Youth Offending and Acquired Brain Injury
- a practical approach
Louise Wilkinson
Information & Learning Manager
Child Brain Injury Trust
© Child Brain Injury Trust 2011
WHAT IS AN ACQUIRED BRAIN INJURY (ABI)?
 After birth
 Illness, accident, stroke, tumour, poisoning, lack
of oxygen, non surgical intervention
 Thinks, feels and responds to situations
© Child Brain Injury Trust 2011
Typical characteristics of a young person with an ABI
Poor memory
Poor attention
and
concentration
Poor verbal
comprehension
Acquired
Brain
Injury
Inability to learn
from
consequences
© Child Brain Injury Trust 2011
Poor social
awareness
Poor planning and
organisation
ability
Circumstances
Support
Networks
Adolescence
Family
ABI
© Child Brain Injury Trust 2011
Young people affected by ABI have a higher likelihood of
entering the criminal justice system
24% - 32% general public
(McKinley et al, 2008; McGuire et al, 1998)
65% - 72% of inmates in a young offenders institution
(Williams et al, 2010; Davies et al, 2012);
……….and
once there, their neurological needs are frequently
poor or indeed appropriately supported.
© Child Brain Injury Trust 2011
Demographics of Acquired Brain Injury
• 40,000 children per year – accidents alone,
resulting in head injury
– Road accidents
– Falls
– Sport / play
39%
28%
17%
• Incidence
– Girls
– Boys
132/100,000 per year
235/100,000 per year
© Child Brain Injury Trust 2011
The vision of the Youth Justice Board is of an
effective youth justice system, where:
•more offenders are caught, held to account for
their actions, and stop offending
•children and young people
receive the support they need to
lead crime-free lives
•victims are better supported
•the public has more confidence in the youth
justice system.
© Child Brain Injury Trust 2011
SLC and the brain
•
•
•
•
•
•
•
Reading
Writing
Processing/calculating
Naming
•
•
•
•
•
•
Visual shapes and
colours
Reading/writing
Picture/object
recognition
•
•
•
•
•
•
•
Sense of balance and coordination of
movement
Verbal dyspraxia
•
•
•
•
•
•
Emotional control centre
Initiation/goal setting
Body movement
Motor Speech
Problem solving
Monitoring and self
correction
Impulse control
Integrating information
Long term memory
Social interaction
Word fluency
Sense of touch, taste, smell
Hearing
Speech recognition
Abstract reasoning/language processing
Short term memory
Facial recognition
© Child Brain Injury Trust 2011
© Child Brain Injury Trust 2011
Adult acquired brain injury
Normal trajectory
Rehabilitation
Acquired brain Injury
© Child Brain Injury Trust 2011
Childhood acquired brain injury
Normal trajectory
Post injury development
Acquired brain Injury
© Child Brain Injury Trust 2011
THE FUNNEL EFFECT
Children with an ABI have a
higher likelihood of being
excluded from school
because of their behaviour
Children who are
excluded from
school are more
likely to offend
Better support in
Education could
reduce Youth
Offending rates
© Child Brain Injury Trust 2011
Impact of Education on the life
outcomes for children and
young people affected by
childhood acquired brain injury
Maximum
outcomes
achieved
Well
supported
Well
supported
Childhood
acquired
brain injury
Environmental
factors
(family, housing
etc)
Poorly
supported
Education
(Rehabilitation)
Good
Neuro
and
Cognitive
rehab
Youth Offending
Poorly
supported
Poor Neuro
and
Cognitive
rehab
© Louise Wilkinson 2011
© Child Brain Injury Trust 2011
School is rehab!
© Child Brain Injury Trust 2011
THE EVIDENCE
Research that proves:
• the definite link between ABI and offending
• a higher number of offenders affected by
ABI than we may realise
© Child Brain Injury Trust 2011
Incidence of ABI in prison
Prof Huw Williams and his team (in prep) on
study of HMP Exeter – sampled 453 prisoners
and found 60% reported head injury – much
higher than community rates
140
estimated:
120
• 10% Severe
100
80
• 5.6 % Moderate
60
Count
40
• 49.4% Mild
20
0
Missing
No
Yes
Any tbi?
© Child Brain Injury Trust 2011
Huw Williams et al 2010
Average age at first imprisonment:
21 Years – Non-TBI offenders
16 years –TBI offenders
Self reported head injury
•65% may have TBI.
•10% Severe
•5.6 % Moderate
•49.4% Mild
© Child Brain Injury Trust 2011
Reoffending
Count
150
Any TBI?
100
No
Yes
50
0
No
Yes
Is this your first time in Prison?
© Child Brain Injury Trust 2011
The number of participants
that were re-offenders
differed significantly
according to whether they
had reported “head injuries”
© Child Brain Injury Trust 2011
…now add a brain injury!
• Loss of IQ (12 points on average)
• Poor short term memory
• Disinhibition
– Reduced awareness of consequence
– Inappropriate behaviours
– Rewards of fight or flight
Dr Andrew Curran (2009)
= Increased likelihood of
offending behaviours
© Child Brain Injury Trust 2011
© Child Brain Injury Trust 2011
Appropriate interventions
• Restorative Justice
– What if young person has lack of empathy
and consequential thinking?
• Community Orders
– Meeting YOT workers at the right time/place
– But what if th etyoung person has poor
organisation and planning skills?
© Child Brain Injury Trust 2011
Complexity of offenders with ABI
‘It’s not only the kind of injury that matters, but
the kind of head’
C. Symonds 1937
Rehabilitation
for Offending
Behaviour
(Dr Ivan Pitman - Consultant Clinical Neuropsychologist, June 2008)
© Child Brain Injury Trust 2011
Rehabilitation
for Cognitive
Deficits
PRACTICAL APPROACH
• Prevention better that cure – programme of “Educating
the Educators”
• Youth Justice or Rough Justice?” Workshops
• Criminal Justice/ABI National Interest Group –
developing awareness and encouraging change
© Child Brain Injury Trust 2011
Members of CJABIIG
© Child Brain Injury Trust 2011
SCREENING & ENHANCING REHABILITATION
• Improved screening for head injury at presentencing and on admission to prison/custodial services
• Better understanding of risk, and for
rehabilitative purposes
– Esp. those with executive & socio-affective difficulties who may
have difficulty in changing behaviour patterns in response to
contingencies
• Rehabilitation interventions in custodial
systems – targeted at impulse control and socioemotional processing eg empathy
© Child Brain Injury Trust 2011