Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT04895670 |
| Other study ID # |
33699 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
August 12, 2021 |
| Est. completion date |
June 30, 2023 |
Study information
| Verified date |
August 2023 |
| Source |
University of Texas Southwestern Medical Center |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
Improving the health literacy of adolescents and increasing the success of transitions to
adulthood from foster care are two defined Healthy People 2030 public health priorities.
Skills to promote health literacy and independent living are often lacking in adolescents in
foster care and young adults who have aged out of care. Frequent placement changes, no
permanent home, lack of trust in adults and systems of care prevent the development of a
strong support system for transitioning to adulthood from foster care, which can result in
lack of access to personal health information, complicated identity documents, and
disconnected child welfare, health care and community resources. These factors limit the
ability to transition to adulthood successfully, drive disparities in health outcomes, and
may explain lack of educational attainment and career development for young adults formerly
in care. Successful transitions to independent living are unattainable unless barriers are
addressed with a multidisciplinary, community-based approach.
The Rees-Jones Center for Foster Care Excellence at Children's Health and the Krissi Holman
Family Resource Library at Children's Health recognized the unique needs of adolescents in
foster care and young adults formerly in care (AYAFC) as they transition to independent
living. We developed a partnership with community agencies (Empowering Youth Taskforce) that
support these youth in the areas of child welfare (TX Department of Family and Protective
Services), education (UNT PuSH Program), career development and housing support (TRAC at City
Square, Zoie's Place), legal support (SMU Dedman Law School), and others, to increase AYAFC
health literacy, access to health care, and awareness and use of available community
resources. Frequent placement changes and unstable housing make it difficult for AYAFC to
keep their health information, identity records and personal documents together, which is
critical for accessing health services, enrolling in health insurance, and maintaining
wellness. Since many have access to a smart phone, using technology is one way to promote
adolescent health and wellness. An app is a possible solution to address many of the barriers
that impede successful transition to independent living.
The goal of this project is to engage AYAFC and stakeholders who support these young people
throughout North Texas to collaboratively design an app to support the transition from foster
care to adulthood. This project will utilize a mixed methods approach to inform the
transition process while addressing both individual and systems level barriers to increase
the success of AYAFC's transition to independent living. This project builds upon work done
by a multidisciplinary community task force led by the Principal Investigator, and the
development of an adolescent transition process at the Rees-Jones Clinic. Community partners
are fully engaged in the design of the intervention and will be involved in AYAFC and
stakeholder recruitment, data analysis, and interpretation of the results.
Description:
This project is uniquely community-based as the only known digital information-sharing
project that will solicit input directly from AYAFC and multiple community stakeholders.
Prior studies had input from youth in care, child welfare personnel and health care
providers; our project includes stakeholders involved in life skills and employment training,
housing support, legal advocacy, and education for a more robust community perspective. Other
information sharing resources have been web-based, which is more challenging to access, or
resulted in a paper guidebook. Our innovative app maximizes ease of access and portability
without requiring significant cellular data usage. Assessing the health literacy skills of
AYAFC can inform future interventions to support transitions to wellness in adulthood while
youth are still in foster care.
This project is supported by the Region 3 Foster Care Consortium, a coalition of
organizations and individuals committed to improving the lives of children involved in the
foster care system. The Empowering Youth Task Force members are community partners who
specialize helping youth in foster care successfully transition to adulthood. Each member
organization contributes expertise on specific issues surrounding AYAFC they serve. They will
engage in participant recruitment, app design and dissemination. Members of the Empowering
Youth Task Force include:
The Rees-Jones Center for Foster Care Excellence is a community leader in clinical care,
policy and advocacy and research. Roles include project design; development focus group
questions; focus group and survey data collection and analysis; expertise on adolescent
transitions from the medical provider, behavioral health provider, foster parent, and
caseworker perspective; stakeholder engagement, and information dissemination.
The Krissi Holman Family Resource Library at Children's Health provide expertise in
literature review and health literacy. Roles include project design; development focus group
questions; survey and focus group and data collection and analysis. They will provide links
to reliable health information and resources, and plain language educational materials that
can be utilized through the app.
The Transition Resource Action Center at City Square supports transition-age youth with
employment, education and housing, providing perspective on the issues facing young adults
aging out of foster care.
The Southern Methodist University Dedman Law School Child Advocacy Clinic is a community
expert on legal issues for youth aging out of foster care and will provide information
resources (letter of support attached) The University of North Texas' Persevere UNTil Success
Happens (PUSH) Program supports former foster youth and will provide additional perspectives
on the needs of youth transitioning out of care.
The Texas Department of Family and Protective Services and their Child Protective Services
and Preparation for Adult Living Program contributes expertise in child welfare transition
services available to youth.
Superior Star Health Transition Services provides expertise in health insurance and support
for AYAFC and will provide perspective regarding youth engagement in health insurance.
Additional community partners include Dallas Court-Appointed Special Advocates (CASA) and
Zoie's Place, who provide information as unbiased child advocates and perspective about needs
surrounding life skills training, support and transitional housing for AYAFC, respectively.
Study Design Most AYAFC have phones. An app is an ideal tool to help them manage reputable
sources for health education and information, document storage, and access to community and
child welfare resources. A community-engaged approach with AYAFC with first-hand knowledge of
the foster care system will result in an app that is relevant and acceptable.
4.1 Study Design: Aim 1: Using mixed methods, (survey and focus groups) conduct a needs
assessment that measures health literacy and assesses health information, supportive care,
and resource needs for AYAFC transitioning from foster care to independent living.
Evaluation Methods: Survey of AYAFC to assess health literacy skills, assessment of knowledge
of health and community resources, attitudes surrounding available resources and confidence
in accessing digital information. Focus groups with AYAFC and community stakeholders to
assess current needs surrounding health literacy, health information and community resources.
AYAFC Inclusion Criteria for all focus groups and surveys: 1) AYAFC: English-speaking, ages
18-24 who live in Texas Region 3.
Community stakeholders Inclusion Criteria (focus groups): English-speaking adults (18+) who
support AYAFC (e.g. caregivers, medical, legal, and social service professionals)
Aim 2: App Development and Implementation: App development and implementation will use a
user-centered design approach. This involves a needs assessment and targeted user feedback to
develop an app framework. After legal approval, app infrastructure, capabilities and
functionality are developed, design build-out and front and back-end integration occurs. User
acceptability testing occurs at each step with testing and piloting before full roll-out.
Evaluation method: (a) Survey of implementation outcomes. (b) 4 additional focus groups with
AYAFC and community stakeholders to assess attitudes toward app content, design, and
usability.
Aim 3: By survey, reassess health literacy skills, and knowledge, attitudes, and confidence
in accessing health information and needs for community resources.
