Feasibility and Acceptability of a Brief Telehealth-delivered Intervention for Improving Sleep Among Children in Foster Care

• In Event: Teleheath Approaches to Fostering Positive Parenting, Child Regulation, and Sleep

Abstract

More than 400K children spent time in the U.S. foster care in 2021; Texas with the second largest number of children across all 50 states. Health disparities in this population of children are extraordinary and span virtually every aspect of functioning, including sleep. Adequate sleep is crucial for healthy growth and development, but emerging data reveal high rates of sleep disruption among children in foster care that go unaddressed and do not improve over time (e.g., after adoption or aging-out of the system). Poor sleep has also been found to predict greater emotional/behavioral problems, placement instability and longer periods spent in foster care. However, there are no available training or intervention programs that address sleep among children in foster care.

In early childhood, sleep is facilitated by nurturing caregivers, predictable routines, and stable environments, which promote feelings of safety and security. Children in foster care are often deprived of these early experiences which, along with other adversities, impede healthy sleep-wake regulation. Thus, targeting sleep problems in this population requires attention to the pivot role of caregivers. To address this need, we developed a three session, telehealth-delivered intervention for foster caregivers aimed at improving sleep among 2- to 5-year-olds in foster care in Texas. Sleep and Adjustment in Foster Environments for Toddlers and Preschoolers (SAFE-T) incorporates ‘gold standard’ pediatric behavioral sleep strategies with a trauma-informed approach to care emphasizing children’s felt-safety, self-regulation, and connection with caregivers (Bath, 2008).

N=25 foster caregivers currently caring for a 2- to 5-year-old were enrolled in a pilot study and randomized to receive the SAFE-T intervention or sleep education support (SES). The SES group was given a booklet about healthy sleep in children to keep. The SAFE-T group completed three sessions with a sleep clinician tailored the specific sleep needs of the child. Ratings of treatment satisfaction, number of sessions attended (SAFE-T only), and post-treatment qualitative feedback were recorded/collected.

Overall, high rates of satisfaction were reported for both interventions, likely reflecting the dearth of services and programs available for foster parents that discuss sleep. Caregivers assigned to SAFE-T attended all sessions and provided highly positive feedback, including a need for child welfare agencies to provide the program for all foster caregivers. In light of dire need to recruit and retain foster caregivers across the U.S., SAFE-T represents a promising program for helping children in foster care thrive and supporting caregivers.

Authors

• Candice A Alfano, University of Houston
  Presenting Author

• Sirine Harmouch, University of Houston

• Megan Rech, University of Houston