TBI TARC is supported by contract number 

HHSP233201500119I from the U.S. Administration for 

Community Living, Department of Health and Human 

Services, Washington, D.C. 20201

TBI Tuesdays

Justice for All: Serving 

Individuals with Brain Injury 

Across the Justice System

March 30, 2021
Welcome to Today’s TBI Tuesday Session

Thom Campbell

TBI Team Lead

Thom.Campbell@acl.hhs.gov

2
Webinar Logistics

• Participants will be in listen-only mode during the 

webinar. Please use the chat feature in Zoom to post 

questions and communicate with the hosts. 

• During specific times in the webinar, we will have 

opportunity to respond to questions that have been 

entered into chat.

3
Feedback and Follow-Up

• After the webinar, you can send follow-up questions 

and feedback to tbitarc@hsri.org

(Please note: This email address will not be monitored 

during the webinar.)

• A recording, including a pdf version of the slides, will 

be available on the ACL website (acl.gov)

4
Who’s Here?

“In what role(s) do you self-identify? Select all that apply.”

1. Person with a traumatic brain injury 5. Social worker, counselor, or care 

(TBI) or other disability manager

2. Family member or friend of 6. Researcher / analyst

a person with a TBI or other 7. Service provider organization disability employee

3. Self-advocate / advocate 8. Government employee 

4. Peer-specialist / peer-mentor (federal, state, tribal, or municipal)

5
What we 

will 

cover

Part 1

6
What we 

will 

cover

Part 2

7
Meet Our Federal Partner Speaker

Kyle Smiddie, 

JD, MSW

Attorney, Special 

Litigation 

U.S. Department of 

Justice

8
Meet Our ACL State Speakers

Peter 

Bisbecos

Executive Director

Rehabilitation 

Hospital of 

Indiana

Lance 

Trexler

Executive Director

Rehabilitation 

Hospital of 

Indiana

Julie Myers, 

MPH

Public Health Program 

Administrator

Pennsylvania 

Department of 

Health

Laura 

Trexler

ACL Grant Clinical 

Program Manager

Rehabilitation 

Hospital of 

Indiana

Karen 

Ferrington, CRC, 

CBIS

Program Manager

MINDSOURCE - Brain Injury 

Network 

9
Meet Our Other Speakers

Jennifer Scott

Individual with a 

Brain Injury

Regi Huerter, MA

Senior Project 

Associate

Policy Research 

Associates

Cheryl Kempf

Individual with a 

Brain Injury

10
BRAIN INJURY AS 

RISK FACTOR 

FOR CRIMINAL 

JUSTICE 

INVOLVEMENT
Presenter & Funding

Lance E. Trexler, PhD, FACRM

Rehabilitation Hospital of Indiana

Indiana University School of Medicine

This presentation was made possible through 

funding provided by the Administration for 

Community Living Traumatic Brain Injury State 

Demonstration Grant Program

Grant No. 90TBSG0034-01-00

12
Outline 

• What is the prevalence of TBI in criminal justice and ethnic 

disparities

• Neurobehavioral consequences of TBI and involvement with 

the JJ/CJ systems

• Preliminary evidence for the effectiveness of resource 

facilitation to reduce recidivism and improve community 

integration

13
Prevalence

Meta-analysis of 20 

epidemiological studies 

found 60% of offenders 

had history of TBI1

Compared to 8.5% of 

people in the community2

1. Shiroma, Ferguson, & Pickelsimer (2012). 

J. Correctional Health Care, 16(2), 147-159.

2. McGuire, Burright, Williams, & Donovick (1998). 

Brain Injury, 12(3), 207-214. 

14
Adolescent TBI and Crime

• 508 psychiatric inpatient adolescents

• Adolescents with TBI had significantly more often committed crimes (53.8%) 

compared to adolescents without TBI (14.7%) 

• Subjects with TBI had significantly more violent crimes

• TBI during childhood and adolescence increased the risk of: 

o Any criminality 6.8-fold (95% 3.0–15.2) 

o Conduct disorder 5.7-fold (95% 2.1–15.4)

o Concomitant criminality & conduct disorder 18.7-fold 

(95% 4.3–80.1)

Luukkainen, S, Riala, K, Laukkanen, M et al (2012). Association of traumatic brain injury with 

criminality in adolescent psychiatric inpatients from Northern Finland. Psychiatry Research, 

200(2-3), 767-772

15
TBI a Clear Risk Factor for Incarceration

83% reported sustaining a TBI before their initial 

involvement with the criminal justice system

Sarapata, M, Herrmann, D, Johnson, T, & Aycock, R (1998). The role of head injury in cognitive 

functioning, emotional adjustment and criminal behavior. Brain Injury, 12(10), 821–842

16
Ethnic and Cultural Disparities (1 of 2)

• TBI incidence rate for Hispanics is 262 per 100,000 persons 

vs the national average of 200 per 100,000 

• Injury risk factors associated to ethnic minority status include poverty, 

restricted occupational and educational opportunities, dangerous 

residential environments, employment in physically demanding and 

dangerous jobs, and/or culture-specific health behaviors

• Despite similar functional status at inpatient rehabilitation discharge, 

Hispanics have poorer functional outcomes at 1 year 

post-injury compared to whites, after controlling for 

age, length of PTA, injury severity, DRS score at 

admission, FIM score at admission, and pre-injury

educational level

17
Ethnic and Cultural Disparities (2 of 2) 

• Adult Black and Hispanic people with TBI are significantly less likely 

to receive intensive rehabilitation, even for those with Medicare

• Adult Black and Hispanic have worse functional outcomes and 

community integration and are less likely to become reemployed

• Adult Black and Hispanic caregivers express more burden, spend 

more time in caregiving, and have fewer met needs as compared to 

white counterparts

• Black and Asian/Pacific Islander people with

TBI have increased depression over time 

as compared to whites, while depression 

decreased for Hispanics.

• Black people with TBI had lower life satisfaction

compared with white and Hispanic people

18
Ethnic and Cultural Disparities —

Slide References

Cooper, Kirby D., et al. The epidemiology of head injury in the Bronx. Neuroepidemiology 2.1-2 (1983): 79-88.

Penn, Nolan E., et al. Panel VI: Ethnic minorities, health care systems, and behavior. Health Psychology 14.7 (1995): 

641.

Uswatte, Gitendra, and Timothy R. Elliott. Ethnic and minority issues in rehabilitation psychology. Rehabilitation 

Psychology 42.1 (1997): 61.

Arango-Lasprilla, Juan Carlos, et al. Functional outcomes from inpatient rehabilitation after traumatic brain injury: how 

do Hispanics fare? Archives of Physical Medicine and Rehabilitation 88.1 (2007): 11-18.

Meagher AD, Beadles CA, Doorey J et al. Racial and ethnic disparities in discharge to rehabilitation following 

traumatic brain injury. J Neurosurg, 2015, 122: 595-601.

Gary KW, Arango-Lasprilla JC & Stevens LF. Do racial/ethnic 

differences exist in post-injury outcomes after TBI? 

A comprehensive review of the literature. 

Brain Injury, 2009: 23(10): 775-789.

Perrin PB, Krch D, Sutter M et al. Racial/ethnic disparities 

in mental health over the first 2 years after 

traumatic brain injury: A model systems study. 

Arch Phys Med Rehabil, 2014, 95: 2288-2295. 

19
Diffuse Axonal Injury

93% of acute CT scans 

are normal in mTBI; 10% 

are normal in severe TBI, 

and significant new 

lesions and ICP may 

develop in as many as 

40% of cases with an 

initially normal head CT

20
DTI and Diffuse Axonal Injury

21
Frontal Regulation of Adaptability 

22
Orbitofrontal Injury

• Disinhibition and impulsivity: dissociation of 

knowledge with behavior (“pseudo-psychopathic”)

• Hyperkinetic & jocularity

• Euphoric & irritability

• Impaired maintenance of 

cognitive set/strategy

23
TBI Consequence & 

Functional Impact on Behavior 

24
Resource Facilitation in the 

Criminal Justice in Pennsylvania

• 163 in maximum security prison 

• 75% screened + for possible brain injury

• 74% of whom were found to have 

cognitive impairment of memory & 

executive functions

• Average of 3.8 brain injuries over lifetime

Descriptive study provided preliminary 

evidence for improved outcomes with 

Resource Facilitation

• Increased productivity –

50% competitively employed

• Decreased recidivism – 17%

Nagele D, Vaccaro M, Schmidt MJ et al (2019). Brain injury in 

an offender population: Implications for reentry and community 

transition. Journal of Offender Rehabilitation, 57(8), 562-585.

25
Resource Facilitation Defined

• Providing brain injury–specific education to individuals with 

brain injury and their families/caregivers

• Proactively helping the individual identify, obtain, and 

navigate needed services and supports (e.g., brain injury, 

instrumental, community)

• Promoting TBI-informed care with other providers

• Ensuring collaboration, integration and coordination 

between providers and community-based resources

26
Resource Facilitation Results

• 64%-70% of those with TBI who received RF returned to work and 

school as compared to 36%-50% of those who did not

• RF resulted in a significant decrease in level of disability on 

measures of abilities, adjustment, and participation in activities at 

home and in the community

• RF resulted in a significant decrease in survivor 

perceived need for services and a significant 

decrease in the services being received

27
Resource Facilitation References

Trexler, L.E., Trexler, L.C., Malec, J.F., Klyce, D., & Parrott, D. (2010). 

Prospective randomized controlled trial of resource facilitation on 

community participation and vocational outcome following brain 

injury. Journal of Head Trauma Rehabilitation, 25(6), 440-446. 

Trexler, L.E., Parrott, D.R., & Malec, J.F. (2016). Replication of a 

prospective randomized controlled trial for resource facilitation to 

improve return to work after brain injury. Archives of Physical 

Medicine and Rehabilitation, 97(2), 204-210.

Trexler, L.E. & Parrott, D.R (2018). Models of brain injury vocational 

rehabilitation: The evidence for resource facilitation from efficacy to 

effectiveness. Journal of Vocational Rehabilitation, 49(2), 195-203. 

28
Impact of Resource Facilitation

Trexler, L.E. & Parrott, D.R (manuscript submitted). The impact of resource facilitation on 

recidivism for individuals with traumatic brain injury. 

29
Decreasing recidivism among juveniles 

w/brain injury re-entering the community 

using resource facilitation 

• OJJDP FY 2020 Second Chance Act 

Youth Offender Reentry Program 

• Randomized controlled trial of 

Resource Facilitation in juvenile justice

• Creating a TBI-continuum of care 

starting in residential placement

• Collaboration of Florida VR

• Estimated completion is 2024

•Sherry Jackson, PhD • Michael Baglivio, PhD 

Florida Department of Youth Opportunity 

Juvenile Justice Investments

• Christina Dillahunt- •Steve Sutter 

Aspillaga, PhD CreateAbility Concepts, Inc.

University of South Florida • Laura Trexler, OTR, 

• Lance Trexler, PhD CBIS

Youth Opportunity Foundation Youth Opportunity Foundation 

• Drew Nagele, PhD • Denny Armington 

Youth Opportunity Foundation Youth Opportunity Foundation

30
QUESTIONS: 

BRAIN INJURY AS A RISK FACTOR FOR 

CRIMINAL JUSTICE INVOLVEMENT
CRIMINAL AND 

JUVENILE 

JUSTICE 

WORKGROUP
Overview

• Participating States:

• Grantees: Alaska, Colorado, Indiana, 

Pennsylvania, Vermont

• Full Collaborative: Alabama, Arizona, Iowa, 

Nebraska, North Carolina, Oregon, 

Washington

• Purpose: To provide mentorship in and to 

develop products for criminal and juvenile justice

• Products:

• Criminal and Juvenile Justice 

Workforce Competencies

• Criminal and Juvenile Justice 

Best Practices Guide 

33
State Highlights - Alabama

Alabama Department of Rehabilitation Services:

• Provided targeted training and intervention inside our 

State Juvenile Justice System staff and partners at different 

levels

• Provided the Department of Youth Services and Juvenile 

Justice staff with skills to screen and identify youth with 

Traumatic Brain Injury, access individual needs, develop and 

provide appropriate interventions, educational planning, 

community reentry, behavioral interventions (The Y Step 

Program) as well as Traumatic Brain Injury Information and 

Referral and Resource Facilitation to youth and families. 

34
State Highlights - Colorado

• Worked in partnership with the Colorado Judicial Branch and 

the Colorado Department of Human Services to incorporate 

brain injury staff training, screening and supports in a 

variety of settings including probation, jails, youth corrections, 

problem-solving courts and treatment programs. 

• The state utilizes a lifetime history screen followed by 

administration of a symptoms questionnaire to uncover 

impairment and automated tools that package up tailored tips 

and strategies for criminal and juvenile justice staff and justiceinvolved individuals.

• Colorado has also created and disseminated 

psychoeducational curriculum for use throughout 

criminal and juvenile justice settings to address 

brain injury.

35
State Highlights - Indiana

Indiana has submitted and is revising an article on the 

efficacy of resource facilitation for reducing 

recidivism among formerly incarcerated adults with 

traumatic brain injury.

• We found that 13% of those who received resource 

facilitation recidivated at 6 months as compared to 36% of 

those who did not receive resource facilitation.

• At 12 months, 32% of those that received resource 

facilitation recidivated as compared to 53% of those that 

did not.

• Both were statistically significant differences.

36
State Highlights - Iowa

Iowa is participating in NASHIA'S inaugural Leading Practices 

Academy which is focusing on criminal and juvenile justice.

• Bringing together stakeholders involved in the child welfare system 

to highlight the importance of screening individuals for a lifetime 

history of brain injury to ensure person-centered plans afford 

accommodations and compensatory strategies needed to lessen 

protective risk factors so the family can remain together.

37
State Highlights - Nebraska

Brain Injury Alliance of Nebraska has brought together 12 state 

and local agencies whose focus is on serving justice-involved 

youth to participate in NASHIA Leading Practices Academy.

Goals include:

• Build Nebraska’s infrastructure to support individuals with brain 

injury served by juvenile justice programs. 

• Increase the juvenile justice provider’s ability to recognize and 

manage brain injury so they can better support the juveniles with 

brain injury. 

• Provide the juvenile justice system with the tools necessary to 

identify and support those individuals. 

• Implement evaluation metrics to illustrate the benefits of this work 

and ensure sustainability.

38
State Highlights - Pennsylvania

The Pennsylvania Department of Health has worked in 

partnership with the Brain Injury Association of Pennsylvania to 

provide brain injury education and training in juvenile justice 

facilities as well as technical assistance to these facilities to help 

them implement brain injury screening, appropriate referral for 

neurocognitive testing, and neuroresource facilitation. 

This work arose out of Pennsylvania’s previous work in criminal 

justice during which the need to shift focus to juvenile justice 

became apparent as a majority of individuals sustained brain 

injuries and onset of behavioral issues in youth. 

39
State Highlights - Vermont

Department of Corrections:

• Embedded Lifetime History of TBI HELPS screening 

tool into the intake assessment for all individuals 

entering a correctional facility

• Have established a workflow/clinical pathway to 

address whatever becomes clinically indicated for 

individuals who screen positive

• Review individuals who have screened positive 

and compare with other metrics:

• Ohio Risk Assessment System (ORAS) score

• # of Sick Slips

• # of Days in Segregation etc.

20% screen positive 

for lifetime history of TBI 

via the HELPS tool

40
State Highlights - Washington

Through a partnership with the University of Washington and 

leveraging initial funding from a grant by the Administration on 

Community Living... 

Washington Department of Corrections launched a TBI pilot 

program at one prison facility:

• Pilot includes initial and advanced screening for TBI for high-risk 

groups (i.e., veterans, people with intellectual disabilities, people 

housed in high-security units).

• Individuals with positive screenings could volunteer to participate 

in a 12-week psychoeducation group and provided linkages and 

resources to use in the community and/or share with their family.

• Community peer support groups were made available through a 

virtual platform called MyPeers and assistance from one of our 

community partners the Department of Social and Health Services 

(DSHS). 41
QUESTIONS: 

WORKGROUP & STATE HIGHLIGHTS
LIVED 

EXPERIENCE –

INTERVIEW 

WITH JENNIFER 

SCOTT

HOW SCREENING FOR BRAIN INJURY, 

AND OFFERING ACCOMMODATIONS AND 

SUPPORTS, CAN CHANGE THE COURSE OF 

A LIFE. 

INTERVIEWER: LAURA TREXLER
QUESTIONS: 

LIVED EXPERIENCE

44
TRANSFORMING 

SYSTEMS & 

IMPROVING 

OUTCOMES THROUGH 

THE SEQUENTIAL 

INTERCEPT MODEL 

REGINA HUERTER, MA 
Sequential Intercept Model - Overview

• People move through the criminal justice 

system in predictable ways.

• Illustrates key points, or intercepts, to 

ensure:

• Prompt access to treatment.

• Opportunities for diversion.

• Timely movement through the criminal 

justice system.

• Engagement with community resources.

46
The “Unsequential” Model

47
48

Sequential Intercept Model
Why is this important? 

Persons living with behavioral health are: 

• More likely to be homeless

• More likely to have co-occurring disorders (CODs)

• Use a greater variety of services (high-cost)

• More likely to have disciplinary problems

• More likely to be unemployed 

• More psychological impairment (including extensive 

trauma histories)1

• Have longer length of stay2

1. James, D.J., Glaze, L.E. (2006). Mental Health Problems of Prison and Jail Inmates Bureau of 

Justice Statistics, NCJ 213600

2. Council of State Governments Justice Center. (2012). Improving Outcomes for People with Mental 

Illnesses Involved with New York City’s Criminal Court and Correction Systems. 49
Intercepts 0 and 1

50
Crisis-to-Stabilization-to-Recovery 

Care Continuum • Cross-System and Cross-Discipline Coordination 

• Crisis Line Coordination (e.g., 911, 211, 988, Crisis/Warmline) 

• Integrated Service Access (Behavioral Hx, FQHC/Hx, Hospital, CCBHC, Homeless, Jail)

• Community-Based Outreach

• Trained LE (CIT, MHFA) 

• Co-LE Response, Alternative Health, Homeless Response Teams 

• Engagement and Ongoing Community-Based Health & Mental 

(FQHC, Community Hx. Worker (CHW)/Promotores, F/ACT, HICM, AOT) 

• Recovery Peers and Harm Reduction/WRAP 

• Brief Screening (e.g., SBIRT, TBI/ABI, MH, SUD, IDD) 

• Tele-Health

• Stabilization Resources 

• Sobering and Detox; “Treatment on Demand” 

• Crisis Stabilization Centers, Hospitals and Bed Mgmt. (e.g., Peer, 23hr, 

Emergency Dept, multiple day, residential Tx.) 

• Familiar Face, Transitional Services and Care Navigation 

• Housing and Homeless 

• Homeless Services Continuum, Outreach and Supports 

• Health – to – Homeless Coordination

• Supported and Supportive Housing 

• Social Impact Bond (SIB) and FUSE Models

• Client Centered, Trauma and Community Support

• Access to Benefits and Entitlements 

• Workforce Development, Staff Wellness and Support 51
Intercept 2 – Initial 

Detention/Initial Court 

Hearings

52
The Numbers

1. Laura M. Maruschak and Todd D. Minton, (2020). Correctional populations 

in the United States, 2020. Bureau of Justice Statistics.

2. Subramainian, R., Delaney, R., Roberts, S., Fishman, N., & McGarry, P. 

(2015). Incarceration's front door: The misuse of jails in America. Vera 

Institute.

53
Putting a Face on High Utilizers 

54
Who is in Jail... Call for OPTIONS

• Familiar Face” Targeted Intervention and Support 

• Jail Population Review Process

• Population Specific Review (e.g., Vets, 

Cognitive/TBI, Co-occurring, Homeless) 

• Define and sort by pre-trial, and sentence 

(e.g., bond, holds, warrants/writs, DOC, Ice, M/M/F, 

continuances, competence, technical violations, 

waiting a bed/service, VA/Veterans)

• Behavioral Health “Supported” Pre-trial Release 

• Mental Health Diversion 

• Technical Violations Reduction and Modification 

• Relative Rate Index (RRI) Data Review 

55
Intercept 3

Jails/Courts

56
Jail Health Care Models

• Jail employs health care staff

• Jail contracts with National Correctional Health Care Vendor

• Jail contracts with local, private or public providers 

(e.g., hospital, Medical School)

• County Health Department 

Jail Services 

• General Population programming, support and reentry 

coordination: Life skills, Cognitive Intervention 

• Mental Health Unit

• Substance Use Disorder Unit

• Reentry Unit 

57
Jails and Courts

In-jail services

• Assessment of in-custody needs

• Access to medications, mental health services, and 

substance use services

• Communication with community-based providers

• Specialized Programs and Services

Treatment/Problem-Solving Courts

• Drug (Juvenile and Adult)

• Driving under the influence (DUI) 

• Integrated Family

• Mental Health 

• Veteran 

• Domestic Violence 

• Tribal Wellness 

• Reentry 

“Individuals receiving an 

in-reach or diversion 

service while in jail were 

twice as likely to receive 

a mental health service 

in the community” 

Kubiak et al, 2019

Tribal Healing to Wellness Courts

wellnesscourts.org/events/?a=593 58
Intercept 4

Reentry

59
Jail to Community Planning & Release 

(1 of 2) 

• Coordinated reentry planning committee 

• Obtain consent to release information

• Promote coordination, service utilization and gap analysis 

through a standardized Transition / Reentry Check List

• Match resources to population’s needs

• Monetary release funds 

• Parole-approval residency requirements 

• Benefits, SOAR

60
Jail to Community Planning & Release 

(2 of 2) 

• Individualized reentry plans using a standardized checklist

• Health (medication, mental & physical health, substance use, 

and treatment) 

• Community Stabilization (housing status, benefits & entitlement)

• Criminogenic (length of time incarcerated, public safety 

concerns, and supervision)

• Wellness (self-care, hygiene, self-regulation, “WRAP”, 

food/nutrition) 

• Social and Leisure (technology and tech-literacy, financial, 

benefits, and peer & social supports, clothing, transportation)

• Case Management and System Navigation 

61
Discharge & Reentry Process and Practices 

(1 of 2)

Policies, processes and practices

• Release time no-later than 3:00 pm; release notification 

list to providers

• Release navigator jail in-reach – in-person or technology

• Technology resource bank; client access to technology 

and technology literacy

• Process to confirm housing and quarantine as needed 

(COVID)

62
Discharge & Reentry Process and Practices 

(2 of 2)

Implement reentry release plans and coordination 

• Paid / filled (7,14, 30+ day) prescription; MAT access and 

Narcan provided

• Warm-hand off and release notification / appointment 

• Photo ID, transportation or transportation fare 

• Peer support

• Activated benefit enrollment 

• Supervision expectations in the community 

• Electronic devices and technology literacy training

• Housing plan, coordination with homeless and housing 

services; community information

• Personal protective equipment (COVID)

• Narcan (OUD, Methamphetamine, Cocaine)

63
Intercept 5

Community Corrections/Community Supports

64
Community-Based Supervision and 

Jail Return Reduction 

• Encourage virtual supervision, monitoring, and education and support

• Review currently incarcerated on technical violations 

• Support early termination

• Incorporate mental / emotional “wellness” questions

• Utilize peer and recovery support

• Minimize need for public transportation and cross-town mtgs

• Support technology access and literacy

• Incorporate client-centered “wellness” 

• Develop reporting standards for external monitoring services

• Develop standards and alternatives

• Apply harm-reduction standards and policies to reduce technical 

violations and jail

• Use home-based monitoring (COVID)

• Establish virtual check-in and classes (COVID)

• Ensure frontline staff is operating under current benefits, entitlements, 

HIPAA, and 42 CFR Part 2 information 65
Summary

• Using the SIM model to leverage the community brain trust

• Address needs of behavioral health populations

• Be air traffic controllers 

• Create seamless transitions across the system

• Strategic approach to protect public safety and improve 

public health

Regina Huerter 

Policy Research Associates

Rhuerter@prainc.com 

720-635-5180 

66
QUESTIONS: 

SEQUENTIAL INTERCEPT MODEL

67
DEPARTMENT OF 

JUSTICE 

PERSPECTIVE ON 

CIVIL RIGHTS

KYLE SMIDDIE, JD, MSW

ATTORNEY, 

SPECIAL LITIGATION 
Civil Rights Division DOJ (1 of 2)

• Civil Rights Division enforces civil rights laws –

housing, education, employment, voting, disability

• Special Litigation Section – works along the 

sequential intercept map: 

Police  Corrections/ Juvenile Justice  Community Services

69
Civil Rights Division DOJ (2 of 2)

• Police: (34 U.S.C. § 12601) Portland, Baltimore

• Corrections/ Juvenile Justice: (CRIPA) Hampton 

Roads Regional Jail (Virginia), LA Jail

• Community Services: (ADA) Virginia

70
QUESTIONS: 

CIVIL RIGHTS DIVISION DOJ

71
BREAK

Up Next: 

• Best Practices Guide

• Lived Experience: 10 Points of Advocacy 

• Discussion

72
Final TBI Session

April 6, 2021, 1:00 - 4:00pm (ET)

"Maximizing the Effectiveness of Advisory 

Boards Through Full Participation." 

Register for the session.

73
CRIMINAL AND 

JUVENILE 

JUSTICE GUIDE
Take Action! A Closer Look at the Criminal 

and Juvenile Justice Guide (1 of 2)

75
Take Action! A Closer Look at the Criminal 

and Juvenile Justice Guide (2 of 2)

• Guide is result of years of learning and implemented 

practices in several states

• Authored by Judy Dettmer with the National Association 

of State Head Injury Administrators (NASHIA)

• Supported by three grantee states (CO, IN, and PA) 

with Administration of Community Living funds –

Traumatic Brain Injury State Partnership Program

• Guide and all tools available online at the NASHIA 

website

76
CJJ Guide – What’s Included?

• Overview of the criminal and juvenile justice system

• Identifying target population and point of intercept (planning)

• Protocol for screening, supports and referral (implementation)

• Sustainability and funding strategies

77
CJJ Guide – Specific Tools

• Training examples

• Psychoeducational tools

• Evidence-based screening tools

• Sample Memorandums of Understanding (MOUs)

• Sample consent/release of information forms

78
CJJ Guide – System Overview

Juvenile justice system

• Diversion

• Detention

• Secure Correctional Placement

• Youth Probation

• Re-Entry

Criminal justice system (adults)

• Law enforcement

• Courts

• Corrections

79
Using the CJJ Guide – Planning (1 of 3)

• Criminal Justice Framework

• Risk-Need-Responsivity Model

• Target populations

80
Using the CJJ Guide –Planning (2 of 3)

Individuals to consider prioritizing:

• Incarcerated juveniles 

• Individuals with co-occurring behavioral health conditions 

• Female offenders 

• Offenders with childhood trauma history 

• Offenders with high criminogenic risks

81
Using the CJJ Guide –Planning (3 of 3)

Settings/partners to consider:

• Juvenile corrections and behavioral health units within adult jails/prisons 

(intercept 3)

• Specialty Courts – e.g., veteran, mental health, and recovery courts 

(intercept 3)

• Re-entry programs (intercept 4)

• Parole & Probation (intercept 5) 

82
Using the CJJ Guide - Implementation

• Training and education for criminal justice personnel 

• Screening for history of brain injury, and assessing for 

impairment from brain injury 

• Psychoeducation for justice-involved individuals with 

brain injury 

• Modifying programming/accommodating for impairment 

• Referral to community-based service 

coordination/resource facilitation 

• Data collection & outcomes evaluation 

83
Using the CJJ Guide - Tools

84
Using the CJJ Guide – Sustainability

• Partners

• Sample of agreements and MOUs

• Producing a body of evidence

• Communications and messaging

• Capacity building

85
QUESTIONS: 

CRIMINAL AND JUVENILE JUSTICE (CJJ) GUIDE

86
10 POINTS OF 

ADVOCACY

CHERYL KEMPF
My Journey

• 1994 – Brain Injury due to Anoxia, permanent numbness in right hand and foot

• 2012 – PTSD from a negative law enforcement encounter due to dropping my 

license from my numb right hand

• 2015 – Texas law HB 1338, Naishtat, 84(R), training for law enforcement on 

recognizing signs of brain injury and /or PTSD and constructive response

• 2019-2020 – HR 6008, sponsored by 

Representatives Bill Pascrell and Don Bacon

in the 116th Congressional Session, did not become a law

• 2021-2022 – will be introduced this session, 

117th Congressional Session

88
10 Points of Criminal Justice Advocacy

(slide 1 of 4)

1. What is your topic? What is the background?

Mine was personal experience, as you heard on my introduction. 

You can find your lead state agency for brain injury, US Brain Injury 

Alliance (USBIA) state affiliates and Brain Injury Association of America 

(BIAA) state affiliates. You can also learn about current efforts and the 

current brain injury plan.

2. What do you want to do?

I did not want this to happen again.

3. How will that get done?

Win bigger than the courtroom. My planning and 

having to be sentenced so this experience could be used.

89
10 Points of Criminal Justice Advocacy

(slide 2 of 4)

4. What are your resources?

Google, libraries, agencies, organizations, your own experience. How is 

this handled other places? Has it occurred elsewhere? Often?

5. Be flexible.

Your plans and goal can change as you learn. Approach this as a gap in 

knowledge that we can fill in, benefit officers and the public.

6. Keep notes.

Many times bits and pieces come together to be an answer. 

The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) 

training for funding, Austin Police Department (APD) 

for trying it with PTSD, being Chair of 

Texas Brain Injury Advisory Council (TBIAC).

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10 Points of Criminal Justice Advocacy

(slide 3 of 4)

7. What level are you working toward?

This changed as I got each step accomplished. The law, speaking, 

other states.

8. There is strength in numbers. 

You have people around you who can be supportive. Every state has 

a lead brain injury agency, which gathers resources and contacts for 

brain injury and PTSD survivors and caregivers. The USBIA and the 

BIAA have state chapters and the National Association of State Head 

Injury Administrators (NASHIA) has resources on a variety of 

important brain injury topics.

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10 Points of Criminal Justice Advocacy

(slide 4 of 4)

9. Advocacy can be hard.

Breathe, look outside yourself, be a helper to someone else. 

10. Grow your advocacy. 

I participate in the efforts of the USBIA, NASHIA and BIAA. Within 

NASHIA, I have worked in the TBI TAL (Traumatic Brain Injury 

Advisory and Leadership) group, as a Subject Matter Expert (SME) 

for the TBI TARC (Traumatic Brain Injury Advisory Technical 

Assistance and Resource Center), and as a speaker on criminal 

justice, law enforcement and advocacy.

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QUESTIONS: 

10 POINTS OF ADVOCACY

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FACILITATED DISCUSSION 
IF TIME PERMITS...
Real-Time Evaluation Questions 

• Please take a moment to respond to these seven evaluation 

questions to help us deliver high-quality TBI TARC webinars

• If you have suggestions on how we might improve TBI TARC 

webinars, or if you have ideas or requests for future webinar topics, 

please send us a note at TBITARC@hsri.org

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Final TBI Session – April 6

April 6, 2021, 1:00 - 4:00pm (ET)

"Maximizing the Effectiveness of Advisory 

Boards Through Full Participation." 

Register for the session.

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The Traumatic Brain Injury Technical Assistance and Resources Center (TBI TARC) is an 

initiative from the Administration for Community Living that helps TBI State Partnership 

Program grantees promote access to integrated, coordinated services and supports for 

people who have sustained a TBI, their families, and their caregivers. The Center also 

provides a variety of resources to non-grantee states, people affected by brain injury, 

policymakers, and providers.

Thank You.
MEET THE PRESENTERS
Kyle Smiddie, JD, MSW

Attorney, Special Litigation 

kyle.smiddie@usdoj.gov 

Kyle Smiddie, JD, MSW, has been an attorney in the Special Litigation Section of the Civil Rights Division of 

the Department of Justice since 2011. He holds a JD and Masters of Social Work from Rutgers University in 

New Jersey. In his work, he enforces the Civil Rights of Institutionalized Prisons Act (CRIPA) and the 

Americans with Disabilities Act (ADA). One focus of this work has been on the use of solitary confinement in 

jails and prisons, especially as it relates to prisoners with mental illness. Another focus has been ensuring that 

persons with intellectual and developmental disabilities are getting the services they need in the most 

integrated setting appropriate to their needs. He currently leads two Consent Decrees – one with the Hampton 

Roads Regional Jail in Portsmouth, Virginia and one with the Commonwealth of Virginia focusing on persons 

with developmental disabilities. He is also the lead attorney investigating the Massachusetts Department of 

Corrections’ use of solitary confinement. Before joining the Civil Rights Division, he worked on issues regarding 

prisoner re-entry, affordable housing, adequate education, and foster children. 

He was raised on a 40-acre farm in rural Ohio.

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Peter Bisbecos

Executive Director

Rehabilitation Hospital of Indiana

Peter.bisbecos@rhin.com

Peter Bisbecos has made a career of overcoming challenges to help others. He combines his legal background with expertise in 

government and regulatory affairs, compliance, and public policy to create often unprecedented solutions. Peter has brought his 

unique skill set to such varied projects as: 

• Working with the community to ensure the Conseco (now Bankers Life) Fieldhouse was the first major sports facility built after the 

ADA became effective to not face accessibility litigation.

• Bringing IndyGo Paratransit system into compliance with the newly enacted ADA without litigation.

• Working with the community and the US Department of Justice to make Indiana the 11th, and largest, state in the nation without any Residential Institutions for 

people Intellectual Disabilities, while standing up the first in the nation statewide crisis management system.

• Negotiating a Voluntary Compliance Agreement between the Federal Highway Administration on behalf of the City of Indianapolis over the City’s curb ramp 

compliance and ensuring the curb ramp information became part of the City’s ongoing infrastructure management.

• Advocacy with the Washington Legal Foundation, including work that led to creation of a civil justice reform model law adopted by the American Legislative 

Exchange Council.

• Representing 40 percent of the Property and Casualty Insurance industry during development and passage of the Terrorism Risk Insurance Act of 2002 and 

Reauthorization in 2004. There was no precedent for terrorism insurance in the United States prior to 9/11.

• Successfully implementing the National Highway Traffic and Safety Administration’s Drugged Recognition Expert (DRE) program for drugged driving interdiction in 

the state through the courts.

• Growing Vocational Rehabilitation Authorizations by 150 percent over 1 year and driving the creation of an enterprise quality case management service that provides 

support for novel brain injury treatment.

In his current role as Executive Director of Resource Facilitation and Neuropsychology Departments at Rehabilitation Hospital of Indiana, Peter helps create 

unprecedented brain injury services, as well as supporting policy advocacy with the ADA and criminal justice systems, where there is limited understanding of the true 

realities of brain injury.

A Hoosier since 1972, Peter lives in Central Indiana with his wife and two sons. Having a lifelong vision deficit, Peter is deeply appreciative of a community that looked 

past this minor limit offering him many opportunities at a time when that was uncommon. His passion is to serve his community providing service and leadership.

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Lance Trexler, PhD, FACRM 

Executive Director

Rehabilitation Hospital of Indiana

lance.trexler@rhin.com

Lance Trexler, PhD, FACRM is the Executive Director, Brain Injury Rehabilitation 

Research and Program Development, Rehabilitation Hospital of Indiana; Adjunct 

Clinical Assistant Professor of PM&R, Indiana University School of Medicine; Adjunct 

Assistant Professor of Speech and Hearing Sciences at Indiana University; and Adjunct 

Assistant Professor of Psychological Sciences at Purdue University. 

Dr. Trexler was designated as a Fellow of the American Congress of Rehabilitation 

Medicine (ACRM) in 2013, and he received the Distinguished Member award in 2015 and 

the Lifetime Achievement Award in 2019. In addition to serving as a clinician in 

rehabilitation neuropsychology since 1979, his overriding commitment as a 

neuropsychologist has been to develop, implement and disseminate rehabilitation and 

social interventions for those with acquired brain injury. Dr. Trexler is an author on over 50 

peer reviewed journal articles and book chapters. 

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Julie Myers, MPH

Public Health Program Administrator

Pennsylvania Department of Health

julimyers@pa.gov

Julie Myers, MPH is the Program Administrator for the Bureau of Family Health's 

Traumatic Brain Injury programs. She is involved in several grant projects involving 

education and training for TBI, school reentry, and neuroresource facilitation. 

She serves on the Board Logistics and Support Team for Pennsylvania's Traumatic 

Brain Injury Advisory Board. She is a graduate of Penn State College of Medicine 

with a Master of Public Health in Health Systems Organization and Policy. 

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Laura Trexler

ACL Grant Clinical Program Manager

Rehabilitation Hospital of Indiana

laura.trexler@rhin.com 

Laura Trexler, OTR, CBIS, Occupational Therapist for 38 years, has worked 

primarily in the field of young adult and adult acquired brain injury program 

development and direct service provision in clinic, community, home, return to 

work settings addressing physical, cognitive, behavioral, and vision rehabilitation 

needs. 

Mrs. Trexler’s past roles have included Clinical Services Manager, HRSA Grant 

Project Coordinator, Vision Rehabilitation Specialist, Driving Evaluator, Certified 

Brain Injury Specialist Trainer, and Rehabilitation Occupational Therapist.

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Karen Ferrington, CRC, CBIS

Karen Ferrington, CRC, CBIS, provides consulting services to organizations 

and individuals and is a part-time, program manager with Colorado's 

MINDSOURCE-Brain Injury Network where she helps administer the brain 

injury trust fund as well as federal and state grant projects. Beyond general and 

criminal justice-focused technical assistance and training related to brain injury, 

Karen has background in various topics related to employment of people with 

disabilities include supported employment, self-employment, managing Social 

Security Administration benefits while working, and Medicaid Buy-In Programs. 

She holds certifications in rehabilitation counseling (CRC) and brain injury 

specialization (CBIS).

Program Manager

MINDSOURCE - Brain Injury Network 

karen.ferrington@state.co.us

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Jennifer Scott

Individual with a Brain Injury

scott.jennifer9876@gmail.com

Jennifer Scott has had three TBIs, the first starting when she was 

little. The second one happened a year later. As a young adult she 

completed dental assistance training and worked for 1 year before 

becoming a stay-at-home mom for 8 years. She reentered the work 

force in real estate and property management and worked for 30 

years. She sustained her third brain injury in 2015 and that is when 

the course of her life significantly changed. 

Today she is happy to report that she is remarried, is soon to become 

a grandmother, and reports living a satisfying life.

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Regi Huerter, MA

Senior Project Associate

Policy Research Associates

rhuerter@prainc.com 

Regina “Regi” Huerter, MA joined Policy Research Associates, Inc. in 2017 as 

Senior Project Associate to provide training and technical assistance to counties engaged 

in the MacArthur Safety and Justice Challenge and, specifically, those addressing the 

intersection of behavioral health and justice. She assists with other PRA initiatives and the work of the SAMHSA 

GAINS Center. 

Prior to joining PRA, Regi was the Executive Director of the Denver Office of Behavioral Health Strategies and Crime 

Prevention and Control Commission for the City and County of Denver. In this capacity she led juvenile and adult 

criminal justice system reform through improved system efficiency, and by innovating effective policy and practices 

with a focus on addressing the needs of individuals with mental illness, substance use disorders, brain injury and 

trauma. The result is a comprehensive array of alternatives for individuals in crisis, and improved access, availability 

and capacity of treatment, housing and other supports for justice involved individuals. 

Regi is the recipient of several awards, including those she is most proud of – the 1995, 9 News “9 Who Care” for 

volunteer service and her work with gang involved youth; in 1997, Judge John R Evans Youth Worker of the Year; in 

1999 the Chamber of Commerce Leadership Denver Alumni Award, in 2008 the NAMI Colorado “Heroes in the Fight” -

- for advocacy and creating changes in the mental health/criminal justice system, and in 2011 The Fields/Wolfe 

Courageous Citizens Colorado Award. 107
Cheryl Kempf

Individual with a Brain Injury

cheryl.kempf5@gmail.com 

Cheryl Kempf is a survivor of an Acquired Brain Injury (ABI) event 

which occurred in 1994. She works and speaks on brain injury recovery, rehabilitation 

and adjusting to life changes, in topics such as "What Do You See When You Look At 

Me?“

In 2012, a negative law enforcement incident added PTSD to her life experience, and 

she became the catalyst for a Texas state law, HB 1338, 84th R Legislative Session, 

Naishtat, through her work summarized as "To Be Different Is Not To Be Guilty." In 2016 

she was invited to Washington, D.C. and first presented this Texas law on a national 

level. On March 4, 2020 she was a panelist for the Congressional Briefing discussing 

this law as part of Brain Injury Awareness Day on the Hill. Her primary website, ever 

evolving, is CherylsWords.com.

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