Pathways to Preventing Substance Use Among Youth in Foster Care

Abstract

Substance use problems are highly prevalent among youth in foster care. Such problems in adolescence have long-lasting implications for subsequent adjustment throughout adulthood and even across generations. Although several programs have demonstrated positive results in reducing substance use in at-risk youth, few studies have systemically examined how such programs work for foster youth and whether they are effective for both genders. This study examined the efficacy of KEEP SAFE, a family-based and skill-focused program designed to prevent substance use and other related health risking behaviors among youth in foster care. We hypothesized that improving the caregiver—youth relationship would lead to later reductions in youths’ involvement with deviant peers, which subsequently would lead to less substance use, and that this mechanism would work comparably for both genders. A sample of 259 youth (154 girls, ages 11–17 years) in foster care and their caregivers participated in a randomized controlled trial and was followed for 18 months postbaseline. Results indicated that the intervention significantly reduced substance use in foster youth at 18 months postbaseline and that the intervention influenced substance use through two processes: youths’ improved quality of relationships with caregivers at 6 months postbaseline and fewer associations with deviant peers at 12 months postbaseline. This suggests that these two processes may be fruitful immediate targets in substance use prevention programs for foster youth. We also found little gender differences in direct and mediating effects of the intervention, suggesting KEEP SAFE may be effective for both genders in foster care.

Sex differences in psychological distress, behavioural and emotional problems, and substance use in young people in out‐of‐home care

“…Conduct disorders in girls may also emerge later, so that by mid-late adolescence girls have similar rates of these problems to males (Mccabe, Rodgers, Yeh, & Hough, 2004). Substance use is common in OoHC (Keller et al, 2010;Kim, Buchanan, & Price, 2017) and described as reflecting substance abuse/dependence rather than recreational or experimental use (Vaughn, Ollie, Mcmillen, Scott, & Munson, 2007). There were concerning rates of substance use in this cohort, with lifetime rates of alcohol, tobacco, cannabis, and amphetamine use at 69.4%…”

“…Substance use is common in OoHC (Keller et al, ; Kim, Buchanan, & Price, ) and described as reflecting substance abuse/dependence rather than recreational or experimental use (Vaughn, Ollie, Mcmillen, Scott, & Munson, ). There were concerning rates of substance use in this cohort, with lifetime rates of alcohol, tobacco, cannabis, and amphetamine use at 69.4% ( n = 120), 63.0% ( n = 109), 52.6% ( n = 91), and 23.7% ( n = 41) respectively.…”

“…This is despite initiatives such as the Victorian Chief Psychiatrist's Guidelines to ensure priority access to mental health support for young people in OoHC (Vine, ). If the mental health and substance use problems are not addressed, then significant difficulties may be encountered transitioning from OoHC care into adulthood (Kim et al, ). In adulthood, these young people are less likely to have their essential needs met (e.g., housing) and to have neither access to basic supports (e.g., education) nor mental health and substance abuse treatments (Keller et al, ).…”

“…Targeted interventions addressing specific problems may also be useful. Interventions for substance use, in this population, for example, the KEEP SAFE family‐based and skill‐focused programme, have been found helpful for both girls and boys (Kim et al, ).…”

“…OoHC care into adulthood (Kim et al, 2017). In adulthood, these young people are less likely to have their essential needs met (e.g., housing) and to have neither access to basic supports (e.g., education) nor mental health and substance abuse treatments (Keller et al, 2010).…”