Researchers from the Brain Injury Research Center at the Icahn School of Medicine at Mount Sinai, in partnership with the Pennsylvania Department of Corrections (PADOC) and the Brain Injury Assocation of Pennsylvania (BIAPA), have launched a rigorous research study to reduce recidivism, or re-offending, among people with brain injury who are leaving incarceration.
The intervention being studied is NeuroResource Facilitation (NRF)—a specialized service that promotes access to services and care coordination tailored to the needs of people with brain injury, who make up a large proportion of prison populations, as one study found that as many as 87 percent of inmates screened positive for at least one brain injury. The study is being funded through a $2.5 million grant from the National Institute of Justice—the research, development, and evaluation agency of the U.S. Department of Justice.
The research team will recruit and follow a cohort of more than 1,500 justice-involved individuals who screen positive for brain injury during the last phase of their prison sentence. Participants will be randomized into one of two groups: an intervention group that will receive at least one year of NRF, or a comparison group that will receive standard re-entry services. Researchers will compare rates of recidivism and related outcomes such as productive activity, gainful employment, stable housing, and use of health-related programs.
Acquired brain injury (BI) is defined as a traumatic or nontraumatic injury to the brain that results in cognitive, behavioral, and mental health challenges. Previous work has established that the prevalence of brain injury is significantly greater in justice-involved populations, and that a substantial proportion of prisoners have likely experienced at least one brain injury during their lifetime. People with cognitive impairments related to brain injury may struggle with the outcomes needed to avoid recidivism: Many are unable to maintain competitive employment; have difficulty completing everyday tasks; grapple with substance misuse or mental health challenges; and report dissatisfaction with their lives. Furthermore, the memory and executive-functioning skills that providers rely on in clinical treatment settings are the very skills that are often negatively impacted by brain injury, rendering traditional interventions ineffective.
NeuroResource Facilitation is similar to intensive-case management in that it goes well beyond information and referral, and can include direct assistance with applications, appointments, problem-solving, and advocacy. NRF uses cognitive and behavioral strategies tailored to accommodate brain-injury-related challenges to help participants to effectively manage day-to-day tasks and take advantage of available treatments and services.
"Previous research conducted by our partners in 2016 demonstrated that one-year recidivism rates among justice-involved individuals with brain injury receiving NRF was 17 percent, which is significantly lower than the average one-year recidivism rate of 35 percent that was reported in the state's 2013 recidivism report," said Maria Kajankova, PhD, Assistant Professor of Rehabilitation and Human Performance at Icahn Mount Sinai, who specializes in rehabilitation neuropsychology and is principal investigator of the new study. "We are eager to partner with the PADOC and BIAPA to further evaluate the NRF intervention in a large-scale, rigorous clinical trial with justice-involved individuals with brain injury and conbribute our Center's extensive experience leading large-scale, randomized, controlled clinical trials and decades of brain injury research."
Through this research project, a protocol for screening inmates for brain injury and cognitive impairment will be implemented, and specialized NRF services will be provided to those individuals who screen positive and are randomized to NRF during the last six-month phase of their sentence. In addition to resource identification, application and connection to specialized neuroresources, the NRF intervention also includes: brain injury education and counseling (both individual and group therapy); cognitive strategy development and implementation; assistance with prison-based programming and services—including education, employment, referrals for prison-based medical appointments, and assistance with planning and problem-solving; and advocacy that may be needed, including outreach to Institutional parole, identified halfway houses, or families. NRF will be provided both before and after release and its effectiveness will be evaluated by comparing reduction in recidivism in both groups and related outcomes such as productive activity, gainful employment, stable housing, and maintenance of health services and programs.
The research study will be implemented in four Pennsylvania State Correctional Institutions: Phoenix, Chester, Frackville, and Mahanoy. During the first six months of the project, an implementation team will be established, and cross-system collaborations between Mount Sinai, PADOC and BIAPA will be initiated. Collaboration with parole officers will be a key component of this project, and specialized brain injury training will be provided to staff at all prisons participating in the project.
"We were encouraged by the results of a demonstration project of the implementation of NRF as an intervention to improve outcomes for justice-involved individuals with brain injury released to the community from a maximum security prison in Pennsylvania. We appreciate the opportunity to partner with the Icahn School of Medicine at Mount Sinai to study the efficacy of this intervention," said Monica Vaccaro, BIAPA Director of Programs.
"A key goal of this integrated, cross-collaborative project is to promote sustainability and build capacity of prison staff by providing training in brain injury screening and assessment of neurocognitive deficits, to obtain evidence to support the NRF intervention, and ultimately to help staff recognize and address brain injury in the prison system long after our research project is completed," Dr. Kajankova says.
