Bounce Back Now! Protocol of a population-based randomized controlled trial to examine the efficacy of a Web-based intervention with disaster-affected families

Abstract

Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including depression and posttraumatic stress disorder. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several web based evaluation studies with various adult populations has shown that web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This is a protocol paper that describes an innovative study design in which we evaluate a self-help web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. The paper includes description and justification for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and web-based assessments, and development and evaluation of a highly individualized web intervention for adolescents. Challenges related to large-scale evaluation of technology-delivered interventions with high-risk samples in time-sensitive research are discussed, as well as implications for future research and practice.

Mental Health Among Adolescents Exposed to a Tornado: The Influence of Social Support and Its Interactions With Sociodemographic Characteristics and Disaster Exposure

“…The full methodology of the study is described in detail by Ruggiero et al (2015). Briefly, we recruited 2,000 families with adolescents from areas affected by the tornadoes in Alabama on April 25–28 ( n = 1,660) and Joplin, Missouri on May 22, 2011 ( n = 340).…”

“…These devastating storms resulted in the injuries to over 3,000 individuals, and deaths of over 350 residents of these areas, as well as destruction of many homes and buildings (National Weather Service [NWS], 2011a; NWS, 2011b). Recruitment procedures were previously described in detail (Adams et al, 2014; Ruggiero et al, 2015). Briefly, tornado track coordinates were used to set parameters for a targeted address-based sampling strategy, allowing for identification and recruitment of households affected by the storms, including cell-phone only households.…”

Web Intervention for Adolescents Affected by Disaster: Population-Based Randomized Controlled Trial

“…Content was guided by behavioral principles and procedures associated with efficacious behavioral interventions. 15,16 The PTSD module provided education as well as evidence-based recommendations focused on exposure, reduction of avoidance of traumatic cues, coping strategies, and anxiety management. 17 The Depression module featured behavioral activation strategies, which have shown promise as easily understood, efficacious, parsimonious, and cost effective approaches in treatment of depression.…”

“…Adolescents who returned to the module (roughly 50% of adolescents and 53% of parents who accessed the site visited the site at least twice 22 ) were provided a brief symptom tracking activity and were prompted to indicate barriers that they had experienced in carrying out recommendations from their prior visit (e.g., not enough time in the day, transportation barriers, limited support network). Motivational and educational content was provided in response to each barrier the user endorsed.…”

“…This adult disaster mental health intervention, Disaster Recovery Web , has been described in detail elsewhere and has performed well in feasibility testing. 8,22 …”