Preparing to "Live a Life of Possibilities": Experiences of Healthcare Providers Readying Autistic Adolescents and Their Families for Independent Driving.

Autistic adolescents and their families may experience barriers to transportation, including independent driving, which is critical to supporting quality of life and engagement in social, educational, and employment opportunities. Healthcare providers may feel unprepared to provide guidance to autistic adolescents, although they are among the professionals families turn to for guidance. This study describes providers' experiences supporting autistic adolescents and families in the decision to pursue licensure and identifies barriers experienced in providing support. We conducted interviews with 15 healthcare providers focused on how they support autistic adolescents and their families in navigating topics related to independence, driving, and transportation. Key themes identified included: importance of understanding adolescents' perspectives and motivations, approaches to readying caregivers for children to pursue driving, and role of providers in fostering agreement between adolescents and caregivers. Results reflect healthcare providers as intermediaries between autistic adolescents and caregivers making the decision to pursue licensure and bring families to consensus. Our findings emphasize the importance of healthcare providers, in collaboration with community-based providers, in supporting autistic adolescents and their families considering licensure. Improving conversations between providers and families provides opportunity to better support quality of life among autistic adolescents and their caregivers navigating the transition to independence.

Caregivers' Perspectives on Use of and Need for Driving Resources for Their Autistic Adolescent.

Introduction: Autistic individuals who independently travel-or commute without companionship or supervision-report feeling more connected to social, education, and employment opportunities. Despite the potential for independent transportation to improve quality of life, little is known about what transportation-related resources, specifically driving focused ones, exist for autistic individuals or how they and their families find and use them. The objectives of this study were to characterize: (1) where and how families in the United States find driving-related resources for their autistic adolescents; (2) families' perceived availability and utility of identified resources; and (3) resources families believe should be developed. Methods: We conducted semi-structured interviews with 33 caregivers of autistic adolescents aged 16-24 years without an intellectual disability. We used a directed-content approach to develop and implement codes; three trained coders analyzed all transcripts (inter-rater reliability ≥0.8 for all codes). Members of the research team reviewed coded data and created code summaries, which were then developed and discussed by the larger research team to determine final consensus. Results: Caregivers described a few existing resources that were helpful in guiding driving-related decisions. In addition, caregivers voiced that there were limited resources tailored to the unique needs that arise while teaching or learning how to drive, particularly ones that support their own and their adolescent's mental health. The limited resources and services identified as helpful-specifically support groups/perspectives of other families and specialized driving instructors-are seemingly difficult to find, costly, and/or perceived as having geographic- and time-related barriers. Conclusion: There is a critical need and opportunity for stakeholders of the autism community to both expand access to existing and develop novel driving-related resources for families with autistic adolescents, with a particular focus of supporting caregiver and adolescent mental health.

Why is this an important issue?: Many autistic teens and young adults rely on caregivers, siblings, family, and friends to give them rides to the places they need to go. Research has found that resources and services created specifically for autistic people can help them decide whether driving is right for them, and if so, then learn how to drive. However, little is known about if, and if so how, families find or use these resources and services. What was the purpose of this study?: This study had three goals: (1) learn what driving resources and services autistic teens and young adults (and their families) use, (2) learn how they find these resources and services, and (3) learn what other things they think would help them make decisions about driving and learn how to drive. What did the researchers do?: The researchers asked 33 caregivers of autistic teens and young adults without an intellectual disability (ID) (teens and young adults were 16­24 years old) questions about their experiences finding and using driving resources and services. These conversations were recorded and later typed out word for word. What were the results of the study?: Caregivers said that they spend a lot of time looking for driving resources and services for their autistic teen or young adult. Many resources and services were not easy to use or helpful. Caregivers said that behind-the-wheel driving instructors with specific training teaching autistic individuals were the most helpful and/or wanted resource. However, caregivers also said that these instructors and their services were hard to find, cost a lot of money, and require families to spend a lot of time training with them to get results. In the future, caregivers said that making it easier to find and get driving resources and services (e.g., making them less expensive) was necessary. Caregivers also had strong interest in their family participating in support groups related to driving. What do these findings add to what was already known?: Previous research has shown that training, resources, and services designed specifically for autistic people help prepare autistic teens and young adults to drive. Before our study, it was unclear if, and if so how, families actually use these resources and services in the real world, or outside of academic research. Families in our study said that it is hard to find or get access to driving resources and services, especially those created specifically for autistic populations. This difficulty is one reason why families think it is stressful and hard for autistic teens and young adults to learn how to drive. What are the potential weaknesses in the study?: We only asked caregivers who lived in the Northeast part of the United States questions, so our findings may not be true for all families. Also, this study only asked questions to caregivers of autistic teens and young adults who did not have an ID. How will these findings help autistic adults now or in the future?: Our findings can help autistic teens and young adults by showing what resources and services families use and want to use while they are learning how to drive or making decisions about if driving is right for them.

Variation in drivers' seat belt use by indicators of community-level vulnerability.

INTRODUCTION: Examining crash reports with linked community-level indicators may optimize efforts aimed at improving traffic safety behaviors, like seat belt use. To examine this, quasi-induced exposure (QIE) methods and linked data were used to (a) estimate trip-level seat belt non-use of New Jersey (NJ) drivers and (b) determine the degree to which seat belt non-use is associated with community-level indicators of vulnerability. METHOD: Driver-specific characteristics were identified from crash reports (age, sex, number of passengers, vehicle type) and licensing data (license status at the time of the crash). Geocoded residential addresses were leveraged within the NJ Safety and Health Outcomes warehouse to create quintiles of community-level vulnerability. QIE methods were applied to estimate trip-level prevalence of seat belt non-use in non-responsible, crash-involved drivers between 2010-2017 (n = 986,837). Generalized linear mixed models were then conducted to calculate adjusted prevalence ratios and 95 % confidence intervals for being unbelted for driver-specific variables and community-level indicators of vulnerability. RESULTS: Drivers were unbelted during 1.2 % of trips. Males, those with suspended licenses, and those without passengers had higher rates of being unbelted than their counterparts. An increase was observed in traveling unbelted with increasing quintiles of vulnerability, such that drivers in the most vulnerable communities were 121 % more likely to be unbelted than those in the least vulnerable communities. CONCLUSIONS: Prevalence of driver seat belt non-use may be lower than previously estimated. Additionally, communities with the highest amount of the population living with three or more indicators of vulnerability have higher rates of seat belt non-use; this may be a particularly useful metric to inform future translational efforts improving seat belt use. PRACTICAL APPLICATIONS: As evidenced by the findings that risk of being unbelted increased as drivers' community vulnerability increased, novel communication efforts tailored to drivers from vulnerable neighborhoods may optimize efforts.

Brief Report: Healthcare Providers' Discussions Regarding Transportation and Driving with Autistic and Non-autistic Patients.

OBJECTIVE: To characterize healthcare and behavioral service providers' transportation-related discussions with their autistic and non-autistic patients. METHOD: 78 providers completed a cross-sectional survey assessing their transportation discussions with patients. We used Mann-Whitney U tests and chi-square tests to compare differences in provider reports by patient diagnosis. RESULTS: Compared with one in two providers who reported they discuss transportation with non-autistic patients, only one in five have these conversations with their autistic patients. Few (8%) providers felt prepared to assess driving readiness in autistic patients, yet only a quarter refer patients elsewhere. CONCLUSION: There is a critical need to develop resources for use in medical settings to effectively support autistic adolescents' independence and mobility as they transition into adulthood.

Restraint use characteristics among crash-involved child passengers: identifying opportunities to enhance optimal restraint use.

OBJECTIVE: Our objective was to describe child passenger restraint use in police reported crashes by key child and driver characteristics. METHODS: We used data from 2017-2019 police reported crashes in New Jersey to identify child passengers who: (1) were less than 13 years of age, (2) were in an identified seating location in the first, second, or third vehicle row, and (3) had a known restraint status at the time of the crash. We described prevalence of child restraint use by key child and driver characteristics (child: age, sex, seating position, and crash-reported injury status; driver: age, sex, restraint use, evidenced alcohol use, and crash fault). We included 108,780 crash-involved child passengers in our analytic sample. RESULTS: A small proportion of child passengers were unrestrained at the time of the crash. Most child passengers <2 years were restrained in a rear-facing restraint (59.7%). However, a sizeable proportion were either forward-facing (26.7%) or belted (11.3%). Use of booster seats among passengers age 5 to 8 years was limited. We observed few fatalities, with most children noted to have no apparent injury (89.8%). Among children with serious, minor, and possible injuries, the greatest proportion of injured children were restrained by the vehicle belt. Regarding driver characteristics, slightly more than half of child passengers riding in vehicles driven by drivers aged 21-34 years were restrained in either rear- or forward-facing restraints (53.0%), whereas the majority of children riding with younger (<21 years) or older (>34 years) drivers were restrained with the vehicle belt. Among unrestrained drivers, drivers with evidence of alcohol use, and drivers at fault for the crash, a larger proportion of children were unrestrained compared to drivers who were restrained, had no evidence of alcohol use, and were not at fault. CONCLUSIONS: While most child passengers were restrained at the time a crash, optimal age-based restraint use was inconsistent, particularly for the youngest child passengers. A sizeable proportion of drivers in this study failed to adhere to best practice recommendations for child restraint use and New Jersey child passenger restraint laws. This was particularly true for drivers who engaged in unsafe driving behaviors, for whom a larger proportion child passengers were unrestrained at the time of the crash. Across all injury categories, the greatest proportion of injured children were restrained by the vehicle belt rather than a child restraint system, suggesting a continued need to understand specific patterns of injuries to inform possible mitigation efforts. Future work to identify intervention opportunities for optimal child restraint practices for drivers is essential to enhancing child passenger safety.

Assault-Related Concussion in a Pediatric Population.

OBJECTIVES: The aim of this study was to compare demographic characteristics, medical care, and outcomes among patients with assault-related concussion (ARC) versus sports and recreation-related concussion (SRC). METHODS: We conducted a retrospective chart review of 124 patients (62 ARC, 62 SRC) aged 8 to 17 years presenting to the care network of a large tertiary care pediatric hospital between July 1, 2012, and June 30, 2014 with a concussion diagnosis at time of presentation. We abstracted patient demographics, initial medical care visit characteristics, and outcome data, and compared proportions using χ2 testing and Fisher exact test and medians using Wilcoxon rank sum test. RESULTS: Patients with ARC were more likely to be Black, publicly insured, and present first for care to the emergency department. Significantly fewer patients with ARC received visio-vestibular testing at initial visit (27% vs 74%, P < 0.001). During recovery, the total number of reported physical, cognitive, emotional, and sleep symptoms did not differ between groups; however, more than twice as many patients with ARC reported decline in grades postinjury compared with patients with SRC (47% vs 20%, P = 0.012). There were trends toward prolonged symptom recovery and time to physician clearance for full return to activities among patients with ARC compared with SRC. CONCLUSIONS: This study highlights potential disparities in the initial evaluation and outcomes of pediatric concussion patients based on mechanism of injury. Patients with ARC were less likely to receive a concussion-specific diagnostic evaluation and reported a greater impact on educational outcomes, suggesting differences in concussion diagnosis and management among assault-injured patients. Further examination in larger populations with prospective studies is needed to address potential inequities in concussion care and outcomes among patients with ARC.

Improving identification of crash injuries: Statewide integration of hospital discharge and crash report data.

OBJECTIVE: The availability of complete and accurate crash injury data is critical to prevention and intervention efforts. Relying solely on hospital discharge data or police crash reports may result in a biased undercount of injuries. Linking hospital data with crash reports may allow for a more robust identification of injuries and an understanding of which populations may be missed in an analysis of one source. We used the New Jersey Safety and Health Outcomes (NJ-SHO) data warehouse to examine the share of the entire crash-injured population identified in each of the two data sources, overall and by age, race/ethnicity, sex, injury severity, and road user type. METHODS: We utilized 2016-2017 data from the NJ-SHO warehouse. We identified crash-involved individuals in hospital discharge data by applying the ICD-10-CM external cause of injury matrix. Among crash-involved individuals, we identified those with injury- or pain-related diagnosis codes as being injured. We also identified crash-involved individuals via crash report data and identified injuries using the KABCO scale. We jointly examined the two sources; injuries in the hospital discharge data were documented as being related to the same crash as injuries found in the crash report data if the date of the crash report preceded the date of hospital admission by no more than two days. RESULTS: In total, there were 262,338 crash-involved individuals with a documented injury in the hospital discharge data or on the crash report during the study period; 168,874 had an injury according to hospital discharge data, and 164,158 had an injury in crash report data. Only 70,694 (26.9%) had an injury in both sources. We observed differences by age, race/ethnicity, injury severity, and road user type: hospital discharge data captured a larger share of those ages 65+, those who were Black or Hispanic, those with higher severity injuries, and those who were bicyclists or motorcyclists. CONCLUSIONS: Each data source in isolation captures approximately two-thirds of the entire crash-injured population; one source alone misses approximately one-third of injured individuals. Each source undercounts people in certain groups, so relying on one source alone may not allow for tailored prevention and intervention efforts.

Transition to Adulthood for Autistic Adolescents: Topics Discussed by Healthcare Providers With Autistic Patients and Families.

PURPOSE: We surveyed healthcare providers to determine the extent to which they discuss transition-to-adulthood topics with autistic patients without intellectual disabilities. METHODS: Seventy-four healthcare providers in the Philadelphia area reported on the patient age at which they begin transition conversations, topics covered, and provider comfort. We calculated the proportion of providers who endorsed each transition topic, overall and by clinical setting. RESULTS: Providers initiated transition-related conversations at a median age of 16 years (IQR: 14, 18), with over half reporting they were "somewhat" or "a little" comfortable with discussions. Nearly all providers discussed at least one healthcare, well-being, and mental health topic, while basic need-related discussions were limited. DISCUSSION: Results suggest providers may delay and feel poorly prepared to provide anticipatory guidance to autistic patients for transition to adulthood. Future efforts to enhance the available resources and preparation available to providers are essential to meet autistic patients' needs.

Behind the Wheel: Specialized Driving Instructors' Experiences and Strategies for Teaching Autistic Adolescents to Drive.

IMPORTANCE: In the transition to adulthood, driving supports independence. For autistic adolescents, training provided by specialized driving instructors, including occupational therapists, may establish fitness to drive and continued independence. OBJECTIVE: To examine specialized driving instructors' experiences providing behind-the-wheel instruction to autistic adolescents. DESIGN: We recruited participants through purposive and snowball sampling of members of ADED, the Association for Driver Rehabilitation Specialists. Interviews investigated experiences providing instruction, autistic students' strengths and challenges, strategies used, and recommendations to improve the learning-to-drive process. We coded transcripts using a directed content analysis approach. SETTING: Telephone interviews. PARTICIPANTS: Specialized driving instructors (N = 17) trained as occupational therapists, driver rehabilitation specialists, or licensed driving instructors with recent experience providing behind-the-wheel training for autistic adolescents participated. RESULTS: Behind-the-wheel challenges included mental inflexibility, distractibility, and difficulties with social cues and motor coordination. Instructors acknowledged students' strengths, including adherence to rules of the road, limited risk taking, and careful observations. Instructors scaffolded learning to help students develop skills. Although licensure and driving outcomes were sometimes unknown to instructors, students who became licensed frequently drove with supervision or restrictions. CONCLUSIONS AND RELEVANCE: Licensure is possible for autistic adolescents, although developing fitness to drive requires individualization and rigorous specialized instruction, which may culminate in delayed or restricted driving. What This Article Adds: This article highlights challenges and strengths encountered by specialized driving instructors teaching autistic adolescents. Despite requiring prolonged training, autistic adolescents can achieve licensure when supported by specialized instruction that is individualized to their needs and strengths.

Facilitating research on racial and ethnic disparities and inequities in transportation: Application and evaluation of the Bayesian Improved Surname Geocoding (BISG) algorithm.

OBJECTIVE: Racial and ethnic disparities and/or inequities have been documented in traffic safety research. However, race/ethnicity data are often not captured in population-level traffic safety databases, limiting the field's ability to comprehensively study racial/ethnic differences in transportation outcomes, as well as our ability to mitigate them. To overcome this limitation, we explored the utility of estimating race and ethnicity for drivers in the New Jersey Safety and Health Outcomes (NJ-SHO) data warehouse using the Bayesian Improved Surname Geocoding (BISG) algorithm. In addition, we summarize important recommendations established to guide researchers developing and implementing racial and ethnic disparity research. METHODS: We applied BISG to estimate population-level race/ethnicity for New Jersey drivers in 2017 and evaluated the concordance between reported values available in integrated administrative sources (e.g., hospital records) and BISG probability distributions using an area under the receiver operator curve (AUC) within each race/ethnicity category. Overall AUC was calculated by weighting each AUC value by the population count in each reported category. In an exemplar analysis using 2017 crash data, we conducted an analysis of average monthly police-reported crash rates in 2017 by race/ethnicity using the NJ-SHO and BISG sets of race/ethnicity values to compare their outputs. RESULTS: We found excellent or outstanding concordance (AUC ≥0.86) between reported race/ethnicity and BISG probabilities for White, Hispanic, Black, and Asian/Pacific Islander drivers. We found poor concordance for American Indian/Alaskan Native drivers (AUC= 0.65), and concordance was no better than random assignment for Multiracial drivers (AUC = 0.52). Among White, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan native drivers, monthly crash rates calculated using both NJ-SHO reported race/ethnicity values and BISG probabilities were similar. Monthly crash rates differed by 11% for Black drivers, and by more than 200% for Multiracial drivers. CONCLUSION: Findings of excellent or outstanding concordance between and mostly similar crash rates derived from reported race/ethnicity and BISG probabilities for White, Hispanic, Black, and Asian/Pacific Islander drivers (98.9% of all drivers in this sample) demonstrate the potential utility of BISG in enabling research on transportation disparities and inequities. Concordance between race/ethnicity values were not acceptable for American Indian/Alaskan Native and Multiracial drivers, which is similar to previous applications and evaluations of BISG. Future work is needed to determine the extent to which BISG may be applied to traffic safety contexts.

Intimate Partner Violence: Childhood Witnessing and Subsequent Experiences of College Undergraduates.

Previous work links witnessing adult violence in the home during childhood ("witnessing") and adolescent relationship violence, but studies are limited to recent experiences with one or two outcomes, missing the holistic viewpoint describing lifetime experiences across multiple types of violence. We measured associations between witnessing and victimization (being harmed by violence) and perpetration (causing harm by violence) among males and females for the three most common types of adolescent relationship violence (physical, sexual, and emotional), and we assessed whether students experienced multiple outcomes ("polyvictimization/ polyperpetration"). We also compared sex-specific differences to assess for additive effect modification. We used an anonymous, cross-sectional survey with 907 undergraduates attending randomly selected classes at three urban East Coast colleges. Multiple logistic regression and marginal standardization were used to estimate predicted probabilities for each outcome among witnesses and non-witnesses; additive interaction by sex was assessed using quantifiable measures. 214 (24%) students reported witnessing and 403 (44%) students experienced adolescent relationship violence, with 162 (17.9%) and 37 (4.1%) experiencing polyvictimization and polyperpetration, respectively. Witnesses had higher risk than non-witnesses for physical, sexual, and emotional victimization and perpetration. Notably, witnesses also had higher risk for polyvictimization and polyperpetration. Additive effect modification by sex was insignificant at 95% confidence bounds, but distinct patterns emerged for males and females. Except for sexual victimization, female witnesses were more likely than female non-witnesses to experience all forms of victimization, including polyvictimization; they also had higher risk for perpetration, particularly physical perpetration. In contrast, victimization outcomes did not differ for male witnesses, but male witnesses were more likely than male non-witnesses to perpetrate all forms of violence, including polyperpetration.

Generating a Core Set of Outcomes for Hospital-Based Violence Intervention Programs.

Hospital-based violence intervention programs (HVIPs) engage individuals who have experienced violent victimization in postmedical care programming, with the goal of reducing the incidence and impact of future injuries. Although there is some empirical support for HVIPs' impact on violence and crime-related outcomes, proper impact assessment is limited by a lack of systematized research on outcomes that relate to the proximal goals and activities of the programs themselves. To address this critical gap, we conducted a two-stage Delphi method to elicit and prioritize these outcomes using the wisdom and experience of those who are engaged in service delivery (i.e., HVIP community-based practitioners, program coordinators, and embedded researchers; N = 79). Through this process, respondents prioritized outcomes related to posttraumatic stress symptoms, beliefs about aggression, coping strategies, and emotional regulation, which have not been consistently measured using validated or standardized tools. Results suggest that, rather than limiting program outcomes to those related to repeat violent injury or criminality, hospital- and community-based violence prevention programs seek to improve and measure mental health and socioemotional outcomes as a benchmark for healing and recovery after a violent injury. Prioritization of these outcomes broadens the definition of recovery to include psychosocial health and well-being. In addition, inclusion of these outcomes in effectiveness studies will serve to bolster the relevance of findings, and provide support for continued development and refinement of HVIP practice.

Head Impact Sensor Studies In Sports: A Systematic Review Of Exposure Confirmation Methods.

To further the understanding of long-term sequelae as a result of repetitive head impacts in sports, in vivo head impact exposure data are critical to expand on existing evidence from animal model and laboratory studies. Recent technological advances have enabled the development of head impact sensors to estimate the head impact exposure of human subjects in vivo. Previous research has identified the limitations of filtering algorithms to process sensor data. In addition, observer and/or video confirmation of sensor-recorded events is crucial to remove false positives. The purpose of the current study was to conduct a systematic review to determine the proportion of published head impact sensor data studies that used filtering algorithms, observer confirmation and/or video confirmation of sensor-recorded events to remove false positives. Articles were eligible for inclusion if collection of head impact sensor data during live sport was reported in the methods section. Descriptive data, confirmation methods and algorithm use for included articles were coded. The primary objective of each study was reviewed to identify the primary measure of exposure, primary outcome and any additional covariates. A total of 168 articles met the inclusion criteria, the publication of which has increased in recent years. The majority used filtering algorithms (74%). The majority did not use observer and/or video confirmation for all sensor-recorded events (64%), which suggests estimates of head impact exposure from these studies may be imprecise.

Teaching Autistic Adolescents and Young Adults to Drive: Perspectives of Specialized Driving Instructors.

Background: Limited transportation access may curtail education, occupational training, social, and community engagement opportunities for autistic adolescents. Nearly one-third of autistic adolescents obtain a driver's license by age 21 years, which may increase mobility and improve autistic adolescents' transition to independent adulthood. This study examined driving instructors' perspectives and experiences of teaching autistic adolescents to drive to facilitate a safe learning-to-drive process. Methods: We conducted interviews with driving instructors with specialized training to teach autistic adolescents to drive. Participants were recruited through purposive and snowball sampling. Semistructured interviews investigated family engagement; instructor observations; instructors' teaching strategies; and recommendations for improving the learning-to-drive process. A directed content analysis approach informed the development of a coding scheme. Coded transcripts were reviewed to identify themes. Results: We interviewed 17 driving instructors who primarily identified as occupational therapists. Key themes included importance of parent engagement; fostering independence; individualization of instructional strategies; and enhancements to the learning-to-drive process. Parent engagement prepared autistic students to undertake on-road instruction and supported skill development. While some families paradoxically limited adolescents' independence (e.g., heavy supervision while cooking, limiting participation in bicycling or lawn mowing) despite wanting them to pursue licensure, instructors believed that demonstrating independence in such life skills was necessary for safely undertaking on-road instruction. Instructors shared how they individualized assessments and tailored lessons over a prolonged period of time to promote safety and skill acquisition. Specific recommendations for enhancing the learning-to-drive process included standardizing instructional approaches and refining clinical assessment tools to determine driver readiness. Conclusions: Our findings highlight the need for parental engagement to support the learning-to-drive process and to foster the independence necessary to undertake highly individualized driving instruction. Efforts to increase families' access to tools to promote driving readiness and establishing best practices for instructors may enhance the efficiency and standardization of the learning-to-drive process. LAY SUMMARY: Why was this study done? Becoming licensed to drive increases the independence and mobility of adolescents, potentially improving access to educational, occupational training, social, and community engagement opportunities. Driving instructors are a critical resource for families, particularly for autistic adolescents who may receive training from specialized instructors, such as occupational therapists (OTs). However, little is known about the process and experience of teaching autistic adolescents to drive, which limits the ability to provide adolescents and families with guidance to prepare for and support the learning-to-drive process. What was the purpose of this study? The goal of this study was to examine the experiences and perspectives of driving instructors who provide behind-the-wheel training for autistic adolescents and young adults. What did the researchers do? We conducted semistructured interviews with specialized driving instructors who had experience working with autistic youth. Team members transcribed the interviews, coded them, and summarized common themes. What were the results of the study? We interviewed 17 driving instructors who primarily identified as OTs. Key themes included the importance of parents as partners, the need to encourage independence in daily living skills before driving, and the individualized approach used when working with autistic adolescents. Instructors provided suggestions for enhancing the learning-to-drive process and supporting nonspecialized instructors who also provide training to adolescents. Suggestions included enhancing the use of state-level Vocational Rehabilitation Services to provide financial support for instruction, use of a life skills checklist to identify and promote prerequisite driving skills, parent-supervised practice driving (including commentary driving where adolescents narrate driving instructions to a driver), and individualization of instruction tailored to adolescents' particular needs. What do these findings add to what was already known? These results inform efforts to prepare parents, nonspecialized instructors, and autistic adolescents themselves for undertaking on-road instruction and licensure. Instructors recommended that parents help adolescents develop independence, including skills to use alternative forms of transportation and practice predriving skills, such as navigation. Furthermore, these results highlight the need to establish best practices for instruction and refinement of tools and strategies used by both specialized and general driving instructors. What are potential weaknesses in the study? Our recruitment approach may have led instructors with similar training or opinions to participate, so important aspects of teaching autistic drivers may have not been elicited. We did not interview general driving instructors who may have different perspectives and needs that were not discussed. We were unable to determine how characteristics such as work location, race/ethnicity, or years in practice may have influenced participants' responses. How will these findings help autistic adults now or in the future? Results from this study identify tools, such as a life skills checklist, and practice activities, such as commentary driving, that can be used by families to support autistic adolescents who are learning to drive. This study highlights the need to examine experiences with the learning-to-drive process from autistic adolescents and parents themselves to understand their needs and recommendations for enhancing the process of safely learning to drive.

Witnessing intimate partner violence as a child: How boys and girls model their parents' behaviors in adolescence.

Childhood witnesses of adult violence at home are at risk for future violence. It is unclear how gender of the child and adult perpetrator are related to adolescent relationship violence. We explore how childhood witnessing of same-gender, opposite-gender, and bidirectional violence perpetrated by adults is associated with adolescent relationship violence victimization only, perpetration only, and combined victimization/perpetration for male and female undergraduates. We gathered cross-sectional data from 907 undergraduates attending 67 randomly-selected classes at three distinct East-Coast colleges using pencil-and-paper surveys administered at the end of class time. Multiple imputation with chained equations was used to impute missing data. Multinomial regression models controlling for gender, age, race, school, and community violence predicted adolescent outcomes for each witnessing exposure; relative risk ratios and average adjusted probabilities with 95% confidence intervals are presented. Adolescent relationship violence outcomes vary based on gender of the child witness and adult perpetrator. Witnessing adult males perpetrate is associated with higher perpetration for boys and higher combined victimization/perpetration for girls. Witnessing adult females perpetrate - either as the sole perpetrator or in a mutually violent relationship with an adult male - increases risk for combined victimization/perpetration for boys and girls during adolescence.

Examining a Statewide Educational Consulting Program for Pediatric Brain Injury.

This study describes characteristics of students with acquired brain injury enrolled in a statewide educational consultation program and the program's support activities. Utilizing deidentified data from a statewide brain injury school consultation program, descriptive analyses of demographic and injury characteristics, including medical diagnosis (concussion/mild traumatic brain injury [TBI], moderate-severe TBI, and non-TBI), referral characteristics, educational placement, and the types of program activities were undertaken. 70% of students were referred for concussions/mild TBI and students were infrequently referred by medical professionals. Most students with concussion/mild TBI experienced recreational injuries (59%), while students with moderate/severe TBI commonly experienced road traffic injuries (48%). The greatest proportion of program team members' time was spent in consultation with school personnel (24%), communication with families (20%), and communication with school personnel (16%). Results suggest that the program addresses important communication and coordination needs among families, medical professionals, and educators and identifies opportunities to enhance program utilization.

The Psychosocial Needs of Adolescent Males Following Interpersonal Assault.

PURPOSE: We examined the self-identified, postassault psychosocial needs of male adolescents to guide recovery and healing after being seen in an emergency department (ED) for a violence-related injury. METHODS: We analyzed deidentified data from 49 adolescent male adolescents who participated in a postdischarge case management program following a violence-related injury. Descriptive statistics summarized youths' demographic characteristics and self-identified needs and goals for postassault recovery. RESULTS: Most participants (80%) were treated for nonpenetrating injuries and discharged from the ED (76%). Nearly two thirds of youth reported clinically significant traumatic stress symptoms and 89% self-identified mental health needs following injury. Legal and educational needs were also commonly identified. CONCLUSIONS: Despite experiencing minor physical injuries, assault-injured youth report clinically significant traumatic stress symptoms and recognize postinjury mental health needs. Results suggest that youth-focused early intervention services, particularly related to mental health, are acceptable and desired by youth soon after a violent injury.

Rear seat safety: Variation in protection by occupant, crash and vehicle characteristics.

OBJECTIVES: Current information on the safety of rear row occupants of all ages is needed to inform further advances in rear seat restraint system design and testing. The objectives of this study were to describe characteristics of occupants in the front and rear rows of model year 2000 and newer vehicles involved in crashes and determine the risk of serious injury for restrained crash-involved rear row occupants and the relative risk of fatal injury for restrained rear row vs. front passenger seat occupants by age group, impact direction, and vehicle model year. METHOD: Data from the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and Fatality Analysis Reporting System (FARS) were queried for all crashes during 2007-2012 involving model year 2000 and newer passenger vehicles. Data from NASS-CDS were used to describe characteristics of occupants in the front and rear rows and to determine the risk of serious injury (AIS 3+) for restrained rear row occupants by occupant age, vehicle model year, and impact direction. Using a combined data set containing data on fatalities from FARS and estimates of the total population of occupants in crashes from NASS-CDS, logistic regression modeling was used to compute the relative risk (RR) of death for restrained occupants in the rear vs. front passenger seat by occupant age, impact direction, and vehicle model year. RESULTS: Among all vehicle occupants in tow-away crashes during 2007-2012, 12.3% were in the rear row where the overall risk of serious injury was 1.3%. Among restrained rear row occupants, the risk of serious injury varied by occupant age, with older adults at the highest risk of serious injury (2.9%); by impact direction, with rollover crashes associated with the highest risk (1.5%); and by vehicle model year, with model year 2007 and newer vehicles having the lowest risk of serious injury (0.3%). Relative risk of death was lower for restrained children up to age 8 in the rear compared with passengers in the right front seat (RR=0.27, 95% CI 0.12-0.58 for 0-3 years, RR=0.55, 95% CI 0.30-0.98 for 4-8 years) but was higher for restrained 9-12-year-old children (RR=1.83, 95% CI 1.18-2.84). There was no evidence for a difference in risk of death in the rear vs. front seat for occupants ages 13-54, but there was some evidence for an increased relative risk of death for adults age 55 and older in the rear vs. passengers in the right front seat (RR=1.41, 95% CI 0.94-2.13), though we could not exclude the possibility of no difference. After controlling for occupant age and gender, the relative risk of death for restrained rear row occupants was significantly higher than that of front seat occupants in model year 2007 and newer vehicles and significantly higher in rear and right side impact crashes. CONCLUSIONS: Results of this study extend prior research on the relative safety of the rear seat compared with the front by examining a more contemporary fleet of vehicles. The rear row is primarily occupied by children and adolescents, but the variable relative risk of death in the rear compared with the front seat for occupants of different age groups highlights the challenges in providing optimal protection to a wide range of rear seat occupants. Findings of an elevated risk of death for rear row occupants, as compared with front row passengers, in the newest model year vehicles provides further evidence that rear seat safety is not keeping pace with advances in the front seat.

Validation of Parent-Reported Injuries to Their Children.

OBJECTIVE: Injury is a leading cause of emergency department visits, disability, and death in children. This study examined the sensitivity and specificity of parental report of children's specific injuries. METHODS: A prospective validation study was conducted in 3 urban pediatric emergency departments from August 2010 to July 2011. Parents of injured children completed a survey at 2-weeks following the emergency department visit, and their responses were compared to injury data that were abstracted from medical records. RESULTS: Parent surveys were completed for 516 injured children. Sensitivities were ≥0.75 for all fractures and ≥0.88 for extremity and skull fractures. Internal organ injuries were generally less accurately reported by parents than fractures. Specificity estimates all exceeded 0.95. CONCLUSIONS: This telephone-administered and mailed self-administered survey enabled parents to accurately report specific head and extremity injuries. PRACTICAL APPLICATIONS: This survey may be a useful tool for pediatric injury surveillance activities.

Extending the value of police crash reports for traffic safety research: collecting supplemental data via surveys of drivers.

BACKGROUND: Police crash reports have been used to advance motor vehicle safety research, though their value is limited by their focus on the crash event rather than outcomes of the crash. OBJECTIVE: To develop and evaluate the effect of enhanced recruitment methods, including a monetary incentive, on response rates of drivers identified on police reports in a national MVC surveillance system. METHODS: The National Automotive Sampling System-General Estimates System (NASS-GES) was used to identify passenger vehicle crashes between 1 July and 30 October 2012 involving drivers ≥16 years old with at least one child occupant ≤17 years old. We collected data from the driver via self-administered hardcopy or interviewer-administered telephone surveys. Within each survey mode, half the drivers were randomly assigned to receive a small monetary incentive. Response rates were calculated overall, and by mode of survey administration and incentive condition. RESULTS: 495 drivers were eligible, and 127 completed the survey, yielding an overall response rate of 25.7% (95% CI 21.8% to 29.5%). The response rate across the two modes was higher for those who received an incentive than for those who did not (35.6% vs 15.7%, p<0.01). The highest response rate (45.9%) was for drivers allocated to the telephone survey who received an incentive. CONCLUSIONS: The NASS-GES provides a surveillance system from which cases of interest can be identified and supplemental data collected via surveys of drivers identified on police reports. We adapted procedures commonly used in public health surveillance systems, including monetary incentives and branded recruitment materials, to improve driver response rates.