Advancing access to substance use prevention for foster youth through digital innovation: an open trial of fostrspace with court appointed special advocate programs
Abstract Background 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....
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BMC
2025-05-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-12811-9 |
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| author | Marina Tolou-Shams Johanna B. Folk Margareth V. Del Cid Jannet Lara Salas Alison Czopp Juan Carlos Gonzalez Tylia Lundberg Erin Michelle Turner Kerrison Martha Shumway Ann Wrixon Robert Salgado Jill Duerr Berrick |
| author_facet | Marina Tolou-Shams Johanna B. Folk Margareth V. Del Cid Jannet Lara Salas Alison Czopp Juan Carlos Gonzalez Tylia Lundberg Erin Michelle Turner Kerrison Martha Shumway Ann Wrixon Robert Salgado Jill Duerr Berrick |
| author_sort | Marina Tolou-Shams |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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). Results 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. Conclusions 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. Trial registration Retrospectively registered. |
| format | Article |
| id | doaj-art-9b81ea6315674626ba9802f4a16da5e9 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-9b81ea6315674626ba9802f4a16da5e92025-08-20T03:53:11ZengBMCBMC Health Services Research1472-69632025-05-0125111210.1186/s12913-025-12811-9Advancing access to substance use prevention for foster youth through digital innovation: an open trial of fostrspace with court appointed special advocate programsMarina Tolou-Shams0Johanna B. Folk1Margareth V. Del Cid2Jannet Lara Salas3Alison Czopp4Juan Carlos Gonzalez5Tylia Lundberg6Erin Michelle Turner Kerrison7Martha Shumway8Ann Wrixon9Robert Salgado10Jill Duerr Berrick11Department of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General HospitalDepartment of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General HospitalDepartment of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General HospitalDepartment of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General HospitalDepartment of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General HospitalDepartment of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General HospitalDepartment of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General HospitalSchool of Social Welfare, University of California, BerkeleyDepartment of Psychiatry and Behavioral Sciences|Weill Institute for Neurosciences, University of California, San Francisco, Zuckerberg San Francisco General HospitalCASA of Contra Costa CountyCASA of Contra Costa CountySchool of Social Welfare, University of California, BerkeleyAbstract Background 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. Methods 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). Results 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. Conclusions 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. Trial registration Retrospectively registered.https://doi.org/10.1186/s12913-025-12811-9Digital behavioral health interventionFoster youthSubstance useMental health |
| spellingShingle | Marina Tolou-Shams Johanna B. Folk Margareth V. Del Cid Jannet Lara Salas Alison Czopp Juan Carlos Gonzalez Tylia Lundberg Erin Michelle Turner Kerrison Martha Shumway Ann Wrixon Robert Salgado Jill Duerr Berrick Advancing access to substance use prevention for foster youth through digital innovation: an open trial of fostrspace with court appointed special advocate programs BMC Health Services Research Digital behavioral health intervention Foster youth Substance use Mental health |
| title | Advancing access to substance use prevention for foster youth through digital innovation: an open trial of fostrspace with court appointed special advocate programs |
| title_full | Advancing access to substance use prevention for foster youth through digital innovation: an open trial of fostrspace with court appointed special advocate programs |
| title_fullStr | Advancing access to substance use prevention for foster youth through digital innovation: an open trial of fostrspace with court appointed special advocate programs |
| title_full_unstemmed | Advancing access to substance use prevention for foster youth through digital innovation: an open trial of fostrspace with court appointed special advocate programs |
| title_short | Advancing access to substance use prevention for foster youth through digital innovation: an open trial of fostrspace with court appointed special advocate programs |
| title_sort | advancing access to substance use prevention for foster youth through digital innovation an open trial of fostrspace with court appointed special advocate programs |
| topic | Digital behavioral health intervention Foster youth Substance use Mental health |
| url | https://doi.org/10.1186/s12913-025-12811-9 |
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