138 - Effectiveness of screening, brief intervention, and referral to treatment for adolescents in foster care

Publication Number: 138.5048

Sarah J. Beal, Cincinnati Children's Hospital, Milford, OH 45150-9685, OH, United States; Grace I. Gerdts, The University of Iowa, Iowa City, IA, United States; Nichole Nidey, University of Iowa College of Public Health, Coralville, IA, United States; Mary Greiner, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Adolescent screening, brief intervention, and referral to treatment (SBIRT) has demonstrated efficacy for reducing substance use but is not widely used in pediatric settings because evidence of effectiveness with diverse populations is limited.

Objective: To identify factors associated with reduced substance use among adolescents in foster care who received SBIRT.

Design/Methods: This study uses clinical and survey data for adolescent patients (N=255) who received brief intervention (BI) after a positive self-administered CRAFFT 2.1+N standardized screening. A trained social worker administered BI, and participants were surveyed about alcohol, nicotine/tobacco, cannabis, and other substance use over the previous 30 days at 4 time points over 6 months. Demographics, placement information, mental health diagnoses, and family history of substance use from the child welfare record were included as predictors of the number of days of substance use in negative binomial hierarchical models.

Results: Adolescents who received brief intervention and agreed to participate were between the ages of 10 and 20 (M=15.9), were primarily young women (61%), and had at least 1 mental health diagnosis (75%). Participants were diverse with respect to race (55% Black, 35% White, 7% more than one race) and living arrangements (25% licensed family foster home, 25% kinship home, 15% group home, 35% independent living). Most (84%) had no documented family history of substance use.
Number of days of use significantly declined across all substances (Fig. 1). Adolescents who were Black, experienced placement stability, and were in licensed foster homes benefited the most with respect to reducing alcohol and nicotine/tobacco use, while those in licensed family foster homes and experiencing placement stability benefited the most with respect to reduced cannabis use (Table 1). Mental health diagnoses reduced the effectiveness of BI for youth using alcohol and nicotine/tobacco products and had no effect on cannabis. A family history of substance use was not significantly associated with substance use outcomes.

Conclusion(s): SBIRT contributes to significant reductions in substance use as reported by adolescent patients in foster care over a 6-month period, with particular benefits when young people are stable in licensed family foster home settings. Investing in the implementation of SBIRT across clinics where diverse adolescents are seen may be helpful for substance use reduction and prevention of substance use disorder.

Hierarchical negative binomial models to predict change in past 30- substance use over 6 months following brief intervention.
Table 1 PAS.pdf

Change in past 30-day substance use over 6 months following brief intervention for alcohol (a), tobacco (b), and cannabis (c).
Figure 1 PAS.pdf