The behavioral and other cognitive changes that TBI can bring, "if left unaddressed, are apt to provide challenges to the offender post-release as they attempt to reintegrate into their respective communities," notes Adam Piccolino, a neuropsychologist for the Minnesota Department of Corrections.
Bridge to the outside
Treating TBI in the broad adult population is not a perfect science. The goal is to "supply them with skills they need to better regulate their behavior and process information," Gordon explains. It often involves cognitive retraining and rehabilitation—and has imperfect results. And as he points out, these therapies have yet to be thoroughly tested on incarcerated populations.
Others argue that tools that seem to work in the broader population should be used in prisons as well. Cognitive rehabilitation therapy is one such tool that seems to be gaining traction in the TBI field. It aims to help those TBI sufferers make better-informed choices and to improve memory. And with such minimal knowledge about TBI and its symptoms, simply educating inmates about their—and others'—condition might go a long way in helping them cope with related challenges, Desrocher says.
Even with proper education and therapy, though, people with TBI will often experience behavioral issues. So many groups have put an emphasis on training staff—and even arresting officers—to handle these sorts of prisoners better in hopes that they "can recognize a behavior for what it is—and not defiance of an infraction of the rules," Maltman says. Resulting altercations can put law and corrections staff—and fellow prisoners—at risk for injury.
But knowing which prisoners might benefit from alternative approaches requires thorough screening processes that are either highly variable across institutions or entirely absent. "Additionally," Piccolino notes, "once an offender is identified with having incurred a TBI, the process of knowing whether they also experience ongoing complications related to their TBI is challenging."
Some organizations, such as the Brain Injury Association of Minnesota, have gone a step further and are also working with prisoners' family members, probation officers and outside support services to ready ex-convicts for release. Klinkhammer notes that for prisoners with TBI, returning to the outside world can be an extremely difficult transition. Once predictable prison routines disappear, he explains, it's almost like Dorothy going from her black-and-white reality in Kansas to the colorized world in Oz. Although that shift might sound like a blessing, for those with a brain injury who have difficulty managing their reactions or processing a lot of incoming information quickly, the new environment can be too much. "It can be very overwhelming, and it could result in one or more reason for a person to 'recidivize'"— do something that will land them back in jail, even if they had no intention of breaking the law— Klinkhammer says.
Much of his group's efforts come down to education and helping family and other community members learn how to support a prisoner with TBI returning to the outside world. And oftentimes just explaining to them that an old injury might be contributing to unpredictable behavior is a big help. "People know that their loved one's been knocked out" or were in a car accident years before, Klinkhammer says. "But the thought that the outcome of that may result in disinhibition or that it could be an aggravating factor to a person's criminal behavior gets lost."
The group does not yet have formal data on the success of the program, but from his observations, Klinkhammer says, "individuals are doing better when they are able to dovetail back into society in a way that they're supported." The key is "making sure that when people step out into the community they're not falling into an abyss," he says. And "in doing that, we're also helping society at large stay safer."