P3.G131: Substance Use Screening Among Youth in Foster Care

Background: Children in foster care face many health challenges, including increased rates of substance use and substance use disorders (SUD). Standardized screening, through Screening, Brief Intervention, and Referral to Treatment (SBIRT), is an evidence-based approach that assesses current substance use. For standardized screening to be effective, disclosure is critical. However, standardized substance use screening among youth in foster care has not been evaluated. The purpose of this study was to describe the validity of standardized substance use screening in a foster care clinic with factors associated with patterns of responding to support recommendations for substance use prevention and reduction in this population.

Methods: With child welfare and Institutional Review Board approval, we collected data from youth aged 10-20 years who were in foster care between February 2022 and March 2023 and seen for a mandated health examination in the foster care clinic at a pediatric medical center in the Midwest United States . Standardized screening for substance use was initially completed with the CRAFFT 2.1 Questionnaire. On September 21, 2022, the screening tool was updated to the CRAFFT2.1+N questionnaire which adds an additional question asking about vaping and tobacco use. The screening was delivered on a tablet with results automatically imported into the electronic health record. Healthcare providers reviewed screening results with patients during the confidential portion of their exam. Providers referred patients who endorsed past-year substance use to a trained interventionist who asked additional questions about substance use in the past 30 days and provided brief intervention +/- referral to treatment. .

Results: During our study period, 373 youth completed substance use screening. Initially, 93 screens were positive. Among the 280 negative substance use screens, 34 (12.1%) endorsed substance use during the confidential interview with healthcare providers, resulting in an overall sample total of 127 (34.0%) youth who endorsed substance use. Youth who denied substance use on screeners and endorsed use with providers were, on average, two years older and were more likely to live in independent living placements when compared to youth who did not change responses. A total of 242 youth completed the screen using the original CRAFFT2.1, with a 31.0% overall positivity rate for all substances. Cannabis was the most endorsed substance within the prior 12 months (n=78, 20.9%). The screening positivity rate slightly increased to 39.7% across 131 youth, with the implementation of the CRAFFT2.1+N.

Conclusion: Youth endorsed past-year substance use (39.7%) at a higher rate than the general population. Some youth had a false negative screen. While standardized substance use screening clearly has value to detect substance use among youth in foster care, research to understand the best modality of screening is necessary to improve detection and, ultimately, provide optimal intervention to prevent or reduce substance use.