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Traumatic Brain Injury in Juvenile Offenders: Findings From the Comprehensive Health Assessment Tool Study and the Development of a Specialist Linkworker Service

Chitsabesan, Prathiba MD; Lennox, Charlotte PhD; Williams, Huw PhD; Tariq, Omar MBChB; Shaw, Jenny PhD

Section Editor(s): Williams, Huw PhD, D Clin Psych

Journal of Head Trauma Rehabilitation: March/April 2015 - Volume 30 - Issue 2 - p 106–115
doi: 10.1097/HTR.0000000000000129
Original Articles

Background: Young people in contact with the youth juvenile justice system have well-documented vulnerabilities including high rates of mental health and neurodevelopmental disorders. Studies have suggested that they may also be at increased risk of traumatic brain injury (TBI).

Objective: (1) To describe the profile of a cohort of juvenile offenders with TBI and associated comorbidity with other neurodevelopmental disorders, mental health needs, and offending behavior. (2) To describe the development of a specialist brain injury service for juvenile offenders with TBI within custody.

Methods: Ninety-three male participants aged 15 to 18 years were consecutively admitted to a custodial secure facility. They were evaluated using a range of different neurocognitive and mental health measures including the Rivermead Post-Concussion Symptoms Questionnaire and the Comprehensive Health Assessment Tool.

Results: Eight-two percent of those interviewed reported experiencing at least 1 TBI, and 44% reported ongoing neuropsychological symptoms. Eighteen percent of those sustaining a TBI reported moderate-severe postconcussion symptoms.

Conclusions: There is a high prevalence of TBI in juvenile offenders in custody, with many experiencing multiple episodes. This study highlights the need for further research in this area. An example of a specialist brain injury linkworker service is described as one example of a model of service delivery for this group.

Centre for Mental Health and Risk, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom (Drs Chitsabesan, Lennox, and Shaw and Mr Tariq); Pennine Care NHS Foundation Trust, Manchester, United Kingdom (Dr Chitsabesan); and Centre for Clinical Neuropsychology Research, University of Exeter, Exeter, Devon, United Kingdom (Dr Williams).

Corresponding Author: Prathiba Chitsabesan, MD, Pennine Care NHS Foundation Trust, Child and Family Service, Tree House, Stepping Hill Hospital, Stockport, M33 6RG Manchester, United Kingdom (

Evaluation of the comprehensive health assessment tool was funded through a research grant from the Department of Health (England) and evaluation of the specialist brain injury linkworker service by a research grant from the Barrow Cadbury Trust. The linkworker service is a 2-year project primarily funded by the Disabilities Trust Foundation. The authors acknowledge the contribution of Deborah Fortescue, Professor Michael Oddy, Kate French, and Tansy Warrilow from the Disabilities Trust Foundation in developing the specialist brain injury linkworker service described.

The authors declare no conflicts of interest.

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