Defense

medicine

OU College of Medicine and US Department of Defense to address problematic sexual behavior of youth

When young people act out sexually in ways that are harmful to others or themselves, the stigma surrounding the issue can be paralyzing for everyone affected. However, data shows that treatment for problematic sexual behavior in youth is highly effective.

Faculty members at the University of Oklahoma Health Sciences Center are among the nation’s leaders on this topic, and they recently received a federal grant to assist the U.S. Department of Defense in addressing problematic sexual behavior of youth in the military.

The National Center on the Sexual Behavior of Youth (NCSBY) is housed within the OU College of Medicine, Department of Pediatrics.

Its personnel have been trailblazers in the research and treatment of problematic sexual behavior of youth, and in training parents, caregivers, healthcare providers and others around the world to prevent and respond to incidents.

NCSBY’s new work is funded by the Office of Juvenile Justice and Delinquency Prevention, a component of the U.S. Department of Justice.

NCSBY is assisting the U.S. Department of Defense in developing training materials and resources to address the issue of youth problematic sexual behavior in all branches of the military.

This is an issue that communities and people worldwide struggle to address.”


Jane Silovsky, Ph.D, Clinical Child Psychologist and Director, National Center on the Sexual Behavior of Youth, University of Oklahoma

“But the Department of Defense has done a remarkable job of understanding the science about the appropriate response to the children with behavior problems, as well as their caregivers and the children who are impacted.”

In many cases, problematic sexual behavior in youth involves one young person harming another young person, Silovsky said. Studies show the behavior peaks between the ages of 12 and 14, and that young people rarely act out on strangers; most of the time, they’re acting out on siblings, cousins, schoolmates and others within their social networks.

Exposure to violence is a major risk factor, whether it’s domestic violence, physical abuse, harsh parenting practices, or community violence.

Exposure to sexualized media is another risk factor; young people can access pornography on any device, despite the best efforts of their caregivers, Silovsky said. In addition, there are individual risks, such as a child having developmental disabilities, being on the autism spectrum and having impulse disorders.

“These risk factors can impact children’s emotional regulation skills, impulse control skills, and their understanding of the rules and how you treat others,” Silovsky said.

“A common myth is that all youth with problematic sexual behavior are being sexually abused themselves. While sexual abuse is a risk factor and a concern, there are many kids with problematic sexual behavior have not been sexually abused.”

Nor are children with problematic sexual behavior the same as adults who have illegal behaviors or adults with pedophilia who have inappropriate arousal toward children, Silovsky said, and treating them as adults does more harm than good.

Rather, the approach involves cognitive behavioral therapy, in which

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medicine

OU College of medicine partners with US Department of Defense

IMAGE

IMAGE: Jane Silovsky, Ph.D.,
Director of the National Center on the Sexual Behavior of Youth
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Credit: OU Health

OKLAHOMA CITY — When young people act out sexually in ways that are harmful to others or themselves, the stigma surrounding the issue can be paralyzing for everyone affected. However, data shows that treatment for problematic sexual behavior in youth is highly effective. Faculty members at the University of Oklahoma Health Sciences Center are among the nation’s leaders on this topic, and they recently received a federal grant to assist the U.S. Department of Defense in addressing problematic sexual behavior of youth in the military.

The National Center on the Sexual Behavior of Youth (NCSBY) is housed within the OU College of Medicine, Department of Pediatrics. Its personnel have been trailblazers in the research and treatment of problematic sexual behavior of youth, and in training parents, caregivers, healthcare providers and others around the world to prevent and respond to incidents.

NCSBY’s new work is funded by the Office of Juvenile Justice and Delinquency Prevention, a component of the U.S. Department of Justice. NCSBY is assisting the U.S. Department of Defense in developing training materials and resources to address the issue of youth problematic sexual behavior in all branches of the military.

“This is an issue that communities and people worldwide struggle to address,” said clinical child psychologist Jane Silovsky, Ph.D., director of NCSBY. “But the Department of Defense has done a remarkable job of understanding the science about the appropriate response to the children with behavior problems, as well as their caregivers and the children who are impacted.”

In many cases, problematic sexual behavior in youth involves one young person harming another young person, Silovsky said. Studies show the behavior peaks between the ages of 12 and 14, and that young people rarely act out on strangers; most of the time, they’re acting out on siblings, cousins, schoolmates and others within their social networks. Exposure to violence is a major risk factor, whether it’s domestic violence, physical abuse, harsh parenting practices, or community violence. Exposure to sexualized media is another risk factor; young people can access pornography on any device, despite the best efforts of their caregivers, Silovsky said. In addition, there are individual risks, such as a child having developmental disabilities, being on the autism spectrum and having impulse disorders.

“These risk factors can impact children’s emotional regulation skills, impulse control skills, and their understanding of the rules and how you treat others,” Silovsky said. “A common myth is that all youth with problematic sexual behavior are being sexually abused themselves. While sexual abuse is a risk factor and a concern, there are many kids with problematic sexual behavior have not been sexually abused.”

Nor are children with problematic sexual behavior the same as adults who have illegal behaviors or adults with pedophilia who have inappropriate arousal toward children, Silovsky said, and treating them as adults does more harm than good. Rather, the approach involves cognitive behavioral therapy,

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health

Dozens of inmates test positive for virus at San Diego federal jail, defense attorneys say

Petco Park anchors downtown San Diego.
Downtown San Diego. (K.C. Alfred / San Diego Union-Tribune)

At least 56 inmates tested positive for the coronavirus last week at a privately run federal jail in downtown San Diego that houses mostly pretrial inmates, according to defense attorneys briefed on the matter.

The GEO Group, which contracts with the U.S. Marshals Service to operate the Western Region Detention Facility, is in the process of testing all inmates there “whether or not they are showing any symptoms,” according to Kathy Nester, executive director of Federal Defenders of San Diego.

“Today we received confirmation of a large number of positive tests arising from that ongoing testing,” Nester wrote in an email Friday.

She said 286 inmates were tested Thursday, and of those, 56 tests came back positive, 114 were negative and 116 were pending.

Another 221 tests were submitted Friday, with all of those results still pending, according to Nester.

She said information about the apparent coronavirus outbreak was provided in a Friday phone call with the Marshals Service, which gives Federal Defenders regular updates “advising us of our clients who have tested positive and when there are ongoing quarantines” at its facilities.

“We are extremely worried about the rate at which the coronavirus is spreading through our detention facilities and the impact that will have on our clients and the community at large,” Nester wrote.

A spokesperson for the GEO Group referred a request for comment to the marshals. Calls to the San Diego-area office of the marshals were not answered Friday.

According to the GEO Group, the Western Region Detention Facility can house up to 770 inmates and is accredited by two national correctional organizations.

In April, Voice of San Diego reported that inmates at the facility reported cramped conditions at the jail that did not allow for social distancing. According to the declaration cited in the report, written by Federal Defenders senior litigator Joshua Jones and signed March 31, inmates at the facility reported several other safety concerns, including a lack of hand sanitizer in housing units and a scarcity of soap.

A study published last month in the Annals of Epidemiology found that “jails are epicenters of COVID-19 transmission in the United States.”

The study’s authors wrote that jails “present an ideal setting for infections to spread” because “incarcerated individuals are at higher risk for infection due to unsanitary living conditions and inability to socially distance.” Additionally, the authors wrote that “correctional officers rarely have public health training, and correctional health systems are chronically underfunded.”

Two of the study’s authors, from Stanford University, said an outbreak inside a jail threatens the community outside because “the people who work there enter and leave every day. They can take the virus out into the community when they go home at night.”

The apparent outbreak at the Western Region Detention Facility follows an outbreak at the Metropolitan Correctional Center, another federal jail in downtown San Diego.

As of Friday, there were three confirmed COVID-19 cases among inmates at

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health

These Female Healthcare Workers Are Rural India’s First Defense Against COVID-19

Archana Ghugare’s ringtone, a Hindu devotional song, has been the background score of her life since March. By 7 a.m. on a mid-October day, the 41-year-old has already received two calls about suspected COVID-19 cases in Pavnar, her village in the Indian state of Maharashtra. As she gets ready and rushes out the door an hour later, she receives at least four more.

“My family jokes that not even Prime Minister Modi gets as many calls as I do,” she says.

Ghugare, and nearly a million other Accredited Social Health Activists (ASHAs) assigned to rural villages and small towns across India, are on the front lines of the country’s fight against the coronavirus. Every day, Ghugare goes door to door in search of potential COVID-19 cases, working to get patients tested or to help them find treatment.

With 8 million confirmed COVID-19 cases, India has the second-highest tally in the world after the United States and its health infrastructure struggled to cope with the surge in COVID-19 patients this summer. India spends only 1.3% of its GDP on public health care, among the lowest in the world. The situation is stark in rural areas where 66% of India’s 1.3 billion people live and where health facilities are scant and medical professionals can be hard to find.

India’s ASHA program is likely the world’s largest army of all-female community health workers. They are the foot soldiers of the country’s health system. Established in 2005, a key focus of the program was reducing maternal and infant deaths, so all recruits are women. They have also played an essential role in India’s efforts to eradicate polio and increase immunization, according to numerous studies.

Read More: How the Pandemic Is Reshaping India

But even as health authorities have leaned on ASHAs to quell the spread of COVID-19 in rural areas, where a substantial number of new cases have been reported, many of these health care workers say the government is failing them. Pay was meager to begin with, but some workers have reported not being paid for months. Their hours have increased dramatically, but pay rises, when they have come, have not reflected the increased demands. Many ASHAs have also complained about not being provided adequate protective equipment for their high-risk work.

“They are the unsung heroes who are fighting to contain the unfettered spread of the virus in rural areas,” says Dr. Smisha Agarwal, Research Director at the John Hopkins Global Health Initiative. She argues it is vital to improve pay to boost morale and sustain this frontline workforce.

Ghugare was chosen from her village of 7,000 people in 2011. Since then, she has overseen countless births, meticulously monitored the health of thousands of newborn babies and strictly ensured immunization through door-to-door awareness campaigns. The personal relationships she built over the years have helped in the fight against COVID-19, giving her a good grasp of the medical histories of most of the 1,500 people assigned to her. “It’s all in

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health

America’s Last Line of Defense for a Safe Vaccine

When the Food and Drug Administration ran into White House resistance to its proposed vaccine safety standards in early October, the agency took a bold step: It published the guidance on its Web site. The public could now see what vaccine manufacturers and the FDA’s own independent advisory panel would require to ensure a longer, scientifically rigorous process.

The two public health agencies responsible for overseeing the approval, distribution and use of a coronavirus vaccine—the FDA and the Centers for Disease Control and Prevention—have been undermined and politicized. The FDA’s proposed guidelines for emergency use of a coronavirus vaccine did finally clear the White House, but the well-publicized resistance has further undermined public trust in Operation Warp Speed just as the United States inches toward a viable vaccine. At a time when trust should be growing, the opposite is happening.

What should give Americans hope, however, is that both the FDA and the CDC have a last line of defense when it comes to approval and distribution of a vaccine: panels of outside experts who now merit the nation’s attention and unequivocal support. If, in the days ahead, either of these independent bodies are sidelined, ignored or in any way circumvented, a red line will have been crossed, and the safety and/or efficacy of a coronavirus vaccine can reasonably be questioned.

For the CDC, it’s the Advisory Committee on Immunization Practices, or ACIP, which next meets October 28–30. We each served terms on this committee at different times, and neither of us ever felt any political pressure during our tenures. The FDA equivalent is the Vaccines and Related Biological Products Advisory Committee, or VRBPAC, which next meets October 22. Most Americans have never heard of either.

These panels of health experts, with expertise in vaccinology, immunology, pediatrics, internal medicine, infectious diseases and preventive medicine, among other disciplines, have been studying and assessing the myriad coronavirus vaccines under consideration. Each has been scouring data from phase I and phase II trials, and now are awaiting phase III data about some of the most promising vaccines in development.

The advisory panels operate with intentional transparency. The public has access, often in real time via livestream, to their discussions and discoveries, and public records document their work. The 15 voting members on each advisory committee all undergo conflict-of-interest reviews, with annual filings to safeguard compliance. Vaccine interests and financial attachments are disclosed, and members must recuse themselves from related votes. Whether for a coronavirus vaccine or other vaccines, these panels make recommendations as to whether a vaccine is safe, efficacious and ready to be licensed (FDA), as well as how and to which populations a vaccine should be distributed (CDC). Though the members on each committee surely understand the politics of the moment, they will never bend to it.

Today, despite regular political pressure being applied on FDA and CDC to meet arbitrary deadlines for a vaccine release, the time-tested vaccine vetting and approval system has held up since it was established nearly

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