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About Street roots. (Portland, OR) 1998-current | View Entire Issue (June 10, 2011)
street roots June 10, 2011 LLlzAXii Many emergency departments have yet to implement screening and referral for (TBXs). As a result, many patients who are treated and released from ERs with instructions to follow up only if they experience dizziness, vomiting or difficulty waking may be experiencing cognitive changes that may never be evaluated. This is a widespread phenomenon and may explain the poor functioning of some persons who fall into homelessness without clear abuse or neglect histories. BRAIN INJURY, from page 3 tallied the average number of “adverse experiences” in the case notes of the original 176 homeless men in Hamilton, she came up with 14 per person. “We find them in spades in this population,” says Petrenchik. Just foul adverse childhood experiences, according to the CDC, put someone at risk for a multitude of health and social problems. Having six or more adverse childhood experiences decreases your life expectancy by 20 years. Dr. Stephen Hwang, leader of the Toronto study, is teaming up with Wismer and other, researchers around the country to try to get funding for a national study on TBI and homelessness. San Francisco, Calif., Baltimore, Md, Albuquerque, N.M., Boston, Mass, Cincinnati, Ohio, Houston, Texas, Orlando, Fla, Los Angeles, Calif., Hyannis, Mass, and Manchester, N.H. are the 10 cities they hope to survey. “We think TBI is under-identified among the homeless,” says Wismer, “and we think a lot of health care workers don’t know about it.” “definitely” sees women coming to the shelter with TBI. In a study of 53 battered women, Dr. Helene Jackson found that s nearly all reported suffering blows to the head while being battered; 40 percent reported loss of consciousness. Mitchell and tier staff are trained to recognize symptoms of TBI, but she says referring women to clinics doesn’t often work. Battered women who are candidates for TBI may have trust issues with counselors and doctors, lack of transportation to clinics, not to mention a host of competing problems. Mitchell says the link between PTSD and TBI is a complex and often a fine line. What a disability attorney knows Cheryl Coon, board member of the Brain What the military knows Injury Association of Oregon and the Social “TBI has become the signature injury of Security disability attorney who represented Smith, says she has many homeless clients • the current wars in Iraq and Afghanistan,” according to the Brain Trauma Foundation. with TBI. She describes a common pattern About 320,000 American troops have > with her TBI clients: first, they stop being suffered TBIs since 2001, with 7 percent able to focus in the workplace. Then, they reporting both TBI and concurring PTSD or los.e their jobs. Their physicians may not major depression, according to a 2008 recognize TBL' And then many becoine report by nonprofit research group RAND homeless. Corporation. Blasts are the leading cause. Chart notes follow Coon’s clients With its massive budget, »the Department whenever they come in contact with the of Defense provides arguably the most system and sometimes these files “come cutting-edge research around TBI treatment. back to haunt folks,” says Coon. If a past Eye-tracking goggles, neuroprotectànts, doctor noted that a client was inebriated or high, even if that client was also diagnosed * biomarkers and hyperbaric oxygen chambers are just a few of the superhuman with TBI, that can be enough reason to technologies being funded by the Pentagon deny them, she says. In fact, Coon thinks of to explore TBI, to varying success. TBI as a “Catch-22 for getting disability But despite funding such gadgets, the benefits” because the symptoms of a TBI Department of Defense has been can be associated with so many other notoriously resistant towards paying for causes. cognitive rehabilitation therapy for the tens “The Social Security Administration is of thousands of service members who have not eager to take these people on,” she suffered TBIs. A 2010 NPR and ProPuhlica says, “blit disability benefits have become investigation found studies by the military’s one of the few safety nets this country has.” health Care program, Tricare, “deeply Winning Smith’s hearing was a personal flawed” and at odds with many médical victory for Coon, who says that around two- groüps. They cite the cost of cognitive thirds of cases are initially denied in rehabilitation to be as much as $50,000 per Oregon. “The number one piece of advice I soldier—a daunting number even for the give for any client is ‘you’ve got to hang in Pentagon’s budget. there and file for appeal,’ because the How many end up homeless? The process is setup to weed out those who Department of Veterans Affairs don’t have the perseverance to pursue it,” says Coon, who estimates that well over half conservatively estimates that 107,000 veterans are homeless on any given night, ’ of cases in Oregon are won when people and that nearly one-fifth of the homeless keep appealing. population is veterans. PTSD, closely linked to TBI, is cited as a leading cause. What a domestic violence shelter knows What the NFL knows Molli Mitchell, residential services director at Bradley Angle House says she Just lastyear, former NFL doctor ira Paper NOT Plastic* “Every time a ' J . f : card is swiped,fly an angel eats ‘ . a kitten." SI ■ C- « . ■_ • MB .• ♦^¿4 RevCom’s got your ¿»MSB PeaceOfTheAction.net . *Credit cards suck our cash out of our communities. Casson told Cotigress, “there is not enough ... scientific evidence at present to, determine whether or not repeat head impacts in professional football result in long-term brain damage.” The resulting outrage from players, doctors and sports reporters led to heightened investigations of TBI cases in pro-football. Mike Webster was one former NFL player held in the spotlight. Doctors estimated that the former Pittsburgh Steelers star’s brain had been through the equivalent of 25,000 car Crashes in his 25 years of playing football. The depression and profound dementia that followed contributed to Webster becoming homeless and dying at age 50. As TBI-affected ex-players come forward, the $33 billion NFL is changing its position on TBI, albeit reluctantly. In coopération : with Boston University, the NFL opened à brain bank in 2010 to conduct post-mortem analyses of players’ brains. They donated $1 million to help fund Boston University’s TBI research, started by a former wrestler. They announced harsher fines (tens of thousands of dollars) for players who tackle above the neck. They explored advanced helmet technology^ High school sports (and the PTAs behind them) seem to be making the true groundbreaking steps on TBL Oregon enacted “Max’s Law” in 2009 — legislation that protects young athletes from damaging multiple concussions by requiring that all high school athletic coaches in the state - receive concussion recognition training. It also prohibits any athlete showing concussion sympttims from playing until the next day. symptoms of a blast and commanders might ignore such symptoms in order to keep soldiers on the field. Medics, forced to prioritize life-threatening injuries, may lack the time to recognize a concussion, the study adds. - ; Homeless people and domestic violence victims know silence better than anyone — lack of trust, resources and support prevent many from seeking help. Stigma certainly plays a role. And a 2007 study of homeless people in Denver found that homeless individuals are less than half as likely to be admitted to a hospital as non-homeless with similar conditions. A 2008 report by The National Health Care for the Homeless Council said the following: Many emergency departments have yet to implement screening and referral for (TBIs). As a result, many patients who are treated and released from ERs with instructions to follow up only if they experience dizziness, vomiting or difficulty waking may be experiencing cognitive changes that may never be evaluated. This is a widespread phenomenon and may explain the poor functioning of some persons who fall into homelessness without clear abuse or neglect histories. ' What Portland knows Dr. Paul Lewis is partnering with Street Roots to start a pilot project to track vital records and cause of death among homeless Portlanders. The deputy health officer for Clackamas, Multnomah and Washington counties says that as far as tie knows, it’s never been done before, and he wouldn’t be surprised if accident injury was a major , cause of death. “(Addressing TBI) is really an upstream problem,” says Lewis. Diane Malbin of the Portland nonprofit FASCETS leads training sessions for parents and professionals on rethinking cognitive disabilities. Malbin believes that teaching, people who work with the homeless to recognize the link between brain function and behavior is crucial, and you don’t need a PhD to do it. “Addressing neurological issues will give us the toehold we need to tackle so many other social problems,” says Malbin. The silent disease ... And doesn’t know All of the above candidates for TBI — homeless people, domestic violence victims, soldiers and pro-football players — are also conditioned to be silent about TBI, Thirty of 160 NFL players surveyèd by , The Associate Press in 2009 said they have hidden or played down the effects of a concussion. “By the time a guy reaches pro sports, he will not complain,” says Jane Arnett, wife of ex-player John Arnett in Lâke Oswego. Together, the couple founded à nonprofit to help disabled èx-NFL players get health benefits. A similar hush factor pervades the ' military. The 2010 NPR/ProPublica. investigation found that, to remain with their unit, soldiers will often ignore “Some cities don’t want to survey for TBI because then you might uncover a real service need,” says Petrenchik. “When we talk about the intersection of social services and health services, no one wants to hear about the need for long-term ¡support... but we pay for it one way or the other.” “Being able to recognize that there is a true disability as opposed to willful noncooperation is helpful,” says Hwang. “It’s worth investigating.” “Who’s keeping track of TBIs?” says ' Coon. “Nobody.” Read “All in their heads,” our first report on traumatic brain injury on the streets, at www:streetrooots. wordpress.com
