Knocking at the wrong door: insured workers' inadequate psychiatric care and workers' compensation claims

ObjectiveTo describe the prevalence of inadequately evaluated and treated psychopathology among insured workers making workers' compensation claims for psychiatric disability whose cases were reviewed by one forensic psychiatrist. To assess the relationship of inadequate evaluation and treatment to the outcomes of these workers' compensation claims.MethodsRecords of a series of 185 workers' compensation cases reviewed in 1998 and 1999 by a California forensic psychiatrist were abstracted. Patient factors (gender, Axis II pathology, psychosocial circumstances, substance abuse), case factors (psychiatric injury secondary to physical injury, or secondary to psychological stresses), type of provider (mental health, or other), adequacy of evaluation and treatment, forensic psychiatrist's recommendation, and claim outcome were categorized. The relationships between case characteristics, adequacy of care, and claim outcome were described.Results22% of cases had adequate evaluation, 48% superficial, and 30% had no evaluation. 11% had adequate treatment, 67% superficial, and 22% had no treatment. Compared to claims for psychiatric disability related to a physical injury, claims related to psychosocial stresses more often had superficial diagnostic evaluations and treatments. Those with superficial treatment were less likely to have their claim granted (19.3%) than those with no treatment (47.5%) or those with adequate treatment (36.8%). Success of claim was not related to provider type.ConclusionsThe majority of the studied workers with employer-provided health insurance who sought workers' compensation for disability due to mental illness did so inappropriately, in that the workplace did not cause the psychopathology. Their seeking workers' compensation was plausibly due to the observed inadequate evaluation and treatment available through their employer-provided health insurance. The adequacy of their care influenced the likelihood their claim would be granted. The relations observed here merit further research to establish their generality and to determine their causes.     

Doctors and AIDS

Just a year ago most authorities considered the chances of patients contracting AIDS from doctors and other healthcare workers a virtual impossibility. But last week a Florida woman who got AIDS from her dentist lay near death, and two Minneapolis physicians admitted they had treated hundreds of patients since being diagnosed with the virus. Although doctors are at far greater risk than patients, the Minneapolis cases renewed the debate over the right of sides to know each other's HIV status.     

Genetic and Environmental Influences on the Association Between Pubertal Maturation and Internalizing Symptoms

The literature consistently shows an association between pubertal maturation and internalizing problems in girls. The association for boys is less clear. The present study examines genetic and environmental influences on the association between pubertal maturation and internalizing problems for boys and girls in two primarily Caucasian adolescent twin/sibling studies: The Swedish Twin study of CHild and Adolescent Development (706 same-sex twin pairs aged 13-14, M = 13.7 years, 50 % female), and the Nonshared Environment in Adolescent Development sample (US-based, 687 same-sex twin/sibling pairs aged 10-18, M = 13.6 years, 47 % female). For girls, more advanced pubertal maturation was associated modestly with more internalizing problems, and that association was entirely explained by shared environmental influences. For boys, the association between pubertal maturation and internalizing problems was weak and inconsistent. Results for girls were remarkably consistent across samples. Findings suggest that nongenetic mechanisms mediate the association between pubertal maturation and internalizing problems. Findings have implications for intervention such that environmental influences shared by twins/siblings may provide the best targets for intervention strategies designed to minimize the potential negative effects of pubertal maturation on internalizing symptoms in girls.     

LESSENING THE STING OF ASFA: THE REHABILITATION‐RELAPSE DILEMMA BROUGHT ABOUT BY DRUG ADDICTION AND TERMINATION OF PARENTAL RIGHTS

Congress passed the Adoption and Safe Families Act of 1997 (ASFA) as a response to children waiting in foster homes for years without permanent placement. In addressing the problem of permanency, however, Congress set a strict limit on how long a child could be in foster care (15 out of the most recent 22 months) before a state must either commence a proceeding to terminate parental rights or else lose valuable federal funding. Due to health care funding schemes and quality of treatment, this requirement, in particular, negatively impacts parents currently in drug rehabilitation whose parental rights may be permanently terminated before a realistic chance to recover is permitted. Although ASFA requires that states make “reasonable efforts” to keep families united, it does not define “reasonable efforts,” leaving parental rights and family unity subject to a chaotic interpretation of this requirement from state to state. “Reasonable efforts” should be interpreted to take into account current drug addiction and recovery research and drug court programs should be used to facilitate this goal. Research has shown that focusing on adequate treatment saves states money and improves the lives of children and their families, reducing the need for reliance on termination of parental rights.     

Innovative Governance in a Federal Europe: Implementing the Convention on the Rights of Persons with Disabilities

A recent development in European law, less heralded, but no less path‐breaking than the Treaty of Lisbon, was the ratification by the EU of its first human rights treaty—the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Concluded as a mixed agreement, the CRPD's pioneering monitoring mechanisms demand a high level of cooperation from both the Union and its Member States. It, thus, provides an opportunity for the Union to further develop a distinctly European notion of federalism by the use of new, innovative governance mechanisms. This article looks at the Union as a federalist project through the prism of the mixed agreement, and specifically the ways that federalism may be balanced within it, using the CRPD as an example. Although the Union has an existing Code of Conduct under the Convention, it lacks true engagement with these issues, and this article proposes changes to that end.