Development and implementation of a digital sleep intervention for preschoolers in foster care

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PROJECT SUMMARY Children in foster care (FC) are at risk for chronic health conditions, in part due to exposure to adverse childhood experiences (ACEs). Early intervention may ameliorate health disparities and economic burden associated with ACEs, with the preschool period yielding a substantially larger return on investment compared to interventions later in development. Children in FC are at high risk for sleep disturbances, which are a major contributor to the development and exacerbation of chronic health conditions, yet behavioral sleep interventions for this population are nonexistent. This K01 proposal seeks to address this critical gap in care and promote health equity in this underserved population by developing and implementing a trauma-informed digital public-health-level sleep intervention called Sleep Wizard, which we will administer to foster caregivers of preschoolers. Our innovative approach involves collaboration with a planning group of key stakeholders including FC workers and parents, and experts in sleep, trauma, health, and interventions in the context of FC. The goal of Aim 1 is to develop and digitize initial Sleep Wizard intervention content with the planning group, informed by the literature on trauma-informed care, evidence-based strategies to support healthy sleep, FC licensing regulations, and foster parent needs and experiences. In Aim 2, Sleep Wizard will be pretested by foster caregivers who will provide quantitative and qualitative data on acceptability, feasibility, and appropriateness of the intervention, which will be used to make final intervention modifications. Aim 3 will evaluate whether Sleep Wizard is associated with improvements in foster caregiver behaviors around sleep, and in child sleep from pre to post intervention, and at a 3-month follow-up. This will be the first large scale sleep intervention developed and tested in this population. Local and national stakeholders have expressed enthusiasm and have committed to involvement in the development, implementation, and evaluation of Sleep Wizard. To achieve the research plan, the PI will execute a structured comprehensive training plan to gain specialized skills in (1) Sleep, mental health, and ACEs in early childhood in the context of foster care, (2) Developing partnerships with the child welfare community, (3) Intervention development and implementation science, (4) Implementation and dissemination of digital interventions, and (5) Conducting clinical trials. Training will be overseen by an outstanding mentorship team with cross-cutting expertise in these areas and a track record of successful mentorship experiences and collaborations. Implementation of the research and training plan will also be bolstered by support from the institutional environment, namely Brown Medical School, Bradley Hospital, and two new major center grants focused on promoting the career development of early-stage investigators in 1) childhood stress, trauma, and resilience, and 2) sleep and circadian rhythms in child and adolescent mental health. This award will catapult my transition to an independent translational scientist with a career high in scientific and public health impact in early life adversity, sleep, and health.