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

项目总结 寄养(FC)儿童的发展、身心健康状况较差 结果甚至比美国最贫穷的儿童和这一脆弱群体中未得到满足的需求更大 高得出奇。在为数不多的早期干预计划中， 对这一人群有效，大多数针对婴儿和幼儿。然而，更多 每年进入足球俱乐部的儿童中，有一半以上年龄在5岁以上，这一时期 人们对自律的期望更高，但虐待/创伤史的可能性更大 范围很广。睡眠障碍是最公认的后果之一，也是最持久的 早期逆境/创伤的后遗症，通过反馈循环唤醒/焦虑 自我调节被放大，自我调节被破坏，生物节奏被改变。越来越多的证据 揭示了FC中大多数儿童存在严重的睡眠障碍，这是 与精神健康问题的增加密切相关。睡眠障碍通常是最严重的 新寄养家庭的最初几周/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，拥有 在儿科睡眠、儿童虐待、依恋和分娩方面具有独特的专业知识 寄养护理干预，将使用创伤信息框架来适应认知行为 儿童失眠治疗最近被安置在一个新的寄养家庭的学龄儿童。 根据RFA-MH-18-706的目标，我们提议进行一项为期3年的多阶段研究，以完成 并测试一项简短的、基于家庭的早期干预计划，称为支持睡眠和 寄养环境的调整(B-SAFE)。B-SAFE的目标机制被告知并 大量研究表明儿童夜间焦虑/觉醒减少 以及更多的父母对就寝时间/睡眠习惯的支持，以适应在 儿童的睡眠、情绪和行为健康。阶段1将包括来自以下方面的输入和反馈 我们的FC机构合作伙伴、专家顾问和几个试点家庭，以最终敲定B- 安全的手册、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个家庭将在新家庭的第一个月内开始B-SAFE计划 儿童安置，30个将作为等待名单(WL)控制。几个月后(第三阶段)，WL 家庭将完成B-SAFE计划，以便与试验组进行比较 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 主观措施，目标交战将得到确认。除了支持 更大的有效性试验，结果将直接为包括培训在内的传播工作提供信息 从业者、替代分娩环境和对其他创伤暴露的潜在适应 儿童群体，对他们来说，不存在循证睡眠干预措施。

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.