Feeling Heard and Not Judged: Perspectives on Substance Use Services Among Youth Formerly in Foster Care

Abstract

Youth in foster care have limited access to substance use services for a variety of reasons. Attempts to unpack this health disparity have focused on foster care systems, administrators, providers, and foster parents. This study seeks to understand the perspectives of youth themselves, with the hope of understanding their experiences with and preferences for such services. Analyses of focus groups with youth who had recently left foster care suggested concrete and perceptual facilitators/barriers to treatment. Concrete facilitators/barriers included the need for expanding social support, access to multiple service options, and tailored intervention approaches. Perceptual concerns revolved around understanding each individual’s readiness to change, feeling judged by authority figures, and desiring help from people with lived experience. Participants also described novel intervention ideas, including a focus on technology-based approaches. By relying on youth voices, we can improve upon the current state of substance use interventions within foster care.

A pilot randomized controlled trial of a technology-based substance use intervention for youth exiting foster care

“…Second, biological confirmation of substance use proved to be difficult. Participants often refused to provide urine drug screens, stating that they had many negative experiences with these requests from case managers, group home leaders, and other authority figures, which fits with reports in our previous work (Braciszewski, Tran, et al, 2018). However, the majority of our participants did not achieve or desire to achieve complete abstinence; rather, most significantly reduced the frequency with which they smoked marijuana.…”

“…Overall, we feel confident that interest in a technology-based intervention, desire to understand more about one’s substance use, or a combination of both were strong motivating factors in choosing to enroll. Indeed, our previous work has indicated that this population is eager for a substance use intervention, provided it fits their needs (Braciszewski, Tran, et al, 2018; Braciszewski, Tzilos Wernette, et al, 2018).…”

“…Unfortunately, many foster care stakeholders do not receive appropriate training in recognizing and addressing adolescent substance use (American Academy of Child and Adolescent Psychiatry and Child Welfare League of America, 2002; Schroeder, Lemieux, & Pogue, 2008). Our focus groups with youth who had recently exited care echoed these statements, as most felt judged and punished for using alcohol and drugs, rather than receiving help from those responsible for their care (Braciszewski, Tran, et al, 2018). Foster parents have duly noted a need for such assistance.…”

Combustible cigarette smoking and alternative tobacco use in a sample of youth transitioning from foster care

“…Indeed, previous work has indicated that youth and young adults exiting foster care may prefer technology-based interventions over individual counseling, given a number of population-specific barriers to in-person approaches. Specifically, this population has reported perceived and actual lack of confidentiality with regard to substance use, reluctance to bond with a provider/counselor given experiences with previous close relationships, general mistrust of institutions, and significant judgment and lack of help by case managers and others for engaging in unhealthy behaviors (Braciszewski, Tran, et al, 2018; Davis, 2003), all of which can decrease the likelihood of seeking health care in its traditional forms or provide disincentive for honest reporting about unhealthy behaviors. Others have noted their need for interventions that are mobile, given housing instability and subsequent difficulties coordinating care (Braciszewski & Havlicek, 2018; Horwitz, Owens, & Simms, 2000; Simms, Dubowitz, & Szilagyi, 2000).…”

“…Health care providers are increasingly having conversations with patients about e-cigarette use (Brown-Johnson et al, 2016; Nickels, Warner, Jenkins, Tilburt, & Hays, 2016; Young-Wolff et al, 2017), though the extent to which physicians and others are knowledgeable about the relative harms and benefits associated with e-cigarette use appears to be low (El-Shahawy, Brown, & Elston Lafata, 2016). Given reports that foster youth are often skeptical of authority figures and institutions (Braciszewski, Tran, et al, 2018; Davis, 2003), health care professionals may benefit from training on partnering with vulnerable populations, such that a trusting bond is more easily and quickly formed. With e-cigarette use on the rise in the general population of youth and young adults (Miech et al, 2017), it is also possible that less attention is being paid to the screening of other combustible products (e.g., hookah, cigars).…”