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Family and Children's
Resource Program

Vol. 23, No. 2
June 2018

Preventing Substance Use Among Youth in Foster Care

Youth in foster care have higher rates of substance use than youth in the general population (Kim, 2017; Braciszewski, 2012; Barn, 2015; Traube, 2012). Research has focused on understanding the variables that contribute to these higher rates. While there is still much debate on exact causes, there is agreement that certain risk and protective factors influence the likelihood of substance use among youth in foster care.

Risk and Protective Factors
Risk Factors. History of maltreatment and trauma are risk factors for the development of behavioral health challenges (Kim, 2017). Thus, the experiences youth have prior to being placed in care do play a role in increasing the risk of substance use.

Risk factors shown to have a higher relationship with future substance use are: school exclusion, involvement in the criminal justice system, association with deviant peers, a history of behavior problems, and co-morbid mental health diagnoses--specifically depression and conduct disorder (Kim, 2017; Babowich, 2016).

Two of the most discussed risks factors are poor relationships with primary caregivers and lack of caregiver supervision. Given that foster care is typically a result of unsafe parenting practices, it makes sense that youth in care would experience these two risk factors at higher rates (Kim, 2012; Traube, 2012).

Protective Factors. The most consistently discussed protective factors are positive relationships with caregivers and level of caregiver supervision (Kim, 2017; Braciszewski, 2012; Barn, 2015; Traube, 2012). This has implications for youth with multiple placements, since they may have a harder time connecting with caregivers.

Other protective factors include school engagement, problem-solving skills, and emotional regulation (Kim, 2017; Traube, 2012, Barn, 2015).

Prevention Strategies
Many substance use prevention strategies focus on strengthening the youth's relationship with caregivers, building caregiver skills for helping youth address behavioral challenges, and improving youth problem solving and peer refusal skills.

An example of this is KEEP SAFE, an intervention that works with caregivers and youth together and separately to build skills that support positive parenting, problem solving, and skills to address peer pressure. One recent study showed KEEP SAFE significantly reduced substance use in foster youth 18 months after participating in the program (Kim, 2017).

Prevention strategies also address the need for increased supervision, particularly for teens. Adolescent brain development puts teens at a higher risk for unsafe behavior because the part of the brain that supports risk taking develops before the part of the brain that supports problem solving and judgment. This means teens are particularly vulnerable to substance use and other risky behavior (Galvan, 2007). Supervision includes knowledge of where teens are and who they are with, building relationships with their peer groups, and paying attention to red flags of substance use.

Opioid Use Prevention
While the risk and protective factors and prevention strategies apply to all types of substance use, there are specific strategies that focus on the prevention of opioid use. According to a national survey, 3.6% of youth age 12-16 reported misusing opioids in 2016 (SAMHSA, 2017) and prescription drug use is one of the fastest growing drug problems in the United States (USDHHS, 2017).

Many of the recommendations from SAMHSA and the U.S. Department of Health and Human Services reflect the protective factors mentioned above, particularly building strong relationships. Other key strategies for preventing teen opioid use are:

  • Treat pain cautiously. Most opioid use starts with a prescription for pain management. Consider alternatives and talk with medical providers about risks and concerns specific to each youth.
  • Store and dispose of medications safely. Many adults use prescription opioids safely, but this can increase risk for youth. Over half who reported misusing prescription drugs said they got them from a friend or relative (CBHSQ, 2017).
  • Know red flags that could indicate opioid use: drowsiness, constipation, nausea, dizziness, vomiting, dry mouth, headaches, sweating, and mood changes (USDHHS, 2017).
  • Talk with youth about the risks of drug use and how to get help when they need it.
  • Support caregivers. "Keeping Youth Drug Free" is a great resource to help caregivers feel comfortable and informed so they can support youth in their home. Download it here.
Here's What Child Welfare Workers Can Do
  • Know the factors that increase the likelihood of substance use and strengthen protective factors to decrease risk
  • Consider caregiver connectedness when making placement decisions; it protects against teen substance use
  • Pay close attention to youth with mental health diagnoses; they are at higher risk of substance use
  • Teach caregivers about red flags and the importance of supervising teens
  • Encourage positive parenting practices
  • Educate caregivers about the specific risks of opioid use and strategies for prevention

References for this and other articles in this issue