Transcript
Jordyn Reiland (0:05):Ìý
You're listening to RadioEd, the ÎÄÐù̽»¨ podcast. I’m your host, Jordyn Reiland.Ìý
Brain injuries are often described as an invisible disability. You don't necessarily know just by looking at somebody that they have a brain injury, and they may not even know they have one, but inside, things can be very different.Ìý
The World Health Organization has identified brain injury as a significant public health concern, and traumatic brain injuries are a major cause of death and disability in the United States. Without the right care or resources, it's easy for these injuries to go unnoticed and untreated.
Jennifer McMahon (0:43):
A lot of times people with brain injuries don't show that they have a brain injury, right? It's one of those things where on the outside you might never know, or you might confuse some of the symptoms that are associated with their brain injury with something else. And a lot of times folks who don't have the resources to get good medical care don't know that they have a brain injury.Ìý
A lot of people that I've talked to, they don't go to the doctor, or they don't go to the hospital, they may not have medical insurance, and so they may not even know what's going on at this point. So, the amount of people that are living with a brain injury and don't know, I would expect to be fairly high, and that's why we consider brain injury to be an invisible disability.
Jordyn Reiland (1:42):
That's Jennifer McMahon, a research assistant professor in the ÎÄÐù̽»¨'s Graduate School of Professional Psychology. Her work combines Neuropsychology and forensic psychology to protect and advocate for justice involved individuals.Ìý
People may only find out if they have sustained a brain injury if or when something happens, and that something could be an alleged crime. That's when McMahon and her team intervene through their work with the Brain Injury Screening Program. The Brain Injury Screening Program, which McMahon and her colleague Kim Gorgens help run, is housed in the Denver Forensic Institute for Research, Service and Training, also known as Denver FIRST.Ìý
The first of its kind pilot program began in 2023. It evaluates people whose competency to stand trial has been called into question, and that decision can slow down or completely put on hold someone's legal proceedings. McMahon refers to this population as justice involved individuals. This group of people are involved in the criminal legal system by being accused of or charged with a crime, but they have not been convicted or sentenced.Ìý
Jordyn Reiland (2:44):
How does the legal system define competence to stand trial, and what role does cognitive functioning play in this determination?
Jennifer McMahon (2:51):
So, competence to stand trial in the state of Colorado, the statute basically says that somebody has a mental illness or an intellectual or developmental disability that's impacting their capacity to understand the legal system and its processes, to appreciate sort of the situation that they're in, and to aid in their defense.Ìý
It’s essentially putting a hold on their case to make sure that their due process rights aren't violated, and the importance of that is so that somebody doesn't agree to something such as a plea deal when they don't fully understand what that means. So, it's protecting an individual's rights.Ìý
When somebody has a cognitive issue, a lot of times, cognitive issues can be static, meaning that they don't change so much over time. When we look at something like schizophrenia, which is a common diagnosis that people in the competency system have that impacts their abilities, a lot of times medication is something that can be the quick fix—so to speak.Ìý
With a cognitive disorder, cognitive impairment, or barriers related to cognitive functioning, those individuals may have more barriers to overcome, but what the research tells us is that people can what we call restore to competency, meaning that they can be found competent after a period of time, but it's going to take more individualized approaches, and it's going to take more time. That’s because there isn't necessarily a quick fix, it’s figuring out what's going to work for that individual.Ìý
For some people, there may not be the possibility of moving forward and then that's a whole other issue, but that just because you have a cognitive issue doesn't mean you cannot move forward with your case. It just might take some more resources, and it might take some more time.
Jordyn Reiland (4:54):Ìý
Of the individuals screened in the competency system, 80 to 90% of them have been positive for a brain injury, preliminary data from the program shows. One of the main goals of the Brain Injury Screening Program is to ensure that justice involved individuals who are screened have access to, and understanding of, what researchers have found.
Jennifer McMahon (5:14):Ìý
A lot of times when folks are moving through the system, they don't have the opportunity to learn about themselves, they don't have the opportunity to tell their story. So, we want to make sure that we provide that opportunity for them, and then we give them that feedback so they can take that and learn about themselves and learn how to advocate for themselves.Ìý
We were doing a screen with somebody who had been dealing with mental illness throughout most of their life, had been on medication, so those things were working for them, and is also deaf, and so there were so many barriers for this person to move through the system. We did a screening with them and found that he was positive for a brain injury, and then we told him about it, right? We didn't just do this assessment and write a report, we provided that feedback to the individual themselves as well.Ìý
For that person to learn, yes, you are positive for a brain injury, yes these are some of the areas that you may have more difficulty with and here are some of the areas that you're really good at—here are some of your strengths.Ìý
So, providing that feedback to that individual, they cried, and they said that they felt like they were validated and had hope going forward to be able to advocate for themselves and learn how to support themselves when they're going through not just the system, but their day-to-day life in the community as well.
Jordyn Reiland (6:44):
One of the unique aspects of the program is its voluntary nature, particularly for justice involved individuals who are more often than not told what to do, McMahon says.
Jennifer McMahon (6:55):
So, when somebody is screened through the program, what we do is we want to make sure that the individual is clear on what they're participating in. A lot of times, folks that are in the system are told what they have to do all the time, so they just kind of follow suit. So, we want to make sure that this person understands and is voluntarily participating, and that's a really big thing for us.
Jordyn Reiland (7:16):
Students then conduct a clinical interview—which allows the individual being screened to share their story—and facilitate a series of self-report measures to determine whether they have had a brain injury and the severity of that injury.
Jennifer McMahon (7:28):
I should emphasize that this is a screener, right? So, this just gives us an idea of where to go next.Ìý
Once that's all done, our student clinicians will write up a report and that will be sent to the referral source. In the report, we highlight some of the relevant background information, whether or not this person is positive for a brain injury, what the impact of that brain injury may have been for them, and what that looks like in terms of strengths in different areas, impairments or even deficits in different areas.Ìý
Then we pull that all together and we provide recommendations of how to best work with this individual, what's going to be most helpful—from dimming the lights to using specific techniques for to enhance learning, and everything in between. So, we provide that information, in addition to a referral to Brain Injury Alliance Colorado.Ìý
After all of that is done, we go back, we meet with the individual again, and we give them a digestible pamphlet that basically is feedback that we go through with them to give them information around what we’ve found and so that they can learn and again, advocate for themselves effectively.
Musical interlude
Jordyn Reiland (8:52):
Another aim of the brain injury screening program is to ensure that the individual, and people they interact with should they need future resources or treatment, have easy access to the two-page report.
Jennifer McMahon (9:03):Ìý
For example, somebody might be in jail and get a competency evaluation (and) they’re found not competent. Then we come in, we do a brain injury screen, and sometime between when we complete the brain Injury screen and they're getting out of the system, they get out on bond, and they go see an outpatient provider. So, we want that report to follow them.
So, we've worked with our state stakeholders and our colleagues to be able to have an efficient system so that this information doesn't get lost.Ìý
A lot of times what we see is as folks enter the system, there's just not a lot of information about where this person has been, what this person has been through, and how to inform where this person goes next, and so we want to make sure that this is one of those resources that's accessible to everybody.
Jordyn Reiland (9:54):
Talk to me about the importance of brain injury screening in the legal system.
Jennifer McMahon (9:58):Ìý
Each person is different. When somebody has a brain injury, they may have strengths in certain domains that other people have impairments in. So, it's really making sure that we can work with the individual to figure out how they can both advocate for themselves and how to best work with them to move through the system.Ìý
Jordyn Reiland (10:18):
McMahon says that people often assume these types of screenings have to involve costly tests like an MRI or a CAT scan, but that is not the case. Justice involved individuals are not likely to have those resources at their disposal, and so different types of neuropsychological assessments and self-reports can still offer the necessary screening.
Jennifer McMahon (10:39):
The populations that we work with, especially in the competency system, they are not just dealing with all of the confusion of the court system.Ìý
No matter how many resources you have or how great your attorney is, it's still confusing. So, not just dealing with that baseline confusion, but then adding mental illness to it a lot of times, that can be really taxing, and a lot of times folks don't know how to advocate for themselves, or they don't have the appropriate resources to have others kind of pick up that slack.Ìý
It’s so important for an individual to be recognized as somebody that, yes, this person may have a mental illness, which we found in our studies that a lot of folks who are positive for brain injury also have co-morbid mental illness, and they also have these barriers that are presenting in different ways.Ìý
So, to be able to look at that individual as an individual, and figure out, how can we best work with this person to move forward? What can we do and how can we do it better?
Jordyn Reiland (11:50):
Yeah, because it kind of goes back to that statement that you made about it's not a one size fit all approach—it has to be very individualized.
Jennifer McMahon (11:57):
No, it's not we see people that range from having a brain injury and are fully functioning—can do anything and everything, don't show any type of impairments, deficits or barriers—and then we see people who have a difficulty completing the assessment because their impairments are impacting how they function so much. So, there's such a wide range.Ìý
I want to be clear that somebody with a brain injury doesn't necessarily mean that they are impaired, right? It can be something that has changed over time. It can be something that never impacted them, and then somebody else with a brain injury could have significant impairment or deficits.
Musical interlude
Jordyn Reiland (12:51):
Why is it important to go further than simply identifying that someone has a brain injury?
Jennifer McMahon (12:56):
I think with identification you kind of get that sigh of relief, right. Having ambiguity, I think, can be really stressful. Not knowing about what's going on or why these things are happening can be the worst in a lot of ways, but that only goes so far.Ìý
Once you have that identification and you feel that potential sigh of relief. Well, what do you do with that then? So, if we were to just stop with identification it would almost be like, all right, good luck, and that's not appropriate and not helpful.Ìý
So being able to link the individual with resources that are going to help them in the community, help them move through the system, help them resolve their case, and that might be just teaching somebody how to work with them. It might be educating them on how to advocate for themselves, and then on the grander scheme of things, we really need to have those resources to provide, you know, something such as cognitive remediation, which is a specialized treatment that could help enhance somebody's functioning if they're dealing with cognitive issues, or housing that's specific to somebody with a brain injury or treatment or therapy methods that are going to be helpful.Ìý
There's a case that has been widely publicized that Dr. Gorgens worked on a number of years ago, and the individual said that half the battle was just learning that this is part of what's going on with that individual, and he has since become a strong, very strong advocate for the brain injury community, and I think that that is also so important, right. To have peers, to have other people who are going to say, ‘yes, this is something that I also deal with’ and normalize some of those feelings that could be isolating for some people.Ìý
So, I think that there are so many important things that need to come next, both on the resource side, but also just the understanding of this is something that a lot of people deal with and having that community.
Jordyn Reiland (15:04):
People sometimes assume that if someone has a brain injury that they must be deemed incompetent, and that's not always the case, according to McMahon.
Jennifer McMahon (15:13):
One of the common misconceptions is that if somebody has a brain injury, then they have a disability that is going to impact everything that they do, and is going to lead to them not being able to move forward with their case—that they're incompetent, they have a brain injury, they can't possibly assist in their defense, and that's just not the case.Ìý
Like I said, it's invisible because a lot of times you can't see the effects of it, and sometimes there just aren't effects of it either. So that's so important to remember, is that finding out what that person's individual needs are and what that person's limitations or barriers are is extremely important when looking at brain injuries and not to just put somebody into a box.
Jordyn Reiland (15:58):
Why should people care about your research?
Jennifer McMahon (16:00):
I think that the research that we do affects people maybe more than you would typically think.Ìý
So, some folks may say, ‘well I don't have a brain injury, I don't know people who have a brain injury, I'm not involved in the system’ and think that there is a big ripple effect in terms of how this system affects all other areas.Ìý
So, what our research is hoping to do is to bring awareness to some of the gaps within the system that may be causing other issues somewhere else and clogging other areas. Whether it's financially, for example sometimes we use local hospitals, and that kind of restricts the availability of some of the beds for folks who might need them, and it's been an amazing resource for us in the criminal legal system.Ìý
But if we can resolve some of these issues and get people to move through the system more efficiently, then I think a lot of other things will fall into place and moving efficiently as well.Ìý
I also think that anybody can get a brain injury, right? It's not just because somebody is involved in the justice system that means that they're positive for a brain injury. We see it all the time. We see it with athletes, we see it with military, we see it with day-to-day. I have a friend who, gosh, we joke all the time that she should wear a helmet because she just keeps getting concussion after concussion, and she's just such a klutz like that—but she's amazing.Ìý
It’s something that the more we know about it, the more we can apply it, the better our resources become for everybody.
Jordyn Reiland (17:49):
McMahon and her team hope to see the program not only continue in Colorado, but that it becomes a model for ways to assess brain injuries among justice involved individuals across the country and all over the world.
Jennifer McMahon (18:02):
We want this to be something that we share with other states, with other provinces, even with other countries.Ìý
We presented on it in national conferences and international conferences. So, we want to take this and make it something that is available for people all over the place. So hopefully that's something that we're working towards.Ìý
Right now, I'm working with colleagues in South Africa to figure out how we can adapt this model to work for an international population. I think that the World Health Organization has said that brain injuries have such a high rate of incidents, and it's not noticed, it’s sort of an invisible pandemic.Ìý
So, we're hoping that this is just one step toward getting that recognition of needing those additional resources.
Jordyn Reiland (18:57):
A big thanks to our guest, ÎÄÐù̽»¨ Research Assistant Professor Jennifer McMahon. More information on her work can be found in the show notes. If you enjoyed this episode, I encourage you to subscribe to the podcast on Apple Music or Spotify—and if you really liked it, leave us a review and rate our work. It really helps us reach a larger audience—and grow the pod.
Emma Atkinson is my co-host. Joy Hamilton is our managing editor. Madeleine Lebovic is our production assistant and musical genius, and James Swearingen arranged our theme. I'm Jordyn Reiland and this is RadioEd.
