Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach

Low back pain (LBP), a leading cause of disability, has been linked with profound economic, personal, and social costs (Hills 2006; World Health Organization 2003). This significant effect propels research in identifying modifiable risk factors that protract LBP; these factors can be targeted in early intervention (EI) (Pransky, Journal of Occupational & Environmental Medicine, 49(3):249–251, 2007; Schultz et al., Journal of Occupational Rehabilitation, 17:327–352, 2007, Journal of Occupational Rehabilitation, 18(2), 140–151, 2008; White et al. 2013). This randomized controlled study evaluated the effectiveness of two approaches, fixed versus flexible, in delivering proactive, interdisciplinary EI with 63 workers within a workers' compensation interdisciplinary case management setting (i.e., WorkSafeBC, Canada). Off-work 4 to 10 weeks post-back injury, the workers were also at risk of protracted work disability (N?=?24 at high risk; N?=?39 at moderate risk). Fixed, protocol-driven, interdisciplinary, multimodal, clinical, occupational, and case management-based EI was compared with a flexible, individual need-driven EI with the same modalities as the fixed approach. Results showed a significant narrowing of the outcome gap between the two interventions. High-risk injured workers tended to benefit more from a fixed, protocol-driven approach, as shown in the pilot study (Schultz et al. Journal of Occupational Rehabilitation, 18(2), 140–151, 2008). The results indicated that moderate-risk workers benefitted from a more flexible, need-based, individual, and low-intensity approach as compared with a fixed approach. The flexible approach for moderate-risk workers was also less costly and consumed fewer rehabilitation and health care resources. Recommendations for future research and practice included larger sample sizes, controllability of research interventions, risk for disability-EI matching, and conditions under which a flexible delivery of multimodal EI is more efficacious than a fixed approach, and vice versa.     

Rapid Assessment Exploring Impediments to Successful Prosecutions of Sex Traffickers of U.S. Minors

Critical psychological, systemic, and legislative barriers to the successful prosecution of child sex traffickers who exploit U.S. citizens were uncovered during a rapid assessment conducted in a U.S. metropolitan region considered a high intensity child prostitution area. Information obtained during 34 face-to-face interviews with criminal justice professionals most likely to encounter child sex trafficking victims was supported by the collection of supplementary quantitative data. Findings revealed complex psychological factors that deter victim participation in prosecutions of traffickers such as child victims’ denial of exploitation, trauma bonding between victims and traffickers, and frequent flight and revictimization. Existing inadequacies within the criminal justice system were found that may contribute to child sex trafficking persisting as a low risk/high reward crime.     

TRENDS IN CHILD PROTECTION MEDIATION: RESULTS OF THE THINK TANK SURVEY AND INTERVIEWS

Several child protection conflict resolution program directors and researchers talked about how best to initiate a networking effort for their field. In September 2007, their conversations culminated in a Think Tank in Columbus, Ohio. This was a collaboration of judges, program directors, researchers, and representatives from national organizations that work in child protection. Participants felt this was a successful effort and that the meeting provided networking opportunities and many provocative discussions. In order to facilitate a meeting that would be meaningful for the Think Tank participants, input was solicited from as many constituent groups as possible. Surveys and interviews were completed in the summer of 2007, which shed light on themes that were ripe for discussion and improvement. This article details the survey and interview results and includes some brief comments from the Think Tank itself. Thoughts about future research in child protection conflict resolution are also provided.     

Evaluation of aortic injury in driver fatalities occurring in motor vehicle accidents in the State of Maryland for 2003 and 2004

Incorporating epidemiological and pathologic factors, a retrospective analysis of aortic injury and driving fatalities was conducted. To better understand the mechanism of injury, data were compiled for decedent demographics, autopsy and toxicology findings, and accident circumstances, with emphasis on directional impact. Review of the autopsy files of the Office of the Chief Medical Examiner in the State of Maryland in 2003 and 2004, identified 150 cases of aortic injury recorded in 537 autopsied drivers. Aortic lacerations occurred in 96% of the cases with aortic injury, two thirds of which were complete or near complete transections. A large percentage of cases involved a side impact collision. Consistent with extant research on frontal and lateral impacts, the majority of aortic injuries occurred at the ligamentum arteriosum. Also, the mechanism of aortic injury seems to be similar for side and frontal impact collisions, involving a combination of rapid deceleration forces along with chest and/or upper abdominal compression. This study emphasizes the importance of side impact collisions as a cause of aortic injury. Aortic lacerations have a high mortality rate and better motor vehicle design may prevent this type of injury.     

THE BEST INTERESTS OF THE CHILD

Despite heavy use of the concept of the "best interests" of the child, there is little consensus about what criteria constitute a child's best interests or how these criteria should be applied. This article explores some of the problems of the best interest concept, from the developmental and psychological perspective, and suggests that the concept is a worthwhile one if decision makers are able to go beyond cliches and superficial definitions.