B-SAFE: A Trauma-Informed Early Intervention Targeting Sleep and Adjustment Among Children in Foster Care

B-SAFE：针对寄养儿童睡眠和调整的创伤知情早期干预措施

• 批准号: 10551279
• 负责人: Candice A Alfano
• 金额: $ 23.25万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10551279
• 关键词: 10 year old; Acute; Adult; Aftercare; Age; Anxiety; Arousal; Behavior; Behavioral; Biological Rhythm; Brain; Caregivers; Caring; Child; Child Abuse and Neglect; Child Care; Child Rearing; Child Welfare; Childhood; Clinical; Cognitive Therapy; Development; Diagnostic; Disease; Early Intervention; Emotional; Environment; Evaluation; Exhibits; Family; Feedback; Foster Home Care; Fostering; Foundations; Goals; Growth; Home; Home environment; Hydrocortisone; Hypothalamic structure; Impairment; Infant; Informal Social Control; Intervention; Intervention Studies; Learning; Life; Literature; Manuals; Measurable; Measures; Mediating; Mediation; Mediator; Mental Health; Outcome; Pattern; Phase; Pituitary Gland; Policies; Population; Prevention; Prevention program; Problem behavior; Procedures; Protocols documentation; Randomized, Controlled Trials; Recording of previous events; Regulation; Reporting; Research; School-Age Population; Severities; Sinus Arrhythmia; Sleep; Sleep Disorders; Sleep disturbances; Sleeplessness; System; Testing; Time; Training; Trauma; Trauma recovery; Waiting Lists; acceptability and feasibility; behavioral health; biobehavior; biological adaptation to stress; care systems; circadian; early life adversity; effectiveness trial; efficacious intervention; evidence base; expectation; experimental group; follow-up; foster care; foster home; high risk population; improved; intervention program; maltreatment; neglect; physical conditioning; pilot test; poor sleep; prevent; preventive intervention; programs; respiratory; sleep health; sleep quality; trauma exposure

PROJECT SUMMARY Children in foster care (FC) evidence poorer developmental, physical and mental health outcomes than even the poorest children in the U.S. and unmet need in this fragile group is extraordinarily high. Of the small number of early intervention programs demonstrated as effective for this population, most are directed at infants and young children. However, more than half of the children entering FC each year are older than 5 years, a time when capacity for and expectations of self-regulation are greater, but history of maltreatment/trauma is likely more extensive. Sleep disturbance is one of the most well-recognized consequences and enduring sequela of early adversity/trauma that creates a feedback loop through which arousal/anxiety is amplified, self-regulation is undermined, and biological rhythms are altered. Mounting evidence reveals the presence of significant sleep disruption among a majority of children in FC, which is closely associated with elevated mental health problems. Sleep disturbances are often worst in the initial weeks/months of a new foster placement. Early intervention programs targeting sleep might therefore prevent a cascade of associated negative outcomes. Our research team, with unique expertise in pediatric sleep, childhood maltreatment, attachment, and the delivery of foster care interventions, will use a trauma-informed framework to adapt cognitive-behavioral therapy for pediatric insomnia for school-aged children recently placed in a new foster home. Aligning with the goals of RFA-MH-18-706, we propose a 3-year, multi-phase study to finalize and test a brief, home-based early intervention program, called Bolstering Sleep and Adjustment in Foster Environments (B-SAFE). B-SAFE's target mechanisms are informed and supported by a wealth of research showing reductions in children's nighttime anxiety/arousal and greater parental support around bedtime/sleep routines to correspond with improvements in children's sleep, emotional and behavioral health. Phase 1 will include input and feedback from our FC agency partners, expert consultants, and several pilot families in order to finalize the B- SAFE manual, materials, and procedures. In Phase 2, we will conduct a randomized, controlled trial among N=60 new families; 30 will start the B-SAFE program within the first month of a new child placement, and 30 will serve as waitlist (WL) controls. Several months later (Phase 3), WL families will complete the B-SAFE program for comparison with the experimental group to inform optimal intervention timing. Feasibility and child-based outcomes including sleep health, emotional/behavioral regulation, and biological rhythms will be examined via objective and subjective measures, and target engagement will be confirmed. In addition to supporting a larger effectiveness trial, findings will directly inform dissemination efforts including training practitioners, alternative delivery settings, and potential adaptation for other trauma-exposed child populations, for whom evidence-based sleep interventions do not exist.

项目概要 寄养儿童 (FC) 的发育、身心健康状况较差 甚至比美国最贫困的儿童的结果还要好，而且这个脆弱群体的需求未得到满足 非常高。少数早期干预计划被证明为 对这一人群有效，大多数针对婴儿和幼儿。然而，更多 每年进入 FC 的儿童中有一半以上年龄超过 5 岁，这是容纳能力的一个时期 对自我调节的期望更高，但虐待/创伤史可能更多 广泛的。睡眠障碍是最广为人知且持久的后果之一 早期逆境/创伤的后遗症，形成一个反馈循环，通过该循环，唤醒/焦虑 放大，自我调节被破坏，生物节律被改变。越来越多的证据 揭示了 FC 的大多数儿童存在严重的睡眠中断，这是 与心理健康问题密切相关。睡眠障碍通常最严重的是 新寄养安置的最初几周/几个月。针对睡眠的早期干预计划 因此可能会防止一系列相关的负面结果。我们的研究团队， 在儿科睡眠、儿童虐待、依恋和分娩方面的独特专业知识 寄养干预措施，将使用创伤知情框架来适应认知行为 针对最近被安置在新寄养家庭的学龄儿童的小儿失眠疗法。 根据 RFA-MH-18-706 的目标，我们提出一项为期 3 年的多阶段研究来最终确定 并测试一个简短的、以家庭为基础的早期干预计划，称为“增强睡眠和睡眠” 寄养环境的调整（B-SAFE）。 B-SAFE 的目标机制已获悉并 大量研究表明，可以减少儿童夜间焦虑/兴奋 以及在就寝时间/睡眠习惯方面提供更多家长支持，以应对睡眠质量的改善 儿童的睡眠、情绪和行为健康。第一阶段将包括来自以下方面的意见和反馈： 我们的 FC 机构合作伙伴、专家顾问和几个试点家庭，以最终确定 B- SAFE 手册、材料和程序。在第二阶段，我们将进行随机、受控的 在N=60个新家庭中进行试验； 30 将在新法案生效的第一个月内启动 B-SAFE 计划 儿童安置，30 个将作为候补名单 (WL) 控制。几个月后（第三阶段），WL 家庭将完成 B-SAFE 计划，以便与实验组进行比较 告知最佳干预时机。可行性和基于儿童的结果，包括睡眠健康、 情绪/行为调节和生物节律将通过客观和客观的方式进行检查 主观措施和目标参与度将得到确认。除了支持一个 更大规模的有效性试验，结果将直接为包括培训在内的传播工作提供信息 从业者、替代分娩环境以及对其他遭受创伤的潜在适应 儿童群体，对于他们来说不存在基于证据的睡眠干预措施。