Incorporating self‐determination into substance abuse prevention programming for youth transitioning from foster care to adulthood

Abstract

Youth transitioning from foster care to adulthood are at higher risk for alcohol and substance abuse disorders than general population youth. At the same time, these youths are often recipients of strong clinical intervention, often at levels considered unnecessary, for other mental health or behavioural challenges. Because of this, there is sometimes resistance from providers to offer services such as substance abuse prevention programming as it may be seen as contributing to youths' overclinicalization, stigmatization, or retraumatization. Using thematic content analysis, this qualitative study analysed focus groups with community stakeholders providing recommendations on support services for youth transitioning from foster care to adulthood to derive strategies for delivering substance abuse prevention programming in a way that enhances youth self‐determination. Findings were organized by self‐determination theory's 3 key psychological needs: autonomy, competence, and relatedness. All three needs were represented in stakeholder recommendations, which were translated into strategies for bolstering youths' achievement of each need. Strategies include a mix of those already present in motivational interviewing‐based brief substance abuse prevention interventions as well as more unique strategies that are much less frequently employed but that may better meet the needs of youth with foster care experience.

Strategies for Promoting Client Self-Determination: A Review of the Literature

“…Self-Determination Theory (SDT), Shared Decision Making (SDM), and the Lundy Model of Participation have concepts that can be integrated into agency procedures to strengthen client self-determination. The SDT concept of client autonomy lends itself into activities that facilitate the self-determination process as observed in the study by Salazar et al (2018). Whereas adoption of SDM equips clients with tools that explain clinical information and options available to them to aid in reaching informed decisions about their care (Elwyn et al, 2010, p. 971), SDT's concept of client autonomy ensures creation of a supportive environment where client perspectives and interests are considered.…”

“…Third-party arrangements involved consultations with relatives and other professionals to document the client's wishes and preferences in instances where the identified client had significant limitations in their ability to fully participate in the self-determination process such as older adults with dementia or minors (Clark, 1998;Nordh & Nedlund, 2017;Österholm et al, 2015). Best practices reported in the articles were informed by models such as Self-Determination Theory's (SDT) concept of client autonomy (Dennis, McCallion, & Ferretti, 2012;Lukens et al, 2013;Salazar, Noell, Cole, Haggerty & Roe, 2018), Shared Decision Making (SDM) reported by Lukens et al (2013), and the Lundy Model (Kennan et al, 2019). Use of SDT principles allowed practitioners to operationalize client self-determination beyond what the client wants (Dennis et al, 2012) as practitioners let clients lead, demonstrated respect for clients' decisions, supported clients in making their own decisions, and involved clients in program decision making and evaluation (Salazar et al, 2018).…”

“…Best practices reported in the articles were informed by models such as Self-Determination Theory's (SDT) concept of client autonomy (Dennis, McCallion, & Ferretti, 2012;Lukens et al, 2013;Salazar, Noell, Cole, Haggerty & Roe, 2018), Shared Decision Making (SDM) reported by Lukens et al (2013), and the Lundy Model (Kennan et al, 2019). Use of SDT principles allowed practitioners to operationalize client self-determination beyond what the client wants (Dennis et al, 2012) as practitioners let clients lead, demonstrated respect for clients' decisions, supported clients in making their own decisions, and involved clients in program decision making and evaluation (Salazar et al, 2018). The strategies reported by Salazar et al are consistent with Sheldon et al's (2008) recommendations for promoting client autonomy and giving consideration to clients' interests and values in the decision making process.…”

Independent Living Coordinators’ Effects on Intangible Domains in an Independent Living Program

“…Greeno et al, 2019aGreeno et al, , 2019b indicated 99% of foster youth in their study were indicated for hazardous drinking and 96% of youth drank between 5 and 6 drinks when consuming alcohol, which is considered binge drinking. Caseworkers should deliver substance abuse prevention services nonjudgmentally, empathetically, and in ways that are empowering (Salazar et al, 2018). Training for child welfare workers to address substance abuse with foster youth is strongly recommended (Braciszewski et al, 2018).…”

The Juramento: Secondary and Tertiary Preventive Benefits of a Religious-Based Brief Alcohol Intervention in the Mexican Immigrant Community

“…For example, Peterson and Reid [10] support interventions that promote empowerment to abstain from substance use, and Brooks et al [11] find that hopefulness is an important component of primary prevention efforts. These approaches are especially common in programs aimed for adolescents, which attempt to deter or delay their engagement in substance use by building social, communication, and coping skills [12][13][14]. Recent literature also explores new delivery methods for prevention strategies.…”