Transcript Document

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
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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 Injury
Grant 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 & exoffenders
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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 Severity
Type
Glascow
Coma Scale
Loss of
Post
consciousne traumatic
ss
Amnesia
Mild
13 to15
Moderate
9 to 12
30 minutes or Less than 1
less
hour
(or none)
30 minutes to 1 to 24 hours
24 hours
Severe
Less than 8
More than 24 More than 24
hours
hours
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Male Findings
■
■
■
■
Severe:
Moderate:
Mild:
No TBI:
13.9%
12.4%
73.7%
172
Severe & Moderate counts
were nearly double using
less conservative criteria
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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%)
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TBI in Minnesota Prison
Population
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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
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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
32
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
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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
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Amnesia for certain parts of the trauma

Difficulty concentrating
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Diagnostic Considerations

Somatic complaints
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Perceptual symptoms
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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
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Comorbid with attention deficits
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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
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Elaborative encoding
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Grouping or chunking

Decrease distractions when working
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How Does This Effect You?

Likely to appear attentive …
but misses information
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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
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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 SelfReported 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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