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Abstract BackgroundAdolescents 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. MethodsSeven 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). ResultsSix 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. ConclusionsTechnological 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 registrationRetrospectively registered. 

This study explores COVID-19 vaccine acceptance among prison security staff and the extent to which they trust varied sources of information about the vaccines. Cross-sectional survey data were obtained from a state-wide sample of corrections officers (COs, hereafter; n = 1208) in February 2021. Group differences, disaggregated by demographic characteristics, were examined using F-tests and t-tests. Despite the comparatively limited risk of contracting the virus, non-security staff reported they would accept a COVID-19 vaccine at no cost (74%), compared to their more vulnerable CO counterparts (49%). We observed vaccine refusal correlations between COs’ reported gender, age, and length of time working as a CO, but none with their self-reported race. Vaccine refusal was more prevalent among womxn officers, younger officers, and those who had spent less time working as prison security staff. Our findings also suggest that the only trusted source of information about vaccines were family members and only for officers who would refuse the vaccine; the quality of trust placed in those sources, however, was not substantially positive and did not vary greatly across CO racial groups. By highlighting characteristics of the observed gaps in COVID-19 vaccine acceptance between COs and their non-security staff coworkers, as well as between corrections officers of varied demographic backgrounds, these findings can inform the development of responsive and accepted occupational health policies for communities both inside and intrinsically linked to prisons.