FostrSpace-CASA R61/R33

CASA and FostrSpace: Systems Delivery of Digital Substance Use Prevention Tools to Foster Youth

The purpose of this study is to understand how an online digital health application (app) called FostrSpace can reduce substance use among youth (ages 13-20 years old) in foster care.

Study Overview

• Status: Active, not recruiting
• Conditions: Substance Use
• Intervention / Treatment: Other: ECHO-FostrSpace; Other: Informational Session

Detailed Description

The goal of this clinical trial is to identify gaps in substance use prevention across existing CASA trainings and the FostrSpace app for foster youth and test how substance use trainings for CASA volunteers could help facilitate FostrSace app referrals to reduce and prevent substance use among CASA youth.

• Study Type: Interventional
• Enrollment (Estimated): 400
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • San Francisco, California, United States, 94131
      • UCSF Zuckerberg San Francisco General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Adolescents and young adults will be eligible if they are age 13-20, are proficient in English, have an assigned CASA worker, and have a device with web access.
• CASAs (ages 18 and over) will be eligible if they are assigned to a youth between the ages of 13- 20.

Exclusion Criteria:

• Youth: Exclusion criteria include being non-English speaking, being within 3 months of ending with CASA services, cognitive impairment that precludes ability to provide informed consent.
• CASA: Exclusion criteria include being non-English speaking and working with a youth who is within 3 months of ending with CASA services.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: InfoECHO; CASA volunteers will attend a six 90-minute/biweekly co-occurring SU and trauma ECHO trainings.	Other: ECHO-FostrSpace; Six ECHO-FostrSpace session training for CASA volunteers.
Other: InfoOnly; CASA volunteers will attend a one-time 30-60 minute co-occurring SU and trauma ECHO training.	Other: Informational Session; One ECHO-FostrSpace session training for CASA volunteers.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of Drug Use	The Texas Christian University (TCU) drug screen with opioid supplement is used to gather detailed information about drug and opioid use.	baseline
Rate of Cigarette Use	The Cigarette smoking and vaping/e-cigarette use is used to gather detailed information about nicotine and/or cannabis use.	baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Alcohol and Marijuana Expectancy Questionnaire	The Alcohol and Marijuana Expectancy questionnaire is used to measure positive and negative expectancies about affective, cognitive and behavioral effects of alcohol and cannabis use. Items are rated from 1-5 scale and higher scores indicate negative alcohol and marijuana expectancies.	baseline
The Brief Young Adult Alcohol Consequences Questionnaire	The Brief Young Adult Alcohol Consequences Questionnaire is used to assess the severity of alcohol consumption. Higher scores indicate greater severity of consequences associated with alcohol consumption.	baseline
The Brief Marijuana Consequences Questionnaire	The Brief Marijuana Consequences Questionnaire is used to assess the severity of marijuana consumption. Higher scores indicate greater severity of consequences associated with marijuana consumption.	baseline
The Brief Symptom Inventory	Brief Symptom Inventory is used to measure depression, anxiety and somatization symptoms to assess for psychiatry distress. Index ranging from 0 to 72 with cut-score of 11 as indication of psychiatric distress.	baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
CASA Background Characteristics	Demographics questionnaire used to gather standard demographics (e.g., age, gender, race) and information such as state agency involvement (e.g., age at first contact with child welfare, number of out-of-home placements, length of time worked with a CASA), immigration status.	baseline
Arrest and Treatment	The Arrest and treatment history (ATH) questionnaire is used to gather information about past juvenile legal system contact (arrest, probation, detention), mental health (MH) and substance use (SU) diagnoses, and past services utilization for SU and/or MH (inpatient, residential, outpatient).	baseline
Youth Background Characteristics	Youth's living situation questionnaire will be used to gather information related to the youth's living situation over the past 4 months (e.g., in the community, residential treatment, or other living situation).	baseline
Social Determinants of Health	We will administer an 18-item yes/no questionnaire to gather information on what youth perceive as most relevant and important social determinants of health items for foster youth (i.e., employment, food, family, healthcare, housing, legal, education, safety at school/work, transportation, "other" needs).	baseline
Therapeutic Alliance	The Working Alliance Inventory (WAI) is used to assess youth's perception of therapeutic alliance (with provider) over time. Scores range from 12-84 with higher scores indicating greater perceived therapeutic alliance.	baseline
Youth/CASA Relationship	Frequency and quality of CASA-youth conversations about substance use: For frequency, we will adapt an item from a validated measure of parent-child communication about sex used in previous studies45 "How many times have you and your CASA talked about [alcohol, marijuana, cocaine]" (each drug asked separately). For quality, we will use one-item from the scale that assesses perceived helpfulness 'How helpful do you think your discussions about alcohol and/or drugs were?' and one-item that assesses perceived comfort 'How comfortable are you with these discussions about alcohol and/or drugs with your [CASA youth] or [CASA].	baseline
Trauma	6: deidentified assessment of Adverse Childhood Experiences (10 items) and Related Life Events (7 items).	baseline
Ethnic Identity	The Scale of Ethnic Experience is used to measures youth ethnicity-related cognitive constructs (e.g., perceptions of their own ethnic group, ethnic group belonging) in four domains: Ethnic Identity(12-items; α =.87); Perceived Discrimination (9-items; α = .91); Mainstream Comfort (6-items; α=.87); and Social Affiliation (5-items; α =.83). Items rated on a scale from 1 (strongly disagree) to 5(strongly agree).	baseline
Stigma	The Social Distance Scale (SDS) is used to assess a person's willingness to interact with others with mental illness (SDS) or substance users (SDS-SU).	baseline
Peer Substance Use	The Monitoring the Future is used to assess how many close friends are using alcohol, cannabis and other drugs occasionally and regularly.	baseline
Background Characteristics	A Demographics Questionnaire is used to gather standard demographics (e.g., age, gender, race) and information about employment, number of years as CASA volunteer, length of time known current foster youth, immigration status, country of origin.	baseline
Substance use prevention related knowledge, beliefs, attitudes and self efficacy	Beliefs about youth SU will be measured using an adapted 9 item perceived risk of SU measure used in studies of similar risk perceptions (among parents) associated with youth substance use. Items such as "If your youth were to use alcohol more than once a week, what do you think are the chances of them becoming (for example) addicted to alcohol, developing cancer (or lung cancer for drugs that can be smoked), experiencing brain injury etc.	baseline
Compassion Satisfaction and Fatigue	The Professional Quality of Life will be used to gather information about compassion satisfaction and compassion fatigue.	30 days post baseline, 60 days post baseline
FostrSpace App Utilization	Number of app log-in's, days of use, time spent using app, number and type of features used e.g.,chat use (peer/FAB), chat use (navigator), number of clicks on SU prevention content (e.g., SU resources requested, peer "adulting 101" SU prevention video watched), requested navigator support (yes/no), requested navigator support about SU (yes/no), requested teletherapy [primary presenting need, type of intervention, e.g., primary SU or MH or co-occurring, modality of intervention (individual, group, family), number and frequency of sessions received].	baseline, 30 days post baseline, 60 days post baseline
Psychiatric Symptoms	The Emotional Wellness Questionnaire is used to assess psychiatric symptoms (e.g., depression, anxiety, mania) and substance use.	baseline
FostrSpace Usability	The System Usability Scale (SUS) is used to gather information about the overall usability of web applications. 10- item measure widely used for web applications and proven superior to other measures. SUS yields a single number representing a composite measures of the overall usability of the system being studied60,61. Scores will be compared to established norms for levels of usability. Our goal is a score of 80 (top 10% of scores), which reflects excellent usability, and is associated with recommending the product to a friend.	30 days post baseline, 60 days post baseline

Collaborators and Investigators

• Sponsor: University of California, San Francisco
• Collaborators: National Institute on Drug Abuse (NIDA)
• Investigators: Principal Investigator: Marina Tolou-Shams, PhD, University of California, San Francisco

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2024
• Primary Completion (Estimated): March 1, 2029
• Study Completion (Estimated): March 1, 2029

Study Registration Dates

• First Submitted: December 16, 2024
• First Submitted That Met QC Criteria: March 7, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 7, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: mHealth; Substance use; Foster youth
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: 1R61DA059860-01 (U.S. NIH Grant/Contract); R61DA059860 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No