Feeling Heard and Not Judged: Perspectives on Substance Use Services Among Youth Formerly in Foster Care

"His heart is hardening, but his BRAIN is softening": Life experiences of adolescents using psychoactive substances: A qualitative study

PURPOSE

The aim of the research was to portray the life experiences of adolescents using psychoactive substances with regard to their substance use.

DESIGN AND METHODS

This study was carried out in a descriptive phenomenological design, which is a qualitative research method. A purposeful sampling method, was used. The sample consisted of 15 adolescents who were treated for a history of substance use. The data were collected by the face-to-face individual interview method. A personal information form and a semi-structured interview form were used to collect data. The content analysis approach proposed by Graneheim and Lundman was used in the analysis of the data. Data were analyzed using the N-VIVO-10 Pro-package program.

RESULTS

Four main themes and thirteen sub-themes were determined: experiences before substance use (sub-themes: life before substance use, predisposing factors for substance use), experiences during substance use (sub-themes: symptoms of addiction, problems caused by substance use, family attitude to substance use, the meaning attached to substances) and experiences of the treatment process (sub-themes: motivation, difficulties experienced during treatment, the need for support, treatment results), prevention recommendations (sub-themes: for peers, for families, for society).

CONCLUSIONS

Many individual, family and social risk factors had an effect on the adolescents starting to use the substances. They were exposed to negative physical, mental, economic, social and life experiences.

PRACTICE IMPLICATIONS

Nurses working with adolescents who use substances can implement nursing interventions such as prevention activities, counselling, health education, coping and strengthening self-esteem in individual and school based interventions.

Technology-Based Smoking Cessation for Youth Exiting Foster Care: A Pilot Randomized Trial

Despite high rates of cigarette use, little attention has been paid to screening and cessation services for youth in foster care. Study aims were to test the feasibility, acceptability, and preliminary efficacy of a technology-based smoking cessation intervention. Study enrollment, satisfaction, and engagement were high in the intervention arm, where readiness to change also significantly increased over time. Intervention and control participants significantly reduced cigarette use at 6-month follow up, though groups did not differ. Technology-based interventions appear to be attractive and offer a potentially scalable link to health care that this vulnerable population may not otherwise seek.

Combustible Cigarette Smoking and Alternative Tobacco Use in a Sample of Youth Transitioning from Foster Care

Among the struggles faced by youth currently in or recently exiting foster care, tobacco use remains a low priority for practitioners and researchers, alike. Indeed, despite the dramatically altered landscape of tobacco products on the market, there have been no studies evaluating the use of alternative tobacco products among this vulnerable population. The current study aimed to determine the prevalence of lifetime and current combustible and non-combustible tobacco use among youth exiting foster care, and report on the prevalence of nicotine dependence, motivation to quit, and preferred methods of tobacco cessation. Youth aged 18-24 (M = 20.13, SD = 1.16) who were transitioning from foster care (N = 154) completed a survey of tobacco product use adapted from the Population Assessment of Tobacco and Health Baseline Survey. Most participants (76%) reported lifetime use of combustible cigarettes, while almost half (42%) were current combustible cigarette smokers. Current use of electronic cigarettes was comparable to general population rates. Many participants (76%) reported interest in quitting and willingness to try through patches/gum (56%) and technology-based (61%) approaches. Youth exiting foster care are at high risk for smoking and other tobacco product use, as well as dependence, yet are rarely screened for use or advised to quit. As tobacco use remains among the most preventable causes of mortality and morbidity, future work should involve implementation of screening within child welfare and tailoring interventions to the unique needs of this population. The current results underscore a missed opportunity to promote public health in a vulnerable population.

A Pilot Randomized Controlled Trial of a Technology-Based Substance Use Intervention for Youth Exiting Foster Care

Youth exiting foster care represent a unique, at-risk population in that they receive supportive health services while under the umbrella of the foster care system, but access to care can drop precipitously upon release from foster custody. Traditional means of substance use treatment may not meet the needs of this vulnerable population. Mobile interventions, however, have demonstrated high acceptability and efficacy across a range of mental and physical health issues. The specific advantages to mobile interventions dovetail well with the barriers faced by youth exiting foster care. This study describes the feasibility, acceptability, and initial efficacy of iHeLP, a computer- and mobile phone-based intervention based in Motivational Interviewing for reducing substance use among youth exiting foster care (n = 33). Participants were randomly assigned to either iHeLP or a contact control, each of which lasted six months. Feasibility was evaluated through eligibility and enrollment rates at baseline, and retention and intervention reach rates 3, 6, 9, and 12 months later. Acceptability was measured through a 5-item satisfaction measure and exit interviews. The two groups were then compared on a monthly measure of substance use. Study enrollment, retention, response rate, engagement, and satisfaction were all very good. Participants receiving iHeLP reported higher percent days abstinent than the control group, with effect sizes ranging from 0.32 to 0.62. Technology-based interventions such as iHeLP may be attractive to this population and support efforts towards reductions in substance use.