street roots
June 10, 2011
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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
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*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