TBI Justice Initiative

There is no disagreement among law enforcement officials that people with disabilities are over-represented in our jails and prisons. NC’s abject failure to adequately invest in community-based mental health services means many people go untreated and end up in crisis, instead of receiving much needed care and treatment. With scant community mental health resources, these people often end up in jail and prison.

NC’s failure to provide community services harms people with Traumatic Brain Injury (TBI), as detailed in a Disability Rights NC (DRNC) report in September 2021, Shamefully Inadequate: NC’s Service System for People with TBI. Making matters worse, jails and prisons screen for some types of disabilities at admission, but not for TBI.

This omission is glaring. According to the Centers for Disease Control and Prevention (CDC), 25-87 percent of prisoners report having experienced a head injury or TBI, compared with 8.5 percent of the general population. Notably, the CDC recognizes TBI as “an important public health problem” in our nation’s jails and prisons.

Launching the TBI Justice Initiative

In fall of 2021, DRNC launched our TBI Justice Initiative to build an innovative program to address safety, education, training, service, and accommodation needs for people with brain injuries in NC’s criminal legal system. DRNC’s project is led by Desireé Gorbea-Finalet, a multiple TBI survivor who has seen and experienced firsthand how people who have sustained a TBI are often isolated and de-humanized through misunderstanding that accommodations are needed. Too often people mislabel brain injury symptoms as the person being ‘non-compliant, disorderly, and mentally or emotionally unstable.’

TBIs are caused by an external force that injures the brain, such as blunt force trauma caused by motor vehicle accidents, being hit in the head by objects, and slips and falls. Effects from these injuries can be physical and mental, and may last a lifetime. Military personnel can experience a TBI from exposure to explosions in combat.

As she began her work with the TBI Justice Initiative, Gorbea-Finalet learned quickly that NC is among dozens of states that don’t screen people for TBI upon admission to prisons or jails. Of course, failing to identify and ignoring the impact of a TBI disability on a person’s behavior does not make the problem disappear. It makes jails and prisons more dangerous for incarcerated people and staff.

Failure to screen also makes successful rehabilitation far less likely and causes problems not only while people with a TBI are locked up, but also when they return to the community – the “important public health problem” cited by the CDC. These injustices have a disproportionately negative impact on populations over-represented in the NC criminal legal system: Black, brown and disabled people, particularly those with low incomes and inadequate health care access.  

There are measures that can be implemented to assist this population while in prison or jail, according to the CDC. Detecting individuals with a TBI would allow for accommodations and coordination of services for people to remain safe in prison. It would make facilities safer for those working in prisons and jails. A 2017 study found that people with TBI were more likely to recidivate post-release than those without TBI. Identifying, addressing, and providing services for TBIs can have a positive impact upon the success of the individual once returned to the community.

Since NC’s prison system is centralized and our 109 jails and detention centers are independently operated, Gorbea-Finalet first set out to work with NC’s prison system to help foster the development and implementation of a screening tool, and supportive services for brain injury. However, she soon realized that while the need is certainly there, there is much outreach to do in the system before that necessary goal can be achieved.

NC’s Veteran Treatment Courts

Undaunted, Gorbea-Finalet reached out to NC’s five Veteran Treatment Courts (VTCs) with the goal of developing a successful initiative that can be duplicated across other NC correctional settings, track outcomes, and serve as a national model. This proved to be an important connection, resulting in a ground-breaking partnership with the courts in Buncombe, Cumberland, Forsyth, Catawba, and Harnett counties. DRNC’s TBI Justice Initiative will work in collaboration with VTC partners to identify brain injury in criminal legal system-involved individuals and implement supportive services, education, training, and accommodations for people with a TBI in the NC criminal legal system.  

Partnering in the TBI Justice Initiative is Adam Shaw, a veteran with TBI, who began as a University of North Carolina (UNC) at Greensboro graduate student intern with the project. Since graduating, he continues to work on the project as a volunteer. “He speaks a lot with veterans in the VTCs. Veterans speak with veterans. They trust me because I have lived experience, but they will always want to speak with veterans,” Gorbea-Finalet said.

To help shape and support the initiative, Gorbea-Finalet brought together an Advisory Committee comprised of veterans (including Shaw), people with lived experience with brain injury and/or the criminal legal system, caregivers of people with TBI, and representatives with the Brain Injury Association of NC, Brain Injury Advisory Council, NC Veteran Treatment Courts, NC Department of Health and Human Services, Veteran Justice Program, UNC Greensboro, Veteran Bridge Home, Community Partnerships Inc., Armed Forces Services Corporation, Alliance of Disability Advocates, NC Central University, and Solutions for Independence.

Work with the VTCs is getting off the ground, and Gorbea-Finalet and DRNC are actively seeking funding to boost this effort. In the meantime, Gorbea-Finalet’s current funding lasts through September, and she is working toward adding three more NC counties that just received funding for VTCs: Iredell, New Hanover, and Onslow.

The important partnership with the VTCs is just one part of the initiative Gorbea-Finalet designed. As she began her work in 2021, she discovered there is no centralized information about what kinds of TBI screening and programs exist in other states’ criminal legal systems. She set out to change that.

TBI Justice National Database

In March 2023, Brain Injury Awareness Month, Gorbea-Finalet launched a national database that compiles criminal legal system-related brain injury screening and supportive service programs, including pilots, academic studies, and projects across the country from the past 30 years.

“It’s a lot of information, but it’s threaded down in a digestible way – you can choose how much information you want to take in, rather than having to read dozens and hundreds of pages,” she said, crediting Shaw with these creative features.

The goal of the database is to provide state and territory information in a concise, coherent way that allows people from all backgrounds to view what is happening in the area of brain injury and criminal legal system involvement. The database will be updated as information continues to come in from states. Information currently in the database is the product of outreach efforts, referrals to reports and studies, interviews with state project investigators and state agencies, and research of academic, justice, and medical journals.

“In the past 15 years, there’s been no national study about people with TBI who are involved in the criminal legal system,” Gorbea-Finalet said. “That’s why we feel this database is so important. The studies from back then indicate as many as 25-87 percent of incarcerated people had a brain injury, and the inference has to be there’s more now, not less.”

Gorbea-Finalet has created a critical foundation for this initiative, including support groups for people with brain injuries involved in the criminal legal system, and a Spanish-speaking support group for people with brain injuries. Through this dedicated work and relationship building, “DRNC is poised to have a meaningful, widespread impact in the tremendously overlooked and underreported disability of TBI,” Gorbea-Finalet said. “Our vision for the project’s outcome is to connect and strengthen existing services and supports, and identify remaining needs and recommendations.”