Translator: Hiroko Kawano Reviewer: Peter van de Ven
Looking around,
I noticed that every one of you brought you brain today.
(Laughter)
In all seriousness, most of us take our brain for granted.
You don't actually have to think about how it works,
it just does.
But that's a luxury that people with a traumatic brain injury
often don't have.
A traumatic brain injury, or TBI,
is a disruption in brain function caused by an external blow to the head.
And when you hear that definition,
you might think about sports and professional athletes
since it's the kind of injury we're used to seeing on the playing field.
And this imagery has really come to define TBI in the public consciousness.
I myself do research on TBI in retired and college athletes,
I stood on a TED stage in 2010,
talking about concussions and kids' sports.
So I have to say, as someone who researches and treats these injuries,
that I've been really gratified to see the growing awareness of TBI
and specifically the short- and long-term risks to athletes.
Today though, I want to introduce you
to a larger but no less controversial group of people
impacted by traumatic brain injury
who don't often show up in the headlines.
I've come to recognize these inmates and probationers
as, surprisingly, among the most vulnerable members of society.
For the last six years, we've been doing research
that has completely changed the way we think about the criminal justice system
and the people in it.
And it may change the way you think about those things too,
so I'll start with a shocking statistic.
50 - 80% of people in criminal justice have a traumatic brain injury.
Up to 80%.
In the general public, in this room, for example,
that number is less than 5%.
And I'm not just talking about getting your bell rung,
these are the kinds of injuries that require hospitalization.
Most of them are the product of a physical assault,
and some of them are actually sustained in jail.
A study, just last year, found that the rate of traumatic brain injuries
is 50 times higher in jails than on city streets.
And as shocking as those numbers are,
all of these numbers are even higher among the women in criminal justice.
Almost every single woman in the criminal justice system
has been exposed to interpersonal violence and abuse.
More than half of these women have been exposed to repeated brain injuries.
In this way,
these women's brains look like the brains of retired NFL players,
and they'll likely face the same risks for dementing diseases as they age -
the same risks.
TBI, together with mental illness and substance abuse and trauma,
makes it hard for people to think.
They have cognitive impairments
like poor judgment and poor impulse control,
problems that lead to the kinds of screw-ups
that make criminal justice a revolving door.
People get arrested and booked into jail.
They oftentimes get into trouble while they're in there,
they get into fights, they fall out of their bunk,
and then they get released and do stupid things
like forgetting mandatory check-ins,
and they get re-arrested.
Statistically speaking, they're actually more likely to be re-arrested than not.
A colleague calls this serving a life sentence, 30 days at a time.
And often times these folks don't know why this is so hard for them.
They feel out of control and frustrated.
And frankly,
it's frustrating for all of us because we have to pay for it.
But imagine how frustrating it is
for the dedicated people who work in that system:
the attorneys and judges, law enforcement, probation,
correctional officers, social workers.
Not to mention the people who love these inmates:
their family members and friends.
So, knowing that TBI is at the root of so many of these challenges,
the mission for a group of us in Colorado has been to disrupt that cycle,
to jam the revolving door.
So, working together with my state and local partners,
we crafted a plan to meet everyone's needs:
the system, the inmates and probationers, my graduate students.
In this program we assess how each person's brain works
so that we can recommend basic modifications
to make this system more effective and safer.
And here, when I say safer, I mean safer not only for the inmates -
thank you - (Laughter)
but also safer for correctional staff.
In some ways, this is such a simple approach.
We're not treating the brain injury,
we're treating the underlying problem
that gets people into all of this trouble in the first place.
And by that, I don't mean we're dragging therapy couches around county jails,
we do quick neuropsychological screening tests
to identify strength and weaknesses in the way an inmate thinks.
Using that information, we write two reports:
one, a report for the system with specific recommendations
on how to manage that inmate;
the other is a letter to the inmate
with specific suggestions for how to manage themselves.
For example, if our test results suggest
that a probationer has a hard time remembering the things they hear,
that would be an auditory memory deficit.
In that case, our letter to the court might suggest
that probationer gets handouts of important information.
And our letter to that probationer would say, among other things,
that they should carry a notebook to record that information for themselves.
Now, most importantly is that I pause here,
to be really clear about one point:
This program does not minimize responsibility
or make excuses for anyone's behavior.
This is about changing long-standing negative perceptions
and building self-advocacy.
It's actually about taking responsibility.
The inmates move from "I am a total screwup, I'm a loser,"
to "Here's what I don't do well,
and here's what I have to do about it."
(Applause)
And the system comes to see an inmate's problematic behavior
as "the things they can't do" versus "the things they won't do."
And that change, seeing behavior as a deficit rather than outright defiance,
is everything in these settings.
We hear from inmates around the country,
and they write, and more than anything they want to know how to help themselves.
This is an excerpt from a letter from Troy in Virginia,
an excerpt from a 50-page letter,
and he writes,
"Can you tell me what you think of all the head traumas I've dealt with?
What can I do?
Can you help me?"
Closer at home, we have thousands of stories like this and smart stories,
stories that have a great outcome.
Here's Vinny.
Vinny was hit by a car when he was 15,
and from that moment forward spent more time in jail than in school.
With some basic skill building,
after our assessment revealed
that he had some pretty significant memory impairments,
Vinny learned to use the alarm and reminder function on his iPhone
to track important appointments.
And he keeps a checklist to break larger tasks into smaller manageable ones.
And with basic tools like that under his belt,
Vinny's been out of jail for two years,
clean for nine months
and recently back to work.
(Applause)
What's so striking for Vinny is
that this is his first time off of court supervision
since his injury more than 15 years ago.
He made it out of the revolving door.
(Applause)
He says now, "I can do anything;
I just have to work a lot harder at it."
(Laughter)
And here's Thomas.
Thomas has some pretty significant attention and behavior problems
after an injury landed him in a coma for more than a month.
After relearning how to walk, his first stop, court.
He couldn't imagine a future where he wasn't in trouble.
He now carries a calendar
to avoid being held in contempt for missed court dates.
And he schedules a break into his day,
every day, to recharge before he gets agitated.
And nobody knows the revolving door better
than the person sitting at the front of the courtroom.
This is my good friend and colleague Judge Brian Bowen.
Now, Judge Bowen was already on a mission to make the system work for everyone,
and when he heard about this program, he saw the perfect fit.
He actually sits down with all of his prosecutors to help them see
that there're basically two categories of defendants in the courtroom.
The ones were afraid of, oftentimes rightfully so,
and the ones were mad at.
There are the ones who miss all of their scheduled appointments,
and they blow through the best-laid probation plans,
and Judge Bowen believes that with a little more support,
we could move people in this latter category,
the maddening category,
through and ultimately out of the system.
He proved that with Navy veteran Mike.
Judge Bowen saw the correlation
between Mike's history of a massive 70-foot fall
and his long-standing pattern
of difficulty showing up on the right day for court appointments,
and complying with mandatory therapy requirements, for example.
And instead of sentencing him to more and more jail time,
Judge Bowen sent him home with maps and checklists and handouts
and recommended instead, vocational rehabilitation
and flexible scheduling for those therapies.
And with those supports, Mike's back to work for the first time
since his injury while he was in the service,
he's repairing relationships with his family,
and just last month, he graduated from Judge Bowen's Veterans Court.
(Applause)
This program shows us the overwhelming prevalence of traumatic brain injuries
and cognitive deficits
and the accumulation of brokenness in the criminal justice system.
And it highlights the extraordinary power of resilience and responsibility.
In Mike and Thomas and Vinny, even Judge Bowen's story,
you saw the transformation made possible
by a change in perception and some simple accommodations.
All told in this program,
these inmates and probationers come to see themselves differently.
The system sees them differently,
and when you meet them in the community,
I hope you see them differently too.
Thanks guys.
(Applause)