All Media
All Media

Addressing Brain Injury in the Criminal Legal System

Categories: ACBIS Insider

By Judy Dettmer and Kelly Miller, National Association of State Head Injury Administrators

Brain injury is a significant public health concern, a fact well-known to professionals in the field and affirmed by the CDC. According to national surveys, about 20 to 30 percent of American adults have a self-reported history of traumatic brain injury 1. This data only reflects those who sustained traumatic brain injuries (TBI); it does not account for individuals who sustained their brain injury through non-traumatic causes, such as stroke or lack of oxygen to the brain.

While the incidence of brain injury in the general population is alarming, the prevalence among those involved in the criminal legal system is staggering. It has been estimated that about 60 percent of incarcerated individuals have a history of brain injury. Prevalence is even higher for those who are females and for those with co-occurring conditions, such as behavioral health concerns 2, 3. Individuals with brain injury report a greater number of incarcerations than those without a brain injury, and inmates who have a brain injury have higher rates of disciplinary actions while incarcerated. Finally, research shows that individuals with brain injuries are more likely to recidivate; a recent study reported that at 12 months post-release, approximately one-third of those without a TBI had recidivated, compared to over half of those with a TBI 5.

The National Association of State Head Injury Administrators (NASHIA) has been collaborating with several states and national partners to improve outcomes for people with brain injury who are involved in the criminal legal system. NASHIA and other national organizations effectively lobbied to ensure the passage of the Traumatic Brain Injury and Post-Traumatic Stress Disorder Law Enforcement Training Act in 2022 (Public Law No: 117-170). As a result of this law, the Bureau of Justice Assistance (BJA) under the Department of Justice has worked to ensure brain injury is recognized in funding opportunities and to develop best practice guidance for justice organizations. To this end, BJA contracted with the Council on State Governments, which collaborated with NASHIA and subject matter experts across the country to develop a best practice set of recommendations report titled Mind Matters: Building a Justice System that is Responsive to Brain Injury.

NASHIA leveraged the inclusion of brain injury within BJA funding announcements to support several states – including Kansas, Arkansas, North Dakota, and Utah – in applying for and securing federal grant dollars to improve outcomes for individuals with brain injury engaged in the criminal legal system through screening and identification, compensatory strategies, and resource facilitation. As a result, NASHIA received a three-year Department of Justice, BJA, Second Chance Act grant.

In Kansas, Minds Matter, LifeStreams, Washburn University, the Wyandotte County Detention Center, and Dr. Kim Gorgens are partnering with NASHIA to implement the project goals. The objectives of the project are:

  1. Strengthen partner capacity through training to identify and support high-risk individuals with brain injury.
  2. Use the Online Brain Injury Screening and Support System (OBISSS) to screen individuals within 90 days of release for brain injury history and related challenges.
  3. Administer the Ohio Risk Assessment System Supplemental Reentry Tool (ORAS SRT) to assess criminogenic risk among those who screen positive for brain injury.
  4. Conduct neuropsychological screening with the Automated Neuropsychological Assessment Metric (ANAM) Core Battery for individuals at moderate or high risk of reoffending.
  5. Deliver OBISSS-generated compensatory strategies and support to promote success in jail and during reentry.
  6. Provide psychoeducation using the Achieving Health through Education Accountability and Determination (AHEAD) curriculum for high-risk individuals with a history of brain injury.
  7. Offer Brain Injury Resource Facilitation to participants with both a positive brain injury screen and moderate or high ORAS risk.

NASHIA is excited to collaborate with its partners in Kansas and other states to implement this important model and improve outcomes for individuals with brain injury within the criminal legal system by reducing recidivism and increasing community engagement.

References:

  1. Daugherty, Jill; Peterson, Alexis; Black, Lindsey; Waltzman, Dana. Summary of the Centers for Disease Control and Prevention’s Self-reported Traumatic Brain Injury Survey Efforts. Journal of Head Trauma Rehabilitation 40(1):p E1-E12, January/February 2025. | DOI: 10.1097/HTR.0000000000000975
  2. Daugherty, Jill PhD; Peterson, Alexis PhD; Black, Lindsey MPH; Waltzman, Dana PhD. Summary of the Centers for Disease Control and Prevention’s Self-reported Traumatic Brain Injury Survey Efforts. Journal of Head Trauma Rehabilitation 40(1):p E1-E12, January/February 2025. | DOI: 10.1097/HTR.0000000000000975
  3. U.S. Centers for Disease Control and Prevention. (2025). Health Disparities in TBI. https://www.cdc.gov/traumatic-brain-injury/health-equity/index.html. Accessed June 27, 2025.
  4. Piccolino and Solberg, “The impact of traumatic brain injury on prison health services and offender management.”
  5. Ray, B., & Richardson, N. J. (2017). Traumatic Brain Injury and Recidivism Among Returning Inmates. Criminal Justice and Behavior, 44(3), 472-486. https://doi.org/10.1177/0093854816686631