Tolou-Shams Marina, Folk Johanna B, Del Cid Margareth V, Salas Jannet Lara, Czopp Alison, Gonzalez Juan Carlos, Lundberg Tylia, Kerrison Erin Michelle Turner, Shumway Martha, Wrixon Ann, Salgado Robert, Berrick Jill Duerr
Department of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General Hospital, Pride Hall 2540 23rd street, San Francisco, CA, 94110, USA.
School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, Berkeley, CA, 94720, USA.
BMC Health Serv Res. 2025 May 10;25(1):676. doi: 10.1186/s12913-025-12811-9.
Adolescents in foster care report high rates of mental health needs, yet intervention access remains limited. Substance use commonly co-occurs with mental health symptoms, but availability of substance use services for foster youth is even more scant than mental health services. Technology has advanced access to behavioral health care across the lifespan, but only for certain sectors of the population. Little research focuses on leveraging technology to advance access for foster youth. We report open trial findings, as a precursor to launching a large-scale implementation science trial, on how a U.S. nationwide serving support system for foster youth, Court Appointed Special Advocates (CASA), might be leveraged to expand access to substance use prevention resources via the FostrSpace app. FostrSpace provides asynchronous resources and synchronous navigator, peer support, and direct clinical intervention. A concurrent 6-session ECHO® substance use prevention telementoring curriculum was co-developed as a FostrSpace implementation strategy with a 6-member CASA Advisory Board.
Seven youth-CASA dyads enrolled in the open trial. We used a mixed-methods design (quantitative assessment and qualitative exit interviews) to assess feasibility and acceptability of ECHO® sessions (CASA-only) and the usability of the FostrSpace app (youth-only).
Six of seven of the youth accessed the app at least once, but a majority reported the app log-in process was burdensome and unappealing, thereby limiting them from frequently using the app. All youth rated the app features, design and content as appealing, helpful and relevant. ECHO® -FostrSpace session attendance was high (most attended 5 or more sessions) and CASAs found the content highly engaging and useful, especially regarding CASA-youth substance use communication skills.
Technological barriers, such as log-in burden, can prevent youth in need from accessing relevant services and must be regularly assessed and resolved. Substance use education and skills-building for CASAs is novel and a viable implementation strategy to increase foster youth access to digital behavioral health services innovations. Substance use prevention content should be integrated within discussions on youth mental health and trauma to be most engaging and relevant. Findings are informing the subsequent hybrid implementation-effectiveness trial design of FostrSpace with 400 youth-CASA dyads across 10 CASA programs in California.
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寄养青少年报告称心理健康需求率很高，但获得干预的机会仍然有限。物质使用通常与心理健康症状同时出现，但为寄养青少年提供的物质使用服务比心理健康服务更加稀缺。技术进步使人们在整个生命周期中都能获得行为医疗保健，但仅针对某些人群。很少有研究关注利用技术来增加寄养青少年获得服务的机会。我们报告了一项开放试验的结果，作为开展大规模实施科学试验的前奏，内容是关于如何利用美国全国性的寄养青少年服务支持系统——法院指定特别倡导者（CASA），通过FostrSpace应用程序扩大获得物质使用预防资源的机会。FostrSpace提供异步资源以及同步导航、同伴支持和直接临床干预。同时，与一个由6名成员组成的CASA咨询委员会共同开发了一个为期6节的ECHO®物质使用预防远程指导课程，作为FostrSpace的实施策略。
七对青少年-CASA组合参与了开放试验。我们采用混合方法设计（定量评估和定性退出访谈）来评估ECHO®课程（仅针对CASA）的可行性和可接受性以及FostrSpace应用程序（仅针对青少年）的可用性。
七名青少年中有六名至少访问过该应用程序一次，但大多数人报告称应用程序的登录过程繁琐且缺乏吸引力，从而限制了他们频繁使用该应用程序。所有青少年都认为应用程序的功能、设计和内容具有吸引力、有帮助且相关。ECHO®-FostrSpace课程的出勤率很高（大多数人参加了5节或更多课程），CASA发现内容非常引人入胜且有用，特别是在CASA与青少年关于物质使用的沟通技巧方面。
诸如登录负担等技术障碍可能会阻止有需要的青少年获得相关服务，必须定期进行评估和解决。为CASA提供物质使用教育和技能培养是一种新颖且可行的实施策略，可增加寄养青少年获得数字行为健康服务创新的机会。物质使用预防内容应融入关于青少年心理健康和创伤的讨论中，以使其最具吸引力和相关性。研究结果为后续在加利福尼亚州10个CASA项目中对400对青少年-CASA组合进行的FostrSpace混合实施效果试验设计提供了参考。
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