Can you drive deck screws through this or does it need to be removed before driving the screw in?

It’s just a spacer. You can drive screws with it in place but not through the spacer. You then need to pry it out and move on. I found it helpful especial with longer deck boards that were not perfectly straight.

Is this tool useful even if using concealed fasteners?

I not 100% sure, although I haven't used concealed fasteners, I think that my understanding is that some of them actually have built in spacing on the fasteners. You might want to look them up to be sure.

ASIN	B0009WG57G
Best Sellers Rank	1,005,886 in DIY & Tools ( See Top 100 in DIY & Tools ) 11,396 in Pipes, Pipe Fittings & Accessories
Brand	Johnson
Colour	Green,orange
Customer Reviews	4.7 out of 5 stars 522 Reviews
Global Trade Identification Number	00049448602759
Item Dimensions L x W	5.1L x 8.9W centimetres
Item Type Name	Deck Mate - Deck Board Spacing Tool
Item Weight	91 g
Item weight	91 g
Manufacturer	Johnson Level & Tool
Manufacturer Warranty Description	1 year warranty: johnson level warrants this product against defects in material and workmanship for one year after the confirmed purchase date. At its option, the company will replace or repair the product if it fails under normal use.
Material	Poly
Operation Mode	Manual
Product dimensions	5.1L x 8.9W centimetres
Style	Standard
UPC	049448602759
Unit Count	1.0 Count

Johnson Level & Tool 60-275 Deck Mate, Deck Board Spacing Tool, Orange, 1 Level

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