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Introduction: Perioperative transfusion guidelines for pediatric sickle cell disease (SCD) patients are underdeveloped. The American Society of Hematology (ASH) provides transfusion recommendations for procedures requiring general anesthesia and lasting >1 hour. However, many pediatric SCD patients require long term central venous access and these short procedures do not fall within these guidelines. The objective of this study is to investigate our institutional preoperative transfusion practices in central venous access procedures. Methods: A retrospective chart review was performed from 2018 to 2022 of SCD patients who underwent a line placement or removal at a stand-alone quaternary care children's hospital. Clinical information including demographics, Hgb levels, number of transfusions, and postoperative complications were collected. Statistical analysis was performed using Fisher exact and Wilcoxon rank sum tests. Results: A total of 30 patients underwent 34 venous access procedures (76 % line placement, 36 % line removal). Half of the patients (15) had an initial Hgb 9 g/dL. Significantly more patients received a preoperative blood transfusion in patients with a Hgb 9 g/dL (73% vs 20 %, p = 0.01) Length of stay, postoperative complications, intraoperative transfusion, and readmission rates were not significantly different in patients who received a preoperative transfusion. Conclusion: We encountered variability in the preoperative transfusion threshold; however, outcomes remained similar with no significant differences based on preoperative Hgb. Future studies focused on quality, safety, and resource allocation are needed for development of practice recommendations.

Background: This study examined the transition to telehealth services during the COVID-19 pandemic in terms of attendance rates, the provision of evidence-based interventions, and clinical outcomes. Methods: The feasibility of in-person versus telehealth visits for integrated primary care sessions was compared using chart review data. Data on patient characteristics, attendance, symptom severity and improvement, and evidence-based intervention use were collected for patients (N = 173) from an integrated primary clinic that primarily serves a low-income, diverse sample of adults and children whose primary presenting problems are depression and anxiety. Results: Attendance significantly improved after the transition to telehealth, as indicated by fewer cancellations and more appointments attended. Patients showed significant improvement and decreases in symptoms. The quality of care was maintained, as indicated by consistent evidence-based intervention use over time. Limitations: This study was limited by the fact that it took place in an academically-affiliated primary care clinic, which may not be representative of all community settings. In addition, analyses related to clinical symptoms were only conducted with a small subset of participants and there was no comparison group. Conclusions: Telehealth through integrated primary care might be a viable option to improve accessibility of mental health services for low-income, racial/ethnic minority adults and children.

Multiple assessment studies demonstrate that juvenile offenders are at increased risk for contracting HIV and other STIs relative to their non-offending counterparts. Such data are used to support the implementation of adolescent HIV prevention interventions within the juvenile justice system. Despite the compelling data related to high rates of unprotected sexual activity, pregnancy, STIs, substance use and psychiatric symptoms, there are very few empirically supported HIV prevention interventions for this adolescent subgroup. Using our experience conducting HIV prevention research studies with court-involved, non-incarcerated (CINI) youth we identify salient and unique challenges to consider when conducting HIV prevention intervention research with this population. Obstacles to consider include lack of "buy-in" and engagement from justice staff and families about the need for youth sexual health promotion and HIV prevention services and logistical barriers (time, transportation, space) related to conducting intervention research with a community-based sample of justice-involved youth. We consider these various challenges and provide recommendations for researchers on how to overcome barriers to continue to develop evidence-based HIV prevention services for communities of youth in need.

Given the continued increases in proportion of young girls entering the juvenile justice system, identifying factors to incorporate into gender responsive programming for these youth is of paramount importance to improving their behavioral health and legal outcomes. Psychiatric factors, including sexual abuse, marijuana use and HIV/STI sexual risk behaviors have been studied, but among detained youth. With increased emphasis on diverting young girls from incarceration, informing prevention and intervention programs about girls' psychiatric symptom profile and co-occurring risk behavior while in the community, but court-involved is of timely relevance. Therefore preliminary associations, by gender, between psychiatric symptoms, history of sexual abuse, substance use and HIV/STI sexual risk behavior among a pilot sample (N=60) of court-involved, non-incarcerated (CINI) youth were explored. Results from chi-square and t-test analysis indicate important gender differences. Girls have higher rates of depression and trauma symptoms, report higher rates sexual abuse and sexual risk behavior. These results provide some initial data related to risk factors for community supervised samples that can be used to begin to inform gender-specific juvenile justice programming.

Approximately 80% of all arrested youth are diverted from detention and supervised in the community through probation, specialty courts and other community-based diversion efforts. Justice-involved youth have greater psychiatric impairment, substance use and sexual risk behaviors than their non-justice-involved peers. Family-based interventions to address mental health, substance use and recidivism have been successful in improving these youth outcomes; but the lack of integration of HIV/STI prevention is notable given the co-occurrence of substance use, delinquency and sexual risk-taking behaviors among justice-involved youth. Moreover, emotion dysregulation may be an important and understudied underlying construct of these co-occurring risk behaviors for justice-involved youth. Study participants were 47 caregiver-youth dyads enrolled in a juvenile drug court program. As part of a pilot efficacy trial, dyads were randomized to a 5-session family-based integrated substance use and HIV/STI prevention intervention that relied on affect management strategies for risk reduction or an adolescent-only psychoeducation condition matched for time and attention. Data collected at baseline and 3months post-intervention suggest that a family-based integrated affect management substance use and HIV prevention pilot intervention may lead to justice-involved youths' enhanced motivation to change their marijuana use, decreased marijuana use and decreased risky sexual behavior over time. Future research is required to replicate these pilot trial findings and should also examine family-level mediators and moderators of treatment response, particularly with respect to HIV prevention efforts for these youth.

Young female offenders represent a growing number of young offenders. Studies have shown that youth in the juvenile justice system, particularly young females, report higher rates of lifetime sexual abuse than their nonoffending peers. The aim of this study was to examine gender differences in risk factors for recidivism, including a history of sexual abuse, among a juvenile court clinic sample. Findings suggest that, even after accounting for previously identified risk factors for recidivism such as prior legal involvement and conduct problems, a history of sexual abuse is the most salient predictor of recidivism for young female offenders, but not for males. The development of gender-responsive interventions to reduce juvenile recidivism and continued legal involvement into adulthood may be warranted.

Juvenile offenders have disproportionately high rates of psychiatric and substance use disorders relative to their nonoffending counterparts. Less is known about the impact of psychiatric and substance use disorders on repeat juvenile justice involvement among juveniles specifically referred for forensic mental health evaluations. We describe the demographic, psychiatric, and legal history background of 404 juveniles who underwent a court clinic forensic mental health evaluation, and we examine the association between these factors and detention rates of 20 percent over a 12-month post-evaluation period. After accounting for known predictors of reoffending, such as prior offense history and externalizing disorders, dual diagnosis (i.e., co-occurring psychiatric and substance use disorders) remained a salient predictor of future detention. Consistent with prior literature on juvenile offending, substance use may greatly enhance the likelihood of subsequent detention.

Court-involved youth living in the community represent a vulnerable, yet understudied, group that is at risk for a variety of concerning outcomes including increased suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). Additionally, sleep disruption, which has been associated with an increase in impulsive decision making, appears to be disproportionately high in this population. However, little is known about any connection between poor sleep and increased suicide risk and NSSI in a group of youth. This study explores the associations between sleep disruption, suicidal ideation, suicide attempts, and NSSI in a sample of court-involved youth in the community referred for mental health evaluation at a court-based mental health clinic. Findings suggest that sleep disruption is related to NSSI in this population but not suicidal ideation and suicide attempts. Additional relationships were found between NSSI and being female, as well as having a lifetime history of trauma and marijuana use. Findings suggest that court clinics may wish to screen for sleep disruption as a risk factor for NSSI, and future studies may wish to explore improved sleep as a protective factor for CINI youth. [ABSTRACT FROM AUTHOR]

Family-based interventions targeting parenting factors, such as parental monitoring and parent-child communication, have been successful in reducing adolescent offenders' substance use and delinquency. This pilot, exploratory study focuses on family and parenting factors that may be relevant in reducing juvenile offenders' substance use and sexual risk taking behavior, and in particular examines the role of family emotional involvement and responsiveness in young offenders' risk-taking behaviors. Participants included 53 juvenile drug court offenders and their parents. Results indicate that poor parent-child communication is associated with marijuana use and unprotected sexual activity for young offenders; however, family affective responsiveness is also a significant unique predictor of unprotected sexual activity for these youth. Findings suggest that interventions focused on improving parent-child communication may reduce both marijuana use and risky sexual behavior among court-involved youth, but a specific intervention focused on improving parents and young offenders' ability to connect with and respond to one another emotionally may provide a novel means of reducing unprotected sexual risk behaviors.

In line with the cognitive-contextual framework proposed by Grych and Fincham (1990), evidence suggests that children exposed to interparental conflict (IPC) are at risk for experiencing conflict within their own intimate relationships. The mediating role of adolescent appraisal in the relation between IPC and adolescent dating behavior was examined in the current study. Specifically, it was hypothesized that self-blame and threat appraisals would mediate the relation between IPC and adolescent maladaptive dating behaviors. To examine the potential mediating role of appraisal, 169 high school students completed the Children's Perception of Interparental Conflict (Grych, Seid, & Fincham, 1992) and Child and Adolescent Dating Relationships Inventory (Wolfe, Scott, Reitzel-Jaffe, Wekerle, Grasley, & Straatman, 2004). Findings suggest that self-blame appraisal partially mediated the relation between IPC and adolescent sexual aggression, and between IPC and adolescent threatening behavior. In addition, perceived threat appraisal partially mediated the relation between IPC and adolescent sexual aggression. Implications for the current findings are discussed. (Contains 1 table and 2 figures.)

Research consistently shows that children exposed to interparental conflict are at-risk for experiencing psychopathology. Establishing a link, however, between interparental conflict and maladjustment is not the same as understanding "how" specific outcomes manifest. Therefore, we examined the relation of interparental conflict and appraisal with adolescent outcome with 169 high school students (ages 14-19 years). Specifically, threat and self-blame appraisals were hypothesized to mediate the relation between interparental conflict and both adaptive and maladaptive outcomes. Results suggest that threat partially mediated the relation between interparental conflict and externalizing problems, interparental conflict and internalizing problems, and interparental conflict and adaptive behaviors. Additionally, self-blame appears to partially mediate the relation between interparental conflict and internalizing problems. Implications of the current findings are discussed.