Special Populations

• TBI Characteristics


  • Primary Disabilities:
  • Memory issues: Difficulty remembering information or events
  • Impulsivity: Acting without thinking about the consequences
  • Difficulty understanding consequences to actions: Trouble grasping the outcomes of behaviours
• TBI Characteristics


  • Secondary Disabilities (results of primary dis..):
  • ADHD: Develop ADHD-like symptoms such as inattention, hyperactivity and impulsivity due to brain injury
  • Depression: Experiences feelings of sadness, hopelessness or loss of interest in activities
  • Personality disorder: Develop patterns of behaviour that are unhealthy or disruptive to relationships
• TBI Characteristics


  • Physical:
  • Brain damage
  • Motor impairment: difficulty with coordination, balance or muscle control
  • Sensory issue: vision changes, hearing or touch sensitivity may occur
• ADHD Characteristics


  • Primary Disabilities:
  • Inattention: Difficulty focusing on tasks or following instructions
  • Hyperactivity: Excessive movement or restlessness
  • Impulsivity: Acting without considering the consequences
• ADHD Characteristics


  • Secondary Disabilities (results of primary dis..):
  • Anxiety: Experience feelings of worry, nervousness, or fear
  • Learning Disabilities: Struggle with academic tasks such as reading or math due to attention difficulties
  • Conduct Disorder: Engage in behaviours that violate rules or the rights of others
• There are no specific physical characteristics as ADHD is primarily a neurodevelopmental disorder
• FASD Characteristics


  • Primary Disabilities:
  • Inconsistent memory and recall
  • Inability to filter out environmental or emotional distractions and sensory stimuli
  • Slow and inconsistent cognitive and auditory processing
  • Decreased mental stamina
  • Difficulty interpreting, and applying abstract concepts (e.g., money, time)
  • Impulsivity and poor judgment
  • Inability to predict outcomes (of their own or others' actions)
  • Difficulty understanding the consequences of their actions
  • Difficulty shifting from one context to another
  • Resistant to change
  • Inability to see another person's perspective
  • Inability to recognize indirect social cues
• FASD Characteristics


  • Secondary Disabilities (Result of Primary Disabilities):
  • ADHD, depression, psychosis, personality disorders, conduct disorder (rule violations; law breaking)
  • Speech delay in infants
  • Mental health problems are a prevalent secondary disability: ADHD, conduct disorder, depression, psychosis
  • Preschoolers display eating disorders, bed wetting, speech delay, stereotypies, ADHD
  • Early school aged children have speech delay, stereotypies, anxiety disorders, sleep disorders, mood disorders, adjustment disorders
  • Adolescents and young adults must learn to cope with lifelong cognitive impairments and psychiatric disorders including substance abuse, psychosis, depression and personality disorders
  • Attachment is also disrupted
• FASD Characteristics


  • Physical:
  • Smooth philtrum
  • Upturned nose
  • Thin upper lip
  • Flat Nasal bridge
  • epicanthal folds
  • small palpebral fissures
  • small head circumference
• Characteristic Hand Features of FAS

  • Curved fifth finger (clinodactyly)
  • Upper palmar crease that widens and ends between the second and third fingers ("hockey stick" crease)
• Characteristic ear features of FAS


  Underdeveloped upper part of the ear parallel to the ear crease below ("railroad track" appearance)
• Programs/Recommendations for TBI


  • Cognitive Training: Doing puzzles to improve memory
  • Occupational Therapy: Learning new ways to do daily tasks
  • Speech Therapy: Practicing speaking clearly
  • Psychotherapy: Provides emotional support and coping strategies for managing changes in mood, behaviour, and relationships post-injury
• Programs/Recommendations for ADHD


  • Cbt: focuses on changing thoughts and emotions
  • Attention/Memory: Memory aids,checklists, schedules, rehearsal and practice
  • Psychotherapy: Provides emotional support and coping strategies for managing changes in mood, and behaviour
• Programs/Recommendations for FASD


  • Social Skills Training: Stimulus control, BST, Role-play
  • Attention/Memory: Memory aids, rehearsal and practice, memory games
  • Motor Skills
  • Emotional Regulation: Emotional labeling, model calmness, journaling
• Delay Discounting


  There are 2 behaviours: The behaviour we want the person to perform (abstinence or staying quiet during a teacher's lecture) and the behaviour they are currently performing (drinking or yelling out in class). Each behaviour has reinforcement associated with it. The person values the reinforcement for the inappropriate behaviour more than the reinforcement for the desired appropriate behaviour so consistently performs the inappropriate behaviour. The 2 reinforcements are competing.
• Delay Discounting


  We must create a reinforcement for the desired behaviour that is more effective, desirable and powerful than the performance of the inappropriate behaviour. Larger amounts, More desirable to the person, Closer to the performance of the behaviour. This is part of the overall behavioural program that includes antecedent manipulation, teaching, and choosing an appropriate behaviour that is socially valid.
• Provincial Adult Correctional Services

  Adult correctional facilities in Ontario are divided into 4 categories: Correctional Centers, Jails, Detention Centres, Treatment Centers. Some facilities are more than 1 type. They are operated under the Ministry of the Attorney General.
• Provincial Correctional Centres


  Correctional centres house sentenced offenders who are serving a period of incarceration of up to two years, less a day
• Provincial Jails and Detention Centres

  Provincial jails and detention centres house: Persons awaiting trial, offenders serving short sentences, offenders awaiting transfer to other facilities. Jails are smaller and older facilities originally established by local governments. Detention centres are larger, regional facilities.
• Adults Awaiting Trial


  The process of detaining a person until their trial after they have been arrested and charged with an offence. This is referred to as being under house arrest or in custody. Given that our legal system is based on presumption of innocence, there are safeguards in place to ensure that people are detained with just cause and for serious crimes.
• Provincial Treatment Facilities


  Treatment centres are specialized facilities treating offenders for sexual misconduct, substance abuse, anger management, and other issues.
• Correctional Programs


  Designed to: Help offenders change or correct their behaviours related to their offence, Hold them responsible for their offence, Promote public safety
• Specific Impact of Crowding


  Cells built for 1or 2 prisoners often have 3, 1sleeping on a mattress on the floor. There are frequent lockdowns which is when prisoners are confined to their cells except for half an hour every second day. There are almost no programs in DCs, and there is very limited access to books. Visits are short (two 20-minute visits a week) and are frequently cancelled without notice. Prisoners are entitled to 20 minutes of fresh air every day, they may only get "yard time" a couple of times a month
• The focus in correctional services is on coercion and punishment rather than incentives and reinforcement.
• Provincial Youth Correctional Facilities


  Also called "secure custody facilities". Hold young people who were between 12 and 17 years of age at the time of offence. Youths are sentenced to secure custody after being found guilty of a crime or if a youth is ordered to be held in custody before or during a trial. Under the jurisdiction of the Ministry of Children, Community, and Social Services. There are 5 in Ontario currently.
• Correctional Officers


  They ensure the security and custody of inmates and make sure inmates have what they need for a successful rehabilitation. Require a minimum of an Ontario Secondary School Graduate Diploma or equivalent from another jurisdiction.
• Life Skills Programs


  • Core Skills: budgeting, goal setting, problem solving, substance abuse, gambling, supportive relationships
  • Employment: resumes, job searches, computer skills
  • Parenting
• Rehabilitative Skills


  • Anger management
  • Anti-criminal behaviour
  • Substance abuse
  • Domestic violence
  • Sexual Offending
• Services Offered in Federal Prisons

  • Correctional Programs: address factors linked to criminal behaviour
  • Social Programs: teach skills, promote healthy choices, target behaviours that are problematic, interaction skills
  • Education Programs
  • Employment Programs
• Using Consequences in Correctional Services

  Typically, negative punishment is used– removal of: Desired activities (visits, phone calls, internet communication with others, library, therapy sessions, physical activities, outside time), Food, Hygiene such as showers. However very aversive positive punishment is also used: Violence, Strip searches, Humiliation
• Using Reinforcement


  If reinforcement is used, it is usually positive reinforcement such as token and/or increased privileges. However, the lack of performance of an inappropriate behaviour is what is typically reinforced – not a clear, objective positive target behaviour.
• Understanding the Impact of TBI,ADHD, and FASD

  First missing step is screening. If the inmate is identified with one of these diagnosis, there is minimal education for staff in correctional settings on these topics. Training would focus on adapting their interactions with the individuals. In particular, understanding impulsivity and delay discounting should be included.
• Strategies for Staff Training

  Avoid ABA focussed terminology but use plain language that would be accepted and not be confusing. Examples: Slow down when speaking, Step by step instructions, Plain simple language, Test for understanding.
• Modifications for TBI Recommended

  • Provide education about TBI for the individuals themselves
  • Use prison specific examples in role playing, discussions
  • Repeat materials from previous sessions
  • Use concrete and literal communication
  • Schedule shorter sessions
  • Schedule sessions when prisoners are most alert
  • Ensure consistent therapists/facilitators
  • Avoid humour
• Use of Contingency Management in Prisons

  Basically, prisoners earn privileges for "responsible behaviour and participation in hard work and other constructive activity". Reinforcements include tokens, privileges, time out of cells, in-cell TV, community visits, own clothes, recreation time. Results have been mixed, but overall reports are that inmate behaviours improved.
• Delay Discounting


  • TBI: Executive dysfunction, self-regulation
  • ADHD: Impulsivity
  • FASD:Impulsivity, Cognitive challenges (difficulty understanding value of delay rewards)