At the end of 2018, the United States had 4.5 million people in community corrections, which was more than double the number of incarcerated individuals in both jails and prisons. While past research has indicated that over 50% of men incarcerated in jails have experienced at least one traumatic brain injury (TBI); however, very little research has looked at the prevalence of TBI in community corrections (e.g., probation and parole). This article summarizes research recently published in the December 2021 issue of Criminal Justice and Behavior, which examines the impact of TBI on the risk of recidivism in community corrections, as well as accommodations that may improve receptivity and successful engagement.
Prevalence of TBI
In order to be classified as TBI, an injury must change the brain function or brain pathology of an individual due to trauma caused by an external force. Common causes of TBI include:
- Exposure to assault or physical violence;
- Motor vehicle accidents;
- Falling accidents;
- Sports-related injuries; and
- Explosive blasts.
The prevalence rate in the general population ranges from 2-9%, and—depending on the severity of the injury—the effects can include:
- Decline in daily functioning and cognitive deficits (e.g., self-regulation, executive function, reasoning, problem solving);
- School-related problems;
- Substance use disorders;
- Emotional changes (e.g., agitation, irritability, depression, impulsivity, aggressive outbursts
- A shorter life expectancy; and
- Death.
Within the criminal justice system, prior research has determined the prevalence of TBI to range anywhere from 23% to 60%, with some studies reporting rates as high as 88%. However, no studies had yet been conducted on the prevalence of TBI among people on probation.
Resulting Vulnerabilities within Criminal Justice
“Persons in jails and prisons with a TBI history are characterized by a unique trajectory. Research shows that TBI confers risk for earlier engagement with criminal justice, a higher number of convictions in one’s lifetime, a greater number of violent or felony offenses, and more behavioral health problems while incarcerated” – Kim A. Gorgens, et al.
The commonly accepted predictors of recidivism beyond release (i.e., “i.e., substance abuse, history of exposure to violence, mental illness, and a lack of treatment compliance”) are all significantly present when looking at the population of people with TBI. This impacts individuals who are released from prison in two key ways:
- Incarcerated individuals with a TBI have a risk of recidivism 1.85 times higher than those with no history of TBI.
- Incarcerated individuals with a TBI have re-offense rates ranging from 33% to 51%, which are higher than those with no history of TBI.
Study Purpose and Design
This study was designed and conducted by Kim A. Gorgens, Laura Meyer, Judy Dettmer, Molly Standeven, Emily Goodwin, Cory Marchi, and Hollis Lyman—and made possible through “partnership between the University Denver, the Colorado Department of Human Services Brain Injury Program, and 11 county jail and probation systems in the Front Range region of Colorado.”
The purpose of the study was to determine the prevalence of TBI within community corrections and to compare “criminal histories, risk, and outcomes” of those on probation with TBI to those without.
The study’s two research questions were as follows:
- “Research Question 1: What is the prevalence of reported TBI history among adults on
probation? - Research Question 2: Are there consistent risk factors and vulnerabilities among males and females with TBI on probation?”
Study Methodology
Participants were gathered from six partner sites within the Colorado probation system between 2012 and 2020. Those with reported history of TBI included 1,029 adults (ranging in age from 18 to 75) on probation during the years of the study. Of that group, 481 individuals were designated as having significant TBI, and 314 agreed to further neuropsychological testing (72.9% male, 26.8% female).
Data for individuals on probation without TBI was aggregated from 41,769 adults (men and women 18 and older) from the Colorado Division of Probation Services database and were matched based on site and age range for purposes of comparison.
The OSU TBI-ID was used to identify a history of significant TBI and was administered by probation officers with the 314 individuals who agreed to participate in the study.
Neuropsychology screening was completed using either the ANAM Core Battery or NAB-SM, each of which is designed to measure deficits in cognitive functioning. The selection of the screening tool used with each participant was left to the discretion of the clinician conducting the screening.
Results
The study found a prevalence rate of 44% to 97% for positive TBI history within the Colorado community corrections system, depending on location.
Within this sample, the following risk factors were identified:
- 92% reported significant history of abuse;
- 68% had a diagnosis of at least one mental health illness;
- 47% were the victim violence in adulthood;
- 50% were the victim of violence in childhood;
- 28% reported at least one attempt at suicide;
- 54% were suspended from school;
- 22% had been expelled from school; and
- 71% were assessed as having “gross cognitive impairment.”
Additionally, researchers found that women with TBIs were just as likely to re-offend as men with TBIs; whereas women on probation with no TBI had fewer convictions and a lower risk for re-offense than their male counterparts.
“In this study, females on probation who have a history of TBI were also more likely than males to have a mental illness, substance abuse disorder, dual diagnoses of mental illness and substance abuse; be a victim of violence in adulthood; and to have made at least one suicide attempt.” – Kim A. Gorgens, et al.
The correlates with the researchers’ earlier findings, which showed that women in jails or on probation were:
- Two times more likely than men to have sustained any type of multiple TBI (e.g., two injuries or more occurring in close proximity);
- Six times more likely to have sustained multiple TBIs due to violence; and
- Four times more likely than women with no history of TBI (related to violence) to have some type of physical health diagnosis.
The final significant finding was that: “The [gross cognitive impairment and no cognitive impairment] groups did differ, however, on history of childhood violence, reflecting the lasting effects of this type of victimization.”
Implications and Next Steps
Awareness of the prevalence of TBI among community corrections populations and understanding of their associated risk factors and vulnerabilities is vital for criminal justice professionals working with this population.
Individuals in community corrections with a history of TBI are:
- At increased risk of re-offense;
- Likely to have several behavioral health comorbidities; and
- Less likely to experience probation success without accommodation.
Potential steps criminal justice professionals within community corrections can take to support individuals with TBI include:
- Prioritizing those with a known history of TBI for behavioral health screenings to identify any history of trauma or comorbidities (e.g., mental health issues, substance use disorders).
- Creating an individualized list of recommendations for “providers and clients to maximize the community adjustment of people on probation.”
- Accommodating cognitive deficits and behavioral health issues by modifying probation meetings “(i.e., repetition of key points, scaffolding skill-building with lists and practice, ensuring people on probation keep lists and calendars with electronic reminders, and scheduling briefer and more frequent appointments).”
These steps may reduce the risk of re-offense, while promoting development of prosocial skills and maintaining accountability. Future research that expands generalizability by focusing on a broader geographic area may also yield insights that increase probation completion and support long-term positive behavioral change.
To read the full article summarized here, visit the IACFP member portal.
Questions for our readers:
- Do you have protocols for knowing the history of significant TBI for the justice-involved persons you work with
- What steps do you take to support individuals with TBI?
- Are you willing to write an article on the work you and your organization are doing to support justice-involved individuals with significant TBI?
Please send your responses to these questions to executivedirectoriacfp@gmail.com
