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El Paso County Focusing on Acquired Brain Injury

In 2010, the Texas Juvenile Justice Department (TJJD) in collaboration with the Office of Acquired Brain Injury (OABI), piloted a program to identify youth involved in the justice system that may have presented with an undiagnosed traumatic brain injury (TBI).  The collaboration between TJJD and the OABI established objectives to identify justice-involved youth with a TBI utilizing the Brain Injury Screening Questionnaire (BISQ) in an effort to provide “pathways to services” designed to reduce recidivism, foster healthier individuals and improve cognitive and emotional regulation skills.

Through the collaboration developed between the TJJD and the OABI, the El Paso County Juvenile Justice Center was able to develop a partnership with Dr. Wayne Gordon at Mount Sinai School of Medicine’s Brain Injury Research Center.  The partnership was designed to afford services to justice-involved youth identified with a TBI.  Through this collaborative effort the development of the Youth Short Term Executive Plus Program (YSTEP) was designed.

The program is based on an adult model developed by and used at Mt. Sinai’s Brain Injury Research Center which has been modified and formatted for an adolescent population through the application of cognitive behavioral strategies coupled with dialectical behavior therapy mindfulness skills.  It is designed to facilitate the development of executive functioning in adolescents as well as develop that have been identified as possibly having a traumatic brain injury through the administration of the BISQ and/or youth that have demonstrated a history of poor problem solving and/or self regulating skills.

The El Paso program focuses on providing group services utilizing the YSTEP curriculum to youth court-ordered into the Challenge Academy, which is a secure post adjudication para-military style program that offers supportive residential drug treatment services and youth court order to Intensive Supervised Probation under the Serious Habitual Offenders Comprehensive Action Program (SHOCAP).   Both populations have been identified as having a higher likelihood of exposure to activities that may enhance the likelihood of a TBI (i.e. history of abuse, assaults, substance use, etc) as well as a higher rate of recidivism based on identified risk factors and limited protective factors.

The YSTEP program is conducted in 10 -12 sessions with each session building upon the previous week’s lesson.  Sessions may range from one to two hours depending on the modalities used (i.e. role play, in vivo activities, coupled with didactic therapy) and programming structure (youth placed in a secure environment vs. community based youth).  Youth participating in the YSTEP program are taught techniques and strategies to aid in understanding how the emotional cycle impacts outcomes and behaviors; to recognize triggering events, thoughts, emotions, sensations and behaviors that contribute to a loss of emotional control as well as poor decision making and or problems solving experiences in an effort to strengthen their understanding of causal relationships.

Lessons include Identifying Triggers and Understanding Anger; Understanding and Exploring Sensations;  Relaxation Strategies and Techniques; Thoughts and Thinking Errors and How they Impact Choices and Outcomes;  Thinking and the Decision Making Process; Understanding Consequences, Outcomes & Behaviors; Types of Communication & Effective Communication Strategies  and the Emotional Cycle as well as Integrating Strategies to Effectively Cope with Difficult Situations.

Although a program evaluation through data analysis being conducted by Dr. Gordon and his team at Mt. Sinai is pending, the lack of resources to address cognitive deficits and emotional regulation issues has sparked interest in the implementation and/or replication of the YSTEP program.  In August 2014, Rebecca Derocher with the Health Resources and Services Administration (HRSA) conducted a site visit at the El Paso County Juvenile Justice Center to review the program and protocols in place.  Interest in implementing the program has also been demonstrated by the country of New Zealand and more recently discussion have occurred with the HRSA TBI Grant Coordinator for the Alabama Department of Rehabilitative Services Ms. Augusta Cash with regards to implementing a program for justice involved youth in Alabama.

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