A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population.

BACKGROUND: Acquired brain injury (ABI) is a major health problem, often with negative effects on behaviour and mental health as well as cognition. Prevalence of ABI is exceptionally high among offenders and increases their re-offending risk. Information on risk factors for ABI and its outcomes among offenders that could guide effective treatment for them is, nevertheless, scarce and dispersed. However, there is a more substantial literature about the general population that could inform work with brain-injured offenders, especially when selecting for samples or subgroups with similar relevant characteristics, such as lower socio-economic status (SES), pre-injury lower tested intelligence score (<85) and pre-injury mental health problems. AIMS: To explore brain injury data from non-offender samples of otherwise similar socio-economic and mental health and ability characteristics to offenders then, first, to describe their untreated outcomes and, secondly, outcomes after frequently used interventions in these circumstances, noting factors associated with their effectiveness. METHOD: Three databases were systematically searched for the years 2010-2022; first, using terms for brain injury or damage and cognitive (dys)function, mental health or quality of life. Second, in a separate search, we used these terms and terms for interventions and rehabilitation. In the second review, studies were selected for clear, distinguishable data on age, sex, SES and lifestyle factors to facilitate inferences for offenders. A narrative analytical approach was adopted for both reviews. RESULTS: Samples with characteristics that are typical in offender groups, including lower SES, lower pre-injury intelligence quotient (<85), prior cognitive impairments and prior mental health problems, had poorer cognitive and behavioural outcomes following ABI than those without such additional problems, together with lower treatment adherence. With respect to treatment, adequate motivation and self-awareness were associated with better cognitive and behavioural outcomes than when these were low or absent, regardless of the outcome measured. CONCLUSIONS: More complex pre-injury mental health problems and social disadvantages typical of offenders are associated with poorer post-brain injury recovery. This paper adds to practical knowledge by bringing together work that follows specific outcome trajectories. Overall, succesful ABI-interventions in the general population that aim at pre-injury difficulties comparable to those seen among offenders, show that personalising injury-specific treatments and taking account of these difficulties, maximised positive outcomes.

Occurrence of Psychiatric Disorders, Self-Sufficiency Problems and Adverse Childhood Experiences in a Population Suspected of Violent Extremism.

BACKGROUND: Public health-inspired programs for Countering Violent Extremism (CVE) have developed internationally in a relatively short period of time. Research into these programs is scarce. There is a need for information that helps drive public health interventions. OBJECTIVES: To present data on the occurrence of psychiatric disorders, self-sufficiency problems and adverse childhood experiences (ACE) in a population suspected of violent extremism. METHODS: A cross-sectional study, with data from screening reports for 34 adult subjects included in a multi-agency case-based approach on violent extremism in Amsterdam, the Netherlands. Subjects were screened in the period between December 2015 to May 2021. Screening reports, which included the Screener for Intelligence and Learning Disabilities (SCIL) and the Dutch version of the Self-sufficiency Matrix (SSM-D), were used to gather information on the main outcome measures. RESULTS: Major psychiatric disease categories were found to be mood and anxiety disorders and mild intellectual disability (each 29.4%), substance related disorders (35.3%), personality disorders (41.2%), and psychotic disorders (14.7%). Complex self-sufficiency problems, measured by the number of people who had self-sufficiency problems in 4+ domains and the number of people who had similar self-sufficiency problems as homeless people in Amsterdam, were found in 35.3 and 32.4% of the client sample. The most prevalent ACE were emotional neglect (47.1%), household mental illness (44.1%), and loss of a parent (38.2%), 35.3% had been exposed to 4+ ACE. An association was found between NACE and self-sufficiency problems on two domains, namely "Mental Health" (rho = 0.51, p = 0.002) and "Law and order" (rho = 0.42, p = 0.013). CONCLUSIONS: An accumulation of social and psychiatric problems in people suspected of violent extremism underlines the importance of professionals in health and social care being actively involved in developing CVE approaches.

Acquired Brain Injury and Interventions in the Offender Population: A Systematic Review.

Background and Aims: The prevalence of acquired brain injury (ABI) in offender populations appears much higher than in the general population, being estimated at 50% compared to 12%, respectively. Taking into account ABI-related cognitive and social impairments or behavioral changes in forensic treatments might be relevant and may improve treatment outcomes. The aim of the current review is to summarize and integrate the literature on psychological interventions or treatments for consequences of ABI in the forensic setting. Reviewing this literature could provide crucial information for improving treatment options for offenders with ABI, which may contribute to reducing recidivism. Methods: The PubMed/MEDLINE, PsychInfo, CINAHL, COCHRANE, and Web of Science databases were searched for studies in adult offenders with ABI that evaluated the effect of psychological interventions with a focus on ABI-related impairments and recidivism. Results: This review identified four intervention studies that met the inclusion criteria. These included an adult population (≥18-year-old) in a forensic setting (given the focus of the current review on treatment, defined here as an environment in which offenders are treated while being incarcerated or as outpatients), non-pharmacological treatments and were published in English or Dutch between 2005 and 2020. All studies reported some positive effects of the intervention on interpersonal behavior, cognition and recidivism. The aspects of the interventions that seemed most beneficial included personalized treatment and re-entry plans, support for the individual and their environment and psychoeducation about the effects of ABI. Discussion: Although positive effects were reported in the studies reviewed, all studies had methodological limitations in terms of sample size, study design and outcome measures which affects the strength of the evidence. This limits strong conclusions and generalizability to the entire offender population. Conclusion: Despite high prevalence of ABI in offender populations, interventions in forensic settings seldom address the effect of ABI. The few studies that did take ABI into account reported positive effects, but those results should be interpreted with caution. Future studies are warranted, since this does seem an important venue to improve treatment, which could eventually contribute to reducing recidivism.

The relationship between adverse childhood experiences and self-sufficiency problems in early adulthood among violent offenders.

BACKGROUND: Although adverse childhood experiences (ACE) are related to many single negative outcomes, its relation with multiproblem situations in early adulthood is largely unknown. OBJECTIVE: To examine ACE's relation with self-sufficiency problems (SSP) in important life-domains among a sample of young adult violent offenders. PARTICIPANTS AND SETTING: Participants were drafted from a local diversion program for violent repeat offenders. Young adults who agreed to a social-psychiatric screening and who had a history of juvenile probation were eligible to participate. METHODS: The screening included the assessment of SSP (N = 523). ACE prevalences were retrieved from historic juvenile probation files (N = 122). The ACE-SSP relation was assessed with multivariable regression analyses with ACE and SSP as cumulative measures. RESULTS: Offenders presented with 6.1 SSPs from 10 life-domains on average and had been exposed to 3.1 ACEs. Exposure to 4+ ACEs was observed for 42 % of the sample. ACE was positively associated with SSP (ß = .38, p < .01) and with impaired functioning in the distinct domains finances (OR = 1.53, p < .05), addiction (OR = 1.33, p < .05), community participation (OR = 1.28, p < .05) and housing (OR = 1.22, p < .05). CONCLUSIONS: Both ACE and SSP are common among violent offenders. Higher diversity in ACE was associated with higher diversity in SSP. Juvenile probation for high-risk juveniles should focus on preventing functioning problems in multiple life-domains. Diversion efforts for young adult offenders require sensitivity to personal histories and vigilance about multi-problem situations.

[Health problems of migrants who don't have a valid residence permit: Somatic and psychiatric problems of migrants who are applying for shelter]. / Gezondheidsproblemen van migranten zonder geldige verblijfsvergunning.

OBJECTIVE Many healthcare professionals are confronted in their practice with migrants who don't have a valid residence permit. With this study, we want to provide more insight in the health problems and healthcare consumption of this group. DESIGN Retrospective file study. METHOD Data were taken from files created by municipal health-service physicians when medically screening people who present to the municipality to apply for 24-hour shelter on the basis of their health condition. Symptoms and disorders were coded according to the International Classification of Primary Care (ICPC), and use of medication according to the Anatomical Therapeutic Chemical Classification (ATC). RESULTS The study population consisted of 356 people, mainly men, 39 years of age on average (range: 18-80 years). Compared with the total population of people without a valid residence permit who presented to the municipality (n = 1010), in the study population both women (25.6%) and people in age categories above 45 years of age (32.0%) were overrepresented. At the time of screening, 45.2% had a regular, stable place of residence. Most people without a valid residence permit (98.6%) reported one or more health problems. Psychological symptoms, such as stress (78.5%), insomnia (69.7%) and feelings of depression, were the most common ones. At the same time, many people without a valid residence permit were receiving medical care (86.8%). CONCLUSION A majority of people without a valid residence permit who present to apply for 24-hour shelter have health problems. Stress and other psychological symptoms are the most common ones. At the same time, a large part is receiving adequate care. This means that barriers to care, at least in Amsterdam, do not seem too high.