Traumatic Brain Injury and Treatment Courts

A client continually misses appointments, drug tests and curfews. Another has no insight into their problems and repeatedly puts themselves in dangerous situations. Another can’t focus in group treatment and interrupts with off-topic, embarrassing comments. Another is irritable and gets angry quickly. Are these signs of long-term substance use? Mental illness? Traumatic brain injury (TBI)? It could be any and all of these, as they frequently co-occur.
 
Treatment courts target people with mental health and substance use challenges, but TBI and its long-term impacts are often “off the radars” of court professionals and providers. Lasting effects of TBIs can be easily mistaken for “personality problems” or intense resistance to treatment. The prevalence of TBIs among treatment court clients is unknown, but they are common in the justice system, resulting from accidents, falls, fights, domestic violence, and military service (CDC, 2010).
 
So, can people with a TBI benefit from treatment court programs? The structure, predictability and case management support that treatment courts provide can make it a good fit, especially if the team is knowledgeable and adapts their practices to meet client needs. Veteran’s Courts are especially aware of these issues, and trainings are periodically offered (check the calendar).
 
But you don’t need to wait: three online guides for substance use treatment, criminal justice, and mental health professionals are listed below and offer strategies for assessing the impact of TBIs and for adapting daily practices and services. Adaptations include using visual aids, patiently repeating information, slowing down interactions, demonstrating self-regulation skills, and tailoring clients’ environments for reminders. Trauma-informed care in this case requires that teams be aware of the cognitive, emotional and behavioral challenges that can persist well beyond the initial injury, and a willingness to respond with compassion–even though it can be very challenging.

References: 

Centers for Disease Control, (2010). Traumatic Brain Injury: A Guide for Criminal Justice Professionals. https://www.brainline.org/article/traumatic-brain-injury-guide-criminal-justice-professionals
 
Center for Substance Abuse Treatment. (2010). Treating Clients With Traumatic Brain Injury. Substance Abuse Treatment Advisory, Volume 9, Issue 2. https://store.samhsa.gov/product/Treating-Clients-With-Traumatic-Brain-Injury/SMA10-4591
 
Struchen, M.A, Davis, L.C., McCauley, S.R, Clark, A.N., (2009). Guidebook for Psychologists: Working with Clients with Traumatic Brain Injury. Baylor College of Medicine. https://www.brainline.org/article/guidebook-psychologists-working-clients-traumatic-brain-injury
 

Written by Sally MacKain, Ph.D., LP

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