Introduction. Although traumatic brain injury (TBI) has been identified as a pervasive problem in incarcerated populations, there remains an unmet need for interventions and services targeting TBI in the prison healthcare system. Clinical guidelines suggest that an educational approach that emphasises information and reassurance can be effective (1). The present study examines the efficacy of a simple, single session psychoeducation intervention for people with TBI that might be appropriate for delivery in prisons. We present here preliminary data from one of a series of projects in Scotland that are associated with the development of a health service for people with HI in the criminal justice system (2). This study explores prisoners’ knowledge of the consequences and long-term effects of HI, as well as self-reported aggression and impulsivity, before and after the intervention and at follow-up. 

Methods. Adult male offenders were recruited from two prisons in Scotland. The study comprised three stages: a screening appointment (T1; n=34), a one hour group intervention (T2; n=19), and a one-month follow-up appointment (T3; n=11). At T1, participants were administered a vignette illustrating the circumstances of a fictitious acquired TBI and had to indicate what the persisting effects/outcome might be. They also completed symptom checklists designed to evaluate their knowledge of typical post-TBI sequelae and questionnaires about their own aggression, impulsivity, TBI, and offending history. T2 consisted of a one-hour interactive group session on TBI and its persisting effects; participants again responded to vignettes and completed symptom checklists immediately after the psychoeducation session, and received written guidance about TBI. At the one-month follow-up (T3), participants completed the measures administered previously once more. 

Results. There was a significant improvement in knowledge about TBI both immediately following the psychoeducation session (p<0.01), and at follow-up (p<0.01). All participants self-reported having had a head injury (n=33), and all but one having had multiple HIs. There was no change in self-reported aggression and impulsivity. Further analyses comparing those self-reporting mild HI (n=20) and moderate-severe HI (n=13) suggest that knowledge improved more in those reporting mild HI after the psychoeducation intervention (p<0.05). 

Conclusion. A single session a psychoeducation program improved knowledge about TBI in male prisoners including at follow-up, particularly in those who self-reported mild HI. This study demonstrates that delivering a brief psychoeducation program to offenders is a feasible way of delivering unmet support needs for HI in prisons. 

1 https://www.nes.scot.nhs.uk/media/3325330/matrix_-_neurologicaltables.pdf

2 http://www.nphn.scot.nhs.uk/wp-content/uploads/2016/07/NPHN-Brain-Injury-and-Offending-Final-Report.pdf

Can a single session psychoeducation program improve knowledge about traumatic brain injury in adult male prisoners?