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Project L.E.A.P. Transcript
Brain Injury Association of Florida presents Project L.E.A.P.
Law Enforcers as Partners with Individuals with Traumatic Brain Injury
The State of Florida Department of Health
Brain & Spinal Cord Injury Program
Slide 1 - Brain Injury Association of Florida presents Project L.E.A.P. - Law Enforcers as Partners with Individuals with Traumatic Brain Injury. Throughout the training, Brain Injury Association of Florida will be referred to as BIAF and traumatic brain injury may be referred to as TBI. Slide 2 – Who we are and What We Do: BIAF is a statewide provider of resources, service and support for survivors of TBI, their families, caregivers and professionals who serve them in Florida. BIAF provides individualized:  Information about brain injury  Resource referrals  Education and training  Legislative advocacy  Family and survivor support coordination services  Community capacity building Brain Injury Association of Florida presents Project L.E.A.P. --- Law Enforcers as Partners with Individuals with Traumatic Brain Injury. Throughout the training, Brain Injury Association of Florida will be referred to as BIAF and traumatic brain injury may be referred to as TBI. BIAF assists individuals with brain injuries, their families, caregivers and professionals by providing services and resources to help survivors live successfully in their home and community post injury. All services and resources are provided free of charge to persons with brain injuries and their families. Since 2000, BIAF has had a strong collaborative partnership with law enforcement agencies throughout the state to provide education about traumatic brain injuries. This presentation is specifically designed to help law enforcement officers enhance their understanding of, and facilitate beneficial contact with individuals who have suffered a TBI. Perhaps now, more than ever, we need to understand what traumatic brain injury is, and how it impacts the lives of people living with its long-term effects. Many of our military personnel, who have served us unconditionally, are returning home with traumatic brain injuries. Slide 3 –The format of this training consists of 3 modules, each approximately 20 minutes in duration, a self-assessment of the training and your recommendations for us. Module One: What is Traumatic Brain Injury?
Module Two: Consequences of TBI & Commonly Prescribed Medications
Module Three: Understanding S.A.R.A. as an Effective Communication Tool &
Applying What You Have Learned
Conclusion: Self-Assessment of Learning
Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 4 – Project L.E.A.P. is training for Law Enforcement Officers on how to Recognize, Evaluate and Respond to Individuals with Traumatic Brain injury. It’s important to recognize that a person with a brain injury is a person first, not a brain-injured person. Slide 5 – Project L.E.A.P. was created to provide law enforcement with background knowledge of traumatic brain injury and a response framework based upon the community policing model of problem solving called S.A.R.A., which will be discussed in more detail later in this training. Slide 6 – Let’s get started with Module 1: What is Traumatic Brain Injury?
Learning Objectives for Module 1:
To identify the legal definition of traumatic brain injury
To identify the causes of traumatic brain injury
To identify the growth and at-risk age groups for traumatic brain injury
To identify the types of traumatic brain injury
To identify the primary sections of the brain, corresponding functions and patterns
of dysfunction

At the conclusion of this module, you will know the legal definition of traumatic brain injury, common causes, growth, at-risk age groups, and types of traumatic brain injury. There’s also a brief tutorial on the brain’s primary sections, corresponding functions and patterns of dysfunction pertaining to the brain. Slide 8 – Florida State Statute Section 381 defines traumatic brain injury as an insult to the skull, brain, or its covering, resulting from external trauma which produces an altered state of consciousness or anatomic, motor, sensory, cognitive, or behavioral deficits. Slide 9 – It is important to remember two key points: 1) Traumatic brain injury is caused from an external blow to the head and 2) Although the individual may not lose consciousness, they may still have an altered state of consciousness or post traumatic amnesia as a result of the external trauma. Slide 10 – As law enforcement officers, all too often you have seen the causes of traumatic brain injuries. Falls and motor vehicle crashes are the leading causes of TBI. Other causes include assaults, sports injuries and shaken baby syndrome. Slide 11 – TBI does not discriminate – it can happen to anyone at any time; a family member, friend, coworker, military personnel, law enforcement officers…and you. Listed here are some of the staggering statistics on traumatic brain injury in Florida. Traumatic Brain Injury Statistics in Florida There are 210,000 people living with a traumatic brain injury related disability. By 2020, it is estimated that number will increase to 260,000. 97,000 traumatic brain injuries occur each year resulting in:  8,300 long-term disabilities and:  4,000 deaths  19,000 hospitalizations  74,000 visits to the E.R. Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 12 – Children ages 1-4, young adults from 15-24, and adults over age 65 are at greatest risk for traumatic brain injuries. The age groups at greatest risk for TBI are:  Children ages 1-4  Young Adults ages 15-24  Adults over age 65 More detailed information, including specific county data on TBI prevalence in Florida available at www.biaf.org Slide 13 – You may have heard the term Acquired Brain Injury. So what is the difference between Acquired Brain Injury and Traumatic Brain Injury? Traumatic Brain Injury is a subset of Acquired Brain Injury. On this slide, you will see examples of both. Traumatic Brain Injuries are preventable! Acquired vs. Traumatic Brain Injury Acquired Brain Injury:  Birth Trauma  Near Drowning  Brain Tumors  Strokes  Other Brain Disorders An Acquired Brain Injury is NOT necessarily a Traumatic Brain Injury  Falls  Vehicle Crashes  Assaults  Sports  Shaken Baby Syndrome Traumatic Brain Injury is a subset of Acquired Brain Injury Slide 14 – Focal injuries are caused when trauma occurs to the brain from a single point of entry, like a knife or gunshot wound. With diffuse injury, trauma occurs to many areas of the brain. Coup/Contra-coup occurs when the brain is jolted first one way, and then snaps back to hit the opposite side of the skull, resulting in bruising in at least two places. Slide 15 – There are three classifications of TBI severity: mild, moderate and severe. It’s important to remember that a mild or moderate brain injury can cause significant or long-term deficits.  Mild – loss of consciousness which can range from seconds and up to 30 minutes.  Moderate – loss of consciousness ranging from minutes to a few hours, followed by days or  Severe – comatose state for days, weeks or longer. Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 16 – The brain (also called the cerebrum) is divided into two almost identical looking halves known as the cerebral hemispheres. Because different parts of the brain control different functions - the diagnosis, treatment and outcome of a traumatic brain injury are affected by which part or parts of the brain have been injured. Slide 17 - Each hemisphere is subdivided into sections called lobes; each lobe controls specific physical and cognitive functions. The Frontal Lobe, located in the front top portion of the skull, is the area of “Executive Function.” When the Frontal Lobe is injured, a person may have difficulty making decisions, initiating actions, controlling emotions, communicating and reading social cues. The Parietal Lobes, located behind the frontal lobe, affect perception and sensation of touch. The left parietal lobe is where visual messages are processed. The temporal lobes are on the sides of the head above the ears. Memory and hearing loss are often a result of temporal lobe injury. The occipital Lobe, located in the back of the skull, is the visual center of the brain. Imagine what your daily life might be like, if one or more of these parts of your brain was injured or permanently damaged. Slide 18 - The human brain is the most complex and mysterious organ in the body. It controls all body functions, from heart rate and movement to emotions and learning - 24 hours, 7 days a week. Understanding how the brain controls all aspects of human life helps to illuminate how devastating a traumatic brain injury can be. Even a so-called mild brain injury can result in major consequences. You have concluded Module 1. Slide 19 – Module 2: Consequences of TBI and Commonly Prescribed Medications
In Module 2, we will examine the impact of a brain injury on Cognitive, Personality, Behavioral and Physical functions, and discuss the drugs that are commonly prescribed for physical and behavioral management. Slide 20 – Learning Objectives for Module 2:
To identify the impact of a traumatic brain injury on cognitive, personality,
behavioral and physical functions.
To identify drugs prescribed to individuals with a traumatic brain injury, understand
the use of the drugs and the possible side effects.
Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 21 – An individual with a traumatic brain injury may experience a wide range of impairments in cognitive (or thinking) functions including communication, memory, judgment, attention, organization and safety awareness. Impairments to Cognitive Functions
Slide 22 – TBI can cause changes to an individual’s personality and behavioral functioning. Typical problem areas include mood swings, inappropriate behavior, agitation, coping and social skills. Recognizing impairments that may be due to TBI can increase an officer’s safety while assisting the individual. Impairments to Personality and Behavioral Functioning:
Slide 23 – Many physical functions that we take for granted every day can be negatively impacted by a TBI. Trouble with speech, vision, hearing, muscle coordination, sensory perception and seizures are common. Impairments to Physical Functioning
Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 24 - No two brain injuries are exactly alike. Each differs in severity and in the area of the brain most affected. The outcome of the injury may also be affected by the medical care received (Pre-hospital, trauma, acute care, inpatient and outpatient rehabilitation). Other factors that influence treatment and recovery include the individual’s pre-injury profile, health status, and family support. Slide 25 – Treatment strategies for behavioral management of individuals with TBI include cognitive therapy, psychotherapy, behavioral analysis and medication. In this module, we will discuss medications that are commonly prescribed. Slide 26 – Anti-convulsants may include the drugs listed here.

Drug Recognition for Traumatic Brain Injury: Anti-Convulsants

Medications
 Phenytoin (Dilantin)  Phenobarbital  Valproic Acid (Depakene)  Carbamazepine (Tegretol)  Gabapentin (Neurontin)  Clonazepam (Klonopin)  Primidone (Mysoline) Slide 27 – Anti-convulsants have therapeutic uses for different types of seizures, panic and bipolar disorders. However, the individual may experience adverse side effects from these drugs, including drowsiness, slurred speech, confusion and blurred vision. Slide 28 – Prescribed anti-depressants can incl
Drug Recognition for Traumatic Brain Injury: Anti-Depressants

Medications
Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 29 – Anti-depressants are used to treat conditions such as depression, anxiety, obsessive compulsive and panic disorders. These drugs also have possible adverse side effects, including dry mouth, dizziness, agitation, confusion and cardiac palpitations. Slide 30 - These anti-anxietals may be prescribed for general anxiety and insomnia, and may
also have adverse effects.
Drug Recognition for Traumatic Brain Injury: Anti-Anxietals

Medications
Slide 31 – Anti-psychotics include the drugs listed here. Drug Recognition for Traumatic Brain Injury: Anti-Psychotics

Medications
 Risperidone (Risperdal)  Haloperidol (Haldol)  Thioridazine (Mellaril)  Chlorpromazine (Thorazine)  Fluphenazine (Prolixin)  Temazepam (Restoril)  Triazolam (Halcion)  Zolpidem (Ambien) Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 32 – Anti-psychotics are prescribed for conditions such as acute mania, drug induced psychoses, and schizophrenia. Side effects may include dizziness, headaches, tremors and blurred vision. Slide 33 – Medications listed here may be prescribed for sleep disorders, and adverse effects can include fatigue, dizziness and loss of memory. Drug Recognition for Traumatic Brain Injury: Sleep Disorders

Medications
Slide 34 – Many possible adverse effects can be caused by pain management drugs, including sedation, dizziness, nausea, and temporary hallucinations. Drug Recognition for Traumatic Brain Injury: Pain Management

Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 35 – Motor system deficiencies such as Parkinson’s may be addressed by these drugs, which can generate numerous side effects ranging from confusion and dizziness to psychotic episodes. Drug Recognition for Traumatic Brain Injury: Motor System/Medications

Medications
Slide 36 - Stimulants may be prescribed to individuals with TBI for narcolepsy and attention deficit disorders. Possible adverse effects include nervousness, palpitations, increased blood pressure and irritability. Drug Recognition for Traumatic Brain Injury: Stimulants

Medications
 Decreased appetite & weight loss Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 37 – This medication may be prescribed for memory and cognition deficiencies, often due to Alzheimer’s Dementia. Possible adverse effects include confusion, nausea, dizziness and ataxia (or muscle coordination difficulties). Drug Recognition for Traumatic Brain Injury: Memory

Medications
Slide 38 – When coming in contact with an individual who has a traumatic brain injury, it’s extremely important that your interview is thorough, and includes the questions listed on this slide. The more information you have about the person, the more effective you will be in handling the situation. Questions You Should Ask About Medications  What medications have been prescribed by the individual’s physician(s) and why?  When did the individual last take the medication(s) and did the dosage comply with the  How often must the individual take the medication(s)?  How long has the individual been taking the medication(s)?  Has the individual ever experienced adverse effects from the medication(s)?  What happens when the individual does not take the prescribed medication(s)?  Does the individual utilize alcohol or illicit drugs when he or she takes the prescribed Slide 39 – It’s important for law enforcement officers to understand the challenges that individuals living with TBI may face. The person may experience cognitive, personality, behavioral and physical changes that result in functional impairments. They may lose their friends, social outlets and their source of income. Adapting to such life-changing losses often leads to frustration and depression where each day can become a difficult challenge. Brain Injury Association of Florida – Project L.E.A.P. Transcript Slide 40 – Understanding S.A.R.A. as an Effective Communication Tool
Applying What You Have Learned

In module 3, we will examine how to use the community oriented policing model of problem
solving – called S.A.R.A to effectively interact and problem solve with individuals who have a
traumatic brain injury.

Slide 41 – Learning Objectives for Module Three
To identify the S.A.R.A. model as an effective tool for communicating with
individuals with traumatic brain injury.
To enable the officer to apply the concepts, tools and knowledge gained from this
training to three typical scenarios involving individuals with TBI.

Specifically, we will examine how to use S.A.R.A as an effective communication tool for problem-solving, and apply this knowledge to three typical law enforcement scenarios. Slide 42 – As law enforcement officers, we must remember that anyone, at anytime, could sustain a Traumatic Brain Injury. Individuals who have sustained a TBI deserve to be treated with respect and dignity. The S.A.R.A. problem-solving model, a primary component of the community policing philosophy, can be an effective tool for enhancing the communication with individuals who have suffered a TBI. It is paramount for us to remember that anyone at anytime can sustain a traumatic brain injury and these individuals deserve to be treated with the same respect and dignity we give to a firefighter, police officer or military officer returning from combat. Slide 43 – The acronym S.A.R.A stands for Scanning, Analysis, Response and
Assessment.

Slide 44 - Scanning: The law enforcement officer who suspects s/he has come in contact with
an individual who has sustained a traumatic brain injury can:
 Visually assess the individual’s physical abilities, cognitive (thinking) abilities, and behavior to observe any impairment in these areas.  Ask the individual or family member if s/he has sustained a brain injury. Scanning is something a police officer does on a daily basis by visually assessing situations. When we apply Scanning to situations involving an individual who may have sustained a traumatic brain injury, we visually assess the individual’s physical and cognitive abilities and behavior to identify any impairments. We also ask the individual or family member if she or he has sustained a traumatic brain injury. Slide 45 – Analysis: After the initial contact, the law enforcement officer can consider the
existence of any impairments and the degree of the impairments in terms of physical and
cognitive abilities and behavior.
 Conducting a thorough analysis helps to determine whether the individual has sustained a Traumatic Brain Injury, or if the individual has engaged in criminal behavior such as a DUI. Brain Injury Association of Florida – Project L.E.A.P. Transcript The second step of the S.A.R.A model is Analysis. We analyze the situation to determine the existence and degree of impairments in terms of physical and cognitive abilities and behavior. Conducting a thorough analysis enables us to determine if the individual’s behavior is the result of a traumatic brain injury, or if the individual is engaged in criminal activity such as DUI. Slide 46 – Response: After analyzing the facts, and the possible existence of physical,
cognitive or behavioral impairments due to a TBI, the law enforcement officer can then
determine the appropriate course of action to resolve the situation.
After we have thoroughly analyzed the facts, an appropriate course of action can be taken to respond to the situation. Slide 47 – Assessment: The officer evaluates the action taken to determine whether or not
the problem has been appropriately addressed.
 The officer determines not only that the incident has been resolved, but also that the The final stage of the S.A.R.A model is Assessment, where we evaluate whether or not the course of action taken addressed the underlying problem to resolve the situation. In the event that the situation has not been resolved, we can repeat the S.A.R.A model for another course of action. Slide 48 – Why should we use the S.A.R.A model when interacting with individuals who have sustained a TBI? The S.A.R.A model reminds us to thoroughly analyze the situation before taking a course of action. Slide 49 – Applying the S.A.R.A. Model You will be shown 3 video lessons to enable you to apply the S.A.R.A. Model. Scanning: What are your observations about the individuals involved in the situation? Analyzing: What factors are important to consider in the situation? Responding: What actions would you take to address the situation? Assessment: How would you determine if the actions you took were effective? Now it’s time to put S.A.R.A into action. You will be shown three typical scenarios that a police officer will encounter and suggestions on how to incorporate the S.A.R.A. model. You may want to make notes to answer the listed questions. Let’s watch the first video which involves a Domestic Complaint. Slide 50 – (video – Domestic Complaint) Slide 51 – Did the S.A.R.A model help you determine the action you would have taken in this scenario? In addition to the helpful hints listed here, you may also consider informing the family about Brain Injury Association of Florida. Brain Injury Association of Florida – Project L.E.A.P. Transcript Summary of Helpful Hints: Domestic Complaint  Determine if the individual has a brain injury – ask the individual, family member or  Determine how the individual is affected by the brain injury – emotional, behavior, and/or  Speak slowly and calmly.  Ask short, simple questions.  Wait for a response.  Rephrase the question, if necessary.  Avoid yes/no questions, when possible. Next, we’ll apply S.A.R.A to a traffic stop. Slide 53 - The useful hints on this slide can help you to implement the S.A.R.A. model.  Determine if the individual has a brain injury.  Speak slowly and clearly.  Give instructions one at a time.  Wait for a response.  Rephrase the question, if necessary.  Ask if the subject is taking any medications.  Consider observed driving behavior.  Consider driving history.  Consider driving time since the brain injury.  Consider initiating the Department of Highway Safety and Motor Vehicles, Medical  Consider recommending applying for the Department of Highway Safety and Motor Vehicles, Application for Disabled Person Parking Permit. Slide 54 – (video – Suspicious Person) Slide 55 – The suggestions listed on this slide can be applied to help you implement the S.A.R.A. model in a number of situations. Summary of Helpful Hints: Suspicious Person  When interacting with the individual, put the person first. Say “person with a brain injury” instead of “brain-injured person.” Many individuals prefer the term “survivor.”  Avoid outdated terms such as “handicapped” or “brain-damaged,” and be aware that many individuals with disabilities dislike euphemistic terms such as “physically challenged.”  Speak slowly and clearly.  Ask short, simple questions.  Focus or redirect the individual’s attention to the issue.  Continually evaluate behavior. Brain Injury Association of Florida – Project L.E.A.P. Transcript  Determine if the individual is taking medication.  Consider the presence of assistive devices.  Watch for sudden outbursts or change in behavior.  As always, expect the unexpected. Slide 56 - Here are more resources and information about traumatic brain injury.  Brain Injury Association of Florida, Inc.
 Centers for Disease Control (January 16, 2001) Traumatic brain injury in the United States: A report to congress. Retrieved from  Department of Highway Safety and Motor Vehicles.  Maryland Police and Correctional Training Commissions. (January 2003) Police interaction with individuals with brain injury.  Pittsburgh Area Brain Injury Alliance.  While You Were Waiting. Rancho Los Amigos Scale/The Levels of Coma. Retrieved For more links and resources, we invite you to visit Slide 57 – BIAF has many services and resources that can help you. If you interact with an individual with traumatic brain injury and the individual needs support or guidance, please refer that person or family member to Brain Injury Association of Florida. BIAF believes in a strong partnership with law enforcement. Brain Injury Association of Florida, Inc. and the people they serve wish to thank: The State of Florida Department of Health – Brain & Spinal Cord Injury Program for supporting the production of this training The Maryland Police and Correctional Training Commission and The Brain Injury Association of Maryland for use of their videotape and manual upon which this training program is based The men and women of Florida’s law enforcement community for their ongoing efforts to understand and respond to the unique challenges faced by survivors of traumatic brain injury. Slide 58 – Please complete our short self-assessment of learning. Thank you. Brain Injury Association of Florida – Project L.E.A.P. Transcript

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