Modules

WEEK 1 - UNDERSTANDING TBI AND SYMPTOM RECOGNITION

WEEK 2 - MEMORY SKILLS AND GOAL SETTING

WEEK 3 - EMOTIONAL REGULATION

WEEK 4 - COMMUNICATION MASTERY

WEEK 5 - TBI AND ANGER: IDENTIFICATION, OPTIONS, AND UNDERSTANDING

WEEK 6 - WHY IS STOPPING AND THINKING IMPORTANT?

OPTIONAL MODULE - GREIVING AND TBI

Materials Needed

INSTRUCTOR MATERIALS

  • Facilitator Guide
  • Class Handouts - Included in each section of the curriculum are the handouts to be copied and distributed to group members for each session, or as homework assignments, as indicated.

STUDENT MATERIALS

  • Paper and pencil - (or other writing instrument)
  • TBI folder - should include the participant’s TBI assessment and/or TBI assessment feedback, as available

SUPPLIES AND EQUIPMENT

  • Whiteboard or large writing pad
  • Markers

Introduction

The AHEAD curriculum was developed in partnership with MINDSOURCE – Brain Injury Network and Dr. Bradley McMillan PhD from the Denver County Jail, Rachel Tiel, and with support from graduate students at the University of Denver, Tyler Camaione and Moses Gur. The goal of the TBI Education & Skill-Building group is to provide justice-involved individuals who have screened positive for traumatic brain injury (TBI) with the insight and tools to better cope with and address the symptoms that they deal with, such as short-term memory loss, delayed speed of processing, and difficulty with emotional regulation. This group curriculum was developed based on best practices for group facilitation for individuals with TBI. In addition, the group topic focus areas were selected to address the hallmark symptoms of TBI. The message for group participants is that just because they have experienced a lifetime history of TBI, they are not a “broken” person. The focus of this group is to help participants understand TBI and build skills for managing their symptoms so that they can be more successful moving forward. Finally, the curriculum was designed in such a way that mental health staff and criminal justice staff, i.e., probation officers, can facilitate the group sessions. To ensure this can be accomplished, we have developed this facilitators’ guide. For more information regarding the AHEAD curriculum please view the following video: https://youtu.be/eYr56gUvCco

The following is a practical, easy-to-follow guide to help you facilitate and lead the AHEAD curriculum. This guide will walk you through how to implement each session. There are a total of 7 sessions with an optional session on grieving. Each session is designed to last about an hour and a half, and is divided into the following sections: introduction, content, activity and reflection. The guide breaks down the goal/objectives of each session, and includes aspects of preparation for the group (such as handouts that will be distributed used during the group). Also included with some sections are handouts described as “homework,” for the facilitator to distribute to group members for completion between sessions. Each transition is indicated with an action symbol, which tells the speaker what is required for that section (e.g., TALK, DISCUSSION, WRITE).

Note: It may be helpful to include icebreaker activities to engage participants at the start of each group and to build rapport between group members. Group icebreaker activities and ideas for enhancing their effectiveness can be found at the links below. Facilitators are encouraged to find and implement approaches that fit their style and complement the overall group dynamic.

CONSIDERATIONS PRIOR TO IMPLEMENTING THE AHEAD CURRICULUM:

Consider how you will recruit participants to the group. This group is designed specifically for individuals with TBI. Often, TBI is not diagnosed or identified; this is especially true in criminal justice populations. If someone has a known TBI, they are a good candidate for participation in this group. In the absence of existing diagnosis, you may want to consider implementing a screening protocol to identify those individuals within your population who may have a TBI. This protocol should include a screen for lifetime history of brain injury. It is suggested that you use a valid and reliable tool. We recommend the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID). This tool is free to use and is normed for this population. The OSU TBI-ID is recommended for use with individuals ages 13 and above. It can be downloaded at https://tinyurl.com/wexnermedical. If working with children/youth, the Brain Check Survey is a preferred screening instrument. It is also free and can be downloaded at http://www.lobi.chhs.colostate.edu/survey.aspx. At this link, you will find both the survey and the scoring rubric.

If an individual screens positive for lifetime history of TBI, a Symptoms Questionnaire is then completed by the individual to identify self-reported areas of difficulty. The Cognitive Strategies Guidebooks for Community Mental Health and Criminal Justice Professionals (PDF) include approaches specific to the nine symptom categories in the Symptoms Questionnaire and can be an excellent resource to tailor this curriculum to an individual’s deficits. In addition, review of the Symptoms Questionnaire with the individual is an important focus of the Goal Setting activities in the Week Two module.

If a neuropsychological screen was conducted, it is suggested that the participant meet with the group facilitator prior to starting the group to review their test results and to identify areas for goal setting. Each participant should also identify a support person such as a mental health provider, friend, or family member to work with in between group sessions (the facilitator should record this information so they can remind the participant to get their support person’s help with homework between group sessions). Participants are encouraged to have a binder for group materials, note-taking, etc. Facilitators should consider providing any other additional materials that may help participants retain information between groups.

Steps may be taken to increase participant connection with the group’s content; for example, having a set folder for each participant wherein they can collect their handouts and homework sheets, providing copies of these documents to their designated support person, allowing for video or audio recording of sessions, etc. We encourage group leaders and/or participating programs to be aware of their group’s identified cognitive limitations and to work with participants to develop individualized strategies to help them get the most out of this curriculum.

The following are things to consider related to facilitating this group:

  1. While it would be ideal for individuals to attend all seven sessions of this curriculum, each section is meant to be a stand-alone unit to accommodate people transitioning into and out of the criminal justice setting at unpredictable times.
  2. The group is most effective with a minimum of four participants and a maximum of twelve participants.
  3. If possible, facilitators should schedule the seven sessions in advance, allow 1.5 hours per session, and hold the group in the same place and on the same day and time of day at each meeting. Consistency in the setting of the group will add a sense of stability and structure to the group, which may serve to minimize distractibility among participants.
  4. Group facilitators are expected to have a basic understanding of TBI prior to facilitating the AHEAD group modules. Facilitators may consider contacting their state’s brain injury program and/or alliance/associations, as many of these agencies offer in-person trainings. To find out who the contacts are in your state, visit the following websites: https://www.nashia.org/, http://www.biausa.org/, http://usbia.org/.

Facilitators can visit the following website to access on-line training on brain injury: http://www.ohiovalley.org/informationeducation/tbi101/index.cfm

The following web addresses will direct facilitators to sets of informational videos, which provide background information on Traumatic Brain Injury. The viewing of these resources prior to conducting the curriculum is recommended, particularly for facilitators who are not already well versed in the causes, symptoms, and treatment of Traumatic Brain Injury.

ACCESSIBILITY HOMEWORK

Click here to download an accessibility version of the homework (PDF).

CAUTION: Participants with TBI may have concurrent mental health diagnoses, such as posttraumatic stress disorder, substance abuse disorders, mood disorders, etc. This curriculum is not designed to address the clinically significant symptoms that may be triggered by discussions in the modules. We recommend that other mental health resources specific to these comorbid conditions be identified ahead of time and be made available for group members, as needed.