Implementation of Screening, Brief Intervention, and Referral to Treatment Services to Reduce Alcohol and Other Drug Consumption Among Foster Youth - There are more than 420,000 children in foster care in the United States; 38% are aged 10 years or older. This high-risk group has been identified to have increased health problems compared with peers in the general population and, due to a lack of coordinated prevention services, increased exposure to poverty and maltreatment, and other systemic challenges, are up to 5 times more likely to receive a substance use disorder (SUD) diagnosis by age 18 compared to the general population. However, SBIRT has had limited impact on youth in foster care. This is related to a failure to spread SBIRT in specialized foster care health centers in pediatric settings, few effective implementation efforts with children’s services, and frequent disruptions in behavioral healthcare and school experienced by foster youth. This study seeks to increase abstinence of alcohol and other drug (AOD) use among adolescents in foster care, reduce frequency of AOD use among foster youth who have initiated use, and increase referral to treatment for adolescents at highest risk for SUD through standardized implementation of SBIRT into specialized foster care health centers in our region. In partnership with children’s services and community behavioral health, including organizations providing substance use disorder treatment to youth in foster care, we will screen all youth in foster care in our region (N = 2240) and provide brief intervention during mandated visits for physical health concerns that occur when children 10 and older enter foster care or experience a change in placement setting. When clinically indicated, youth will also be referred to treatment. An evaluation of SBIRT for foster youth with N = 832 youth will include a comparison sample collected in years 1-3 at a site delaying implementation of SBIRT. Results will demonstrate that 1) SBIRT can be effectively implemented and sustained in settings tailored to meet the unique needs of foster youth; 2) Existing community behavioral health services for foster youth can be enhanced to address treatment needs with this population, in partnership with foster youth healthcare centers; and 3) When standardized substance use screening and response (SBIRT) is implemented, it is associated with an increase in abstinence, a reduction in the frequency of AOD use, and an increase in youth who are successfully referred and receive treatment for SUD. Additional efforts focused on training providers and stakeholders who work with foster youth in SBIRT (e.g., clinicians, therapists, caseworkers) and in demonstrating sustainability through standardized automation of screening and referral practices and modifications to billing and reimbursement will promote generalizability of the findings from this project to the more than 50 specialized foster care clinics across the US, ensuring further benefit of this proposed work.
