Life After Brain Injury? Manifesto for children, young people and offending behaviour

Presentation summary Overview of UKABIF Campaign ‘Life After Brain Injury - Improve Services Now’ Brain development and the effects of TBI Young offenders and the issues Identifying and managing young offenders with brain injury Manifesto recommendations Next steps

UKABIF Campaign To raise awareness of Acquired Brain Injury To highlight the need for improvements in the provision of services for people with Acquired Brain Injury  Life After Brain Injury – Improve Services Now  3 Manifestos launched since 2012

Campaign overview Life After Brain Injury? Improve Services Now Adult Manifesto ‘Life After Brain Injury – A Way Forward Launched July 2012 Children and Young People Manifesto ‘Life After Brain Injury – A Way Forward Launched November 2013 ‘Life after Brain injury – young people and offending behaviour ‘ Launched November 2015

3 rd Manifesto November 2015 Life After Brain Injury Manifesto for children, young people and offending behaviour

3 rd Manifesto objectives To raise awareness of the issues faced by children and young people with ABI who are ‘at- risk’ of offending behaviour To continue to maintain and raise awareness of the UKABIF Campaign ‘Life After Brain Injury - Improve Services Now’ To raise awareness of UKABIF, ABI and the need for change

Brain development Brain development occurs in leaps and spurts during early childhood and first two decades of life; the developmental stages are crucial in the context of the timing of a brain injury Young people, unlike adults, have limited cognitive reserve e.g. children who sustain a brain injury have little prior knowledge and/or prior life experiences to draw upon to support their recovery, especially cognitive and behavioural functioning and to develop “functioning” compensatory strategies

Brain development – outcome Brain injury in children, adolescents and young adults is a developing disability Q: Not to be confused with a learning disability or a developmental delay?

Children and young people: TBI effects Memory loss Loss of concentration Decreased awareness of own/others emotional state Poor impulse control Poor social judgement Increased aggression Cognitive problems Social/relationship difficulties Increased mental health problems Higher rates of depression or mood disorders Childhood developmental disorders e.g. ADHD Disruptive behaviour difficulties Underachievement

Young offenders: facts and figures 30% of juvenile offenders have sustained a previous brain injury 14% have possible intellectual disability 32% have a borderline disability range 30% of the youth prison population have clinically diagnosed ADHD 50% of individuals convicted for non-violent crimes have a past history of TBI Violent offenders have disproportionately more lesions in their brains, particularly in the frontal areas

Key report Large numbers young people in secure setting with undiagnosed neurodevelopmental conditions which have directly contributed to their offending behaviour difficulties Failure to identify such disorders is a tragedy Need to identify and treat these conditions at an early stage  Avoid the individual, social and financial costs of criminal behaviours

Prevalence of TBI (Hughes et al 2015) Nature of TBIPrevalence among young people in general population (%) Prevalence among young people in custody (%) Any head injury Head injury resulting in loss of consciousness Head injury resulting in loss of consciousness of 20 minutes or more More than one head injury

Facts and figures 5% of young offenders are responsible for nearly 33% of all proven offences committed by <18yrs 71% of young people released from detention go on to break the law within 12 months 4% of young people sentenced for an offence already had 15 or more offences Offending rate is decreasing but re-offending rate has increased to 36.1%; average 1.08 re-offences/offender and 2.99 re-offences/offender

Cost implications 2012/2013: the Ministry of Justice and Youth Justice Board spent £247 million on the detention of young offenders Average annual cost of a youth custodial place ranges from £65,000 at a Youth Offender Institution to £212,000 for a place at a Secure Children’s Home

The problem Children and young people with ABI are often failed by the health service, social care, education system and the criminal justice system at a high personal and economic cost

Brain injury and offending behaviour summary Brain injury is a significant variable in offending behaviour Long-term brain injury in childhood and young adulthood associated with increased tendency of offending behaviour High prevalence of brain injury amongst young offenders in custody (>60%) compared to general population ABI is linked to earlier, repeated offences, a greater total time spent in custody and more violent offending

What happens now with young offenders? Rare for youth justice professionals to consider whether an offender may have a brain injury Children and young people are not generally screened for brain injury and are not referred for the necessary neurorehabilitation Primary contact for young people with a brain injury is the Youth Justice System whose personnel are not trained or equipped to manage brain injury

What can happen with young offenders? The Disabilities Trust has been piloting a specialist brain injury Linkworker Service for prisoners and young offenders to: Work with those identified as having a brain injury Address their problems Assist in their engagement with rehabilitation programmes Improve re-offending outcomes

What we want going forwards Identify brain injury problems early ideally before children and young people enter the YJS  Identify those ‘at-risk’  Provide integrated support from health, education and social services  Prevent offending/reduce likelihood of re-offending

UKABIF Manifesto recommendations Recommendation 1 Increased awareness and training is required about the prevalence of ABI amongst children and young offenders throughout the youth and criminal justice system This together with an understanding and acceptance of the need for early assessment and management. Brain injury should be a key consideration when making decisions about children and young people on arrest.

UKABIF Manifesto recommendations Recommendation 2 Long-term, ongoing monitoring of children and young people with an ABI is required. Early intervention is essential, by trained professionals within the school and healthcare environments, when problems arise that highlight individuals who may be ‘at-risk’ of offending behaviour.

UKABIF Manifesto recommendations(cont’d) Recommendation 3 An assessment tool should be used in schools to facilitate the identification of those children and young people with ABI who are ‘at-risk’ of offending. Recommendation 4 Practical guidelines are required for the management of children and young people with an ABI who are ‘at-risk’ of offending, for use across all sectors; health, education and social services.

What next? UKABIF will be facilitating its recommendations: Implementing an awareness campaign Encouraging training for education professionals e.g. SENCOs Promoting the use of assessment tool(s) in schools Development of guidelines for integrated care involving education, health and social services

Life After Brain Injury? Improve Services Now