Bridging the Gap: A Secondary Data Analysis of Implementation Outcomes and Symptom Trajectories of an eHealth Mental Health and Parenting Treatment Among Mothers With and Without At-Risk Substance Use

Background: Several eHealth treatments, including the Building Emotional Awareness and Mental Health (BEAM) program, are feasible and effective for mothers with mental health concerns such as depression and/or anxiety. BEAM is a mental health and parenting program that does not directly address substance use. Prior BEAM trials observed high rates of alcohol and cannabis use among participants, despite not recruiting based on substance use. No research has examined BEAM among mothers with mental health concerns and at-risk substance use (ARSU), highlighting the need to understand implementation metrics and symptom trajectories among mothers with depression/anxiety and ARSU (ARSU+) and without ARSU (ARSU-). Objectives: To address this gap, we examined BEAM implementation metrics (retention, session attendance, perceived usefulness, safety) and mental health and parenting stress symptom trajectories over time in mothers with ARSU+ and ARSU-. Design: This was a secondary data analysis of 2 BEAM trials for mothers of infants (6-18 months) and toddlers (18-36 months). Methods: = 31.85) from the BEAM arm of 2 trials: infant (n = 40) and toddler trials (n = 70). Implementation metrics were evaluated against pre-specified benchmarks. Mental health and parenting stress symptom trajectories were examined across time using 2-level mixed models. Results: Treatment adherence and safety benchmarks were met in both groups, the perceived usefulness benchmark was met only in the ARSU+ group, and the retention benchmark was not met for either group. Mental health and parenting stress symptom trajectories were largely similar between ARSU subgroups over time. Conclusion: This study extends evidence on BEAM by showing that mothers with ARSU+ can safely engage with BEAM, have acceptable treatment adherence, and describe BEAM as useful. Retention remains the key implementation barrier for mothers with ARSU+. Future BEAM iterations should prioritize retention-focused supports (eg, proactive engagement, incentives) to strengthen real-world impact.