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

项目摘要 寄养儿童（FC）的发展，身体和心理健康状况较差 结果甚至比美国最贫困的儿童和未满足的需求在这个脆弱的群体是 非常高。在为数不多的早期干预计划中， 对这一人群有效的，大多数是针对婴幼儿的。但更多 每年进入FC的儿童中有一半以上年龄超过5岁， 和自我调节的期望更高，但虐待/创伤史可能更多 广泛。睡眠障碍是最公认的后果之一， 早期逆境/创伤的后遗症，创造了一个反馈回路，通过这个回路，唤醒/焦虑被 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中大多数儿童存在显著的睡眠中断， 与心理健康问题密切相关。睡眠障碍往往是最严重的， 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，依恋和提供 寄养干预，将使用创伤知情的框架，以适应认知行为 最近被安置在一个新的寄养家庭的学龄儿童的儿科失眠治疗。 根据RFA-MH-18-706的目标，我们建议进行一项为期3年的多阶段研究， 并测试一个简短的，以家庭为基础的早期干预计划，称为支持睡眠， 寄养环境中的调整（B-SAFE）。B-SAFE的目标机制是知情的， 大量研究表明，儿童夜间焦虑/觉醒减少， 以及父母对睡前/睡眠习惯的更多支持，以与以下方面的改善相对应： 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投入和反馈： 我们的FC机构合作伙伴，专家顾问和几个试点家庭，以最终确定B- 安全手册、材料和程序。在第二阶段，我们将进行一项随机、对照 在N=60个新家庭中进行试验; 30个将在新家庭的第一个月内开始B-SAFE计划 儿童安置，30将作为候补名单（WL）的控制。几个月后（第三阶段），WL 家庭将完成B-SAFE计划，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 主观测量和目标接合将被确认。除了支持 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 医生，替代交付环境，以及对其他创伤暴露的潜在适应 儿童群体，对他们来说，基于证据的睡眠干预措施并不存在。

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.