Bounce Back Now: A Low-Cost Intervention to Facilitate Post-Disaster Recovery

 描述(申请人提供)：灾难使个人面临广泛的压力来源，包括死亡或受伤的威胁，失去亲人，获得基本需求的机会有限，以及因财产损坏或就业中断而造成的经济压力。许多幸存者都很有弹性或恢复得很快，但也有相当一部分人出现了行为健康问题，如创伤后应激障碍和抑郁症。这些心理健康问题有一些有效的治疗方法，但许多灾难幸存者在接受服务方面遇到了障碍(例如，污名、时间承诺、成本、日程安排、交通)。提供简短、有效、免费和高可获得性的干预措施，以促进个人和社区的复原力以及快速和持续的恢复，对受灾社区和救灾机构可能具有巨大的价值。我们建议评估BBN，一种新颖的、可扩展的、高度可持续的基于技术的干预措施。BBN将可以通过任何连接到互联网的设备访问，如计算机、智能手机或平板电脑；它将针对移动设备进行优化，以确保其高度可访问和用户友好。干预措施由三个主要部分组成：(1)一个症状/活动跟踪部分，旨在促进灾后紧急阶段的自我监测；(2)一个简短的自助干预部分，旨在加速相对于创伤后应激障碍和情绪症状的心理健康恢复；以及(3)一个提供者援助部分，将把幸存者连接到国家灾难救助热线。我们的研究支持了BBN的前两个组成部分的可行性，以及BBN的短暂干预成分的初步疗效。灾难求助热线是由药物滥用和精神健康服务管理局管理的一项全国性服务，为精神健康提供者提供危机咨询和当地转介。我们将招募5000名灾难幸存者来测试干预措施：2500人将被随机分配到BBN条件下，另外2500人将被分配到增强型日常护理比较条件下。我们还将研究BBN干预相对于加强日常护理的成本效益。第二个研究目标集中在探索与精神健康恢复、BBN的使用和服务利用相关的分诊级别的风险因素。美国红十字会和主管准备和反应事务的助理秘书办公室已就这一申请与我们合作，并将协助我们招募参与者和收集与分流级别风险因素有关的数据。我们将使用创新的分阶段供资方法进行这项研究，以确保我们准备好在引发灾难事件后立即启动研究。这项研究将显著改善基于技术的灾难心理健康干预的证据基础。

 DESCRIPTION (provided by applicant): Disasters confront individuals with a wide range of stressors, including threat of death or injury, loss of loved ones, limited access to basic needs, and financial strain due to property damage or disruptions in employment. Many survivors are resilient or recover rapidly, but a significant minority develops behavioral health problems such as posttraumatic stress disorder and depression. Some efficacious treatments exist for these mental health problems, but many disaster survivors encounter barriers to receipt of services (e.g., stigma, time commitment, cost, scheduling, transportation). The availability of brief, effective, free, and highly accessible interventions to facilitate personal and community resilience and rapid and sustained recovery is potentially of tremendous value to disaster-affected communities and disaster response agencies. We propose to evaluate Bounce Back Now (BBN), a novel, scalable, and highly sustainable technology-based intervention. BBN will be accessible via any device that is connected to the internet, such as a computer, smartphone, or tablet; it will be optimized for mobile devices to ensure that it is highly accessible and user friendly. The intervention consists of three major components: (1) a symptom/activity tracking component designed to facilitate self-monitoring in the acute post-disaster phase; (2) a brief self-help intervention component that aims to accelerate mental health recovery relative to PTSD and mood symptoms; and (3) a provider assistance component that will connect survivors to a national Disaster Distress Helpline. Our research has supported the feasibility of the first two components of BBN, and the initial efficacy of the brief intervention component of BBN. The Disaster Distress Helpline is a national service administered by the Substance Abuse and Mental Health Services Administration that provides crisis counseling and local referrals to mental health providers. We will recruit 5,000 disaster survivors to test the intervention: 2,500 will be randomly assigned to the BBN condition, the other 2,500 to an enhanced usual care comparison condition. We will also examine the cost effectiveness of the BBN intervention relative to enhanced usual care. A secondary research aim centers on the exploration of triage- level risk factors that are associated with mental health recovery, use of BBN, and service utilization. The American Red Cross and the Office of the Assistant Secretary for Preparedness and Response have partnered with us on this application and will assist us with participant recruitment and collection of data relating to triage- level risk factors. We will conduct this research using an innovative phased-funding approach that will ensure that we are prepared to initiate research in the immediate aftermath of a triggering disaster incident. This study will significantly improve the evidence base around technology-based disaster mental health interventions.