Implementing Evidence-Based Behavioral Sleep Intervention in Urban Primary Care

项目总结/摘要 这项K23提案将解决对可获得的、基于证据的行为睡眠干预的迫切需求， 较低的社会经济地位（SES）的儿童，并将准备申请人，阿里尔威廉姆森，博士，成为一个 在初级保健中对低社会经济地位儿童进行行为干预方面具有专业知识的独立调查员。 行为睡眠问题，包括失眠和睡眠不足，与不良的身体， 神经行为和社会情感的结果。睡眠问题影响20-30%的幼儿， 不成比例地影响社会经济地位较低的儿童。关于行为睡眠干预的研究很少， 社会经济地位较低的年轻人，没有研究在初级保健中检查这些干预措施，这是一种可获得的环境。这 该项目将适应和试点睡得好-好，一个有效的行为睡眠干预，使其内容 和服务提供的方法是适合较低的SES学龄前儿童和初级保健的背景。要求1 确定态度、信念和行为，这些对于适应和实施良好睡眠至关重要 为社会经济地位较低的学龄前儿童提供初级保健。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的低SES照顾者（N = 30）和初级保健提供者（N = 20 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]）。目标二是 根据需要反复调整，并试行“睡得好，做得好”。目标1的结果，与较低的SES照顾者的试点测试- 儿童二元组（N = 18），以及来自护理人员和初级保健提供者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。目的3是进行一项试验性随机对照研究 对适应性干预措施进行试验，以检查干预措施的可接受性;招募、随机化 和测量程序;治疗参与和依从性;以及干预效果的大小。 SES较低的学龄前儿童（N = 80）将被随机分配到干预或加强日常护理（睡眠 教育），并评估客观的和无限期报告的儿童睡眠，以及儿童行为，在 治疗前、治疗后和3个月随访。拟议的研究和职业发展计划 我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 （2）进行临床试验，特别是实用性试验;（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的专家团队， 导师和顾问，将提供一个杰出的背景下启动博士威廉姆森的职业生涯。该项目将 也为威廉姆森博士未来提交的R 01大规模有效性提供必要的数据- 在初级保健中实施行为睡眠干预试验。该项目符合NICHD的优先事项， 因为它侧重于初级保健中的行为干预和低社会经济地位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.