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

Globally, an average of 390 disasters, 100,000 related deaths, 260 million disaster victims,
and $140 billion in economic damages were recorded per year between 2002-2012. The U.S. is
one of the top 5 countries—with China, Philippines, India, and Indonesia—most frequently
affected by disasters. The adverse mental health effects of disasters are extraordinary and
costly. Up to 38% of distressed survivors presenting to shelters and assistance centers have
stress-related and adjustment disorders. Most survivors who develop disaster-related mental
health problems do not receive services. The 2013 report of the International Federation of
Red Cross and Red Crescent Societies calls for technology-based solutions to heighten access
to disaster assistance resources. With US cellphone and smartphone ownership now topping 90%
and 60%, respectively, opportunities are tremendous to create cost-efficient, scalable
solutions that increase capacity to address mental health needs in disaster-affected
communities. The investigators propose highly innovative, time-sensitive research to examine
the effectiveness of a widely accessible, technology-based disaster mental health
intervention.

Mental health recovery trajectories are highly variable in disaster settings. 7,14 Most
survivors recover without intervention and may need nothing more than a brief symptom
tracking resource (i.e., watchful waiting). Some develop mental health needs (e.g.,
post-traumatic stress, depression) for which a brief self-help intervention may aid recovery.
Some have chronic mental health problems (pre-existing or disaster related) that necessitate
formal treatment. Others (e.g., serious mental illness) may require immediate assistance. The
proposed intervention, Bounce Back Now (BBN), addresses each level of need using a
web/smartphone-based approach that builds on the investigator's prior work. BBN consists of 3
key components: (1) a symptom and activity-tracking component that we piloted in emergency
department settings, (2) a self-help intervention that was found to be efficacious in a
recent RCT with families affected by a tornado outbreak, and (3) a resource component that
principally connects survivors to the SAMHSA-administered Disaster Distress Helpline (DDH)
when immediate assistance is needed (e.g., serious mental illness) or when local mental
health treatment referrals are needed or preferred.

This study will leverage the mental health workforce to recruit 5,000 disaster survivors via
partnerships with the American Red Cross (ARC) and Office of the Assistant Secretary for
Preparedness and Response (ASPR). These partnerships allow cost-efficient testing of
interventions, recruitment of individuals at high risk for developing disaster-related mental
health problems, and collection of data at the level of triage to aid in prediction of mental
health needs and coordination of care. Participants will be randomly assigned to receive BBN
vs. enhanced usual care (i.e., EUC; usual care plus comprehensive resource list). BBN will be
optimized for smartphones but accessible from any device with an internet connection.

Inclusion Criteria:

1. individuals must be aged 18 years and older who were directly or indirectly affected
by the disaster.

2. individual must be at least 18 years of age

3. have access to an internet-accessible device or computer, and

4. be English-speaking (i.e., all of the intervention content will be developed in the
English language; it is cost-prohibitive to develop the system in multiple language in
the testing phase)