PM3046: Sleep Kits: An In-office Intervention to Address Trauma Related Sleep Issues Among Children in Foster Care

Background: Pediatric visits are a fundamental opportunity to address trauma symptoms among children in foster care. Sleep disturbance is a common trauma symptom that adversely impacts mood, relationships, and functioning. We developed and piloted sleep kits, an in-office intervention to address sleep disturbance as part of a comprehensive response to trauma symptoms.

Methods: Sleep kit design was informed by literature review and input from trauma therapists. All kits contained an informational handout (information about sleep hygiene, guide to using sleep kit items, online resources about sleep), sleep journal notebook, and directions for downloading a free age-appropriate relaxation technique app (Elmo belly breathing, PTSD coach). Additionally, kits for teenagers contained a sound machine, aromatherapy spray and sleep mask, while kits for younger children contained reassurance matching stuffed toys to share with someone they want to feel connected to and a LED rechargeable nightlight. The 23$ - 44$ cost per kit was covered by an internal grant.

Kits were distributed to patients at a clinic for children in foster care when sleep disturbances were identified through standardized screening tools (Pediatric Traumatic Stress Screening Tool) and/or clinical history. Clinic providers briefly explained items in the kit to children and caregivers at the time of distribution.

Caregivers were contacted by phone at least one week after receipt of the kit to evaluate if kit items were used. Caregivers were asked to rate how the kit helped with sleep on a 3-point scale (not at all, somewhat, very much). Caregivers also had the opportunity to provide comments about the kit. Responses were recorded in REDCap.

Results: Twenty-four children with median age 10.7 years (range 2.7 - 18.1) received sleep kits. Questionnaire response rate was 19/24 (79%). Table 1 details sleep kit item utilization. Two respondents were unable to provide an answer to the question “did your sleep kit help with sleep” (caregiver unaware due to communication barrier with child; child eloped prior to using kit). The remaining 17 answered as follows: not at all 2 (12%); somewhat 4 (24%); very much 11 (65%). Open ended comments were grouped into themes and summarized in table 2.

Conclusion: Aside from relaxation technique apps, sleep kit items were majorly used. Our sleep kit pilot project had a positive impact on sleep in 79% of children with questionnaire response. Future directions include developing strategies to improve utilization of items especially apps, address utilization barriers, and sustain the project. Our pilot project shows promise for an in-office intervention to improve a trauma symptom, and further study using research design such as controlled trial is warranted. This area of study is important in the context of the prevalence of trauma symptoms, impact on well-being, and barriers such as waitlists when accessing trauma informed community services.