1. © Child Brain Injury Trust 2011 Youth Offending and Acquired Brain Injury - a practical approach Louise Wilkinson Information & Learning Manager Child Brain Injury Trust

2. © Child Brain Injury Trust 2011 After birth Illness, accident, stroke, tumour, poisoning, lack of oxygen, non surgical intervention Thinks, feels and responds to situations WHAT IS AN ACQUIRED BRAIN INJURY (ABI)?

3. © Child Brain Injury Trust 2011 Typical characteristics of a young person with an ABI Acquired Brain Injury Poor memory Poor social awareness Poor planning and organisation ability Inability to learn from consequences Poor verbal comprehension Poor attention and concentration

4. © Child Brain Injury Trust 2011 Circumstances Adolescence ABIFamily Support Networks

5. © Child Brain Injury Trust 2011 Young people affected by ABI have a higher likelihood of entering the criminal justice system 24% - 32% general public (McKinley et al, 2008; McGuire et al, 1998) 65% - 72% of inmates in a young offenders institution (Williams et al, 2010; Davies et al, 2012); ………. and once there, their neurological needs are frequently poor or indeed appropriately supported.

6. © Child Brain Injury Trust 2011 Demographics of Acquired Brain Injury 40,000 children per year – accidents alone, resulting in head injury –Road accidents39% –Falls28% –Sport / play17% Incidence –Girls 132/100,000 per year –Boys 235/100,000 per year

7. © Child Brain Injury Trust 2011 The vision of the Youth Justice Board is of an effective youth justice system, where: more offenders are caught, held to account for their actions, and stop offending children and young people receive the support they need to lead crime-free lives victims are better supported the public has more confidence in the youth justice system.

8. © Child Brain Injury Trust 2011 SLC and the brain Sense of balance and coordination of movement Verbal dyspraxia Visual shapes and colours Reading/writing Picture/object recognition Sense of touch, taste, smell Hearing Speech recognition Abstract reasoning/language processing Short term memory Facial recognition Emotional control centre Initiation/goal setting Body movement Motor Speech Problem solving Monitoring and self correction Impulse control Integrating information Long term memory Social interaction Word fluency Reading Writing Processing/calculating Naming

9. © Child Brain Injury Trust 2011

10. Adult acquired brain injury Normal trajectory

11. © Child Brain Injury Trust 2011 Childhood acquired brain injury Normal trajectory

12. © Child Brain Injury Trust 2011 THE FUNNEL EFFECT Children with an ABI have a higher likelihood of being excluded from school because of their behaviour Children who are excluded from school are more likely to offend Better support in Education could reduce Youth Offending rates

13. © Child Brain Injury Trust 2011 Childhood acquired brain injury Environmental factors (family, housing etc) Education (Rehabilitation) Youth Offending Well supported Poorly supported Well supported Maximum outcomes achieved Poor Neuro and Cognitive rehab Good Neuro and Cognitive rehab Impact of Education on the life outcomes for children and young people affected by childhood acquired brain injury © Louise Wilkinson 2011

14. © Child Brain Injury Trust 2011 School is rehab!

15. © Child Brain Injury Trust 2011 THE EVIDENCE Research that proves: the definite link between ABI and offending a higher number of offenders affected by ABI than we may realise

16. © Child Brain Injury Trust 2011 Incidence of ABI in prison Prof Huw Williams and his team (in prep) on study of HMP Exeter – sampled 453 prisoners and found 60% reported head injury – much higher than community rates estimated: 10% Severe 5.6 % Moderate 49.4% Mild

17. © Child Brain Injury Trust 2011 Huw Williams et al 2010 Average age at first imprisonment: 21 Years – Non-TBI offenders 16 years –TBI offenders Self reported head injury 65% may have TBI. 10% Severe 5.6 % Moderate 49.4% Mild

18. © Child Brain Injury Trust 2011 Reoffending Is this your first time in Prison? Any TBI? No Yes NoYes The number of participants that were re-offenders differed significantly according to whether they had reported “head injuries” 150 100 50 0 Count

19. © Child Brain Injury Trust 2011

20. …now add a brain injury! Loss of IQ (12 points on average) Poor short term memory Disinhibition –Reduced awareness of consequence –Inappropriate behaviours –Rewards of fight or flight = Increased likelihood of offending behaviours Dr Andrew Curran (2009)

21. © Child Brain Injury Trust 2011

22. Appropriate interventions Restorative Justice –What if young person has lack of empathy and consequential thinking? Community Orders –Meeting YOT workers at the right time/place –But what if th etyoung person has poor organisation and planning skills?

23. © Child Brain Injury Trust 2011 Complexity of offenders with ABI ‘It’s not only the kind of injury that matters, but the kind of head’ C. Symonds 1937 Rehabilitation for Cognitive Deficits Rehabilitation for Offending Behaviour (Dr Ivan Pitman - Consultant Clinical Neuropsychologist, June 2008)

24. © Child Brain Injury Trust 2011 PRACTICAL APPROACH Prevention better that cure – programme of “Educating the Educators” Youth Justice or Rough Justice?” Workshops Criminal Justice/ABI National Interest Group – developing awareness and encouraging change

25. © Child Brain Injury Trust 2011 Members of CJABIIG

26. © Child Brain Injury Trust 2011 SCREENING & ENHANCING REHABILITATION Improved screening for head injury at pre- sentencing and on admission to prison/custodial services Better understanding of risk, and for rehabilitative purposes –Esp. those with executive & socio-affective difficulties who may have difficulty in changing behaviour patterns in response to contingencies Rehabilitation interventions in custodial systems – targeted at impulse control and socio- emotional processing eg empathy