Advancing Engagement and Efficacy of Interventions for Co-Morbid Sleep and BehaviorProblems in Young Children

提高幼儿共病睡眠和行为问题干预措施的参与度和有效性

• 批准号: 10158521
• 负责人: Amanda Tarullo
• 金额: $ 64.72万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-04 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10158521
• 关键词: Acute; Address; Behavior; Behavior Therapy; Child; Child Behavior; Child Health; Development; Early Intervention; Enrollment; Family; Functional disorder; Health; Health Benefit; Home visitation; Household; Hygiene; Income; Intervention; Lead; Logistics; Low income; Maintenance; Measures; Mental Health; Motivation; Outcome; Parents; Poverty; Problem behavior; Randomized; Randomized Controlled Trials; Rest; Risk; Safety; Self Determination; Sleep; Sleep Disorders; Symptoms; System; Testing; Toddler; Transact; Treatment Efficacy; active control; aged; barrier to care; behavioral health; behavioral health intervention; behavioral outcome; checkup examination; comorbidity; design; early childhood; emotion regulation; evidence base; health disparity; health equity; high risk; improved; innovation; intervention effect; lower income families; novel strategies; physical conditioning; post intervention; preference; prevent; response; sleep behavior; sleep health; social stigma; socioeconomics; stressor; successful intervention; trial design

PROJECT SUMMARY/ABSTRACT Socioeconomic health disparities in sleep and behavior problems are evident from early childhood. Young children in low-income families are at high risk of sleep and behavior problems, which often co-occur and predict long-term poor mental and physical health. These problems cause added strain in families that are already facing multiple poverty-related stressors, and family dysfunction in turn contributes to persistence and worsening of sleep and behavior problems. Engaging the family is essential to treating co-morbid sleep and behavior problems and preventing entrenched health disparities. Family interventions enhance child health outcomes; moreover, because child sleep, child behavior, and family functioning are intertwined, a successful intervention that addresses either sleep or behavior may lead to improvements both within and across domains. However, low-income families are often reluctant to seek or accept early intervention. Difficulty enrolling and retaining families undermines potential health benefits. Stigma associated with treating behavior problems also discourages families from accepting treatment. This project determines how best to overcome barriers to treatment in low-income families of children with co-morbid sleep and behavior problems. We compare how low-income families respond to two empirically-supported home visiting interventions, one treating sleep and the other treating behavior. Both are designed to address cultural, motivational, and logistical barriers to engagement. We also take the innovative approach of testing whether giving families a choice between a sleep or behavior intervention, so that the initial frame with which they enter the intervention relationship is one of self-determination, enhances family engagement and child outcomes. With a randomized, controlled trial design, we test effects of intervention (sleep vs. behavior), engagement, and family input (choice vs. assigned) on child symptoms and family functioning, and assess which intervention families most prefer, engage with, and value. We will enroll 500 low-income toddlers with co-morbid sleep and behavior problems, randomized to 4 home-visiting interventions: sleep, behavior, family choice (sleep or behavior), and an active control. At baseline and at 1, 5, and 9 months post- intervention, we will assess child sleep and behavior and family functioning. We will measure family preference, engagement, and perceived value of each intervention. Aim 1 is to examine effects of evidence- based sleep and behavior interventions in young low-income children with co-morbid sleep and behavior problems on child sleep and behavior and family functioning. Aim 2 is to determine whether parents prefer, engage with, and value a sleep or behavior intervention more. Aim 3 is to examine if giving families a choice of intervention results in higher engagement, higher perceived value and better family and child outcomes than assignment to intervention. By informing best practices for engaging low-income families to treat co-morbid sleep and behavior problems, results will be critical to reducing health disparities for children living in poverty.

项目摘要/摘要 睡眠和行为问题的社会经济健康差异从幼儿就很明显。年轻的 低收入家庭中的儿童患睡眠和行为问题的风险很高，这通常是同时发生的 预测长期不良的身心健康。这些问题导致家庭增加的压力 已经面临多种与贫困相关的压力源，而家庭功能障碍反过来有助于持久性和 睡眠和行为问题恶化。让家庭互动对于治疗合并睡眠至关重要 和行为问题并防止牢固的健康差异。家庭干预措施增强了孩子 健康结果；而且，由于儿童睡眠，孩子的行为和家庭功能是交织在一起的，所以 解决睡眠或行为的成功干预措施可能会导致内部和 跨域。但是，低收入家庭通常不愿寻求或接受早期干预。 招募和保留家庭的困难会破坏潜在的健康益处。与治疗相关的污名 行为问题还阻止家庭接受治疗。该项目决定了如何最好的 克服障碍的障碍，在患有睡眠和行为的儿童的低收入家庭中 问题。我们比较低收入家庭对两个经验支持的家庭访问的回应 干预措施，一种治疗睡眠和另一种治疗行为。两者都是为了解决文化的目的 参与的动机和后勤障碍。我们还采取了测试的创新方法 让家庭在睡眠或行为干预之间进行选择，以便他们进入的初始框架 干预关系是自决的一种，可以增强家庭参与和儿童成果。 通过随机，对照试验设计，我们测试干预效果（睡眠与行为）， 参与性和家庭意见（选择与分配）有关儿童症状和家庭功能，以及 评估哪些干预家庭最喜欢，参与和价值。我们将注册500个低收入 有共睡眠和行为问题的幼儿，随机分配到4个家庭访问干预措施：睡眠， 行为，家庭选择（睡眠或行为）和主动控制。在基线和1、5和9个月后 - 干预，我们将评估儿童睡眠，行为和家庭功能。我们将衡量家庭 每种干预的偏好，参与和感知价值。目的1是检查证据的影响 - 与患有睡眠和行为的年轻低收入儿童的基于睡眠和行为干预 儿童睡眠，行为和家庭功能的问题。目标2是确定父母是否喜欢， 与睡眠或行为干预更加重视并重视。目标3是检查是否给家庭选择 干预会导致更高的参与度，更高的感知价值以及更好的家庭和儿童成果 分配干预。通过告知最佳实践，以吸引低收入家庭治疗合并症 睡眠和行为问题，结果对于减少贫困儿童的健康差异至关重要。