Synapse 2023-24 Annual Review

Australia’s Brain Injury Organisation Annual Review 2023–24

Our vision Our mission

Our values

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Rethink brain injury.

Change society.

Ensure the rights of people impacted by brain injury by connecting knowledge, policy, services and systems.

We listen to understand.

We build relationships.

We are courageous.

We are here for each other.

We are creative.

Contents Synapse overview

Support and innovate

CEO’s message

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Training

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Our board

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The Synapse community journey

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Breaking the cycle of vulnerability

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Peer support groups

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Brain injury facts and figures

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Social enterprise

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Court Link

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Court Link case study

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Housing

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Ageing services

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Research: The Guddi Way Screen

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Advocate with impact Services snapshot

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National reach

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Focus on systems Townsville Women’s Correctional Centre -Intersection of DV and criminal justice

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Research: “It’s been like a spiritual awakening for me”

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Brain injury and the link to perpetrators of domestic violence

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Research: Synapse and AUS-mTBI

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Paul Ramsay Foundation Guddi work

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Rethinking the invisible disability: The silent epidemic

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Brain injury remains invisible to Federal Government

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Brain injury fact

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Synapse 2023-24 Our team

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Our partners

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Financial summary

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Acknowledgement of Country We respectfully acknowledge the traditional custodians of the lands, seas and waterways upon which we provide services. We pay our respects to the Elders, past, present and future, and commit to working side by side.

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Synapse overview

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CEO’s message ...we thrive through our team’s lived experience, this is the Synapse way.

The Synapse team has achieved so much this year, giving back to the communities we advocate for and support daily. Synapse doesn’t exist without our strong team with real lived experience – in fact we thrive through our team’s lived experience, this is the Synapse way.

We know that more must be done for people impacted by brain injury. Life is complex and sometimes messy for us all, even without the additional impact of brain injury. Brain injury must be understood in the context of life, not merely disability. Our obligation as a national voice for those impacted by brain injury is to make a real difference in people’s lives. This includes recognising that life for each of us is the sum of the connections, relationships and opportunities available to us. We recognise, strengthen, create and contribute to that network of knowledge, experience and learning that aims to leave no person impacted by brain injury behind.

This year we have continued to pursue our core vision, “Rethink Brain Injury. Change Society” – with a strong focus on systems. We know a staggering number of individuals involved in the justice system live with a brain injury – often unknowingly. Working closely with these systems that continually see individuals with a brain injury treated indifferently due to a lack of understanding both by the system and the individual of what is occurring. If an individual (or system) doesn’t know they have a brain injury, how can the system respond in ways that are actually helpful let alone effective?

Our team has overseen the national expansion of the Guddi Way Screening, a culturally informed tool that screens for brain injury in Aboriginal and/or Torres Strait Islander people. The team has travelled far and wide across Australia training community and organisations in the Guddi Way Screening process. This is a major step forward for all individuals who have

a brain injury and are in contact with government or service systems that misunderstand them, discriminate against them, or criminalise them – detection means an assessment can alter their pathway forward immeasurably.

Our work in the Townsville Women’s Correctional Centre is but one proud example, creating impact well beyond the walls of the Townsville centre. We must acknowledge the staff and leadership team at the Townsville Correctional Centre who have welcomed our work and provided opportunities to women inside the prison. Opportunities, that have significantly improved the women’s own knowledge, awareness of their own decisions and choices - their lives and their future. We extend our most heartfelt respect to the Townsville team and Elders that have and continue to guide our work through the Sisters for Change initiative, and Justice Galbidera Way. Through education, understanding and respect, everyone can be the beneficiary of the work Synapse undertakes. With a majority of prisoners flagging for significant head trauma, we don’t need more prisons, as is so often suggested, we need adequate systems that instead of punishing those at a disadvantage with brain injury, supports them, in a respectful and dignified way. A way that shapes our Australian society and communities for the better.

Our work proudly continues to ensure that the ‘invisible disability’ doesn’t remain invisible to the Australian community and systems.

Jennifer Cullen Synapse CEO

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Our board Paul Watson Non-Executive Director

Paul is a Director of Berrill & Watson Lawyers and an expert in superannuation and life insurance.

For the past decade, Paul has delivered seminars and workshops for disability support groups, financial counsellors, and consumers with the aim of improving the lives of people with a disability, injury, or chronic illness. Paul is a member of the Consumer Law Committee of the Law Council of Australia and was awarded an Honorary Life Membership with Palliative Care Queensland for the support he provided to the organisation.

Paul Raciborski Non-Executive Director

Paul experienced a severe brain injury as the result of a fall in 2003. Since then, he has strived to make a difference for others who have lived through similar experiences. Paul is the Rehabilitation Tradesperson at Liverpool Hospital Brain Injury Rehabilitation Unit. In teaching woodworking to clients with a brain injury, he is part of a team providing cognitive, physical and behavioural therapy. Paul previously enjoyed a successful corporate career in manufacturing and project management.

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Greg Luck Non-Executive Director

Greg is an entrepreneurial and purpose-driven leader with a global footprint of C-Suite experience across Australia/NZ, Asia Pacific, North & South America, Europe, the Middle East, and Africa.

Greg has worked in public, private, and non-profit organisations spanning Professional, Human and Commercial Services. He holds a Masters Degree in Business Administration, a Bachelor’s Degree in Vocational Education and Training, and an Engineering qualification. He is a Fellow of the CEO Institute and a Member of the Australian Institute of Company Directors.

Hannah Hiscox Non-Executive Director

Hannah is a chartered accountant and registered company auditor with more than 20 years’ professional experience. Currently a partner in the Audit and Assurance team at Grant Thornton Australia, Hannah audits a portfolio of charities registered with the Australian Charities and Not‑For‑Profits Commission. Hannah has a Bachelor of Business (Accounting) and a Graduate Certificate in Business (Philanthropy and Non-profit Studies).

Ian Wilson Non-Executive Director

Ian is a qualified accountant (CPA Fellow), a chartered company secretary, and has been a director of commercial and not-for-profit companies in Australia and overseas for over 30 years. Ian’s early career was mainly in the technology and finance industries before moving to senior management positions within the notfor-profit sector. Ian currently holds a finance role with The Florey, the largest brain research centre in the Southern Hemisphere, with teams of researchers dedicated to building knowledge on a range of neurological and psychiatric conditions.

Frances Quan Farrant Non-Executive Director

Frances has worked in the community and disability sectors for two decades. As a social scientist and social worker, Frances has an extensive background in advocacy, policy, and disability rights, including expertise on the United Nations Convention on the Rights of Persons with Disabilities. Frances has represented disabled people at the United Nations in both Geneva and New York on many occasions. With a Bachelor of Arts from Macquarie University and a Master of Social Work from QUT, Frances is presently enrolled in a PhD at The University of Queensland researching the implementation of The Convention of the Rights of Persons with Disabilities in Australia and internationally.

Joe Capozza Non-Executive Director

Joe has over 25 years of leadership experience in the not-for-profit sector, offering a strategic business perspective and practical expertise.

His roles include CEO of a community housing association for women escaping violence, National Volunteer Manager for a children’s charity, and Director of Volunteer Services in a public hospital.

Joe has served over 10 years on the board of Volunteering SA&NT Inc. He has held various positions, including Deputy Chair of the Property Council of Australia (SA Division) Residential Committee, Treasurer for Rostrum Club 18, and multiple social housing committees. His recent role involved working with a disability housing provider and managing housing strategy at Believe Housing Australia Ltd.

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Breaking the cycle of vulnerability Brain injury can impact you at any stage of life.

No two brain injuries are the same and how they affect each person can have far-reaching impact for those living with a brain injury and people supporting someone who has a brain injury. When a brain injury occurs, it can affect many things including cognitive functions.

Brain injury can alter the life of a person and those close to them. Some of these impacts can amplify vulnerabilities and limit choices and self‑determination.

Without the right support, knowledge, and opportunities at key milestones throughout life, people impacted by a brain injury can fall into a cycle of amplified vulnerability.

Synapse exists to break the cycle of vulnerability by connecting knowledge, policy, services, and systems for people living with a brain injury, their families, and their communities.

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or Seni

The vulnerabilities experienced by people living with a brain injury are increased when government systems do not connect and integrate. People are often subjected to interventions that fail to recognise or adequately address and respect the needs that result from injury and can change someone’s life trajectory.

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Cycle-breaking

As we develop, stability can impact our wellbeing, feeding into many areas of life.

The cycle of vulnerability can be broken by: • educational engagement and learning • positive cultural, social, and health connections • belonging and identity • employment and housing.

Vulnerable experiences For children, some experiences and exposure to brain injury can have significant development consequences. Exposure to the following can have impacts on a child’s wellbeing: • family violence • mental health issues • fetal alcohol spectrum disorders • disconnection from family.

For young adults, difficult home environments can contribute to poorer wellbeing through: • reduced educational outcomes • lack of employment • exposure to or use of drugs and alcohol • interaction with the youth justice system • lack of or insecure housing.

As we age, we are at higher risk of a brain injury including dementia and Parkinson’s disease. Without proper support, seniors with a brain injury are more at risk of:

Early vulnerable experiences can create gaps in access to systems that grow larger in adulthood. As an adult these situations and systems can be amplified through:

• being isolated

• family violence • drug and alcohol • lack of employment misuse • lack of or insecure • criminal justice housing.

• drug and alcohol misuse • impacted rights to decision-making and self-determination • lack of housing.

Yo u

ult Ad ng

Our first cultural and social connections come from our family, extending to systems through life. The cycle of vulnerability can be broken by: • informed parental support • positive early health, social, and cultural connections • early intervention.

People living with a brain injury may require additional support to maintain selfdetermination and connection. The cycle of vulnerability can be broken by: • positive cultural, social, and health connections that help with belonging and identity • access to housing.

Choice and self-determination are limited by how connected we are to our communities.

The cycle of vulnerability can be broken by: • positive cultural, social, and health connections that help with belonging and identity • access to employment • access to housing.

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Vulnerable experiences

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Cycle-breaking

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Brain injury facts and figures The figures we have on brain injury impact in Australia don’t quite tell the whole story. There’s a significant number of Australians whose experiences aren’t represented in these outdated statistics. It’s crucial that we shed light on this, giving voice to those who are often overlooked.

1 in 45 Australians live with a brain injury Every 4 minutes, someone in Australia is hospitalised for a head injury

Almost 3 in 4 people with a brain injury are under 65 1 in 4 brain injury hospitalisations are people aged 14-24

Family Violence 1 in 10 (10%, or 380) involved assault by hanging, strangulation and suffocation

Assaults cause 12% of brain injuries Motor vehicle and cycling accidents cause 31% of brain injuries

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More information about the sources of these statistics is available online.

Scan this QR code for a direct link to our web page: synapse.org.au/key-facts-figures-sources/

2% Over 450,000 Australians live with a brain injury I in 6 Australians aged over 65 have dementia

Fall related injury is 6 times more likely to occur in residential aged care than the home

More men than women have brain injuries 82% of male prison entrants reported a history of a head injury Almost 2 in 5 (38%) prison entrants reported a history of a head injury resulting in loss of consciousness

Falls cause 39% of brain injuries

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Advocate with impact

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Services snapshot We focus on providing support and resources for individuals with brain injuries, along with their families and caregivers.

Our services and programs are tailored to empower these individuals, helping them to thrive and succeed in their daily lives.

We understand that every brain injury is different, just like the people who experience it. We focus on getting to know each person’s specific needs and providing the personalised support they require to achieve their best possible outcomes. Synapse considers all intersections of life where the experience of brain injury can introduce or amplify challenges. This shapes the way we seek to create meaningful impact. Taking a holistic approach that recognises how a brain injury can affect various functions of life and identity helps us to work with each person to find the pathways and solutions that are right for them.

Working alongside communities We connect with individuals and communities to better understand the gaps in brain injury services. No matter who they are or what they need, we focus on these gaps through our national efforts. Dealing with brain injuries can be tough, but you don’t have to go through it alone.

Our services • • • • • • • • • •

Information and referral NDIS support coordination Individual and systemic advocacy Housing Research Peer support groups and programs Hospital and rehabilitation Assessment, screening and planning Brain injury training and education Support at home

Top services requested Advocacy and NDIS appeals 19% Ageing support 14% Information referral 36% Support coordination 4% Training 4% Peer support 8% Housing 3% Other 12%

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National reach Synapse is the leading national organisation dedicated to improving the lives of individuals impacted by brain injury.

With our extensive reach across the country, Synapse provides vital services, including advocacy, information, and support, to individuals and families navigating the challenges of brain injury.

In 2024, we extended our staff presence to include Adelaide, Wyong, and Townsville.

Our programs address diverse needs, from connecting people with local resources to

offering specialised housing solutions and community engagement initiatives.

Through partnerships with healthcare providers, government agencies, and community groups, Synapse ensures that individuals in metropolitan, regional, and remote areas have access to the support they need, fostering a more inclusive and empowered Australia.

Torres Strait Islands

Staff locations Services Cairns Townsville

Sunshine Coast Brisbane

Dubbo Wyong Parramatta

Perth

Adelaide

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Focus on systems Systemic advocacy

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Townsville Women’s Correctional Centre Intersection of DV and criminal justice .

Trauma, mental health complexities, exposure to violence, drug and alcohol use and incarceration frequently characterise the life experience of many, a cycle of entrapment that is very difficult to escape. The experience of brain injury creates vulnerabilities to these experiences, significantly limiting someone’s ability to escape them.

Synapse confronts these realities daily.

Understanding the interrelationships of these difficulties is critical for improving outcomes, for individuals, families, communities and society.

Ignorance is less an excuse, and more of an intentional assault on the human rights of people that experience cognitive impairment, frequently undiagnosed. Without this recognition, systems continue to hold people impacted by brain injury captive without reasonable pathways to recovery and rehabilitation.

At the invitation of Prisoner Legal Services (PLS), Synapse met with women from the Townsville Correctional Centre. PLS was concerned by the high proportion of individuals they encountered where cognitive impairment may be a concern and linked to offending behaviour. A chance meeting with Sisters for Change during this visit sparked a continuing shared journey of understanding, sharing and healing beyond expectation.

The power of yarning Facilitated by Red Cross, Sisters for Change are a representative group of incarcerated women developing their leadership through advocacy about issues important to the women inside the centre including improving safety, wellbeing and hope for the future. Synapse spoke with the women about brain injury and the many ways it can occur including but not limited to physical assaults, domestic violence, alcohol and drug use as well as Foetal alcohol spectrum disorder (FASD).

The stories that emerged were equally inspiring as they were harrowing. The women begun to understand brain injury and its impacts on a person’s life. Stories of domestic violence and physical assaults were shared by every woman without exception and the women began to consider the likely impact of brain injury on their lives, their offending, the experiences of those close to them both inside and outside

Brain injury is rarely screened for in prison populations, and many mental health issues can be confused for or conflated by a brain injury – further contributing to erratic behaviour and frustration while serving a sentence.

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the centre. For many, they began, for the first time to recognise why they may have trouble remembering times and dates, not see clearly, have trouble managing how they’re feeling or reacting to stressful situations, forgetting things or not recognising people. Brain injury is rarely screened for in prison populations, and many mental health concerns can be conflated with a brain injury – further contributing to erratic behaviour and frustration that may lead to reoffending or experienced within the prison environment itself.

Guddi Way Screening Synapse spent many visits in the prison at the request of the women. The women wanted to learn more, and to educate each other, those inside the prison and their families on the outside. After identifying commonalities between themselves and some of the experiences of a person impacted by brain injury, many women asked to be screened to determine if brain injury may be impacting them, their lives, their choices and decisions and importantly, their past and their future. Synapse continues to return to the prison at intervals to conduct screening for women that self-nominate or identify particular concerns with someone known to them.

They presented to the correctional centre authorities about brain injury and how it was affecting the lives and wellbeing of other women in the centre. This was a strong and decisive step that allowed for practical solutions to issues that had been occurring inside the centre’s walls.

By building the relationship with Sisters for Change and the women involved, Synapse has been able to provide the tools for those so often unable advocate for themselves. Though this is only one correctional centre in Australia, it shows the impact that knowledge and understanding of brain injury can have on a community.

The future In recent weeks, Synapse has provided on-theground training in the Guddi Way Screening for a local Elders group, Elders for Change. This training enables the Elders to now perform screenings in the prison, meaning it’s local, trusted, culturally safe and accessible. Included in this were male Elders, who can now perform screenings in the men’s prison. As the expansion of Guddi Way Screening’s continues, we expect to see more positive outcomes and hear harrowing stories just like those from the Women’s Townsville Correctional Centre.

Unseen and unheard, no more As the women gained a greater understanding of brain injury and the effect it can and could have on them and their fellow residents, they decided to come together to advocate for themselves and to teach others in the correctional centre about brain injury. On each returning visit, Synapse encountered more women wanting to yarn with the team about their experiences.

Through the Sisters for Change and their newfound knowledge the women were empowered to advocate for themselves.

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Brain injury and the link to perpetrators of domestic violence Currently, 82% of the male prison population in Australia reported at least one past brain injury with persisting side-effects.

Inadequate rehabilitation When we consider this statistic, it is shocking that there is no system in place to address and assess or screen individuals for brain injury when they enter the criminal justice system – particularly those arrested and charged with domestic violence offences – to determine their best path through rehabilitation and back into society.

The current justice system fails to recognise the significant link between domestic violence among perpetrators, victim survivors, and brain injury. In fact, individuals are dealt with, as if they don’t have a brain injury – which leads to inadequate rehabilitation and recovery outcomes for people impacted by brain injury as victim survivors or perpetrators of violence. We know that being a victim of domestic violence is a significant cause of brain injury in our country, and the current method of rehabilitation provided to perpetrators with a brain injury does not provide favourable outcomes for anyone

The current justice system fails to recognise the significant link between domestic violence of both perpetrators, victim survivors, and brain injury.

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involved. Discussions of perpetrators with a brain injury being accountable for their actions are quite inadequate – and a fruitless exercise often – where the impact of brain injury may frequently lead to escalated levels of violence, impaired impulse control, difficulty linking cause and effect and lack of insight amongst multiple other complications.

Individuals with a brain injury may often struggle with laying down new memories, retaining information, learning, and have poor recall.

Because of these factors, individuals with a brain injury may often struggle with behaviour change– regardless of the significant consequences they might face – individuals with a brain injury require a different approach to domestic violence rehabilitation and education. It should be stated that not all domestic violence perpetrators live with a brain injury and that many people living with a brain injury will not commit actions of domestic violence.

The current system misses them Currently, the narrative around rehabilitating violent individuals continues to reinforce violence as an issue that can be changed through a perpetrator taking accountability for their behaviour and impact on others. What this narrative neglects is that perpetrators of domestic violence with a brain injury often struggle to regulate their emotions, become angry quickly, lack impulse control and sometimes may not even remember what has occurred afterwards.

Though their actions are, and without question, inexcusable, understanding the very real impact of brain injury on impulse control and emotion regulation is critical to ensuring improved safety for victims of violence and assisting rehabilitation efforts for perpetrators.

How do we improve rehabilitation outcomes for all?

We can never negate or excuse the significant trauma and physical harm that domestic violence perpetrators inflict. However, for behaviour change in those living with a brain injury, a different approach is required, one that can help break the cycle of violence without ignoring the science of brain injury or reducing its impact to being labelled a deliberate choice.

Understanding the presence of brain injury, which is often unidentified, can enable improved measures to be taken to better achieve behaviour change outcomes, one that reduces the likelihood of reoffending. Otherwise, those that live with a brain injury with heightened impulsivity and impaired decision making, will continue to offend, continue to amplify risk to others, and continue to be incarcerated.

The Synapse approach is not advocating to be soft on crime; what we do advocate for is a more evidence–informed and outcome–driven approach. This approach ensures safer and less traumatic outcomes for all people involved, in addition, this would see lower reoffence and offender rates. The current national discussion on domestic violence is seeing Australians wake up to the reality of what is occurring across our country. However, what is missing from the discussion is the need to look deeper at what could be a greater cause for the high rates of domestic and family violence we continue to see – we need to formally address the link between brain injury and domestic violence.

SOURCES: • Australian Institute of Health and Welfare (Accessed May 2024). Family, domestic and sexual violence in Australia: continuing the national story 2019.

• Australian Institute of Health and Welfare (Accessed May 2024). The health of people in Australia’s prison 2022.

• Independent (Accessed May 2024). ‘I pleaded for him to stop’: Domestic abuse victim tells of ordeal of living with 7 brain injuries.

• National Domestic Violence Hotline (Accessed April 2024). Warning Signs Of Abuse • Perkes I, Schofield PW, Butler T, Hollis S. Traumatic brain injury rates and sequelae: a comparison of prisoners with a matched community sample in Australia. Brain Inj. 2011;25 (2):131–141. doi: 10.3109/02699052.2010.536193.

• Queensland Centre for Domestic and Family Research (Accessed May 2024). The voices of women affected by non-fatal strangulation.

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Paul Ramsay Foundation Guddi work At Synapse, we are committed to addressing a vital issue within the Australian Justice System: the critical link between brain injury and recidivism.

We know that understanding and identifying brain injury can significantly lower recidivism rates among individuals within the Australian Justice System.

According to the 2022 report from the Australian Institute of Health and Welfare, nearly 40% of prison entrants reported a history of head injury that resulted in loss of consciousness. This alarming statistic highlights brain injury as a central concern within our prisons, given that these injuries can have profound, often unseen effects on cognition, behaviour, and emotional regulation.

Currently, brain injury remains largely unrecognised in the criminal justice system. This lack of awareness is particularly troubling for Australian Indigenous peoples, who face brain injury rates up to three times higher than their non-Indigenous counterparts. In 2022, Indigenous Australians, who represent only 3.8% of the total population, comprised a staggering 32% of the prison population*.

A Guddi Way Screening can identify the possible existence of a brain injury in a culturally informed way for Indigenous Australians. When a person lives with a brain injury, it can affect how they think, what they understand, how they manage emotions or react to situations, what they remember, how they speak, their insight into themselves, their behaviour and much more. The impact of brain injury on behaviour is not changed by punishment or consequences. Without the right supports, a person is largely set up to fail as their opportunity to engage in rehabilitation is limited.

There are strategies that can be implemented to combat the difficulties which frequently contribute

to offending. The first step is to identify the possibility of a brain injury in an individual.

Identifying cognitive difficulty prior to sentencing can have a critical impact on acknowledging the support a person needs to minimise reoffending, and to improve compliance with court conditions and community expectations. These in turn can have a positive impact on sentencing outcomes.

The intersection of brain injury, mental health and trauma has undeniable impact on accessing employment, housing, health care, and creating positive connections to the community. All of which are important protective factors against reoffending. Understanding the impact of brain injury for a person can help to break the cycle of their offending.

Synapse, with funding from the Paul Ramsay Foundation is working to deliver Guddi Way Screens in courts across Australia to foster a more inclusive and rehabilitative approach to justice, paving the way for a better society. We are doing this by equipping Magistrates, individuals, court support services, Elders, families and other support services with an overview of a Guddi Way Screening. This can then assist with making decisions about bail, parole or sentencing with an improved understanding of a person’s difficulties, limitations or life experiences. This of course, increases the chance that the court process supports a person to minimise future engagement with the justice system by identifying what the person can do successfully relative to the support available to them.

SOURCES: • Australian Insitute of Health and Welfare. (Accessed July 2024) The health of people in Australia’s prisons 2022.

• McIntyre M et al. (2024) The development of a cognitive screening protocol for Aboriginal and/or Torres Strait Islander peoples: the Guddi Way screen. Brain Impairment 25, IB23058. doi:10.1071/IB23058.

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Rethinking the invisible disability: The silent epidemic Brain injury can change life in an instant. It can impact relationships, work, learning and education. It can change how you think, understand, express yourself, cope with difficult situations or decisions, how you parent, how you see the world around you.

For some, the impact is greater than others. Good access to rehabilitation and therapies, supportive family, friends and financial resources can make a critical difference and exponentially improve the long-term rehabilitation outcomes. This most often starts with access to medical support after sustaining an injury. For some rehabilitation can vastly limit long term effects, for others it can improve functioning and help regain skills.

For others it is the critical point of connection with services and knowledge that are central to recovery, understanding and coping with the changes that may affect both the individual and those close to them.

Unaware and suffering Imagine a scenario without a specific incident leading to medical support, such as a car accident, violent assault or a fall resulting in hospitalisation.

Without a doctor to diagnose or guide recovery, consider that the impact of a brain injury may be progressive or noticed in different ways, and it can be worsened by subsequent injuries. Imagine reflecting on the confusion of not understanding your feelings, thoughts, memory issues, and impulsive decision-making due to the unrecognised

injury. Consider not having an explanation to understand how you’re feeling, how you’re thinking, why you can’t remember things, why you might make decisions impulsively and without always thinking about the consequences. Imagine that you had a brain injury and you weren’t aware.

This is the reality for many. Many that we don’t talk about, because to talk about brain injury generally requires a diagnosis to first be aware of it. Injury caused by drugs and alcohol; by an incident or long term addiction; injury caused by domestic violence by not feeling safe to seek help after being injured once, or repeatedly; brain injury present from birth due to FASD. Or consider living in a remote location where access to services to identify a brain injury doesn’t exist, or where the assessments used to identify brain injury are at best not culturally valid, or at worst culturally harmful.

Not knowing that brain injury is impacting you, means you don’t seek help. No doctors, no rehabilitation, no knowledge and no support.

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Synapse developed Guddi Way Screen, the only culturally validated screen for cognitive impairment in Aboriginal and/or Torres Strait Islander people.

The impact Not knowing that brain injury is impacting you, means you don’t seek help. No doctors, no rehabilitation, no knowledge and no support.

Only judgement, assumption and exclusion. The impact of injury frequently leads to difficulty with behaviour, learning, anger, impulsivity, decision making, memory and concentration among many others. Contact with police and the justice system are amplified, difficulty maintaining employment that results in financial hardship and housing insecurity, relationships can become strained and social isolation is all too common. Vulnerability to mental health concerns escalate, as does the vulnerability to substance abuse and addictions.

All of which in turn expose a person to higher risk of sustaining further injury.

Our research Synapse and Griffith University undertook groundbreaking research in 2022, titled ‘Assessing the Disability Needs of Indigenous Prisoners (ADNIP)”. This research examined the literature and processes used to identify brain injury in First Nations people incarcerated in Australian prisons and their subsequent experience of the system. Unsurprisingly, the findings were stark, indicating no uniform process other than isolated examples of self report, if anything at all. The GWS developed by Synapse, is the only culturally validated screen for cognitive impairment in Aboriginal and/or Torres Strait Islander people.

Synapse doesn’t shy away from these hard conversations. We continue to see unacceptably high numbers of people trapped in systems and cycles of disadvantage, addiction, violence, disconnection and racism because their brain injury remains invisible, unidentified, unsupported.

Conveniently so. We instead identify the symptoms like addiction problems, offending behaviour, violence and mental health leading to judgements and assumptions being made that bias our

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interest in remaining curious enough to consider underlying difficulties that may be making things harder.

Synapse continues to surface this reality through our work in brain injury screening within the court system, geared not toward minimising accountability of offenders but to ensure realistic expectations and the right support for rehabilitation and minimising future reoffending. With the support of the Paul Ramsey Foundation, a three year program of work will see culturally safe screening piloted nationally in Indigenous sentencing courts, building on our long partnership with Queensland Murri Courts. The Guddi Way Screening will shortly be available across all QLD Murri Courts, ensuring magistrates can make decisions that are informed by understanding a person and the support they need to make change in their lives. Great progress is being made to commence pilots across NSW, WA and NT.

Brian injury often means vulnerability without support Awareness, training, and screening in prisons, along with post-release supports and housing, help individuals impacted by brain injury to find the right support after incarceration. Sometimes this undiagnosed injury may contribute to risk of offending and keep them vulnerable to poor mental health, homelessness, substance abuse difficulties, and disconnection from family. All leading to further risk of offending, and high risk behaviour and situations that create vulnerability to further brain injury. Understanding the things a person finds hard are critical to being able to connect the right supports and services to help a person be successful in future, and make the difference in reconnecting with children and family, Culture, employment, and safe housing.

Synapse screening data in a women’s prison indicated 87% of people screened had experienced prior head injury but without any diagnosis at all.

100% had experienced head injury in the past. 80% of these reported 10+ prior injuries including a period of lost consciousness. 72% sustained their first injury before the age of 23.

The growing incidence of brain injury resulting from exposure to domestic violence brings yet another lens to this complexity. Whether it’s the 1 in 6 women that experience violence or the 7% of brain injury inflicted by a domestic partner, it’s well acknowledged that violence is underreported and therefore even this confronting data, is likely underestimated. Then consider where perpetrators of violence are also impacted by brain injury.

Some may have escalated levels of aggression and emotional dysregulation, impulse control difficulties and lack of insight into how they’re interacting. Specialist programs to assist people with brain injury to learn, become aware of and reflect on how their brain works becomes critical to curbing this violence. Synapse is proud to be working on the design Men’s Behaviour Change Program for those with cognitive impairment that use violence, in partnership with Department of Justice and Attorney-General acknowledging that brain injury often impacts how we learn, how we retain information and apply it, the insight into ourselves and how we make decisions and regulate our emotions.

Synapse continues to call for routine screening of both survivors of violence, as well as those who use violence. We must always acknowledge that the very real impact of brain injury is well evidenced. Its not a matter of opinion or a matter of

choice. We accept this as fact when it’s the result of a critical accident, a tumour, a stroke, dementia, a fall, or a violent assault. We accept this as a lasting, scientifically understood consequence of injury, even after rehabilitation has been exhausted. Yet we frequently selectively apply this acceptance only to those felt deserving of that understanding by community standards, or according to government agenda, or community and cultural bias.

Synapse screening data of Aboriginal and/or Torres Strait Islander people engaged in the justice system (courts, prison and post release) found that 80% of people screened were identified to have deficits in at least one area of cognitive functioning.

40% experienced deficits in 3 or more areas, highlighting a high frequency of difficulty with impulse control, memory recall, laying down new memories, sequencing, planning and conceptual reasoning.

It’s necessary, in fact incumbent upon us all, to now consider if the presence of unidentified brain injury for many, has resulted from, or contributed to the very vulnerabilities that in fact escalate the risk of brain injury to begin with.

They’re hard conversations to have; disadvantage, violence, suicide, mental health, substance abuse, homelessness, and incarceration. Othering masks ignorance and distance from the reality that these conversations cannot be had without also talking about the impact of, or vulnerability to brain injury.

We remain resolute in our commitment to elevate the voices of those impacted by brain injury.

Rethink brain injury, change society.

Synapse screening data in a womens prison indicated 87% of people screened had experienced prior head injury but without any diagnosis at all. 100% had experienced head injury in the past. 80% of these reported 10+ prior injuries including a period of lost consciousness. 72% sustained their first injury before the age of 23.

SOURCES: • Australian Government Department of Socia Services (Accessed November 2024) Assessing the Disability needs of Indigenous Prisoners.

• McIntyre M et al. (2024) The development of a cognitive screening protocol for Aboriginal and/or Torres Strait Islander peoples: the Guddi Way screen. Brain Impairment 25, IB23058. doi:10.1071/IB23058.

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Brain injury remains invisible to Federal Government In 2022-2023 the Federal Government doubled the Disability Representative Organisations grants (DRO) from $2.6 million to $5.2 million annually – an incredible policy change that will see so many lives in the disability sector improved. However, the government failed to recognise brain injury organisations in this new grant scheme.

This is a fundamentally flawed outcome that leaves some of society’s most vulnerable, and well over 400,000 Australians underrepresented at an organisational level.

We know from the government’s own figures from the Australian Institute of Health and Welfare that they estimate that 1 in 45 Australians live with a brain injury. We also know this number sharply increases for those in our prison population. Corrections Victoria estimates 42% of their male prison population presented with a brain injury.

Corrections Victoria estimates 42% of their male prison population presented with a brain injury.

This situation highlights the difficulties that those with brain injury struggle with, the organisations that advocate policy and societal change are not recognised and are in fact overlooked at the highest levels when it comes to representative opportunities. So, how do the government and society view those living with a brain injury?

We acknowledge that the government has doubled its financial commitment to the disability advocacy sector – which is a commendable policy outcome for the sector. The government is clearly committed to furthering financial investment into the disability advocacy sector, but, we need to see them recognise and fund brain injury organisations that are the only professional and structured voice for those that live with a brain injury in Australia. We can’t leave behind half a million Australians.

SOURCES: • Australian Insitute of Health and Welfare. (Accessed July 2024) Disability in Australia: acquired brain injury.

• Australian Government Department for Social Services. (Accessed July 2024) Disbility Representative Organisations.

• RMIT University. (Accessed July 2024) People with an acquired brain injury (ABI) let down by Australia’s judicial system.

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More than 450,000 Australians have a brain injury

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Support and innovate

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Training This year Synapse launched its two new eLearning modules for brain injury, Understanding The Brain and Impacts of Brain Injury.

This year Synapse launched several new eLearning modules. The interactive learning program covers foundational knowledge about brain injury, Understanding The Brain and Impacts of Brain Injury.

These new modules give insight into brain injury as well as understanding of what individuals with brain injury face in their daily lives.

The eLearning training is designed to build awareness of how brain injury impacts a person and provides critical knowledge that challenges the misconceptions and assumptions that too frequently lead to people with brain injury being misunderstood.

Synapse’s specialised brain injury awareness training is unique in Australia, informed by more than 35 years’ experience working with people living with a brain injury. Most importantly, training is informed by what we hear is most needed every day from organisations, people impacted by brain injury, family and carers.

We know that to change the landscape of services and improve outcomes for people impacted by brain injury, knowledge is the foundation.

We need to improve the understanding and capability of the workforce nationally to achieve better outcomes for people impacted by brain injury. This is not merely a disability issue, rather it relies on workforces across all systems to play their part. Domestic violence services, homelessness services, disability services, child protection, drug and alcohol rehabilitation, mental health, the legal and corrections systems.

In 2025 we will be launching additional eLearning modules and learning pathways for different professional contexts and social service areas.

Knowing about brain injury provides limited utility. However, understanding how brain injury impacts these different issues and vulnerabilities is the key to making real change in the lives of people and is often what can break the cycle of vulnerability that people with brain injury so often face.

Moving forward we will continue to deliver training that meets an organisations individual needs through eLearning, workshops and webinars.

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The Synapse community journey Through connecting with the brain injury community at a national and local level, we engage, navigate and develop relationships that have real impact.

Listening and connecting No two brain injuries are the same and no two person’s stories of brain injury are the same. The uniqueness of each person’s story guides us in our work and how best to support those living with a brain injury.

Synapse is unwavering in its commitment to amplifying the voices of individuals impacted by brain injury, ensuring their rights, needs, and interests are never overlooked.

Our national Information and Referral team are our first point of contact with many in our community, a resource that has and will continue to have significant impact on people’s lives. They continually assist individuals, families, and carers seeking help in navigating complex systems across housing, health, NDIS, employment, and ageing services.

Synapse is committed to fostering connections through our Brain Injury Network Events, which bring together professionals to discuss shared experiences and strengthen our community ties.

These events highlight the collaborative ways in which we support individuals impacted by brain injury and enhance the resources available to them. Additionally, our Brain Injury Matters community drop ins offer people impacted by brain injury, along with their families, opportunities to connect, access support, and share both challenges and successes.

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Synapse’s reach extends beyond major cities, with a focus on regional and remote areas as well. An example of where Synapse plays a vital role in supporting regional communities, is the Koori Wellbeing Support Group in Dubbo, which brings together older Aboriginal people to discuss health, chronic diseases, and wellness practices.

This group, with 50 registered members aged 55 to 60, provides a safe and welcoming space where participants can learn about available health services and ask questions of medical professionals. Monthly guest speaker sessions, featuring doctors, nurses, paramedics, and health specialists, help bridge the gap in Aboriginal health by addressing topics like cardiac, respiratory, renal wellness, and mental health.

By partnering with services like Synapse, the group has seen a positive shift in participants’ comfort with seeking medical care. Members now feel more confident in approaching doctors and accessing treatment. The group also collaborates with the School of Rural Health, allowing medical students to gain experience in providing culturally sensitive care to Aboriginal communities.

Synapse’s support in this initiative, along with other local health services, has helped the Koori Wellbeing Support Group thrive, and there are plans to replicate this successful model in other NSW communities.

Forging partnerships and tailoring support At Synapse, understanding the diverse needs of local communities and individuals is at the core of our work, driving authentic relationships across Australia. We collaborate with a range of organisations within the brain injury sector to share knowledge and develop tailored support systems. We also collaborate with dedicated volunteers by offering mentorship and guidance.

By co-designing this support, we ensure that individuals with lived experiences can share their stories with others.

The support we provide to Guthrie House, a transitional service for women exiting the criminal justice system, has been enhanced through the Guddi Way Screen, which helps identify cognitive impairment, in a culturally safe manner. This tool enables Guthrie House to better understand the specific needs of Aboriginal and/or Torres Strait Islander women and tailor their support services accordingly. By using the Guddi Way Screen, Guthrie House can more effectively connect these women to both specialist and mainstream services, improving their overall access to the resources necessary for a successful and supported transition back to community life.

We have strengthened community partnerships, building meaningful collaborations with a range of organisations and service providers dedicated to supporting individuals impacted by brain injury. Our continued work with Brain Injury Units and regional hospitals, alongside initiatives like the BeStreetSmart Campaign and Brain Injury Awareness Week, plays a crucial role in building strong community connections. We have worked closely with the Stroke Recovery Association of NSW, participated in interagency meetings across metro, regional, and remote areas, and delivered customised training to Allied Health organisations and support worker providers. Our involvement in key groups such as the Guardianship Working Group and Accessible Transport Advisory Committee highlights our commitment to advocating for better access, services, and opportunities for people impacted by brain injury and disability. These partnerships are a testament to our dedication to improving outcomes, raising awareness, and fostering positive change for the community across all sectors of society.

Training and advocating to breaking the cycle of vulnerability Synapse is unwavering in its commitment to amplifying the voices of individuals impacted by brain injury, ensuring their rights, needs, and interests are never overlooked. Our advocacy services play a crucial role in supporting individuals and families navigating complex systems like the NDIS and other essential services. With great passion and expertise, we empower people to make informed decisions, to speak up for themselves or offer the necessary support when their voices are not heard. Whether it’s advocating for improved services, supporting important meetings, or fighting for fair treatment, Synapse ensures that no one is left behind in the pursuit of justice, dignity, and the right to live a life of choice and opportunity. Through our training and advocacy efforts, we work to break the cycle of vulnerability for those living with brain injury, addressing the systemic barriers that often overlook their needs.

By using the Guddi Way Screen, the Guthrie House can more effectively connect these women to both specialist and mainstream services.

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Peer support groups Having a space to connect, share, learn, and get support from people who truly understand is invaluable.

Our Reconnections support groups provide those living with a brain injury, or caring for someone with a brain injury, with an opportunity to connect with other individuals and their families. Hearing other people’s stories, learning from their experiences, and talking about issues that are important to anyone impacted by brain injury is a key reason these groups continue to grow.

This year we have added an online support group Australia wide specifically for carers.

This gives carers nationwide an opportunity to connect, share each other’s experiences and ask questions. We also provide digital social media groups that allow individuals to connect with each other, build genuine friendships, and share their experiences with others living similar lives as them.

Our Wurri-Wurri Outreach in Queensland’s Far North is about respecting Elders. Together, in partnership with Elders, we can keep them strong, both mentally and physically. We do this by listening to what is important to our Elders for keeping them healthy as they get older, including what help they may need from mob or services.

Elders run the Wurri-Wurri Outreach in different communities around the Cairns region. They have a yarn and a feed while learning about what assistance may be needed or what information Elders require.

Synapse hosts the following Reconnections groups across Australia.

WA Reconnections support group events: 10 Groups (3 family/carer, 7 younger generation ) NSW Reconnections support group events: Online =136 Sessions and in-person =99 Groups QLD Reconnections support group events: Online =12 Sessions and in-person =12 Groups

WA

NSW

Online Perth

Online Central Coast Goulburn Hunter Illawarra Northern Beaches Parramatta Shoalhaven Wagga Wagga

QLD Online

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Social enterprise At Synapse, the idea of connection drives everything we do.

Just as synapses link brain cells, we aim to build meaningful links between individuals, businesses, and communities.

We know that change is needed for Aboriginal and/or Torres Strait Islander people. Who are frequently unidentified and disproportionally impacted by incarceration, homelessness, exposure to violence, a lack of access to quality health care, unemployment, and exposure to drug and alcohol. Our social enterprise exists to meet these issues, with the leadership and cultural insight necessary to advocate for and realise change. Our work focuses primarily on strengthening awareness and impact of brain injury with a community and cultural lens.

We work closely with Traditional Owners, Elders, communities and stakeholders to ensure that our brain injury services and programs reflect the needs and wishes of Aboriginal and Torres Strait Islander people. We foster partnerships across Australia with government, organisations and businesses, helping to ensure that our social systems recognise the complexity of brain injury and its impact on life, culture and self-determination.

Our work blends local action with national reach.

This is how we ensure that Aboriginal and/or Torres Strait Islander community voices remain at the forefront of everything we do, grounded in local leadership, knowledge and control. We work with non-Indigenous and Indigenous organisations to build awareness of Culture and brain injury while growing capability in organisations to

identify and respond to the needs of Aboriginal and Torres Strait Islander people impacted by brain injury.

With active partnerships and initiatives spanning the court system, corrections, mental health, housing, drug and alcohol, disability, domestic violence to name a few. Social enterprise exists as a change agent at the intersection of these systems and the experience of brain injury. With a primary focus of national scaling and application of the Guddi Way Screen at its heart. We seek to contribute to growing a national Indigenous workforce within our partner organisations and customers. A national workforce and community that couples the necessary cultural knowledge with skills to screen for brain injury at the intersection of systems that so often fail Aboriginal and/or Torres Strait Islander people.

Working alongside Non-Indigenous organisations and workforce is ever critical, making sure that organisational understanding of Culture is not superficial, but is a way of working and listening, led by Aboriginal and/or Torres Strait Islander people.

Synapse’s social enterprise model is geared toward generating revenue that is invested directly back into Aboriginal and/or Torres Strait Islander communities.

The social enterprise team delivers the following training services: • Cultural awareness - This workshop is designed to acknowledge the wrongs of the past, and to provide the information and the tools to work together to build a better future for all Australians.

• Mental health first aid - This course focuses on the mental and emotional well-being of employees.

• Brain injury training - Recognising how brain injury impacts a person’s life, identity and keeping connected to what is most important to a person. Understanding the impact of brain injury is not separable from Culture.

Culture and identity influences the impact of injury on a person.

• Guddi Way Screen training - The Guddi Way Screen (GWS) is a culturally developed and sensitive process to screen for cognitive impairment in Aboriginal and/or Torres Strait Islander people. Only Aboriginal and/ or Torres Strait Islander are trained to administer the GWS.

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Court Link Court Link is a transformative support program in Cairns, Queensland, designed to assist individuals navigating the court system. It provides comprehensive services such as transportation, outreach, and culturally informed support to improve outcomes over a 12-week period.

Led by Synapse, the Court Link Community Support Service (CLCS) exemplifies how focused support can change lives. For many participants, attending court or community appointments can be daunting, especially when facing multiple complexities including living with a disability or impacted by domestic violence. They may be homeless, as well as living with mental health issues or drug and alcohol difficulties. The CLCS addresses these barriers by offering essential transportation and moral support, ensuring individuals can fulfil their obligations without the added stress of logistics. The presence of CLCS team members in court helps participants feel more at ease and informed about the legal processes they are navigating.

Aboriginal and Torres Strait Islander people are overrepresented in the court system in Cairns and represent 62% of Court Link participants.

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Synapse emphasises the importance of culturally informed practices to enhance engagement with the program, ultimately fostering a positive impact on sentencing. A person, family, Culture and community-centred approach is vital in helping individuals meet court requirements prior to sentencing decisions. This means connecting participants with CLCS team members based on cultural and language preferences, gender, age, and personal experiences.

Court Link Community Support services • Transporting participants to court and community appointments • Attending court with participants • Checking in with participants • Connecting participants with relevant services in the area to meet goals • Providing advice, information, and general support to participants.

Court Link Case Study This case study examines the journey of Jensen, a 28 year old Aboriginal man, as he navigates lifestyle changes and personal growth while participating in the Court Link program in Cairns.

Jensen is a 28-year-old Aboriginal man who has recently relocated to Cairns from Mt Isa. At the start of the Court Link program, Jensen was living in Moorabool and engaging in daily drinking and smoking. To avoid negative influences, he moved in with his sister in Freshwater to “stay out of it” [Brad] - bad influences.

as an Indigenous man, and to understand the expectations of others. Jensen was introduced to the local men’s group and attends weekly.

As a result of Jensen’s success and positive engagement with the supports, Brad is now commencing another support group focussing on mental health.

Jensen has built a strong and trusted relationship with Brad. Brad checks in with Jensen regularly and Jensen is quick to respond or return Brad’s phone calls. Jensen is often described as a “quiet fella, doesn’t talk much”. Establishing a relationship and understanding from a cultural perspective including ways of engaging have been critical. Brad yarns with him and he opens up “How you?” “What’s happening? Jensen will open up and yarn about what he is happy with, what he is struggling with or things that are getting him down and expresses that he knows that Brad listens and understands where he’s coming from.

Jensen is really motivated to get a good outcome from the Court Link program, and “he is willing to do all he can”. He has attended all his appointments and sometimes makes his own way to and from appointments. If Jensen can arrange his own transport via bus, he will always call Synapse prior and arrange a place and time to meet. He has a positive attitude, and this has been consistent all the way through.

This relationship has allowed many yarns of encouragement to quit the drinking and smoking and the pressures within family and community that can make this hard. The Synapse staff member has built a respectful and equal relationship that makes it safe to share experiences and offer support and guidance around the impact of these difficulties on his life (present and future), and what might help to set himself up for success, including and beyond Court Link.

An older male offering guidance plays a crucial role in building trust and respect that helps Jensen remember what is important for him

Brad recalls, “first time I picked him up he was drinking and smoking every day. Now he doesn’t drink as much, or smoke weed (at all).” On initial visits, Brad would go to Jensen’s home to pick him up and Jensen would not recall he was coming. Having smelt that Jensen had been smoking and then yarning with him about this and the impact has helped Jensen make different choices because he wants to be respectful of the staff member. This led to Jensen not smoking if he knew the staff member was coming. This was early on, and he doesn’t smoke at all now. Brad reports a noticeable difference as a result, and he has gained a healthier weight. Although Jensen lives very near to two pubs, he does not frequent these at all as he’s “trying to give up drinking”.

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Housing Every Australian has the right to safe and secure housing. People with a brain injury shouldn’t have to experience homelessness.

Home can make all the difference when attempting to secure a job or access services. Having a home can be a foundational opportunity in life, giving people the ability to connect with friends and family.

To provide a solid foundation – a home needs to be safe, in good condition, and appropriate. The unpredictable nature of recovery after a brain injury means it’s not always possible to return home, this can leave many people with a brain injury homeless. Memory and other cognitive challenges can make it difficult for people living with brain injury to uphold their responsibilities in a tenancy agreement—such as paying bills on time—resulting in the loss of housing. Without a stable address,

people often struggle to find and keep a job. Equally important is choosing how and where people want to live and having the right supports in place. There is an immense need for appropriate housing that creates a sense of home and belonging while also providing people with uninterrupted access to appropriate services and supports. This can help reduce pressures on health, criminal justice, and social systems. With a clear understanding of how a person with brain injury is impacted and what their specific needs are, we work to assist and guide transition to the most suitable housing and support options.

30% of Australians seeking homelessness services have a disability (1) 1 in 5 people experiencing homelessness are Aboriginal and Torres Strait Islander people (2) 28% cite family violence or other violence and abuse as the main reason they need help (3)

Community Living Initiative Our Cairns community exemplifies our collaboration with local partners to develop meaningful and improved housing options for Aboriginal and Torres Strait Islander peoples impacted by brain injury and disability. This initiative represents just one of the many housing strategies employed by Synapse, which recognises that safety and connection can vary greatly for each individual, much like their brain injury.

Our Community Living Initiative has culture at its heart. Family is the foundation to how Synapse supports Aboriginal and Torres Strait Islander peoples with disability. As Australia’s only initiative of its kind, the Community Living Initiative connects community, cultural knowledge and family to the way support is provided. Under the wisdom of the Elders and the team, support is delivered in a way that respects Culture and connection as the foundation of strength and healing.

SOURCES: • AustralianBureau of Statistics (2021). Aboriginal and Torres Strait Islander peoples experiencing homelessness.

Available at: https://www.abs.gov.au/articles/aboriginal-and-torres-strait-islander-peoples-experiencinghomelessness.

• Australian Institute of Health and Welfare (2022). People with disability in Australia. Canberra: AIHW, Australian Government; Available at: https://www.aihw.gov.au/reports/disability/people-with-disability-in-australia.

• Homelessness Australia, https://homelessnessaustralia.org.au/wp-content/uploads/2023/07/Homelessness-factsheet-2023-1.pdf.

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Ageing services Everyone deserves to have support that enables them to continue to live as independently as possible, while having choice and control in their everyday life.

Synapse is dedicated to continuous learning and listening. Our team is committed to providing tailored support that puts the individual first and connecting services that people tell us are most needed to help them age well at home.

Ageing is a risk factor for brain injury. For people over 65, there is an increased incidence of conditions including stroke, Parkinson’s disease and Dementia disorders, as well as increased risk of traumatic brain injury through falls. Having an acquired brain injury also puts people in a higher risk category for developing dementia. Our ageing service is here to provide information, resources, and support to help individuals navigate these challenges and enhance their quality of life.

Having an acquired brain injury also puts people in a higher risk category for developing dementia.

Our Ageing Team focuses on helping older Australians access the support they need. We connect individuals affected by brain injury who are over 65 years old, or over 50 for Aboriginal and Torres Strait Islanders, with information consultants. These consultants listen to concerns, discuss what matters most, provide resources, and assist in finding local services, guiding individuals through often complex systems of aged care, health services and community support.

Helping ageing carers The care needs of those living with a brain injury can impact children, spouses, or siblings. Our team assists anyone impacted by brain injury, including carers and family. We help carers access the most current resources, information, and tools needed to support their loved one and themselves. Synapse’s information consultants can also help find carer support groups. These groups provide invaluable discussions about how to care for someone as they age. It is vital for carers’ wellbeing to take time out and these groups can be a good way to do that.

Our information and referral team provided over 4950 hours of support over the 2023-24 financial year to older Australians.

Our team attended over 100 community events to share education and awareness about brain injury and how it impacts people as they age.

Synapse received 436 incoming enquiries regarding support for older Australians with a brain injury in 2023 - 24 Financial year.

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Research The development of a cognitive screening protocol for Aboriginal and/or Torres Strait Islander peoples: the Guddi Way Screen.

An important focus for Synapse over the last 10 plus years has been the development of the Guddi Way Screen. This year, CSIRO Publishing released a report presenting the initial results, validating all the work done so far and supporting the Guddi Way Screen’s further implementation of justice systems nationwide.

GWS was developed to ensure a screening protocol existed that is not only culturally informed in its application but, most importantly, culturally validated. Since its initial inception many years ago, GWS has been embraced in various contexts throughout the country. Its purpose is to facilitate the identification of cognitive difficulties in Aboriginal and/or Torres Strait Islander individuals, especially in cases where challenges and brain injuries often go undiagnosed.

Importantly, this work is occurring across systems nationally that continue to see an overrepresentation of Aboriginal and/or Torres Strait Islander people and often criminalisation of people. Due to the impact of their injury that amplifies vulnerability to engagement with mental health, the justice system, homelessness, domestic violence, drug, and alcohol misuse, and so many other issues that limit opportunity for people impacted by brain injury.

GWS is not only a screener for cognitive impairment but, importantly, it’s a way to hear, understand, and respect a person’s story and experiences to appreciate how cognitive impairment impacts what is most important to that person. Recognising the diversity of life experiences that influence what is important to each of us to stay well and live well. Not focussing on diagnosis but instead on what a person needs to be connected in a way that holds meaning for and to them.

Extensive work over these years to design an online interface that allows GWS to be used by non-clinicians nationally means we continue to be committed to seeing GWS in use far and wide. From the corners of remote WA and NT to the Torres Strait Islands, south to Tasmania and everywhere in between, GWS has and continues to be a driving opportunity to change the way systems respond to Aboriginal and/or Torres Strait Islander people impacted by Brain Injury.

Synapse now has so many activities occurring nationally where focus on GWS and its implementation is changing the awareness of brain injury across Australia, its causes and impacts and most importantly the opportunity for people with brain injury to be better understood.

GWS is being used in courts, in prisons, and in the areas of domestic violence, mental health, and disability.

SOURCES: • McIntyre M et al. (2024) The development of a cognitive screening protocol for Aboriginal and/or Torres Strait Islander peoples: the Guddi Way Screen. Brain Impairment 25, IB23058. doi:10.1071/IB23058.

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Research “It’s been like a spiritual awakening for me”: The impacts of traumatic brain injury education with Aboriginal and Torres Strait Islander women in the Australian correctional system.

Partnerships and research are central to how we take action on systemic issues affecting people living with brain injury and their communities.

In 2024, the research paper “It’s been like a spiritual awakening for me”: The impacts of traumatic brain injury education with Aboriginal and Torres Strait Islander women in the Australian correctional system explored the transformative effects of culturally tailored Traumatic Brain Injury education among Aboriginal and Torres Strait Islander women in correctional facilities. This research was conducted in collaboration with Western Sydney University, Charles Darwin University, and James Cook University, and provided targeted Traumatic Brain Injury education through workshops with Aboriginal facilitators, reaching women in Queensland correctional centres impacted by family violence.

In August 2023, two Aboriginal facilitators delivered a three-session workshop on acquired brain injury to two groups of women involved in a peer mentor group at one regional Australia prison. The workshops helped the women understand Traumatic Brain Injury’s impacts on cognitive, emotional, and social well-being, equipping them with insights into brain anatomy, symptoms, and coping mechanisms within their correctional environment and post release.

This study intersects with previous research in Understanding the Lives of Aboriginal and Torres Strait Islander Women with Traumatic Brain Injury from Family Violence in Australia, highlighting the ongoing effects of violenceinduced Traumatic Brain Injury among Aboriginal women. This highlighted the need for accessible, culturally sensitive brain health education in justice settings to support women’s healing and encourage self-awareness.

These findings offer insights for shaping policies and practices in family violence, disability, and correctional health care for Aboriginal and Torres Strait Islander communities. Given the high incidence of TBI among women in the prison population, researchers have identified several ways correctional facilities can improve their responses and support systems. Key recommendations include offering education workshops not only for the incarcerated women but also for frontline staff, such as correctional officers and probation and parole officers.

Additionally, implementing TBI screening and creating referral pathways, integrating TBI considerations into prison policies and programs, and establishing support pathways both within the prison and post-release are essential for providing care. Together, these strategies can foster a safer, more supportive environment for Aboriginal and Torres Strait Islander women affected by TBI. Earlier this year, in March 2024, Synapse and Dr Michelle Fitts presented this research at the “Hidden Cost of Violence” Conference in Whanganui, New Zealand; A conference that focused on the diverse impacts of violence, particularly how it intersects with traumatic brain injuries and the social, financial, and healthrelated costs associated with it. This conference aimed to highlight the often-overlooked consequence of violence-related brain injuries on individuals and communities, emphasising the need for systemic support, early intervention, and comprehensive care approaches to mitigate these costs.

SOURCES: • Fitts, M. (et al.) 2024. “It’s been like a spiritual awakening for me”: The impacts of traumatic brain injury education with Aboriginal and Torres Strait Islander women in the Australian correctional system, in Frontiers. Educ. Sec. Language, Culture and Diversity, Volume 9 - 2024 | doi: 10.3389/feduc.2024.1406413.

• Fitts, M. (et al.) 2023. Understanding the Lives of Aboriginal and Torres Strait Islander Women with Traumatic Brain Injury from Family Violence in Australia: A Qualitative Study Protocol, in International Journal of Environment Research and Public Health, 20(2) 1607; https://doi.org/10.3390/ijerph20021607.

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Research Synapse and AUS-mTB Aboriginal and Torres Strait Islander people are known to be impacted by brain injury up to three times as often (or more) than non-Aboriginal people. That is why it is vitally important that the study hears directly from Aboriginal and Torres Strait Islander people.

Synapse is part of a national research collaboration project called AUS-mTBI. This multi-year study is being funded through the Medical Research Future Fund.

This project aims to improve outcomes for Australians who live with a mild traumatic brain injury, including concussion. The study aims to be the first comprehensive collection of national data on mild traumatic brain injury, enabling better prediction of recovery and design of interventions.

The AUS-mTBI team will develop comprehensive online platforms that personalise and improve care for mild traumatic brain injury. This platform will modify current technical applications, focusing on major areas of biology, treatment, and social engagement, to recommend the best care pathways to improve outcomes.

Synapse’s role in the project Synapse’s main role in this project is to assist in the Aboriginal and/or Torres Strait Islander sub-study. This sub-study will capture important information specific to Aboriginal and Torres Strait Islander communities in Queensland, New South Wales, and Western Australia, enriching the data and ensuring inclusion of First Nations peoples in the project. As Aboriginal and Torres Strait Islander people are known to suffer from TBI up to 3 times as often (and higher in the case of assault) as non-Aboriginal Australians, it is important that Aboriginal and Torres Strait Islander people are included in the study. The sub-study is being conducted under the guidance of the Aboriginal Advisory Committee.

This project will assist in improving care for Aboriginal and Torres Strait Islander people with mild traumatic brain injury and concussion. It will also raise awareness of mild brain injury within Aboriginal and/or Torres Strait Islander communities, targeting health service planners and providers, as well as addressing specific challenges faced by individuals living with brain injuries and their families. The study also aims to understand what and how we collect information, to design pathways and treatments that are culturally appropriate and accessible.

In May of this year, Synapse presented “Data Sovereignty in the AUS-mTBI Study” at the Australasian Society for the Study of Brain Impairment (ASSBI); A conference held in Sydney that features advancing research, knowledge and clinical practices in brain impairment, neuropsychology, and rehabilitation.

The AUS-mTBI study is now collecting data via the evidence-based concussion management app “HeadCheck”. The app can be downloaded for free from the App Store or Google Play, or accessed via the web-based platform at https://app. headcheck.com.au/home. By clicking on the link to the AUS-mTBI study in HeadCheck, participants can help improve care and outcomes for others who get a concussion in the future. Participants will also be able to get guidance and track their own recovery through a unique symptom tracking tool.

SOURCES: • Colegate. K (et.al.) Data Sovereignty in the AUS-mTBI study: Having Aboriginal and Torres Strait Islander control over Aboriginal and Torres Strait Islander data.

• Gabbe,B. (et al.) 2024. The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Demographic, Injury Event, and Social Characteristics on Outcomes for People With Moderate-Severe Traumatic Brain Injury. 2024 Apr 1. doi: 10.1089/neu.2023.0461.

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Synapse 2023 - 24 40

AUSTRALIA’S BRAIN INJURY ORGANISATION

Our team The heart of Synapse Synapse employees are committed and deeply passionate about seeing people living with a brain injury live meaningful and independent lives. Our people reflect the diversity of the communities we serve, the lived experiences we support, and the environments in which we operate.

Snapshot of our team (As of 30th June 2024) Age breakdown of staff for 2024 18-24 25-34 35-44 45-54 55-64 65+

Gender breakdown of staff for 2024

6.4% 29.6% 25.8% 15.4% 16.1% 5.8%

Male 38% Female 62%

Tenure breakdown of staff for 2024

Location of staff for 2024 84% 3.2% 0.6% 12.2%

More than 10 years 5 -10 years Less than 5 years 0

20

40

60

80

100

Aboriginal and/or Torres Strait Islander representation of staff for 2024

94%

Far North QLD team

47%

Leadership & management

29%

Overall Synapse team

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Our partners At Synapse, we are only one piece of a larger puzzle.

Synapse partners with philanthropists, private business, government agencies, and academic institutions across Australia.

Our partners provide perspectives and evidence that shape how we deliver services and influence national and global conversations around brain injuries.

Partners in delivery

Partners in research

We would not be able to provide our range of support services to people living with a brain injury without the belief and support from our funding and industry partners, including:

• • • • • •

• Australian Government Department of Social Services • Australian Government Department of Health (My Aged Care) • NSW Government Department of Health • NSW Government Department of Community & Justice • NSW Government Insurance & Care (iCare) • National Injury Insurance Scheme Queensland (NiiSQ) • National Disability Insurance Agency (NDIA) • Paul Ramsay Foundation • Queensland Brain Institute • Queensland Government Department of Child Safety, Seniors and Disability Services • Queensland Government Department of Justice and Attorney-General

42

AUSTRALIA’S BRAIN INJURY ORGANISATION

Western Sydney University James Cook University Griffith University – The Hopkins Centre Flinders University Monash University Perron Institute for Neurological and Translational Science • Curtin Health Innovation Research Institute • Edith Cowan University • The University of Queensland

Other partners • Australian Government’s Healthdirect • Clayton Utz • Les & Gladys Blatchford Foundation

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43

Financial summary Income For the year ended 30 June 2024

Sources of income

10,000 9,000 8,000 10,000 7,000

2024

9,000 6,000

2023

8,000 5,000

2022

7,000 4,000 6,000 3,000 5,000 2,000 4,000 1,000 3,000 0 2,000

2024 2023 2022

Cwth Govt Contracts

State Govt Contracts

Service Fees

Donations & Partnerships

Tenant Income

Other Income

Recurrent Grants Non-Recurrent Grants Service Fees Rental Income

31% 1% 10% 2%

Donations & Partnerships NDIS Income Other Income

Contracts Contracts Expenditure

Service Fees

Donations & Partnerships

Tenant Income

Other Income

Recurrent Grants Non-Recurrent Grants Service Fees Rental Income

31% 1% 10% 2%

Donations & Partnerships NDIS Income Other Income

Employee Expenses Property Interest Paid Client Support Services

71% 3% 6% 10%

IT Expenditure Consultants Depreciation and Amortisation Travel & Accommodation

Employee Expenses Property Interest Paid Client Support Services

71% 3% 6% 10%

IT Expenditure Consultants Depreciation and Amortisation Travel & Accommodation

1,000

12,000

0

Cwth Govt

State Govt

10,000 For the year ended 30 June 2024 12,000 8,000

2023 2022 2024

6,000 2,000

2022

0

44

Sources of expenditure

8,000 4,000

2,000

2% 53% 1%

2024

10,000 6,000

4,000 0

2% 53% 1%

2023

Employee Expenses

Client Support Services

Depreciation & IT Consultancy Amortisation Expenditure Fees

Property Expenses

Other Expenses

Employee Expenses

Client Support Services

Depreciation & IT Consultancy Amortisation Expenditure Fees

Property Expenses

Other Expenses

AUSTRALIA’S BRAIN INJURY ORGANISATION

3% 1% 4% 1% 3% 1% 4% 1%

Statement of profit or loss and other comprehensive income Synapse recorded an operating deficit of $155k for the financial year, investment was once again made to fund future growth and systems from prior year surplus funds.

Earnings before depreciation and amortisation in the financial year was $368k.

For the year ended 30 June 2024 2024

2023

$

$

14,971,977

13,535,390

Accountancy and auditor’s remuneration

(36,540)

(33,601)

Advertising and promotions

(66,398)

(54,472)

Client support services

(1,489,580)

(998,418)

Computer expenses

(480,656)

(468,000)

Consultancy fees

(181,309)

(99,968)

Depreciation and amortisation expense

(522,964)

(609,107)

Employee benefits expense

(10,750,546)

(10,235,754)

Finance costs and charges

(112,802)

(101,801)

Insurance

(112,172)

(121,788)

Legal expenses

(22,485)

(29,729)

Motor vehicle expenses

(53,458)

(48,973)

Office expenses

(254,244)

(236,088)

Other expenses

(603,442)

(398,643)

Property expenses

(440,025)

(360,900)

0

0

(154,744)

(261,852)

0

0

(154,744)

(261,852)

Revaluation of land and buildings

0

0

Total other comprehensive income

0

0

(154,744)

(261,852)

Operating revenue

Gain/(loss) on disposal of assets Operating surplus / (deficit) for the year Non-operating activities Surplus / (deficit) for the year Other comprehensive income

Total comprehensive income for the year

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Statement of financial position For the year ended 30 June 2024 2024

2023

$

$

Cash and cash equivalents

5,184,509

6,220,876

Trade and other receivables

784,021

848,063

Other current assets

204,882

178,163

Total current assets

6,173,412

7,247,102

11,617,698

12,013,764

871,038

1,160,001

Total non-current assets

12,488,736

13,173,765

Total assets

20,420,867

20,420,867

Trade and other payables

682,203

887,073

Contract liabilities

906,651

2,103,373

1,018,118

0

Employee provisions

825,775

694,139

Lease liabilities

76,083

144,089

3,828,674

3,828,674

0

1,018,118

Employee provisions

165,806

138,969

Lease liabilities

575,834

863,784

Provision for lease make good

65,000

70,000

Total non-current liabilities

806,640

2,090,871

Total liabilities

4,315,570

5,919,545

Net assets

14,346,578

14,501,322

Accumulated surplus

11,415,495

11,570,239

Property revaluation reserve

2,931,083

2,931,083

14,346,578

14,501,322

Current assets

Non-current assets Property, plant and equipment Right-of-use assets

Current liabilities

Borrowings

Total current liabilities Non-current liabilities Borrowings

Equity

Total equity

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AUSTRALIA’S BRAIN INJURY ORGANISATION

Statement of cash flows For the year ended 30 June 2024 2023

2022

$

$

Receipts from donations, grants and client-related activities

14,231,845

13,457,146

Payments to suppliers and employees

(15,018,851)

(13,438,785)

Interest received

77,639

55,242

Finance costs

(88,634)

(101,801)

(798,001)

(28,198)

(38,003)

(97,313)

0

0

(38,003)

(97,313)

(0)

(1,499,970)

Repayment of lease liabilities

(200,363)

(178,678)

Net cash used in financing activities

(200,363)

(1,678,648)

Net (decrease)/increase in cash held

(1,036,367)

(1,804,159)

Cash and cash equivalents at the beginning of financial year

6,220,876

8,025,035

Cash and cash equivalents at the end of financial year

5,184,509

6,220,876

Cash flows from operating activities

Net cash generated from operating activities Cash flows from investing activities Purchase of property, plant and equipment Proceed from sale of property, plant and equipment Total cash flows from investing activities Cash flows from financing activities Repayment of borrowing

Financial Audit & Risk Committee Hannah Hiscox

Hans Larsson

Greg Luck

Yvette Wirken

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Freecall: 1800 673 074 Email: info@synapse.org.au synapse.org.au

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