Young people who use drugs and the child welfare system : evidence to improve outcomes

Background: Youth exposed to the child welfare system (CWS) experience elevated rates of subsequent homelessness and other negative health-related outcomes. The objectives of this dissertation were to: systematically search and synthesize the literature on the relationship between the CWS and substance use outcomes; examine possible intergenerational impacts of the residential school system (RSS) on CWS-involvement among Indigenous youth; investigate the relationship between the CWS and injection initiation among street-involved youth; and evaluate if utilizing services while aging-out of care is associated with improved long-term health-related outcomes among a high-risk sample of younger people who use drugs (PWUD). Methods: Data were derived from two harmonized, community-recruited prospective cohorts of PWUD in Vancouver, Canada. Study participants were seen semi-annually to complete an interviewer-administered questionnaire. Multivariable logistic regression analyses were used to investigate the intersections between social and structural forces associated with CWS-involvement and their influence on substance use and health-related outcomes. Results: Collectively, the findings of this dissertation indicate that the CWS and related exposures act as a risk environment for youth in care. Having a history of CWS-involvement was independently associated with initiating injection drug use before age 18 among street-involved youth. Among Indigenous PWUD, immediate familial RSS exposure (i.e., grandparent, parent) was common (66.3%) and independently associated with a higher likelihood for having been personally placed into the CWS. Further, when controlling for familial RSS exposure, a non-detectable difference in the odds of CWS-involvement between Indigenous and non-Indigenous PWUD was found. Among PWUD, approximately half of the sample utilized financial, independent living, and medical services while aging-out, but low utilization rates and high unmet demand were reported for education, employment, and life-skills services. PWUD who utilized a higher number of transitional services while aging-out were significantly less likely to report subsequent daily drug use or housing instability. Conclusions: This dissertation identifies several policy opportunities to improve the health and wellbeing of marginalized youth in care, and particularly supports calls to extend care and services to facilitate successful transitions to independence among those who age-out. Evidence-based interventions that address the upstream social and structural determinants of CWS-involvement are also urgently needed.Graduate and Postdoctoral StudiesGraduat