Advancing Engagement and Efficacy of Interventions for Co-Morbid Sleep and BehaviorProblems in Young Children

项目摘要/摘要 睡眠和行为问题的社会经济健康差距从儿童早期就很明显。年青的 低收入家庭的儿童睡眠和行为问题的风险很高，这些问题经常同时发生和 预测长期心理和身体健康状况不佳。这些问题给家庭带来了额外的压力 已经面临多种与贫困相关的压力源，家庭功能障碍反过来又有助于坚持不懈和 睡眠和行为问题恶化。让家人参与是治疗共病睡眠的关键 和行为问题，并防止根深蒂固的健康差距。家庭干预促进儿童健康 健康结果；此外，由于儿童睡眠、儿童行为和家庭功能是相互交织的， 成功的针对睡眠或行为的干预措施可能会改善睡眠和精神状态 跨域。然而，低收入家庭往往不愿寻求或接受早期干预。 登记和留住家庭的困难破坏了潜在的健康益处。与治疗相关的耻辱 行为问题也会阻碍家庭接受治疗。该项目决定了如何最好地 克服睡眠和行为共病儿童的低收入家庭的治疗障碍 有问题。我们比较了低收入家庭对两种经验支持的家访的反应 干预，一个治疗睡眠，另一个治疗行为。两者都旨在解决文化、 参与的动机和后勤障碍。我们还采取了创新的方法来测试 让家庭在睡眠或行为干预之间做出选择，这样他们进入的初始框架 这种干预关系是一种自决关系，提高了家庭参与度和孩子的结果。 通过随机对照试验设计，我们测试了干预的效果(睡眠与行为)， 参与，以及家庭对儿童症状和家庭功能的投入(选择与分配)，以及 评估家庭最喜欢、最参与和最重视哪些干预措施。我们将招收500名低收入者 患有睡眠和行为问题的幼儿，随机分为4种家访干预措施：睡眠， 行为、家庭选择(睡眠或行为)和主动控制。在基线以及1、5和9个月后- 通过干预，我们将评估儿童的睡眠和行为以及家庭功能。我们将测量家庭 每项干预措施的偏好、参与度和感知价值。目标1是检查证据的效果- 睡眠和行为共病的低收入幼儿的睡眠和行为干预 儿童睡眠、行为和家庭功能方面的问题。目标二是确定父母是否更喜欢， 更多地参与并重视睡眠或行为干预。目标3是检查是否让家庭可以选择 干预会带来更高的参与度、更高的感知价值以及更好的家庭和儿童结果 分配给干预组。通过向低收入家庭提供治疗共病的最佳做法 在睡眠和行为问题方面，结果将对减少贫困儿童的健康差距至关重要。

PROJECT SUMMARY/ABSTRACT Socioeconomic health disparities in sleep and behavior problems are evident from early childhood. Young children in low-income families are at high risk of sleep and behavior problems, which often co-occur and predict long-term poor mental and physical health. These problems cause added strain in families that are already facing multiple poverty-related stressors, and family dysfunction in turn contributes to persistence and worsening of sleep and behavior problems. Engaging the family is essential to treating co-morbid sleep and behavior problems and preventing entrenched health disparities. Family interventions enhance child health outcomes; moreover, because child sleep, child behavior, and family functioning are intertwined, a successful intervention that addresses either sleep or behavior may lead to improvements both within and across domains. However, low-income families are often reluctant to seek or accept early intervention. Difficulty enrolling and retaining families undermines potential health benefits. Stigma associated with treating behavior problems also discourages families from accepting treatment. This project determines how best to overcome barriers to treatment in low-income families of children with co-morbid sleep and behavior problems. We compare how low-income families respond to two empirically-supported home visiting interventions, one treating sleep and the other treating behavior. Both are designed to address cultural, motivational, and logistical barriers to engagement. We also take the innovative approach of testing whether giving families a choice between a sleep or behavior intervention, so that the initial frame with which they enter the intervention relationship is one of self-determination, enhances family engagement and child outcomes. With a randomized, controlled trial design, we test effects of intervention (sleep vs. behavior), engagement, and family input (choice vs. assigned) on child symptoms and family functioning, and assess which intervention families most prefer, engage with, and value. We will enroll 500 low-income toddlers with co-morbid sleep and behavior problems, randomized to 4 home-visiting interventions: sleep, behavior, family choice (sleep or behavior), and an active control. At baseline and at 1, 5, and 9 months post- intervention, we will assess child sleep and behavior and family functioning. We will measure family preference, engagement, and perceived value of each intervention. Aim 1 is to examine effects of evidence- based sleep and behavior interventions in young low-income children with co-morbid sleep and behavior problems on child sleep and behavior and family functioning. Aim 2 is to determine whether parents prefer, engage with, and value a sleep or behavior intervention more. Aim 3 is to examine if giving families a choice of intervention results in higher engagement, higher perceived value and better family and child outcomes than assignment to intervention. By informing best practices for engaging low-income families to treat co-morbid sleep and behavior problems, results will be critical to reducing health disparities for children living in poverty.