Reducing Recidivism After Traumatic Brain Injury: Results From the Re-entry Continuum for Brain Injury (RCBI) Trial.

OBJECTIVES

To examine the effects of an intervention (Re-entry Continuum for Brain Injury [RCBI]) designed to support individuals with traumatic brain injury (TBI) pending release from prison. RCBI started about 6 months prior to release. The aims were to examine the impact of RCBI on (1) recidivism up to 3 years postrelease and (2) participants' behavioral infractions, self-efficacy, aggression, negative attributions, and executive functioning while still incarcerated.

DESIGN

Randomized controlled trial comparing RCBI with treatment as usual (TAU). Assessment times were: time 1 (∼6 months before prerelease); time 2 (near release); time 3 (2 weeks postrelease); and times 3-5 (1, 2, and 3 years postrelease, respectively).

SETTING

Department of Corrections and community setting.

PARTICIPANTS

Men with TBI who were incarcerated and between 5 and 8 months of release (N=91; RCBI=45; TAU=46).

INTERVENTIONS: RCBI intervention teaching brain injury coping skills and anger management while incarcerated, and 12 months of resource facilitation immediately after release.

MAIN OUTCOME MEASURES: (1) Recidivism (reincarceration, arrests, and criminal charges); (2) Brain Injury Coping Skills Questionnaire (BICS-Q; self-efficacy); (3) Aggression Questionnaire (AQ), Ambiguous Intentions Hostility Questionnaire (AIHQ), and Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A).

RESULTS

Compared with TAU, RCBI participants had significantly lower rates of returning to prison (46% vs 17%), arrests (86% vs 43%), and criminal charges resulting in prison or jail time (79% vs 42%) 3 years postrelease. Behavioral infractions while in prison decreased over time in both groups, but were significantly lower for RCBI participants after the intervention than for TAU participants. After controlling for baseline scores, RCBI participants had significantly better BICS-Q and BRIEF-A outcomes than TAU participants. No differences were observed in AQ or AIHQ outcomes.

CONCLUSIONS

Individuals with TBI are overrepresented in the justice system and susceptible to recidivism. RCBI improved successful community reintegration after incarceration in this TBI sample.