(PS9-17) Current Practices in Treating Adolescent Opioid Use in Community Settings

As the national opioid crisis grows, there has been an increase in opioid-related overdose deaths among adolescents and young adults. Evidence-based treatments (EBTs) for adolescent substance use have demonstrated some efficacy in reducing opioid use. However, access to EBTs remains low in community settings, particularly for minoritized youth. Thus, little is known about current practices in screening and treatment of adolescent opioid use in community mental health settings. This study explored use of best practices for adolescent opioid use disorder (OUD), as well as self-efficacy in their use, in a sample of 51 community-based mental health clinicians (47.1% white; 82% female; M_age = 40.6) who work across multiple settings. All clinicians were participating in a training on the diagnosis and treatment of adolescent OUD.

Clinicians completed a pre-training survey. The first set of questions asked about caseload demographics and use of best practices in adolescent opioid use screening, diagnosis, and treatment. The second set of questions assessed clinician self-efficacy in use of best practices, using a scale of 1 (not at all) to 5 (very much). Descriptive statistics were used to analyze these data.

On average, clinicians reported that the majority of their caseload were from minoritized backgrounds. Approximately 70.0% were racial-ethnic minorities, 48.9% Medicaid-funded, 46.9% immigrants, and 19.8% identified as LGBTQIA+. With regard to screening and diagnosis of substance use disorders (SUDs) in their adolescent clients, only 43.1% (N=22) of clinicians reported using validated substance use screening measures and 35.3% (N=18) used validated diagnostic interviews.

A majority of clinicians were also currently treating adolescent clients with an OUD (N=33; 64.7%), with an average caseload of 15.4 of these adolescents. These clinicians were asked to select all treatments they are using for adolescent OUD from a checklist. They endorsed using the following EBTs for adolescent substance use: 52.9% MI; 52.9% CBT; 9.8% Family Therapy (FFT, MDFT, MST); 5.9% Medication Assisted Treatment; and 3.9% ACRA. While 78.8% of these clinicians indicated including caregivers in treatment with every or almost every case, only 39.4% developed opioid overdose prevention plans, and 36.4% used urine drug screens, when treating adolescents with OUD.

Overall, self-efficacy in use of best practices was low, both for those who were currently treating adolescents with OUD (N=33; M=2.75; SD=0.84) and those who were not (N=18; M=2.07; (SD = 0.62).

These results suggest large variability in use of best practices for screening and treating adolescent OUD. Overall, there were low rates of use of validated screening measures and diagnostic interviews, opioid overdose prevention plans, and urine drug screens. Thus, it is not surprising that clinicians reported relatively low self-efficacy in use of these practices. While use of some EBTs were higher than expected in community samples, the present sample had access to free CBT and MI training through a local training consortium. These data speak to the need for additional training to ensure youth with OUD receive high-quality, evidence-based care in the context of community settings.