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

项目总结/摘要 睡眠和行为问题的社会经济健康差异从幼儿时期就很明显。年轻 低收入家庭的儿童有很高的睡眠和行为问题的风险，这些问题往往同时发生， 预测长期不良的心理和身体健康。这些问题导致家庭压力增加， 已经面临多种与贫困有关的压力因素，而家庭功能障碍反过来又导致持续存在， 睡眠和行为问题恶化。参与家庭对于治疗共病睡眠至关重要 和行为问题以及防止根深蒂固的健康差距。家庭干预提高儿童 健康结果;此外，由于儿童睡眠，儿童行为和家庭功能相互交织， 解决睡眠或行为的成功干预可能会导致内部和 跨域。然而，低收入家庭往往不愿意寻求或接受早期干预。 难以招募和留住家庭损害了潜在的健康益处。与治疗相关的耻辱 行为问题也使家庭不愿接受治疗。这个项目决定了如何最好地 克服低收入家庭中患有睡眠和行为共病儿童的治疗障碍 问题我们比较了低收入家庭如何应对两个医疗支持家访 一种是治疗睡眠，另一种是治疗行为。两者都是为了解决文化， 参与的动机和后勤障碍我们还采取创新的方法， 让家庭在睡眠或行为干预之间做出选择， 干预关系是一种自决关系，可加强家庭参与和儿童成果。 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、参与和重视的干预措施。我们将招收500名低收入者 患有共病睡眠和行为问题的幼儿，随机接受4种家访干预：睡眠， 行为、家庭选择（睡眠或行为）和主动控制。在基线和术后1、5和9个月， 干预，我们将评估儿童的睡眠和行为和家庭功能。我们将衡量家庭 偏好、参与度和每项干预措施的感知价值。目的1是审查证据的效力- 对患有睡眠和行为共病的低收入家庭儿童进行基于睡眠和行为的干预 儿童睡眠、行为和家庭功能的问题。目标2是确定父母是否喜欢， 更重视睡眠或行为干预。目标3是研究是否让家庭选择 干预导致更高的参与度，更高的感知价值和更好的家庭和儿童结果， 分配到干预。通过宣传低收入家庭参与治疗共病的最佳做法， 睡眠和行为问题，结果将是至关重要的，以减少生活在贫困中的儿童的健康差距。

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.