Phone app for grounding (de-escalation) of substance-abusing transition-age youth

AbstractSubstance use disorderSUDis the second most common psychiatric diagnosis in the U Spopulationwithdeveloping it in their lifetimeTransition age youthTAYfrom agesare especially vulnerable to substance use and SUDThis time periodtermed theage of instability"is now understood to represent a distinct stage separate from adolescence and later adulthoodIt includes tasks such as leaving home to enter collegethe workforceor the militaryclarifying vocational goalsattaining legal drinking ageandfor someaging out of foster care or state custodywhich end at ageThis period is also prime for experimentation with substance use and associated risks such as driving under the influenceaccidentsfighting and violenceHIVand vulnerability to sexual assaultIn this projectwe focus on a major strategygroundingto help TAY de escalatereduceintense negative emotions and impulsesGrounding has long been used in psychiatric hospitals to provide a safequickand powerful way to reduce any intense negative feeling such as impulses to hurt self or otherssubstance cravingangeranxietyetcDescribed in detail in the book Seeking SafetySSgrounding using three pathways to focus the mindmentalbodyphysicaland heartsoothingGrounding provides a way to regulate emotionwhich is a major challenge for TAYespecially given their hormone changes and emotional intensityIndeed substance use is often described as a short term way to regulate emotionGrounding is a key module of SSa widely implementedevidence based SUD treatment modelIn this proposal we focus exclusively on grounding as it is an essential skill and widely identified as easy to learn for even the most complex and vulnerable clientsIn phasewe developed a beta version of a grounding appThe app promotes the use of grounding in any environment in which emotions and impulses need to be regulatedIt capitalizes on TAYswidespread use of mobile devicesand because grounding is a stand alone skill and sensory orientedit lends itself wonderfully to an app approachWe used an iterative product development methodology based on end user feedback and studied the impact of the app in a pilot randomized controlled trialRCTwithTAYHalf received the app and the other half received grounding handoutsResults showed that the app was consistently more positively rated than the handouts and was associated with significantly more use of grounding and a higher score on a grounding knowledge testAll phasebenchmarks were metIn phasewe propose to scale up both the app and the evaluation of itWe have two specific aimsTo enhance the mobile grounding app by using excitinginnovative technology approaches as well as expanding the grounding content in amount and typeTo conduct an RCT withTAY to evaluate the grounding app versus a control appThe control app would control for both the use of a mobile device and the grounding contentHowever it would lack the gamification and technology innovations of the experimental app so that we can determine the impact of theseOur primary outcome is based on power analysis from our phasepilotwe also include other outcomes and measuresThe RCT uses rigorous scientific methods in its designmeasuresand statisticsOur team represents an exceptional mix of expertise in SUDTAYapp and gaming technologygroundingSBIRsand public health oriented products based on evidence based care