Developing a tailored substance use intervention for youth exiting foster care

Abstract

Youth who are aging out of the foster care system face significant barriers to accessing substance use treatment. Mobile interventions have shown efficacy for several mental and physical health issues and may be helpful in overcoming barriers facing foster youth with substance use problems. A program (iHeLP) for substance use reduction was developed that used a computerized screening and brief intervention (SBI) followed by six months of dynamically-tailored text messages. The program was shown to focus groups of youth (N = 24) ages 18-19 who recently left foster care and had moderate to severe substance use risk. Focus group feedback was used to modify iHeLP prior to delivery in an open trial (N = 16). Both study phases included assessments of feasibility and acceptability; the open trial also included assessments of substance use outcomes at 3 and 6 months. Focus groups indicated a high level of acceptability for the proposed intervention components. Of those screened for the open trial, 43% were eligible and 74% of those eligible enrolled, indicating good feasibility. Retention through the final follow-up was 59%, and drop out was associated with involvement in the criminal justice system. Participant ratings for liking, ease of working with, interest in and respectfulness of the SBI were high. Satisfaction ratings for the texting component were also high. A computerized brief screening intervention for substance use risk reduction together with tailored text messaging is both feasible and highly acceptable among youth who have recently aged-out of foster care.

A pilot randomized controlled trial of a technology-based substance use intervention for youth exiting foster care

“…Our finding that the ratings were not significantly different suggests that our nonthreatening intervention tool may have an important advantage over traditional approaches. Results from the exit interviews further support this interpretation, as satisfaction with the text messaging component mirrored our previous quantitative work in this area, where youth exiting care were highly supportive of using mobile phones to deliver intervention content (Braciszewski, Tzilos Wernette, et al, 2018). In addition, participants suggested that we offer iHeLP for longer than six months and extend care beyond the text messages to contact with other peers or professionals.…”

“…Participants had strongly positive feelings about the texting component, stating that it made them think, built motivation, was easy to use, and felt like someone else was caring about their health. New iHeLP components suggested in our previous open trial (biweekly goal reminders and weekly feedback on substance use; Braciszewski, Tzilos Wernette, et al, 2018) were very well received. All participants indicated that the goal reminders were helpful to keep on track and that feedback on progress was empowering and provided specific motivation for not smoking marijuana.…”

“…Overall, we feel confident that interest in a technology-based intervention, desire to understand more about one’s substance use, or a combination of both were strong motivating factors in choosing to enroll. Indeed, our previous work has indicated that this population is eager for a substance use intervention, provided it fits their needs (Braciszewski, Tran, et al, 2018; Braciszewski, Tzilos Wernette, et al, 2018).…”

“…If participants responded with a Readiness Ruler score that would alter their TTM stage, weekly text message content, thereafter, reflected that change. Based on feedback from earlier iterations of iHeLP (Braciszewski, Tzilos Wernette, et al, 2018), participants also received weekly feedback on their substance use, as well as twice-monthly reminders of self-identified reasons to change, methods of change, and downsides to using substances.…”

A text message delivered smoking cessation intervention: Design and rationale of the Text My Quit Study

“…Since we are hoping to recruit a sample of smokers from the general population, recruitment methods include posting advertisements online on social media websites such as Craigslist or Facebook, as well as through flyers targeted at a variety of venues including pharmacies, grocery stores, and churches. These methods have proven successful in our previous studies [37,41,42]. In addition, we will be reviewing the hospital's electronic health records for patients who tentatively match the eligibility criteria (i.e.…”