Attachment deficits have been suggested as an etiological explanation underlying the development of sexually abusive behaviors and general delinquency among youth. Yet, few researchers have explored the discriminating functions of attachment characteristics or investigated attachments as a stand-alone risk/protective factor explaining offending profiles among youth sexual offenders. This article explored the differences in characteristics of parental and peer attachments between youth sexual ( n = 355) and non-sexual offenders ( n = 150). Furthermore, associations between family and peer attachments and criminal profiles of sexual offenders were tested. The t-test results revealed that the groups of youth differed on various mother and father attachment characteristics, with youth sexual offenders exhibiting greater deficits. Regression models revealed lower levels of mother and peer trust and communication were associated with more severe sexual offenses; low levels of mother trust were associated with more victims; and low levels of mother trust and high father alienation were associated with more non-sexual criminality. Practice implications suggest the need to amalgamate families more consistently into treatment and addressing peer dynamics within groups and community contexts.

The cost of healthcare in the United States has increased over time. However, patient health outcomes have not trended with spending. There is a need to better comprehend the association between healthcare costs in the United States and hospital quality outcomes. Medicare spending per beneficiary (MSPB), a homogeneous metric across providers, can be used to evaluate the association between episodic Medicare spending and quality of care. Fifteen inpatient outcome measures were selected from Hospital Compare data among all (n = 4758) facilities and transformed to quintiles to ensure comparability across measures and to reduce the influence of outliers on the analysis. Both univariate and multiresponse multinomial ordered probit regression models were utilized across outcome domains to quantify associations between outcomes and spending. We found that MSPB was not associated with quality of care in most cases, adding evidence of a lack of outcome accountability among Medicare-funded facilities. Furthermore, worse outcomes were found to be associated with increased spending for some metrics. Policies are needed to align quality of care outcomes with the increasing costs of U.S. healthcare.