(PS9-6) Applying a Hub-and-spoke Model Framework to Children Impacted by Unhealthy Caregiver Substance Use: Lessons Learned and Next Steps

Children exposed to caregiver unhealthy substance use are at high risk of developing behavioral health (BH) and substance use disorders (SUDs; McGovern et al., 2020). Caregiving stress and child BH concerns are also linked with a caregiver’s risk of relapse. Existing evidence suggests benefits from early recognition and access to family oriented and strengths based BH care, including improved child BH symptoms, decreased risk of caregiver relapse and overdose, and improved family functioning (Kim, Brook, & Akin, 2018; Moreland & McRae-Clark, 2018).

Despite these findings, these families are underrecognized and underserved in community and clinical settings. Screening for children impacted by CUSU is rare in pediatric primary care settings, even as screening for other social determinants of health rise (Oldfield et al., 2021). Existing family-oriented care models are rarely offered outside of residential substance use treatment settings, serve primarily mothers and young children, and focus on improvements in maternal symptomatology (Moreland & McRae-Clark, 2019). Empirically supported treatments (ESTs) are limited and rarely used in community settings (Walsh Pedersen, Niehaus, & Sheldon, 2023). Beyond these barriers, families face immense internalized stigma and overt stigma from their community (McCann et al., 2018; Smyth & Newland, 2019). This is especially true for marginalized groups, such as low-income and racial/ethnic minorities. Research suggests that psychoeducational training for families, school, community, and medical personnel may decrease stigmatizing beliefs and behaviors that impact engagement in care (Khenti, Bobbili, & Sapag, 2019; Bielenberg et al., 2021).

We will present an application of a Hub-and-Spoke framework in a safety-net hospital system to address these gaps. We used the hospital system’s existing Hub and Spoke model for the treatment of adults with Opioid Use Disorder and leveraged existing electronic health record tracking to include all caregiver substance use types, screen for CUSU in 19 federally qualified health centers, tailor Parent-Child Interaction Therapy and Alternatives for Families: a Cognitive Behavioral Therapy for these families, and design community-informed psychoeducational groups. Using repeated mixed-method approaches, we obtained stakeholders’ views of barriers to model fit, acceptability, and effectiveness, providing real-world implementation guidance. We will present initial data regarding two years of model implementation, including number of families served and key takeaways from implementation successes and failures. Findings from this work inform the uptake of similar models in this underserved population, especially in low-resourced and publicly funded settings.