Acquired Brain Injury and Interventions in the Offender Population: A Systematic Review

Abstract

Background and Aims: The prevalence of acquired brain injury (ABI) in offender populations appears much higher than in the general population, being estimated at 50% compared to 12%, respectively. Taking into account ABI-related cognitive and social impairments or behavioral changes in forensic treatments might be relevant and may improve treatment outcomes. The aim of the current review is to summarize and integrate the literature on psychological interventions or treatments for consequences of ABI in the forensic setting. Reviewing this literature could provide crucial information for improving treatment options for offenders with ABI, which may contribute to reducing recidivism.Methods: The PubMed/MEDLINE, PsychInfo, CINAHL, COCHRANE, and Web of Science databases were searched for studies in adult offenders with ABI that evaluated the effect of psychological interventions with a focus on ABI-related impairments and recidivism.Results: This review identified four intervention studies that met the inclusion criteria. These included an adult population (≥18-year-old) in a forensic setting (given the focus of the current review on treatment, defined here as an environment in which offenders are treated while being incarcerated or as outpatients), non-pharmacological treatments and were published in English or Dutch between 2005 and 2020. All studies reported some positive effects of the intervention on interpersonal behavior, cognition and recidivism. The aspects of the interventions that seemed most beneficial included personalized treatment and re-entry plans, support for the individual and their environment and psychoeducation about the effects of ABI.Discussion: Although positive effects were reported in the studies reviewed, all studies had methodological limitations in terms of sample size, study design and outcome measures which affects the strength of the evidence. This limits strong conclusions and generalizability to the entire offender population.Conclusion: Despite high prevalence of ABI in offender populations, interventions in forensic settings seldom address the effect of ABI. The few studies that did take ABI into account reported positive effects, but those results should be interpreted with caution. Future studies are warranted, since this does seem an important venue to improve treatment, which could eventually contribute to reducing recidivism.

The Impact of Traumatic Brain Injury on the Receipt of Services Following Release from Prison

“…While not all individuals who experience TBI will have negative long-term outcomes, many will experience a decline in their daily functioning [35]. TBI may cause problems with various brain functions that can lead to slowed information processing, diminished decision-making capacity, attention disorders and other executive functioning impairments [36][37][38]. TBI is associated with cognitive impacts, including memory and attention deficits, impulsive behavior, and slowed responses [35].…”

“…TBI is associated with cognitive impacts, including memory and attention deficits, impulsive behavior, and slowed responses [35]. The long-term social-emotional effects of TBI make individuals vulnerable for the risk factors associated with justice involvement, including aggression, rule-breaking, violence, irritability and risk-taking [37][38][39].…”

Rehabilitation among individuals with traumatic brain injury who intersect with the criminal justice system: A scoping review

“…Third, this review considered rehabilitation for individuals with TBI who intersect with all parts of the CJS (i.e., police, court, corrections, and parole). This addressed an existing research and knowledge gap, as most reviews on TBI and the CJS to date focus on identifying the prevalence of TBI, not rehabilitation, and/or are limited to the corrections setting ( 4 – 8 , 10 , 26 ). Finally, preliminary findings from this scoping review were shared with a PAC consisting of service providers and healthcare professionals in the CJS and brain injury sectors; health administrators, decision-makers, and policy-makers; and researchers and trainees who conduct research on rehabilitation, TBI, and the CJS ( 47 , 48 ).…”

“…TBI rehabilitation, which encompasses assessment and management of TBI sequelae, is critical to addressing TBI symptoms, improving functional status, and facilitating return-to-work ( 22 , 23 ) and community integration or reintegration ( 24 , 25 ). However, most reviews on TBI within the CJS have focused on TBI prevalence and are limited to the corrections setting ( 4 – 8 , 10 , 26 ). As such, there is a significant knowledge gap regarding the availability of rehabilitation both in the corrections setting as well as in other parts of the CJS (e.g., policing, court, and parole) ( 27 – 29 ).…”

Protocol for a scoping review on rehabilitation among individuals with traumatic brain injury who intersect with the criminal justice system

“…Evidence suggests that rehabilitation after TBI can reduce complications and comorbidities, improve return to work and community integration, and reduce overall healthcare cost [ 22 – 26 ]. However, despite its reported importance and benefits, most reviews on TBI in the CJS to date focus on identifying the prevalence of TBI, not rehabilitation, and/or are limited to the corrections setting [ 2 – 7 , 27 ]. As such, it is unclear whether the current literature on rehabilitation after TBI considers all components of the CJS and concurrently, whether the literature on rehabilitation provided in correctional settings considers TBI-specific concerns.…”