)
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What Did We Learn?2006-2009: TBI Prevalence
82%+ of offenders successfully
interviewed had a history of TBI
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2006-2009 Major Grant Products
Prevalence Data
Extensive TBI Training for Department of Corrections Staff
Development of Three on-line Training modules for Department of Corrections staff & partners
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2006-2009 Major Grant Products
Prevalence Data:
What Did We Learn?
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TBI Severity Criteria Severe:
>24 hours Length of Coma (LOC) &/or
>24 hours Post Traumatic Amnesia (PTA) Moderate:
60 minutes to 24 hours LOC &/or
1-24 hours PTA Mild:
0-59 minutes LOC &/or PTA <1hour PTA
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Another Measure of SeverityType Glascow
Coma ScaleLoss of consciousness
Post traumatic Amnesia
Mild 13 to15 30 minutes or less(or none)
Less than 1 hour
Moderate 9 to 12 30 minutes to 24 hours
1 to 24 hours
Severe Less than 8 More than 24 hours
More than 24 hours
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Male Findings
■ Severe: 13.9%■ Moderate: 12.4%■ Mild: 73.7%■ No TBI: 172
Severe & Moderate counts were nearly double using less conservative criteria
mild moderate severe0
10
20
30
40
50
60
70
80
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Juvenile Males
49 out of 50 reported history of TBI
Most were moderate & severe
Most were due to domestic assault
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Female Findings
■ 96 out of 100 female offenders met criteria for having sustained a head injury
■ 22.1% Mild (male=73.7%)■ 44.2% Moderate (male=12.4%)■ 33.7% Severe (male=13.9%)
mild moderate severe0
20
40
60
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TBI in Minnesota Prison Population
No TBI
Mild
Mod
erat
e
Sever
e0
20
40
60
80
100
Self-Report TBI Hx
All Offenders (N=998)
Registry Only (n=52)
Self-report TBI Hx
Per
cen
t
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MN DOC Offender Statistics as of 01-01-2012
Incarcerated: • 9,302 adults • 43 juveniles
Average age: 36
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MN DOC Offender Statistics as of 01-01-2012
Approximately:■ 53% White ■ 35.5% Black■ 9% American
Indian ■ 7.3% Hispanic ■ 2.4% Asian
Whit
e
Black
Amer
ican
India
n
Hispan
ic
Asian
0%
10%
20%
30%
40%
50%
60%
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What Did We Learn? Needed:
Refined process to identify offenders with TBI & related functional impairment
Plan to assist in prison & with discharge back to the community
Ongoing training & staff dedicated to TBI in critical programs
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TBI in Minnesota Correctional Facilities: Changing the System
(2010-2014)
MN Departments of Human Services & Corrections 2nd partnership grant is building on the work of our earlier grant
Current grant life: 2010-2014
$250,000.00 award per year
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Current Grant Project
Literature suggests that cognitive problems
associated with a past TBI may affect
potential to succeed in rehabilitation
(Valliant, et al, 2003; Corrigan, 1995, as cited in Wald, Helgeson, & Langlois, 2008, para. 8), including SA
treatment (SAMHSA, 1998a, as cited in Wald, Helgeson, & Langlois, 2008)
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Current Grant Project: Successful Return to Community
Long term goal: systemic change within the DOC to offer an improved response for offenders with TBI
Coordination of services to better transition to the community
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Current Grant Project: Successful Return to Community
Development & implementation of DOC system to identify & track offenders with TBI requiring supportive services
Follow identified offenders as they complete chemical dependency treatment
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Current Grant Project: Successful Return to Community
Release planning to coordinate appropriate TBI services in the community after leaving prison
Comprehensive psychological / cognitive assessment process to identify offenders with special needs
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Changing the System: Current Grant Accomplishments
Developed / Refined MN DOC TBI Screening Tool
Grant funded DOC Neuropsychologist & TBI Release Planner
Developed CD Treatment protocols for offenders with TBI / cognitive deficits
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Changing the System: Current Grant Accomplishments
Continue DOC staff/ Community Training Established DHS TBI Advisory Committee
grant subcommittee
Developed Native American Resource Guide
Held American Indian Listening Session
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Changing the System: Identified Populations
Primary population served: “Offenders in the state prison system, including those who test positive for TBI & have functional needs”
Secondary population served: “incarcerated American Indians”
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American Indians
U.S. Study found TBI-related hospital discharge rates were highest for American Indians / Alaskan Natives - 75.3 per 100,000 (Langlois, Kegler, & Butler, 2003, as cited in McCrea, 2008)
Risk factors include SES & substance abuse
American Indians are identified as a group of interest for the current grant
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2005-2009 MDH TBI Registry:
Rate of Nonfatal Hospitalizations
White: 87.7
Black: 100.2
Am. Indian/Alaska Native: 162.7
Asian/Pac. Island: 48
Hispanic: 1.1
WhiteBlackAm. Indian-Alaska Nat.Asian-Pac. Isl.Hispanic
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American Indian Listening Session: Suggestions On Policy
• TBI education for Chemical & Mental Health workers
• Ensure TBI is taken into account during sentencing, mental health assessment, & child protection case investigations
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American Indian Listening Session:Suggestions On Policy
• Inform Law Enforcement/Community Services of offender return to community
• Formalize inmate access to spiritual & cultural practices – increase access to spiritual leaders.
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Changing the System: Grant Plans
Share updated on-line DOC training
Work with MNHELP.INFO to enrich site content for ex-offenders & people with BI
Follow-up on selected American Indian Listening Session recommendations
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What You Need To Know About TBI Symptoms
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TBI Symptoms
Tremors
Weakness/fatigue
Sensation deficits
Vision problems
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TBI Symptoms
Language problems
Poor judgment of space
Confusing right/left
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TBI Symptoms
Problems reading or writing or adding
Problems following conversations
Getting stuck on topics
Not following instructions
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TBI Symptoms
Tremors
Weakness/fatigue
Sensation deficits
Vision problems
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TBI Symptoms
Cognitive:• Learning new information
• Easily Distracted
• Losing train of thought
• Forgetting things that have been completed
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TBI Symptoms
Ignoring one side of body
Irritability, anger, mood swings
Change in appetite / hygiene / social
skills
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TBI Irritability & Anger
35% to 96% show agitated behavior during acute recovery (Silver, Yudofsky, & Anderson, 2011)
Of 60 offenders in jail those who sustained TBI in last year showed worse anger/aggression (Slaughter, 2003)
Risk factors: irritability, impulsivity, & past aggression
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What You Need To Know
About TBI Diagnostic
Considerations & Memory
Strategies
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Diagnostic Considerations
Post-traumatic Stress Disorder
Frequent incidence in soldiers—blast injury
Amnesia for certain parts of the trauma
Difficulty concentrating
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Diagnostic Considerations
Somatic complaints
Perceptual symptoms
Severity does not influence
Over 40% comorbid PTSD/TBI failed effort tests (consideration of meaning of effort)
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Diagnostic Considerations
Obsessive-compulsive behaviors
Comorbid with attention deficits
Perseveration & hyper vigilance
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Diagnostic Considerations
Schizophrenia-like psychosis
● Paranoid delusions
● Auditory hallucinations ● Catatonic features, formal thought disorder & negative symptoms uncommon (Johnson & Lovell, 2011)
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Memory Strategies
Take notes—Keep notepad, post-it, or cell phone handy to immediately record
• Things to do• What was completed in a day• Important phone numbers & addresses• Ideas & feelings• What to do in an emergency
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Memory Strategies
Use electronic devices to program reminders in advance of appointments, assignments, projects, etc.
Focus on one task at a time
Take breaks
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Memory Strategies
Take breaks
Be organized—structure & routine
Repetition
When reading: preview, question, read, state, & test
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Memory Strategies
Visual imagery
Elaborative encoding
Grouping or chunking
Decrease distractions when working
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How Does This Effect You?
Likely to appear attentive … but misses information
Hard to sit still
Fidgety & moving around
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How Does This Effect You?
Appears to forget 5 seconds (or less) after being told information
Appears defiant
Irritable & easily angered
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Methods for Assistance
Divide instruction into small concrete components of expectations
Model cues & gestures to comprehend expectations
Written instructions alone are not sufficient
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Methods for Assistance
When learning something new:
• Master each small task of multi-part process
• Provide opportunity to practice & Provide feedback to correct problems
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References
Gordon, W.A., Haddad, L., Brown, M., Hibbardt, M.R., & Sliwinski, M. (2000). The Sensitivity & Specificity of Self-Reported Symptoms in Individuals with Traumatic Brain Injury. Brain Injury, 14, 21-23.
McCrea, M. A., (2008). Mild traumatic brain injury & post concussion syndrome. American Academy of Clinical Neuropsychology.
Minnesota Department of Health. (2011). Minnesota Injury Data Access System (MIDAS).
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Brain Injury in Minnesota
Correctional Facilities:
Changing the System
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