NR Times speaks to the team at Brainkind, which won the NR Times Research Project of the Year Award 2024, sponsored by Leading FES Rehabilitation.
Brain injury charity Brainkind has spent the last ten years carrying out research examining the experience of brain injury interventions delivered in prison and probation services for males.
Previous research has demonstrated that brain injuries are disproportionately high in prison populations, and that brain injuries can prevent this population’s capacity to effectively rehabilitate, and transition back into society.
The project, Neurorehabilitation behind closed doors, assessed the impact of Brainkind’s Brain Injury Linkworker (BIL) service on criminal justice outcomes, exploring the extent to which men who have completed the service felt that they had benefitted and to what degree.
Brainkind began delivering its BIL service in 2013, which provides tailored brain injury interventions directly to people in prison and on probation, and the organisation says that a recent study observed that men in prison who completed the service not only reported a reduction in their brain injury symptoms, but also improved mood.
Elizabeth Wilce, project manager of the Brain Injury Link Worker Team, said: “Over a decade ago, some of the team from Brainkind conducted research at HMP Leeds and within the homeless population in Leeds. That research revealed that 47 per cent of men in prison had an acquired brain injury, as did 48 per cent of people experiencing homelessness. Based on these findings, we established a Brain Injury Link Worker service.
“We began by screening individuals using a questionnaire, and, if an individual screened positive, they were referred to our Brain Injury Link Worker for further assessment and support.
“As the service evolved, the role of the Link Worker expanded beyond assessment to include therapeutic interventions. We were fortunate to build a team of clinical psychologists and neuropsychologists to support these interventions, which focused on key areas such as memory, frustration, and anger management. The impact was evident early on – even having just one dedicated Link Worker in the prison led to a noticeable reduction in these issues among the men we worked with.
“Alongside direct support, we also provided in-depth training for prison officers, healthcare staff, and other professionals. This training encouraged staff to adjust their approach when working with individuals affected by brain injuries, using simple but effective strategies such as post-it notes for reminders and scheduling sessions at consistent times each week.
“These small adjustments made a significant difference.”
Following five years of operation in Leeds, the services expanded into Wales in 2016, currently working in HMP Swansea, HMP Cardiff, HMP Berwyn, and three approved premises, and running a pilot scheme in the South East across four prisons.
The charity has now published its mood-related research, which the team says reflects how supporting men with brain injuries has a secondary impact of improving anxiety and mood.
Brainkind’s consultant clinical neuropsychologist, Dr. Annmarie Burns, said: “For many of the people we work with, this is often the first time they have had the opportunity to talk about their head or brain injury, explore what it means for them, and discuss the consequences they are experiencing.
“Many of the individuals we support have reasons why they might not seek hospital care after an injury. Even if they do present at hospital, their circumstances often make it difficult to engage with follow-up appointments, so they don’t receive the kind of feedback from medical teams that you or I might expect.
“The Brain Injury Link Worker spends a significant amount of time helping them understand what it means to have experienced a brain injury and the challenges they may face. The feedback we receive suggests that this support is really valuable and offers them an important opportunity to explore these issues.”
“The team also developed the Perception of Change Questionnaire which assesses both the area intervention and factors that influence engagement with the prison regime.
“We know that if people are more engaged and complete their interventions, they are hopefully less likely to reoffend – though that data is complex to analyse,” said Burns.
“Our findings show that after intervention, men improve across all of these measures. Obviously, in healthcare, patient-reported outcomes are crucial, and this questionnaire is one aspect of that. It sits alongside other measures, including mental health assessments. We also try to capture environmental factors, such as how individuals engage with the prison regime, though this is not always straightforward. However, it is an area for potential future development.”
The research project will now look into expanding into women’s prisons women’s prisons, exploring whether the model works well with women.
“We try each time to address study limitations, as well as extending the findings in prison settings to other populations,” said Davina Jones, head of policy, influencing, and social change programmes at Brainkind.
“So we have done work with women in prison, but also with women outside prison who have a history of domestic abuse. We try to evaluate the service from different perspectives using different methodologies, qualitative as well as quantitative, but also different measures. It’s part of trying to grasp what we’re achieving, but also the relationships between all the factors that we encounter, which may be brain injury, but, people are also sometimes from deprived backgrounds or have childhood adverse experiences.
“By building this kind of data, we can start to understand some of those connections. And of course, that then helps us to get better ways of intervening.”
On receiving the award, Jones added: “It’s really nice for the work to be recognised. This has been a very long term project, and it can feel really difficult sometimes doing research in prisons when you’re struggling to get data. It’s really great when all that hard work pays off and it gets recognised.”
In the coming months, the project will be expanding into five to six prisons in the North West.
