(PS6-100) Screening for Caregiver Substance Use in Federally Qualified Health Centers: Provider and Caregiver Perspectives

Caregiver substance use is associated with short and long-term risks for children, including developing a substance use disorder (Lipari & Van Horn, 2017). Although these children would benefit from prevention and intervention services, they often face barriers to accessing behavioral health (BH) services. Caregiver substance use screening in primary care settings is a promising method to identify these families and increase access to behavioral health services due to higher visit frequency and easier care access.  Existing studies suggest screening is rarely implemented due to provider lack of time during appointments, discomfort with measures, and stigmatizing attitudes toward those using substances (Matson, 2022a). This is contrast to findings that caregivers both believe that it is acceptable for pediatricians to screen for caregiver substance use and a third of caregivers report concern regarding the impact of a caregiver’s substance use on their children (Matson et al., 2022b). Addressing this discrepancy and understanding the full range of barriers and facilitators to the implementation of screening is vital to ensure non-stigmatizing and effective early identification of impacted children. 

This study addresses this gap through mixed-method data, inclusion of providers and caregivers, and assessment of other factors in implementation success. Our sample includes healthcare providers at five southwestern Federally Qualified Heath Centers and caregivers whose children receive care at these clinics. Providers were generally White Non-Hispanic, from diverse training backgrounds, and served youth of all ages. Other provider data collected included provider reported demographics, scope of practice, provider attitudes toward caregivers with unhealthy substance use, prior training in caregiver substance use, and comfort with screening. Caregivers recruited were identified as primarily racial/ethnic minorities, had children receiving publicly funded insurance, and experienced high rates of adverse child experiences. Caregiver data also included other important demographic data, experiences with health care discrimination, ratings of stigma towards caregivers with substance misuse, and trust in their child’s provider.  

We will present the results of two multiple regression models examining the effects of these variables on provider and caregiver comfort with screening for substance use. We hypothesize that providers reporting higher levels of burnout, more stigmatizing attitudes toward caregivers with unhealthy substance use, and less prior training will have lower acceptance and comfort with unhealthy caregiver substance use screening. For caregivers, we hypothesize that caregivers reporting unhealthy substance use, more ACEs, and more experiences of health care discrimination will report more negative attitudes towards screening. Study results inform future implementation efforts in publicly funded settings with underrepresented populations.