Implementing Evidence-Based Behavioral Sleep Intervention in Urban Primary Care

项目摘要/摘要 这项K23提案将满足对可获得的、基于证据的行为睡眠干预的迫切需求 低社会经济地位(SES)儿童，并将为申请者Ariel Williamson博士准备成为 独立调查员，在初级保健中对低社会经济地位儿童的行为干预方面具有专业知识。 行为睡眠问题，包括失眠和睡眠不足，与身体不适有关， 神经行为和社会情绪的结果。睡眠问题影响20%-30%的幼儿和 对低社会经济地位儿童的影响不成比例。很少有关于行为睡眠干预的研究 在初级保健这一无障碍环境中，没有研究对这些干预措施进行审查。这 项目将改编和试点睡眠良好，这是一种有效的行为睡眠干预，使其内容 服务提供方式适合于低社会经济地位学龄前儿童和初级保健环境。目标1 是确定态度、信念和行为，这些对于适应和实施睡眠好是至关重要的 适用于初级保健中的低社会经济地位学龄前儿童。这一目标涉及从以下方面收集定性和定量数据 有睡眠问题的学龄前儿童(N=30)和初级保健提供者(N=20)的低SES照顾者 儿科医生、护士和综合行为健康临床医生(社会工作者和心理学家)。目标2是 根据需要反复调整，并引导睡眠良好-保持良好。目标1结果，对较低SES照顾者的试点测试- 儿童二胎(N=18)，以及由照顾者和初级保健提供者组成的咨询小组的意见将指导所需的 适应和新方法的潜在发展。目标3是进行随机对照试验 适应性干预试验以检查干预的可接受性；招募的可行性，随机化， 和测量程序；治疗参与度和依从性；以及干预效果的大小。 低SES学龄前儿童(N=80)将被随机分配到干预或加强日常护理(睡眠)中 教育)，对客观和照顾者报告的儿童睡眠以及儿童行为进行评估，网址为 治疗前、治疗后及3个月随访。拟议的研究和职业发展计划 将支持威廉姆森博士的培训目标，以获得以下方面的技能和知识：(1)定性和混合方法 用于干预适应和发展；(2)进行临床试验，特别是实用试验；和(3) 实施科学方法和框架在初级保健研究中的应用。的资源 费城儿童医院和宾夕法尼亚大学，以及一个跨学科的专家团队 导师和顾问，将为威廉姆森博士的职业生涯提供一个出色的背景。这个项目将 也为威廉姆森博士未来R01提交的大规模有效性提供必要的数据- 初级保健中实施行为睡眠干预的试验。该项目与NICHD的优先事项一致， 因为它侧重于初级保健中的行为干预和对低SES儿童的行为健康促进。

PROJECT SUMMARY/ABSTRACT This K23 proposal will address a critical need for accessible, evidence-based behavioral sleep interventions for lower-socioeconomic status (SES) children, and will prepare the applicant, Ariel Williamson, PhD, to become an independent investigator with expertise in behavioral interventions for lower-SES children in primary care. Behavioral sleep problems, including insomnia and insufficient sleep, are associated with adverse physical, neurobehavioral, and social-emotional outcomes. Sleep problems impact 20-30% of young children and disproportionately impact lower-SES children. There is little research on behavioral sleep interventions with lower-SES youth, and no studies have examined these interventions in primary care, an accessible setting. This project will adapt and pilot Sleep Well – Be Well, an effective behavioral sleep intervention, so that its contents and service delivery methods are appropriate for lower-SES preschoolers and the primary care context. Aim 1 is to identify attitudes, beliefs, and behaviors that are critical for adapting and implementing Sleep Well – Be Well for lower-SES preschoolers in primary care. This aim involves collecting qualitative and quantitative data from lower-SES caregivers of preschoolers with sleep problems (N = 30) and primary care providers (N = 20 pediatricians, nurses, and integrated behavioral health clinicians [social workers and psychologists]). Aim 2 is to iteratively adapt as needed and pilot Sleep Well – Be Well. Aim 1 results, pilot testing with lower-SES caregiver- child dyads (N = 18), and input from an advisory panel of caregivers and primary care providers will guide needed adaptations and the potential development of new approaches. Aim 3 is to conduct a pilot randomized controlled trial of the adapted intervention to examine intervention acceptability; feasibility of recruitment, randomization, and measurement procedures; treatment engagement and adherence; and the magnitude of intervention effects. Lower-SES preschoolers (N = 80) will be randomly assigned to intervention or to enhanced usual care (sleep education), with assessments of objective and caregiver-reported child sleep, as well as child behavior, at pretreatment, posttreatment, and 3-month follow-up. The proposed research and the career development plan will support Dr. Williamson’s training goals to acquire skills and knowledge in: (1) qualitative and mixed methods for intervention adaptation and development; (2) the conduct of clinical, and especially pragmatic, trials; and (3) the application of implementation science methods and frameworks to primary care research. The resources of Children’s Hospital of Philadelphia and University of Pennsylvania, and an expert team of interdisciplinary mentors and consultants, will provide an outstanding context to launch Dr. Williamson’s career. This project will also provide necessary data for Dr. Williamson’s future R01 submission of a large-scale effectiveness- implementation trial of a behavioral sleep intervention in primary care. This project aligns with NICHD’s priorities, as it focuses on behavioral intervention in primary care and behavioral health promotion for lower-SES children.