A.H.E.A.D. FOR JUVENILES
Achieving Healing through Education, Accountability, and Determination

Introduction

The Traumatic Brain Injury (TBI) Education & Skill-Building Youth Group Curriculum was developed in partnership with MINDSOURCE-Brain Injury Network and University of Denver Graduate Students (Alexandra Murphy, Haley Hawkins, Kayla Storm, Catie O’Brien, Tera Hunter-Johnson, Alex Bahr, Evan Davies, Erica Flooding, Conor Johnson, Emma Rosenblum, Meli Sarkissian, Amber Jackson, Laura Hauglid, Marissa Jennings, Stephanie Sanchez, Zakk Parlato, Jahsana Banks, Alyssa Dugger, Brooke Miller, Erin Murray, Kelsie Smith, Natasha Fominykh, Madeleine Kelly, Blair Motluk, Emma Oremus, Chelsie Padilla, Zianya De la Mora, Angelie Severino, Claire Beck-Alper, Ayla Sjoberg, and Evan Praznik). 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 the symptoms that they deal with, such as short-term memory loss, delayed speed of processing, and difficulty with emotional regulation.

This group curriculum is 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. Some individuals may not have received a diagnosis of TBI. Others may have had a diagnosis of “concussion” but are experiencing the long term challenges associated with brain injury. By definition a concussion is the same as a mild TBI. There are three levels of severity of brain injury; mild, moderate, and severe. The diagnosis at the time of injury does not necessarily predict level of impairment a person may experience down the road. In fact, if a person has had a complicate or multiple concussions and continue to experience symptoms long term, this may be considered a moderate brain injury. It is important that part of this group is to educate the participant about this difference as it will help the individual be a better self-advocate when they understand this (e.g. certain services may be available to them and care/treatment may be more appropriate if they know they have a brain injury).

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 TBI Education & Skill Building psychoeducational curriculum. This guide will walk you through how to implement each session. There are a total of 6 sessions with an optional session on acceptance. 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 (all these sections are italicized), DISCUSSION, WRITE). The symbol “*” designates helpful notes for each module. All homework assignments are found at the end of each module.

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.

• http://www.newhealthadvisor.com/group-therapy-activities.html

CONSIDERATIONS PRIOR TO IMPLEMENTING THE TBI EDUCATION & SKILL-BUILDING GROUP:

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. If someone has a known TBI, they are a good candidate for participation in this group. In the absence of an existing diagnosis, you may want to consider implementing a screening protocol to identify those individuals 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://www.brainline.org/article/ohio-state-university-tbi-identification-method. 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, it is recommended that they participate in a neuropsychological screen for impairment. This can provide valuable information by helping to tailor this curriculum to an individual’s identified deficits and strengths.

Ideally, each participant should meet with the group facilitator prior to starting the group to review their test results and to identify their goals. Use this information to tailor the curriculum to each individual in the group. Each participant should also identify a support person such as a mental health provider, friend, or family member to work with between group sessions. The facilitator should record this information, so they can remind the participant to get their support person’s help with practice between group sessions. Facilitators should have multiple copies of all handouts to provide participants and their parents, guardians, support person, and probation officers. This will further reinforce the practical application of the skills learned. Participants are encouraged to start a binder for group materials, note-taking, etc. Overall, facilitators should be flexible with their application of the material in each individual group and be responsive to the discussions, allowing improvisation when necessary. Facilitators should consider providing any other additional materials that may help participants retain information between groups.

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 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. Its recommended that they participate in secondary screen or neuropsychological evaluation as available.

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 six 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. The curriculum may also be used in different settings (correctional facility, probation class, schools, etc.) so the activities should be adjusted to fit each setting accordingly.
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 six sessions in advance, allow 1 to 1.5 hours per session, and hold the group in the same place and on the same day and time of day for 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. Allow plenty of time to contact the individuals beforehand and incentivize them when they are in the room for each module.
4. Incentivizing the juveniles might be a difficult task for a variety of reasons. Candy is an effective method as an incentive and actual food is more effective, particularly for adolescents who are scheduled to complete modules after a long day of school.
5. Positive language with a clear and concise message is also recommended. Consider approaching
   each individual with language that focuses on their specific strengths and avoid pathologizing or stigmatizing language.
6. These modules were developed to encourage constructive feedback for program improvement. At the start of each module, ask the juveniles to keep in mind one thing that they liked or did not like to discuss at the end of the module.
7. Group facilitators should have a basic understanding of TBI prior to running the TBI group modules. The following are online trainings: https://vimeo.com/200048378, https://vimeo.com/231905469 or https://tbi.osu.edu. The link below directs you to a series of videos about Traumatic Brain Injury. https://tinyurl.com/BI-Playlist. You may also consider contacting your state’s brain injury program and/or state brain injury alliance/associations, as many of these agencies offer in-person trainings. The contacts in your stat are here: nashia.org, biausa.org, usbia.org. There is a correlation between a knowledgeable and confident educator and increased participation and engagement in group learning settings. To learn more about Brain injury and its behavioral effects, please visit cokidswithbraininjury.com and/or brainline.org.
8. There are several exceptions that require facilitators to break confidentiality. Facilitators who are mental health or correctional personnel are mandatory reporters and are required to report any of the following disclosures:
   • Suicidal intent or inability to care for oneself. Reporting is meant to ensure the safety and appropriate care of the participant.
   • Homicidal intent; in the event of homicidal intent, the facilitator has the duty to warn the object of the participant’s intent. This is intended to protect both the participant and the person they wish to harm.
   • Child or elder abuse, which is reported to the Department of Human Services. Child abuse is described as the abuse (physical, sexual, mental, etc.) or neglect of a child under the age of 18. Elder abuse is described as the abuse (physical, sexual, mental, etc.) or neglect of an at-risk elder (someone with intellectual or physical deficits, as well as elder who is dependent on their caretaker).”

ACCESSIBILITY HOMEWORK

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

CAUTION: Participants with a brain injury history 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 following 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.