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Brain Injury in Minnesota Correctional Facilities: Changing the System Dr. Charlotte Johnson Psychologist, MN Department of Corrections Mary Enge Regional.

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Presentation on theme: "Brain Injury in Minnesota Correctional Facilities: Changing the System Dr. Charlotte Johnson Psychologist, MN Department of Corrections Mary Enge Regional."— Presentation transcript:

1 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 1

2 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 2

3 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 3

4 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 4

5 Demographics of MN US Census population for the state of MN estimated in 2010 as 5,303, % White 5.2% Black 4% Asian 1.1% American Indian/Alaska Native 5

6 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 6

7 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 7

8 Traumatic Brain Injury Grant 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 8

9 Minnesota Department of Corrections Prison Facilities 9

10 Minnesota State Prisons 10

11 What Did We Learn? : 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) 11

12 What Did We Learn? : TBI Prevalence 82%+ of offenders successfully interviewed had a history of TBI 12

13 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 13

14 Major Grant Products Prevalence Data: What Did We Learn? 14

15 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 15

16 Another Measure of Severity TypeGlascow Coma Scale Loss of consciousne ss Post traumatic Amnesia Mild13 to1530 minutes or less (or none) Less than 1 hour Moderate9 to 1230 minutes to 24 hours 1 to 24 hours SevereLess than 8More than 24 hours 16

17 Male Findings ■ Severe: 13.9% ■ Moderate: 12.4% ■ Mild: 73.7% ■ No TBI:172 Severe & Moderate counts were nearly double using less conservative criteria 17

18 Juvenile Males 49 out of 50 reported history of TBI Most were moderate & severe Most were due to domestic assault 18

19 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%) 19

20 TBI in Minnesota Prison Population 20

21 MN DOC Offender Statistics as of Incarcerated: 9,302 adults 43 juveniles Average age: 36 21

22 MN DOC Offender Statistics as of Approximately: ■ 53% White ■ 35.5% Black ■ 9% American Indian ■ 7.3% Hispanic ■ 2.4% Asian 22

23 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 23

24 TBI in Minnesota Correctional Facilities: Changing the System ( ) MN Departments of Human Services & Corrections 2 nd partnership grant is building on the work of our earlier grant Current grant life: $250, award per year 24

25 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) 25

26 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 26

27 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 27

28 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 28

29 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 29

30 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 30

31 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” 31

32 American Indians U.S. Study found TBI-related hospital discharge rates were highest for American Indians / Alaskan Natives 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 32

33 MDH TBI Registry: Rate of Nonfatal Hospitalizations White: 87.7 Black: Am. Indian/Alaska Native: Asian/Pac. Island: 48 Hispanic:

34 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 34

35 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. 35

36 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 36

37 What You Need To Know About TBI Symptoms 37

38 TBI Symptoms  Tremors  Weakness/fatigue  Sensation deficits  Vision problems 38

39 TBI Symptoms  Language problems  Poor judgment of space  Confusing right/left 39

40 TBI Symptoms  Problems reading or writing or adding  Problems following conversations  Getting stuck on topics  Not following instructions 40

41 TBI Symptoms  Tremors  Weakness/fatigue  Sensation deficits  Vision problems 41

42 TBI Symptoms Cognitive: Learning new information Easily Distracted Losing train of thought Forgetting things that have been completed 42

43 TBI Symptoms  Ignoring one side of body  Irritability, anger, mood swings  Change in appetite / hygiene / social skills 43

44 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 44

45 What You Need To Know About TBI Diagnostic Considerations & Memory Strategies 45

46 Diagnostic Considerations Post-traumatic Stress Disorder Frequent incidence in soldiers—blast injury Amnesia for certain parts of the trauma Difficulty concentrating 46

47 Diagnostic Considerations Somatic complaints Perceptual symptoms Severity does not influence Over 40% comorbid PTSD/TBI failed effort tests (consideration of meaning of effort) 47

48 Diagnostic Considerations Obsessive-compulsive behaviors Comorbid with attention deficits Perseveration & hyper vigilance 48

49 Diagnostic Considerations Schizophrenia-like psychosis ● Paranoid delusions ● Auditory hallucinations ● Catatonic features, formal thought disorder & negative symptoms uncommon (Johnson & Lovell, 2011) 49

50 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 50

51 Memory Strategies Use electronic devices to program reminders in advance of appointments, assignments, projects, etc. Focus on one task at a time Take breaks 51

52 Memory Strategies Take breaks Be organized—structure & routine Repetition When reading: preview, question, read, state, & test 52

53 Memory Strategies Visual imagery Elaborative encoding Grouping or chunking Decrease distractions when working 53

54 How Does This Effect You? Likely to appear attentive … but misses information Hard to sit still Fidgety & moving around 54

55 How Does This Effect You? Appears to forget 5 seconds (or less) after being told information Appears defiant Irritable & easily angered 55

56 Methods for Assistance Divide instruction into small concrete components of expectations Model cues & gestures to comprehend expectations Written instructions alone are not sufficient 56

57 Methods for Assistance When learning something new: Master each small task of multi-part process Provide opportunity to practice & Provide feedback to correct problems 57

58 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, 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). 58

59 Brain Injury in Minnesota Correctional Facilities: Changing the System 59


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