UTSA researchers study traumatic brain injury in the formerly incarcerated

Chantal Fahmy (left) and Alicia Swan (right) are co-principal investigators on a project examining traumatic brain injury among people reentering the community after incarceration.

JULY 14, 2022 — Researchers from the UTSA College for Health, Community and Policy (HCAP) have received a seed grant from the UTSA Brain Health Consortium and the UTSA Research, Economic Development, and Knowledge Enterprise (REDKE) that will fund their studies of traumatic brain injury (TBI) among people reentering the community after incarceration.

The researchers’ aim is to gather as much information as they can on these mild TBI exposures and their effect on the long-term health and behavior of the individuals. Research points to repeated TBI leading to increased aggression and harmful behaviors – thereby feeding the cycle of crime and imprisonment. They see this work as particularly timely and relevant for Bexar County and beyond and hope their work will shed some light on issues that can be fixed.

Chantal Fahmy, assistant professor of criminology and criminal justice, and Alicia Swan, assistant professor of psychology are the co-PIs on the project. Other researchers on the project include Alex Testa, formerly a UTSA professor who is now at UT Health Houston, and Katherine Kelton, a post-doctoral fellow at the Veterans Administration (VA).

“By highlighting the importance and scope of the problem of TBI, we would help rectify cognitive deficits to better society as a whole.”

The researchers will work with the Bexar County Reentry Center to collect data on formerly incarcerated persons. They will have a computer set up in the center, along with QR codes posted for smartphone use to conduct surveys. The team will follow up on those who state they have experience with mild brain injury. The target goal for the first round of data collection is 400 surveys and 50 face-to-face interviews.

The team plans to make use of a well-known validation tool: the Ohio State University TBI Identification Method (OSU TBI ID). This tool is standardized procedure for eliciting a person’s lifetime history of TBI via a short, structured interview. This will ensure that the professors are using the best, most accurate data for this project.

“By highlighting the importance and scope of the problem of TBI, we would help rectify cognitive deficits to better society as a whole,” Fahmy said. “Right now, the recidivism rate [the rate at which people return to prison following release] is about 70%. We’re not making our city safer. For the people who are actually in the cycle of recidivism and reentry, we can help improve that with data on how TBI is affecting them. Then, what ends up happening is it trickles down to taxpayers.”

Fahmy and Swan also found that the need for a sense of community and belonging among this population was further exacerbated by the COVID-19 pandemic. Particularly among those with mild TBI, the missing sense of community can drive persons into harmful cycles which drive up prison numbers.

“One piece that comes up a lot in the TBI injury space is that their injuries are preventing them from engaging in social or recreational activities, so they don't feel like they're part of a healthy community,” said Swan. “When you have those more fundamental, happy positive connections with your environment and your community, you're less likely to engage in behaviors that are going to be maladaptive and lead you to substance abuse or negative behaviors.”

While both professors teach in HCAP, it was this research topic that brought their disciplines together.

“I’ve written a few papers looking at TBI in incarcerated and reentering populations, and the social aspect keeps coming up,” Fahmy said. “I ended up cold-emailing Alicia Swan because her faculty page lists functional outcomes after TBI as one of her research interests.

Swan, who also serves as the graduate advisor of record for the psychology department, readily agreed to take on the project.

“The cumulative effect of lifetime TBI exposure is probably the best indicator of long-term health,” Swan said. “The idea that multiple exposures to mild traumatic brain injury can have a hastening effect with cognitive age-related changes and aggression, irritability, impulsivity—that would be something you would expect to see in greater frequency among both veterans and formerly incarcerated individuals.”

Given the number of veterans who are susceptible to TBI and are incarcerated, this project could have long-term benefits, Fahmy added.

“Down the line, if we find that this online monitoring tool works in this sample, we can use it at the intake or release stage of incarceration and hopefully have better rehabilitation efforts for the city.”

The researchers will begin data collection in the fall and will have data to analyze by spring 2023. They hope their data will inform not only the Bexar County jail and reentry systems, but eventually the general public.

“A history of mild TBI is something that we need to consider for navigating mental and physical healthcare,” Swan said, “but this project will also reveal the importance of engagement with communities, particularly on the other side of a pandemic. I think we all see the importance of having ties to communities and social groups.”

 “Social health is something we don’t talk about enough. It matters in a lot of cases,” Fahmy added.

— Amanda Cerreto