In a recent TBI personal injuries case, three neuropsychologists, psychiatrists and neurologists gave evidence. Under cross examination, an astute attorney asked experts whether it was necessary the victim "lost consciousness" to sustain moderate or gross brain damage. "He noted the most common form of brain damage was cerebral concussion but patients with this disorder need not lose consciousness and typically have amnesia for a few seconds to several minutes". General practitioners have become traditionally reliant on neurologists who are now reliant on neuropsychological assessments rather than solely, CT Scans and MRI. The following references offer an erudite treatese from "Neuropsychology for the Attorney", (Sbordone, 1996).

While studies have shown that the two most widely used standardised neuropsychological test batteries - the Luria-Nebraska and Halsted-Reitan - have demonstrated over 90% accuracy in discriminating the performance of brain-damaged patient groups (Golden, Hammeke and Purisc, 1987; Wheeler and Reitan, 1974), it should be recognised that neuropsychological tests are best utilised in providing information about the behavoural impairments resulting from brain dysfunction, since a variety of neurological tests such as topographical brain mapping, MRI and CTscans, have lessened the need for neurological assessment to localise the site of brain damage.

Unfortunately, these neurological tests do not tell us about the cognitive, behavioural and emotional impairments which typically result from brain trauma. Thus, it is the neuropsychologist who, because of his or her expertise, training and experience, is able to provide a comprehensive description of the impairments resulting from brain trauma and their effects on the patient. While diagnosis of brain injury is not the primary role of the clinical neuropsychologist, it is not uncommon for the neuropsychologist to detect a pattern of cognitive impairments during neuropsychological assessment that is consistent with brain damage. For example, the neuropsychologist may find a pattern of impairments consistent with right frontotemporal lobe damage, even though the patient 's neurological examination, including an EEG, CTscan and MRI, was normal.

Neuropsychological assessment examines the patient's intellectual functioning, language processing skills, perceptual skills, higher motor functions, attention and concentration skills, judgment, reasoning skills, mental flexibility, memory, constructional skills, abstract thinking and conceptulisation skills, problem solving skills, behavioural regulation, personality alterations and emotional functioning. Since the brain is the organ of behaviour, any insult, however small, is capable of producing an alteration in one or more of these areas. Thus, the neuropsychologist's task is to carefully evaluate each of these areas and determine whether or not any significant alterations have occurred and the degree to which such alterations are indicative of brain injury and the degree to which they affect the patient's life and significant others. The neuropsychologist, by virtue of his or her training and expertise, is capable of fully evaluating each of these areas in considerable specificity, as well as determine the severity of these impairments. The neuropsychologist can also provide specific reports and testimony on the relationship between brain injury and altered behaviour and how such behavioural alterations are manifested.

Within the past 10 years, there has been a growing realisation that the emotional and behavioural problems that accompany traumatic brain injury are more disabling than the cognitive problems that are produced (Lezak, 1987; Sbordone, 1990). Patients with traumatic brain injuries are likely to exhibit significant emotional and personality changes consisting of either euphoria, apathy, emotional liability, irritability, changes in libido, poor frustration tolerance, impatience and rapid mood swings. Additionally, the sensitivity of the brain-injured to the needs and feelings of others is frequently dramatically altered. This typically results in significant interpersonal difficulties, loss of friends, marital problems, divorce and alienation of one's family. In addition to these problems, patients with brain injuries also exhibit impaired social judgment and planning skills, diminished self-control, impulsivity, poor self-education skills, pathological egocentiricity, increased dependency, diminished initiative and motivation, and inability to regulate their own behaviour and their emotional reaction to others. These problems can be evaluated by the neuropsychologist and can add significantly to damages in personal injury cases.

The family of the traumatically brain-injured patient undergoes extremely severe psychological stress as a result of disruption of the normal family interaction patterns, coping with a brain-injured patient's altered cognitive and behavioural functioning, trying to control or monitor the patient's behaviour, and often must struggle with enormous financial responsibilities. However, the family of the brain-injured patient frequently exhibit what has been described as a "command performance syndrome" (Sbordone et al., 1984), in that they appear relatively "normal" and typically mask their psychological or psychiatric intervention. As a result of coping to the impact of a traumatic brain injury, families are likely to display a variety of pathological behaviours and psychiatric problems which require psychological or psychiatric treatment.

Patients who sustain traumatic brain injuries are likely to receive either psychotherapy, behavior modification, or cognitive rehabilitation, depending on the severity of their cognitive, behavioural, or emotional problems and the time since injury. During the early stages, however, environmental modification may be necessary to minimise some of the patient's cognitive difficulties, as well as to maximise their functioning. Environmental modifications would include eliminating environmental precipitants such as pain, a flat bladder or bowels, unfamiliar surroundings, or insensitive or authoritative handling of the patients (Eames, 1988). Other investigators have shown that placing the brain-injured patient in a highly structured environment and strict routine can significantly reduce their cognitive condition and anxiety (Howard, 1988). As the patient's cognitive functioning improves, cognitive rehabilitation, which also includes computer-assisted cognitive rehabilitation, has been shown to improve the social and emotional functioning of the patient.

Sbordone, Robert, J., (1996). Neuropsychology for the Attorney. GR/St. Lucia Press, Florida.

Two innovations originating from Mobile and Melbourne have adopted collaborative models and attracted ACFE interest at our 1997 San Diego scientific meetings. Both systems redress, notions of "community powerlessness". These models will be presented at the 56th Annual Convention of the International Council Of Psychologists with special reference to earlier reciprocated international visits by members of the American College Of Forensic Examiners

Mobile South Alabama has developed an exemplar partnership between the College of Education at the University of South Alabama and the Office of the District Attorney for Mobile County and Department Of Justice. For example, the time required to bring murder cases to trial has been reduced from over two years to about 6 months and the 2,000 case backlog of the Grand Jury has been eliminated

Their powerful approach together has combined advanced software, connecting three professional facilities, simultaneously. Through consultation and direct participation, representatives within the various units of the College, including psychological counseling programs, technology-oriented programs and teacher education programs, provide direct assistance and guidance to the District Attorney.

As our US readers already know, in the American legal system the District Attorney is responsible for investigating and prosecuting major crimes. As such, there exists a compelling motivation for crime prevention through education and early intervention. The partnership was established was established long ago to assist with these objectives and improve existing functions such as investigation, charging, and trial work.

The initial need of the District Attorney was effective technology utilization. Several objectives have already been realized as a result of software innovations. With the technological resources established, the partnership began implementation of several other components: An educational program targeted at juvenile offenders and at-risk youth offers literature, parent letters and a virtual prison tour for children and their parents. An early intervention program, through a liaison with the Counseling program in the College, is being developed and is slated for implementation by year end. Additionally, a collaborative effort with the school system is planned for the development of alternative school environments for juvenile offenders. These schools will offer continuing educational opportunities for offenders and provide counseling services aimed at the reduction of recidivism.

The partnership involves a model of prevention, intervention, and community liaison targeted at crime reduction. Through their technology enriched approach, Professors Charles Guest, and Phillip Feldman are providing a glimpse into an exciting and successful program, potentially offering a blueprint for replication with national and international partnership.

From Melbourne Victoria, the objectives of this State service (VRAS) are being achieved successfully to help any victim of crime recover from their traumatic experience through immediate access to counselling. Again, emphasis on practical collaboration is illustrated through the Department of Justice, Police and the Community. Victims of crime referrals are provided instantly, post trauma, to appropriate support services with additional information about legal services and immediate financial assistance.

Apart from victims suffering physical or psychological injury, the VRAS also extends to family members of a person killed or injured and likewise those witnessing a crime who suffer trauma although not, physically harmed. Crimes victims reporting to the police are eligible for up to five free consultations from an approved psychologist or counsellor. Notably, this applies also for victims gaining an "intervention order". The State Tribunal gives priority to requests for payment of counselling, grants these without a hearing and will extend the number of consultations on further application. Crimes where assistance can be sought from the Tribunal include armed robbery, aggravated burglary, sexual assault, homicides, assault, threat to kill and stalking, culpable driving, assault and robbery.

The Victoria State Police operating 24hrs/day, provides a Victim Advisory Unit. A Victim Liaison Officer is available as a contact point for those needing information or advice and also provides special services for families of victims of homicide, motor vehicle fatalities or suicides. A Criminal court may also make a "compensation order for pain and suffering and for damage to property" where an offender is found guilty and the court has appropriate evidence before it to make such an order if the victim requests that this is done.

Trauma counselling provides a "safe space away from other demands" and focuses on a person's emotionals needs, offering time to explore and come to grips with abreactive nightmares, phobic thoughts and feelings. Coping strategies are designed for individualised programs without forcing a victim to reveal personal material through heavily directive guidance. Through the Victorian criminal justice system, victims are treated with courtesy, compassion and with respect for their dignity and privacy. Significantly, they are offered the right to receive information about their case, the progress of the investigation and details of court proceedings with a responsibility to assist police in their investigations and to participate in any court case which may follow. This is imperative in both the "forensic and clinical psychological healing process", redresses insidious reactions of "powerlessnes, external locus of control, impoverished self esteem and the unestimated wounding to ego strength".

Resource Contacts and References:
Dean George E. Uhlig, College Of Education, University of South Alabama, Mobile, AL 36688-002
Judith Dixon, Director, VR&AS, GPO Box 435600, Melbourne, AUSTRALIA 3001 Cheetham J., and Costello B.R., (1979). "Parent power", Sun Books, Melbourne, ISBN 0 7251 0349 3
Victorian State Department Of Justice (1997). "Information for victims of crime", Victims Referral & Assistance Service.