Exploring NeuroResource Facilitation for Incarcerated Individuals With Brain Injury

For justice-involved individuals—which includes people who have been incarcerated, on probation, or parole—two statistics stand out to Maria Kajankova, PhD, Assistant Professor, Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai. The first is that 70 percent of people who are released from prison are arrested again within the next five years, according to the Bureau of Justice Statistics. The other is the high incidence of brain injury among prison populations, estimated between 25 and 88 percent in prisons for males and 44 and 72 percent in prisons for females, according to studies.

“What we are seeing is these brain injuries are happening while these individuals are young, which is likely contributing to them being incarcerated, but also poses issues during and after incarceration,” says Dr. Kajankova.

It follows, then, that standard reentry services provided by correctional facilities might be inadequate for individuals with brain injuries. To address that gap, Dr. Kajankova and a team of researchers from the Brain Injury Research Center of Mount Sinai and the BIAPA are investigating whether a specialized intervention, NeuroResource Facilitation (NRF), can be effective in helping these individuals integrate successfully into society after their release from prison, thereby reducing recidivism.

A Large Study With Significant Potential

For justice-involved individuals, intensive case management might involve case managers providing information, referrals, and assistance for job placements, housing, and other day-to-day needs. However, NRF goes beyond that, as facilitators are trained to accommodate the brain-injury-related challenges, such as problems with memory, attention, and planning, that can make it so difficult to make use of available resources in the community. The NRF team provides direct assistance with applications for resources, provides psychoeducation related to brain injury in an individual and group format, and integrates individualized cognitive and behavioral strategies to accommodate brain-injury-related challenges.

The study is funded by a $2.5 million grant from the National Institute of Justice (NIJ) and is being conducted in partnership with the PADOC and the BIAPA. It planned to enroll 765 participants with brain injuries, randomized into two cohorts—one receiving at least one year of NRF and one receiving standard reentry services. The measured outcomes include rates of recidivism, productive activity, gainful employment, stable housing, and use of health-related programs.

This study follows a 2016 pilot study conducted by the PADOC and the BIAPA, which found the one-year recidivism rate among justice-involved individuals who received NRF was 17 percent, lower than the average rate of 35 percent in the state’s 2013 recidivism report.

“This is the largest study of its kind, and there is considerable interest in what we find because it could have a big impact on the kinds of supports that people advocate for,” says Dr. Kajankova.

Challenges, Findings, and Continued Advocacy

The study faced several challenges, including the COVID-19 pandemic and participants who were not granted release as planned. Despite this challenge, the study successfully recruited 652 participants, with 440 randomized to the NRF cohort and 212 to the standard cohort.

“It may be there is something related to brain injury that contributed to the lower release rates,” Dr. Kajankova says. “That is something we want to look into to see how they compare with those from the general Pennsylvania prison population.”

The research team is following participants for up to 36 months through interviews at specific intervals to assess recidivism rates and secondary outcomes. The team plans to use multiple data sources, as it can be difficult to remain in contact with justice-involved populations.

“We sometimes do not have reliable phone numbers for study participants or, if we do, those change or participants do not answer the phone,” says Dr. Kajankova. “This is not uncommon among this population, and we repeatedly seek input and advice from study advisors with a history of justice involvement to optimize our retention methods.”

One preliminary finding has emerged over the course of the study, which is due to be completed in December 2026. Of the 1,022 candidates screened for the study, 91 percent were found to have a brain injury, and the average number of injuries was three. Moreover, 81 percent of these individuals demonstrated significant cognitive impairment. The full data analysis is expected to be completed in September 2026.

“Although we cannot speak as yet to the effectiveness of the intervention, we can confirm that brain injury is a major problem among this population,” says Dr. Kajankova. “In that sense, the study is already a success, because it provides rigorously collected data that underscore the need for brain injury screening and some form of intervention or supports.”

Even as Dr. Kajankova and her colleagues are continuing with data collection and analysis, they are also developing specialized brain injury training for the correctional facilities that participated in the project and working with their study partners to implement brain injury screening for everyone entering the state’s correctional system.

Dr. Kajankova hopes these measures will lead to the introduction of more comprehensive assessments involving cognitive impairment and thus more interventions or supports for justice-involved individuals with brain injuries. Regardless, she and her colleagues are in talks with other organizations about conducting similar studies and continuing to advocate for change based on their work.

“We are optimistic about what we will find when we complete our data analysis based on previous studies that did not have the same level of rigor,” says Dr. Kajankova. “Regardless, we will continue pushing for more brain injury screening and education because the data provide irrefutable support for this urgent need.”