'I am not drunk, I have an ABI': findings from a qualitative study into systematic challenges in responding to people with acquired brain injuries in the justice system

Evaluating social rehabilitation of aggression for persons with Acquired Brain Injury: a systematic review

PURPOSE

Social rehabilitation of aggression following an Acquired Brain Injury (ABI) is critically important for persons with ABI due to increased vulnerability of criminal behaviour related to post-injury changes in functioning. This review presents findings from studies that evaluated aggression interventions in both community and forensic populations of people with ABI.

METHODS

We searched PsycINFO, EMBASE, SocINDEX, CINAHL and Medline databases for studies published between 1st January 2000 and 15th October 2023.

RESULTS

There were 15 studies (14 community-based, one forensic) that met inclusion criteria. Pharmacological management (6) was largely ineffective and anger management interventions (6) presented with inconsistent effectiveness. Emotion regulation (1) may be effective for externalised aggression. Both mindfulness and transcranial direct current stimulation (1) were effective, and the results of a forensic peer group approach (1) were not tested for statistical significance. There was variability in the measurement of aggression, injury severity, and cognitive impairment.

CONCLUSIONS

Whilst community interventions for aggression in persons with ABI are prevalent, findings for effectiveness have been mixed and there is a paucity of evaluated interventions in forensic samples. Further research is needed to unravel the complex interplay of factors contributing to aggression and develop effective social rehabilitation for persons with ABI.

Exploring the Cognitive-Communication Challenges of Adults With Histories of Traumatic Brain Injury and Criminal Justice System Involvement: A Pilot Study

INTRODUCTION

The prevalence of traumatic brain injury (TBI) in the criminal justice system (CJS) is well known. Furthermore, the impact of TBI on communication has been well documented; however, no study has explored the communication challenges of those with TBI in the CJS or considered their implications within CJS contexts. Moreover, no study has examined the possible differences in communication between those with TBI and CJS history and those with TBI but no CJS history.

PURPOSE

This cross-sectional pilot study provides a preliminary exploration of the cognitive-communication challenges in a sample of adults with histories of TBI and CJS involvement compared with a sample of adults with histories of TBI but no CJS involvement.

METHOD

Eight individuals with histories of TBI and CJS involvement were recruited through community agencies. The La Trobe Communication Questionnaire (LCQ) was administered to collect self-reported data on perceived cognitive-communication abilities, including social communication behaviors. Findings were examined and then compared with a previously studied sample of 160 individuals with TBI. Logistic regressions were calculated to determine whether response scores on the LCQ would be predictive of group membership (i.e., TBI + CJS or TBI only).

RESULTS

A range of cognitive-communication challenges were reported by both groups. A logistic regression analysis demonstrated a reasonable inference that LCQ responses may predict group membership and support the potential for statistically significant and meaningful results to justify future studies.

CONCLUSIONS

These challenges have the potential to negatively impact the success of communication interactions within the CJS and illustrate a need for speech-language pathology services for individuals with TBI in the CJS. The nature and magnitude of between-group differences merits further investigation with larger samples to explore whether any specific cognitive-communication challenge is unique to, or predictive of, CJS involvement for purposes of targeted assessment and intervention.

Strengthening the Connection Between Acquired Brain Injury (ABI) and Family Violence: The Importance of Ongoing Monitoring, Research and Inclusive Terminology

Family violence (FV) harms communities worldwide so FV prevention strategies and effective responses are urgently needed. This article reports on FV apparent in a study which explored the experiences of people with both ABI and justice system encounters in Victoria, Australia. One hundred interviews and one focus group consulted people with ABI, their families and carers, and various stakeholder groups in the Victorian justice system in Australia. Qualitative content analysis determined dominant themes and sub-themes and the less common themes. Inductive interpretive content analysis identified themes commonly found in previous published research and themes that appeared unique to, or unanticipated in, our data, such as the FV theme upon which this article focuses. Our findings reveal that FV has adversely affected many people with ABI who came into contact with Victoria's justice system. Further, as ABI and FV often co-occur with substance abuse, mental health problems, socio-economic and many other significant disadvantages, for some FV perpetrators with an ABI, their ABI symptoms and characteristic co-morbidities may be a mitigating factor in their offending. The connection between ABI and family violence emerged as a troubling research theme. Indeed, the impact of FV on too many of our participants with an ABI compels us to call for further related research and secondary prevention programs targeted at FV victims, and offenders, living with ABI. An intersectional understanding of family violence and TBI/ABI in social ecological contexts is required to better understand brain injury at both individual and population levels.

Experiences of offenders with traumatic brain injury

Purpose:

Traumatic brain injury is recognised as a significant and pervasive health issue among offender populations. Despite this, no qualitative research exists exploring the experiences and perceptions of offenders with TBI in prison.

Methods:

Qualitative interviews were conducted with male and female offenders housed in a UK prison. Interviews examined what participants felt led them to offend, experiences of incarceration, and post-release plans. Presence of TBI was assessed via the Brain Injury Screening Index. Data were analysed by means of inductive content analysis.

Findings:

Both male and female prisoners primarily attributed their incarceration to drugs and alcohol use, with males also referencing more issues with aggression, while mental illness and past abuse were more commonly mentioned among females. A lack of recognition for the possible role of TBI was noted, with several males describing themselves as ‘stupid’ or prone to making ‘poor lifestyle choices’. Both groups indicated a desire to return to education or work post-release.

Conclusions:

Despite significant rates of injury, there is a clear lack of understanding and consideration of the role of TBI in the behaviour and presentation of offenders. There is need for improved identification and education around TBI early in the criminal justice process.