JMIR Publications

ABSTRACT

Background:

Foster youth experience high rates of unmet mental health and substance use needs, yet simultaneously face numerous barriers to accessing and engaging in community-based services. Behavioral Intervention Technologies (BITs) are promising for overcoming some of the barriers to service engagement, particularly when designed in collaboration with the intended users.

Objective:

The current study describes lessons learned from a 31-month process of co-designing FostrSpace, a BIT to address social determinants of health and behavioral health needs among foster youth. Our overall aim is to provide a roadmap for other scholars wishing to co-design BITs with minoritized youth that have the potential to address social determinants of health and increase access to and engagement in behavioral health care.

Methods:

The co-design process of creating FostrSpace included five phases: design, development, launch, testing and evaluation, and iterative refinement. We describe the activities conducted during each phase, as well as the resultant FostrSpace application. In-application FostrSpace utilization data was collected as part of a quality improvement effort to iteratively refine the application; during registration, all youth signed a user agreement which detailed data usage.

Results:

FostrSpace utilization data was collected from 40 youth (78% (n=31) ages 18-26 years; 20% (n=8) 13-17 years). Based on the resource needs survey at sign-up, youth sought resources in the domains of emotional wellness (n=29), healthcare (n=17), housing (n=16), transportation (n=15), employment (n=15), school (n=13), food (n=12), family (n=11), and legal (n=7) resources, or other/not sure (n=16). Ten youth requested support from the personal care navigator. Fourteen youth completed the emotional wellness questionnaire (EWQ) and identified substance use, depression, anger/irritability, mania, anxiety, somatic symptoms, and sleep problems as areas of concern. Seven of these youth initiated behavioral health services with a FostrSpace clinician.

Conclusions:

Engaging in participatory co-design of BITs with foster youth and other minoritized communities requires careful attention to power dynamics and to creating a space where co-designers feel there is mutual benefit to engaging in the process and it is psychologically safe to share their experiences. We describe lessons learned from engaging in this co-design work, including how it relates to decisions about the technology (e.g., balancing youth privacy with burden of login process), working with third-party developers (e.g., ensuring technology development partners have sufficient knowledge about the population you are co-designing with to meaningfully engage with them) and considerations for the strategic embedding of technology-based interventions within existing systems of care to promote uptake.