Family-Focused Interventions to Prevent Substance Use Disorders in Adolescence Proceedings of a Workshop (2022) / Chapter Skim
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2 Family-Focused Interventions in Health Care Settings
2 Family-Focused Interventions in Health Care Settings
Pages 3-22
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From page 3... ...
According to the 2019 Youth Risk Behavior Survey conducted in high schools, Walker-Harding noted one in seven high school students reported misusing prescription opioids. Mental health struggles can be a reason some youth use substances, she said, but there are many other risk factors to consider as well.
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From page 4... ...
However, Walker-Harding said, caregivers should help their adolescents identify healthy risks.1 She presented evidence that when youth choose not to use substances, they are more likely to graduate and less likely have depression and anxiety.2 In discussing the importance of prevention efforts, Walker-Harding shared data showing the discrepancy in federal drug control spending that goes toward prevention programs compared with the investment in law enforcement and treatment programs for substance use disorder (see Figure 2-1)
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From page 5... ...
Instead, staff expressed that a substance use prevention program would be greatly appreciated. Considering existing pediatric practices, Velasquez noted two questions asked as part of an 11-year-old well-child visit, one related to alcohol and drug use with the other asking if the child is around people who smoke.
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From page 6... ...
MAKING THE CASE FOR INTERVENTIONS This section focuses on the motivations and justifications for familyfocused interventions targeting prevention. Speakers discuss the impacts of interventions on children and families, the structural racism that affects successful outcomes, and the potential for culturally sensitive interventions for specific population groups.
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From page 7... ...
SOURCE: Adger's presentation, May 5, 2022. Data from the National Surveys on Drug Use and Health, 2009 to 2014, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
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From page 8... ...
For example, Adger advocated for primary health providers to educate patients and families about the dangers of and risk factors associated with substance use, to screen for risky substance use, to provide interventions as well as referrals for assessment, and to help make connections to treatment services for cases that require more resources and expertise. However, while the evidence supports primary care FIGURE 2-3 Family disease model of addiction.
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From page 9... ...
Without acknowledging the structurally racist and punitive history of approaches to substance use, she said, it will be difficult to achieve equitable outcomes. Taylor identified several challenges to implementing family-focused interventions in culturally and linguistically effective ways, which can ultimately lead to more equitable access and outcomes.
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From page 10... ...
Instead, she advocated for equitable access and culturally and linguistically effective interventions to meet the needs of all youth. Creating a Culturally Relevant Prevention Intervention John Lowe, professor at the University of Texas at Austin School of Nursing, introduced himself as a Cherokee tribal member, and explained that most of his work is centered on community-based participatory research (CBPR)
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From page 11... ...
Nataki MacMurray, prevention policy analyst at the Office of National Drug Control Policy, asked about the opportunity to scale additional substance use screening. Lowe responded that many screening efforts happen at the community level or in school systems but not as much within the health system.
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From page 12... ...
She highlighted that many current prevention efforts focus on adolescence because it is a period of intense brain development and the developmental stage most vulnerable to taking risks, including experimenting with substance use. However, she said, the earlier someone initiates substance use, the higher the risk of substance use disorder (see Figure 2-4)
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From page 13... ...
Even though mitigating risk factors and strengthening protective factors within the family and community are understood to be important, they are not always prioritized. Traditional approaches to prevention tend to focus on reducing risk instead of promoting health and resilience, and target the child to the exclusion of the influences on the child in the surrounding environment, Richter said.
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From page 14... ...
When the ACE is prolonged, she said, it can produce a toxic stress response which interferes with normal brain development and effects can often be intergenerational. Although it is unusual to think this way, she noted, building a framework to address risk factors even as early as infancy and early childhood would be a valuable approach.
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From page 15... ...
• Ensure sustainable funding for a broader and earlier approach to prevention: This can be done through documenting short- and long-term effects of investments in family health and stability on youth risk, tracking changes in risk factor prevalence for ACEs and protective factors, and monitoring longer-term effects of prevention programs on youth substance use. State-Level Policies to Support Family-Focused Interventions Vinu Ilakkuvan, founder and principal consultant at PoP Health, LLC,3 reviewed state policies to support the types of family-focused prevention 3 PoP Health is a public health consulting agency that aims to help communities and orga nizations prioritize prevention by more effectively addressing upstream social determinants of health.
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From page 16... ...
Leaders in this field should also equip providers with the training they need to engage effectively through positive youth development and trauma-informed approaches, she said. Ilakkuvan concluded by reiterating the need to start prevention work earlier in life, knowing that substance use is a behavior that can be passed down through generations.
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Ilakkuvan gave the example of Communities that Care (CTC) , a prevention-planning system and network for promoting positive youth development, which involves building community partnerships to target risk factors such as antisocial behavior and family conflict before they become problems.
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From page 18... ...
As an example, the Evidence-based Prevention and Intervention Support center in Pennsylvania acts as a statewide technical assistance center and supports prevention by connecting research, policy, and practice. It also facilitates dissemination and sharing of best practices, provides tech nical assistance and access to learning networks, and supports continuous improvement of locally developed positive youth programs.
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From page 19... ...
The 1115 waiver, for example, gives broad authority to test policy innovations, she explained. Brykman highlighted a couple examples of innovative care models and services related to SUD prevention that Medicaid agencies are supporting through state plan amendments.
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From page 20... ...
Many states and other payers are moving towards value-based payments that link financial incentives to providers' performance on a defined set of quality measures. Brykman explained that such models could potentially support SUD prevention efforts by: (1)
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From page 21... ...
Furthermore, Brykman and Walker-Harding both commented that the conversation needs to move beyond screening only, and focus further upstream on more preventive efforts, as well getting prevention interventions covered universally by insurance. Ilakkuvan suggested that several interventions have strong evidence in preventing adverse outcomes, which the federal government could fund, including prenatal care, early childhood, and parenting supports.
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