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Helseth SA, Micalizzi L, Piper K, Gomez A, Elwy AR, Becker SJ, Kemp K, Spirito A. Tailoring opioid use prevention content for juvenile diversion programs with adolescents and their caregivers. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209470. [PMID: 39094900 DOI: 10.1016/j.josat.2024.209470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/26/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Opioid use (OU) skyrockets as youth transition into young adulthood, indicating adolescence is a critical time for prevention. The juvenile legal system (JLS) presents an ideal setting for OU prevention, as it is the single largest referral source for youth outpatient OU treatment, after self-referral. However, no OU prevention programs have been developed for youth in JLS diversion programs or their families. The current formative study established specific OU prevention needs and preferences of families in JLS programs, to guide future tailored prevention efforts. METHODS We interviewed 21 adolescents with substance use and 20 of their caregivers referred by a JLS diversion program in the northeastern United States to explore their OU-related knowledge, personal experiences, motivations, and behavioral skills. We used a deductive qualitative analysis approach wherein data were analyzed using an a priori coding framework based on the Information Motivation Behavioral Skills model. RESULTS Caregivers knew more about OU than youth, several of whom misidentified both opiates and non-opiates. Few participants reported a history of personal OU, though many knew of others' OU. Participants perceived several potential motivations for OU: mental health problems, relationships, life stressors, difficulty accessing preferred substances, and experimentation. Though often unfamiliar with the symptoms, participants were eager to learn skills to identify and manage a suspected overdose. CONCLUSIONS Youth involved in a JLS diversion program and their caregivers were open to and eager for tailored opioid use prevention content to help them reduce risks. We discuss implications for OU prevention and intervention program development.
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Affiliation(s)
- Sarah A Helseth
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, United States of America; Dept. of Behavioral and Social Sciences, Brown University School of Public Health, United States of America.
| | - Lauren Micalizzi
- Dept. of Behavioral and Social Sciences, Brown University School of Public Health, United States of America
| | - Kaitlin Piper
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, United States of America
| | - Ashley Gomez
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, United States of America
| | - A Rani Elwy
- Dept. of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, United States of America
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, United States of America; Dept. of Behavioral and Social Sciences, Brown University School of Public Health, United States of America
| | - Kathleen Kemp
- Dept. of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America; Rhode Island Hospital, United States of America
| | - Anthony Spirito
- Dept. of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
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Ow N, Zivanovic R, Tee K, Mathias S, Barbic SP. Health through the eyes of youths: a qualitative study. Front Public Health 2024; 12:1271215. [PMID: 38827611 PMCID: PMC11141052 DOI: 10.3389/fpubh.2024.1271215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/09/2024] [Indexed: 06/04/2024] Open
Abstract
Background Emerging definitions of health have suggested a shift in focus to one's ability to manage their health condition, function, and social determinants of health. The construct of health for youths with mental health and substance use disorders (MHSU) is complex and multi-dimensional with interplay between biological, behavioral, and social conditions. Expanding definitions of health is crucial in the measurement of health and evaluation of integrated youth services (IYS) systems for people with MHSU disorders. Hence, it is critical to understand the construct of health from the perspective of a young person living with a MHSU disorder. Methods This study was conducted using inductive thematic analysis. Three focus groups were conducted from July to August 2017. Results A total of 22 youths (17-24 years) took part in this study. Results showed that health is a multidimensional construct situated in the ecosystem of a person's environment. Health can be understood from two macro themes: Individual health and Determinants of health. It consisted of physical health, mental health, day-to-day functioning, and being in control of your own health condition. Systemic and social factors were factors that influenced the state of health. Conclusion This study contributes to a conceptualization of good health in youth with MHSU disorders. This conceptualization can aid in the development of more accurate measures of health and functioning and the evaluation of mental health services for youth with MHSU.
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Affiliation(s)
- Nikki Ow
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Zivanovic
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Steve Mathias
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Foundry, Vancouver, BC, Canada
| | - Skye Pamela Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Foundry, Vancouver, BC, Canada
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Ow N, Marchand K, Liu G, Mallia E, Mathias S, Sutherland J, Barbic SP. Patterns of service utilization among youth with substance use service need: a cohort study. Subst Abuse Treat Prev Policy 2023; 18:62. [PMID: 37924116 PMCID: PMC10623844 DOI: 10.1186/s13011-023-00572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Integrated youth services (IYS) are vital to addressing the needs of youth who use substances. Evidence on the characteristics of youths accessing these services and the types of services accessed have been limited. The objectives were to identify sociodemographic, self-reported health and mental health, patterns of service utilization (service type and frequency of visits) among youths with different levels of substance use service needs (low, moderate, and high), and to estimate the extent to which substance use service needs, self-reported health and mental health influenced the frequency of visits and types of service utilized. METHODS Data were collected from youth (12-24 years) accessing IYS centres in Canada. Information on socio-demographic factors, substance use in the last month, self-rated health measures, number of service visits, and type of services utilized were included. Poisson regression was used to estimate the relationship between substance use needs and number of service visits and the different type of services utilized. RESULTS Of 6181 youths, 48.0% were categorized as low substance use service needs, 30.6% had moderate needs and 21.4% had high needs, with higher proportion of men in the high needs group. Mental health and substance use (MHSU) services were utilized the most across all three groups, followed by counseling. The median number of visits was 4 for the low and moderate needs group and 5 in the high needs group. People with high service needs had 10% higher rate of service visits and utilized 10% more services than people with low service needs (service visits: RR = 1.1 (95%CI: 1.1-1.2); service type: RR = 1.1 (95%CI:1.0-1.1)). The rate of service visits increased by 30 to 50% and the number of services increased by 10-20% for people who rated their health good/fair/poor. Similarly, the rate of service visits increased by 40 to 60% and the number of services increased by 20% for people who rated their mental health good/fair/poor. CONCLUSIONS AND IMPACTS Our study highlighted that regardless of service needs, youth who use alcohol and drugs have complex intersecting needs that present once they access integrated youth services.
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Affiliation(s)
- Nikki Ow
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Kirsten Marchand
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Guiping Liu
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Emilie Mallia
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| | - Steve Mathias
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Jason Sutherland
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Skye Pamela Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
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Marchand K, Turuba R, Katan C, Brasset C, Fogarty O, Tallon C, Fairbank J, Mathias S, Barbic S. Becoming our young people’s case managers: caregivers’ experiences, needs, and ideas for improving opioid use treatments for young people using opioids. Subst Abuse Treat Prev Policy 2022; 17:34. [PMID: 35525987 PMCID: PMC9077957 DOI: 10.1186/s13011-022-00466-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Evidence continues to show that young people, ages 15-24, remain at significant risk of harms from non-medical opioid use and opioid use disorder (OUD), with experts calling for widespread implementation of developmentally-appropriate interventions. These recommendations include the involvement of caregivers in the prevention, early intervention, and treatment of young people using opioids. However, little research has investigated caregivers’ experiences supporting young people, leaving critical gaps in understanding this role. The aim of this study is to explore caregivers’ experiences accessing opioid use treatments with young people and their needs and ideas for improving such treatments. Methods This study reports qualitative findings from Phase 1 of the Improving Treatment Together project, a multi-phase, multi-site community-based participatory study broadly aimed at co-designing opioid use treatments to improve the experiences and outcomes of young people using non-medical opioids. During Phase 1, a total of 27 caregivers (parents, guardians) participated in full-day workshops that were conducted in three communities in British Columbia, Canada. Following human-centred co-design methods, caregivers engaged in small and large group discussions of their experiences, needs, and ideas for improving opioid use treatments for young people. Discussions were audio-recorded, transcribed verbatim, and thematically analysed. Results Across communities, caregivers’ main experiences were defined as ‘becoming our young people’s case managers’ and ‘enduring a never-ending rollercoaster’. To improve these experiences, two needs themes were identified – expanding organizational and system-level capacity and wider-spread understanding of opioid use as a health issue. Caregivers brainstormed a total of 378 individual ideas to meet these needs, several of which spanned multiple needs themes. Conclusions Caregivers’ experiences, needs, and ideas reveal critical opportunities for improving the quality of interventions for opioid use among young people. This study represents a substantial contribution to the design and implementation of developmentally-appropriate and family-centred interventions for young people using opioids.
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Ji X, Hu X, Brock KE, Mertens AC, Cummings JR, Effinger KE. Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors. J Natl Cancer Inst 2022; 114:895-906. [PMID: 35262708 PMCID: PMC9194632 DOI: 10.1093/jnci/djac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/22/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric cancer survivors often have pain, which may be managed with opioids. We examined the prevalence of opioid prescriptions, potential misuse, and substance use disorders (SUDs) among pediatric cancer survivors during the first year posttherapy. METHODS Using MarketScan Commercial Database, we identified 8969 survivors (aged 21 years or younger at diagnosis) who completed cancer therapy in 2009-2018 and remained continuously enrolled for at least 1 year posttherapy and 44 845 age-, sex-, and region-matched enrollees without cancer as a comparison group. Outcomes included opioid prescriptions, any indicator of potential prescription opioid misuse, and SUDs within 1 year posttherapy. Outcomes were compared between survivors and noncancer peers in bivariate and adjusted analyses, stratified by off-therapy age (children: 0-11 years; adolescents: 12-17 years; young adults: 18-28 years). All statistical tests were 2-sided. RESULTS A higher proportion of survivors than noncancer peers filled opioid prescriptions (children: 12.7% vs 2.0%; adolescents: 22.9% vs 7.7%; young adults: 26.0% vs 11.9%). In models adjusting for sociodemographic factors and health status, survivors remained 74.4%-404.8% more likely than noncancer peer to fill opioid prescriptions (P < .001). The prevalence of potential misuse or SUDs was low, with 1.4% of child, 4.7% of adolescent, and 9.4% of young adult survivors fulfilling at least 1 criterion; however, it was higher than noncancer peers (0.1%, 1.4%, and 4.3%, respectively). In adjusted models, the likelihood of potential misuse among survivors remained at least 2 times higher than that among noncancer peers (P < .001), and the difference in SUDs became nonstatistically significant. CONCLUSION Statistically significantly higher rates of opioid prescriptions and potential misuse were found among pediatric cancer survivors within 1 year posttherapy as compared with peers without cancer.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Xin Hu
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Katharine E Brock
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Janet R Cummings
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Karen E Effinger
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
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