Online Program

Prevalence and incidence of traumatic brain injury among incarcerated New York City adolescents

Monday, November 4, 2013 : 9:30 a.m. - 9:50 a.m.

Ross MacDonald, MD, Correctional Health Services, New York City Department of Health and Mental Hygiene, East Elmhurst, NY
Fatos Kaba, MA, Correctional Health Services, New York City Department Of Health and Mental Hygiene, Long Island City, NY
Alpha Haque, Bureau of Correctional Health, NYC Department of Health and Mental Hygiene, Queens, NY
Homer D. Venters, MD MS, Correctional Health Services, New York City Department of Health and Mental Hygeine, Queens, NY
Traumatic Brain Injury (TBI) is a significant public health issue among incarcerated populations and has been associated with behavioral problems during incarceration and may be associated with heightened recidivism. In the NYC jail system, the bureau of Correctional Health Services (CHS) of the New York City Department of Health and Mental Hygiene has undertaken an assessment of the clinical prevalence and incidence of TBI among adolescent patients. In order to assess the prevalence of TBI among adolescents, a validated TBI screening survey was administered to 300 male and 150 female adolescents newly admitted to the NYC Jail system between September 15, 2012 and May 15, 2013. The screening tool comprised 45-items assessing lifetime head injury history and the experience of associated symptoms. Positive history of TBI was defined as head injury involving loss of consciousness for greater than 5 minutes or leading to posttraumatic amnesia. Of 300 males and 150 females interviewed, over 80% and 90%, respectively, reported at least one head injury during their lifetime. TBI was reported by 50% of the adolescent males and 66% of adolescent girls. In order to assess the incidence of new TBI cases in the jail system, CHS altered the injury template contained in the electronic health record (EHR) to include specific questions about blow to the head, loss of consciousness or being dazed or confused. These questions are asked of all patients presented for any injury, representing approximately 1,500 encounters per month, approximately 25% of which are for adolescent patients. Analysis of incidence data is ongoing; however, initial analysis reveals approximately 9% of all adolescents sustain a blow to the head with either loss of consciousness or being dazed/confused during their incarceration. Our early findings suggest that TBI prevalence among adolescents in NYC jail facilities is high and that a significant number of adolescents sustain new TBI while in jail. Patients with severe TBI are often known to the clinical medical and mental health teams; however, the high overall prevalence of TBI suggests the need for a broad intervention. CHS is in the planning stages of programming that will begin to engage patients, security staff and medical providers on the key elements of TBI, including the emotional dysregulation and impaired information processing. These clinical sequelae of TBI can be misinterpreted in the jail setting, with serious consequences, including new TBI.

Learning Areas:

Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe what is known about the prevalance and incidence of Traumatic Brain Injury in incarcerated adolescents. Define Traumatic Brain Injury and mild Traumatic Brain Injury. Explain how Traumatic Brain Injury could lead to violence and infractions in the jail environment. Discuss potential interventions for Traumatic Brain Injury in the jail setting.

Keyword(s): Correctional Health Care, Injury

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Medical Director for the Bureau of Correctonal Health Services in the NYC Dept. of Health and Mental Hygiene. In this role I oversee medical care for all those incarcerated in NYC jails. I am responsible for the care of over 12,000 incarcerated patients in a system with over a dozen clinics and over 100 clinicians.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3053.0: Jail and prison health