By CHARITY CHUKWU
The Dallas Examiner
In recognition of Brain Injury Awareness Month, the Texas Health and Human Services Commission hosted the 2021 Texas Brain Injury Conference March 26. The two-day virtual conference and webinar series celebrated the achievements of people living with a brain injury and provided awareness and education about brain injuries and treatment options.
State and national experts discussed brain injuries in relation to criminal and juvenile justice, the emotional needs of brain injury survivors and educational needs for students.
Joe Perez, interim deputy executive commissioner of Health, Developmental and Independence Services at Texas HHSC, began the event by sharing a video that highlighted the work of the rehabilitation services program and the courageous stories of brain injury survivors who were helped by the program.
“The effects of each survivor’s brain injury are unique to them and require a recovery plan that’s catered to their specific needs,” said HHSC Brain Injury Programs Manager Christine Medeiros in the video. “We work with survivors and their families to help them get the appropriate supports, resources, education and rehabilitation services for recovery. We are with them every step of the way as they work to regain their independence.”
More than 380,000 Texans sustain a traumatic brain injury each year. The most common causes of traumatic brain injuries are slips and falls, vehicle crashes, violence and explosions.
“Our wish is that no one would ever need brain injury services, but it’s comforting to know that in the unfortunate event that they do, our conference of rehabilitation services is ready to support them on their road to recovery,” Perez said.
The justice system
The opening lecture given by Judy Dettmer, director of strategic partnerships at the National Association of State Head Injury Administrators, focused on understanding brain injury in the context of the criminal and juvenile justice system. She discussed the prevalence, screening and accommodation and the psychoeducational supports needed to improve outcomes for people with brain injuries during incarceration.
A meta-analysis found that the occurrence of traumatic brain injuries in the justice population to be 60.2% compared to 8.5% in the general population. Additionally, across all settings 30% of juvenile offenders were identified to have sustained a previous brain injury.
“We know that people are already predisposed to criminal behavior or interference with the criminal justice system once they have a brain injury, and once they’re in the system it’s harder for them to be successful and exit that system,” Dettmer said.
She continued by describing how to use person-centered planning, a wraparound approach and trauma-informed care to identify and treat people in the justice system that may have had a brain injury. In a six-point administration of best practices starting with screening for a lifetime history of brain injury and ending on a referral to community-based support, Dettmer relayed what she considers is the “Cadillac Model” protocol for solutions to better outcomes in the justice system.
“What we’re stressing is that we are not saying that we’re asking you to treat the brain injury, what we are asking is that you’re thinking about brain injury when you’re doing behavioral health for other treatments and thinking about how those things can interfere with the success of treatments. So, it’s about that demystification,” she said.
Emotional support
Deana Adams, president and founder of Hope After Brain Injury and executive director of Hope Behavioral Health, co-led the next session of the conference focusing on the mental and emotional needs following a brain injury.
Adams explained the three major mental health issues – depression, anxiety and PTSD – associated with those affected by a traumatic brain injury and the different coping strategies used to help calm patients. Along with exercise, journaling and breathing exercises, Adams noted that creating purpose, remaining optimistic and reciting self-affirming statements as ways of regaining control in times of uneasiness.
As for the emotional health issues, the three most commonly expressed in brain injuries are anger, fatigue and self-care. Some of the contributing factors for fatigue are attention and processing speed.
“You can actually break a sweat trying to think. So we cannot discount or minimize when somebody’s trying to figure something out, and a survivor specifically, love on them give them the space,” Adams said.
She offered advice on what family and loved ones should do when confronting anger during rehabilitation from their injury.
“When we take things personally, we assume it’s us, and it’s not. When someone is angered with brain injury it could be a million things,” she said. “It could be the light’s too bright; it could be the TV is on and somebody is trying to talk to them; it could be there’s too many people in the room. You don’t know what the trigger is. So just realize, let it be a signal instead of an assault.”
Patti Foster, inspirational speaker and former radio personality, shared her story as a survivor of a major brain injury. Foster was considered dead at the crash scene on June 18, 2002 when a speeding semi slammed into her stopped vehicle.
She gave words of inspiration for those adjusting to life in wake of brain injury and also provided personal tips for how to combat day-to-day struggles. She reminded the audience that “seeing is not believing when it comes to brain injury” referring to the internal struggles that face survivors. With her motto “persevere through adversity” she wrote the book Coping with Traumatic Brain Injury and dedicates her time advocating for others.
Youth and education
For the last session, Brenda Eagan-Johnson, state project director of BrainSTEPS/Brain Injury Association of Pennsylvania and Heather Hotchkiss, principal brain injury specialist at the Colorado Department of Education discussed the educational needs for students with acquired brain injuries.
After a brain injury occurs, students typically retain prior knowledge and memories however new learning is difficult.
“When they come back to school after a traumatic brain injury, they may need to have new strategies taught to them because their prior study skills may not work in the same way as they did before,” Eagan-Johnson said.
Students remember who they used to be before their brain injury, making it difficult for them to adjust to their sudden staggered abilities according to Eagan-Johnson.
“If they’re struggling, they have to come to terms with their old self and their new self, and that can be hard. It’s hard for parents, it can be hard for students, so that’s something that you really need to support,” she explained.
Due to students’ scattered performance, teaching practices need to be different after a brain injury to accommodate for frustration from attention issues and cognitive fatigue. To address the critical need to train schools, the Pennsylvania Department of Health developed the consulting program BrainSTEPS – which stands for Strategies Teaching Educators, Parents and Students – to assist educational support structures following acquired brain injury.
The program prepares students for the return to school by communicating with the district, family, medical and rehab professionals to gather medical and educational records to help the school in making educational recommendations. Most importantly it monitors all referred students annual until graduation.
The program can be adapted to work in any state and was done successfully in Colorado. Hotchkiss detailed how the model was used in collaboration with the Colorado Department of Education’s Building Blocks of Brain Development program.
“The reason we developed the Building Blocks of Brain Development is to really give the BrainSTEPS team a framework, a model, a set of tools that really aligns nicely with not only all of the neuroscience research, how to access brain processes or neurocognitive kinds of areas in the school setting so they have the right information to be able to act on that,” Hotckiss said.
“But also, to give that team and the parents who have children who have had an acquired brain injury a simplistic kind of framework to understand a very complex organ such as the brain and some simple ways to communicate about those issues, identify those deficits and really address those needs.”
In closing Michelle Alletto, chief program and service officer of Texas HHSC, shared a testimonial about a young man helped by the Comprehensive Rehabilitation Services program after sustaining a traumatic brain injury playing the sport he loved in high school.
“I try as often as I can to talk about the people we do serve. I mentioned some numbers, but behind each of those numbers is an individual and a family,” she said.