Barker Brittany, Shoveller Jean, Grant Cameron, Kerr Thomas, DeBeck Kora
B.C. Centre on Substance Use, 1045 Howe St., Vancouver, B.C., V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, B.C., V5Z 1M9 Canada.
B.C. Centre on Substance Use, 1045 Howe St., Vancouver, B.C., V6Z 2A9 Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, B.C., V6T 1Z3 Canada.
Int J Drug Policy. 2020 Nov;85:102912. doi: 10.1016/j.drugpo.2020.102912. Epub 2020 Sep 1.
Youth aging-out of the child welfare system (CWS) experience numerous vulnerabilities including, elevated rates of substance use and substance use disorders. Calls to improve services to transition youth to independence are common; however, evidence of the long-term impacts associated with transitional service utilization is scarce. Further, existing services frequently lack appropriate supports for substance using youth and it is unknown if youth are able to access such services. In the present study, we assess the relationship between transitional service utilization and health and social outcomes among a cohort of people who use drugs (PWUD) that aged-out of the CWS.
Data were obtained from two harmonized cohorts of PWUD in Vancouver, Canada. Those who reported aging-out were asked about service utilization, availability, barriers, and interest across seven categories of transitional services. Multivariable logistic regression analyses were conducted to assess the relationship between having previously utilized transitional services and current health and social outcomes.
Between December 2014 and November 2017, 217 PWUD reported having previously aged-out of the CWS. Across service categories, reported service utilization prevalence ranged from 16.6-61.8% while unmet demand ranged from 64.8-78.4%. In multivariable analyses, compared to individuals who utilized ≤1 service while aging-out, having utilized 4-7 services was significantly associated with reduced odds of current homelessness (adjusted odds ratio [AOR]=0.29) and engaging in daily drug use (AOR=0.35) (both p<0.05).
Findings suggest that this understudied high-risk population of PWUD and aged-out of the CWS experience long-term benefits associated with transitional service utilization and are interested and willing to engage in these services. However, given high unmet demand, findings also highlight considerable gaps in service delivery and support calls for extending the age of emancipation for all youth in the CWS and in particular, for additional harm reduction and substance use supports embedded into service models.
从儿童福利系统（CWS）中成年脱离的青少年面临诸多脆弱性，包括物质使用及物质使用障碍的发生率较高。改善服务以帮助过渡青年实现独立的呼声很常见；然而，关于过渡服务利用所带来的长期影响的证据却很少。此外，现有服务往往缺乏对使用物质青年的适当支持，而且不清楚青年是否能够获得此类服务。在本研究中，我们评估了在一群从CWS成年脱离的吸毒者（PWUD）中，过渡服务利用与健康及社会结果之间的关系。
数据来自加拿大温哥华的两个吸毒者协调队列。那些报告已成年脱离的人被问及在七类过渡服务中的服务利用情况、可获得性、障碍及兴趣。进行多变量逻辑回归分析以评估先前使用过渡服务与当前健康及社会结果之间的关系。
在2014年12月至2017年11月期间，217名吸毒者报告称他们之前已从CWS成年脱离。在各类服务中，报告的服务利用患病率在16.6%-61.8%之间，而未满足的需求在64.8%-78.4%之间。在多变量分析中，与成年脱离时使用≤1项服务的个体相比，使用4-7项服务与当前无家可归几率降低（调整后的优势比[AOR]=0.29）和每日吸毒几率降低（AOR=0.35）显著相关（两者p<0.05）。
研究结果表明，这个未得到充分研究的从CWS成年脱离的高危吸毒者群体从过渡服务利用中获得了长期益处，并且对这些服务感兴趣并愿意参与。然而，鉴于未满足的需求较高，研究结果也凸显了服务提供方面的巨大差距，并呼吁延长CWS中所有青年的脱离年龄，特别是在服务模式中纳入更多的减少伤害和物质使用支持。
