hello everyone welcome to the OBSSR Director's webinar for January. The title
community partnership for healthy sleep. I'm Bill Riley, Director of the Office of
Behavioral and Social Science Research here at the National Institutes of
Health. Before I introduce today's speakers I'd like to mention just a few
housekeeping items today's webinar is being recorded and a recording of the
webinar will be available on the OBSSR website approximately in one month. Today's
presentation will be followed by a question-and-answer session all the
phone lines will be muted during the webinar questions and comments will not
be taken by phone but will be taken by the Q&A feature which your screen looks
like mine is on the bottom right corner of your screen and you can click on that
Q&A select all panelists and type in your questions and get send you don't
have to remember your questions until we get to the end of the presentation you
can type them in as you hear them and think about them and as once we get to
the end I'll moderate questions for our speakers and presenters today okay so
today's speakers I'm really pleased to introduce both doctors Nancy redeker and
dr. lois adler dr. rhett occurs director of the NIH funded Yale Center for sleep
disturbance and acute and chronic conditions and the ysn bio behavioral
laboratory she has a sustained program of research conducted over more than 25
years which addresses the role of sleep and sleep disorders among patients with
acute and chronic conditions and the effects of behavioral sleep promotion
interventions for clinical and community populations her co presenter today dr.
Salas professor at the Yale School of Nursing where she teaches master's and
doctoral nursing students in the areas of Family Studies Child Development
pediatric health promotion and other topics for research interests include
the evaluation and specialized support programs for at-risk young parents and
their children our publications and presentations are an analyst of primary
health care issues community engaged research high-risk families alison
Parenthood and visiting in 2014 their home visiting
program called minding the baby which has developed and tested with colleagues
from the Yale Child Study Center was designated by a Department of Health and
Human Services as an evidence-based home visiting model one of only 17 models
such nationwide so on the topic of community partnership and healthy sleep
let me introduce dr. rena ger and dr. Sadler thank you so much dr. Reilly we
are very delighted to present today and this is a great example of an
interdisciplinary and community engaged partnership so what the way we'll do
this is I'm going to present our findings to date this is a project
that's in progress we we are completed about almost a year
and a half of the two-year r21 and so no means the final words but I think we're
going to talk today about where we think we're headed these interesting data that
we collected so I first of all like to acknowledge our partnership obviously we
can't do community engagement search without excellent community partners our
partners include parents residing in the Greater New Haven Connecticut area which
is a very ethnically diverse as well as socially economically diverse community
our providers and pediatricians within the yellow human health care system and
the primary care center which is specifically the clinical setting that
serves particularly low-income families in the community we've also reached out
about wasn't in the original grant will tell you why we're including a child
care provider in the community as well as work by CPR a cultural ambassadors
that yvg is Miguel PPSA that has done and has been involved in a lot of this
and a lot of outreach into the community and their cultural ambassadors or their
community representatives to work closely with the TTA
who has been instrumental in helping us with this project the other group I'd
like to recognize is the husband for progressive action and ignited a group
in the mutated community that advocates a lot for Hispanic and Latino
populations a lot of people in our community our Yale team includes
doctors father and myself of course Megan O'Connell different program
manager monocle ordinay who's a very promising young faculty member has
another related program of research looking at the idea of stress biological
stress and sleep in these young families Nancy banana directed the pediatric
nurse practitioner as well as Angela Crowley done extensive work in community
childcare centers and dr. Otto fennec who works in pediatric primary care at
the piece ensuite and dr. Craig cannon parodies of pediatric sleep specialists
into our ongoing collaborate of a large part of this project has been about
building this team so that we can go forward with more work in the future so
basically just to give you a little bit of background as they are frequently
aware help me please it's critical to children's health we particularly know
that sleep difficulties are common in young children with a regular bedtime
short sleep duration nighttime awakening and bedtime resistance there's quite a
number of epidemiologic studies showing right now are showing that no children
particularly children that live in families do economic adversity have
shorter sleep and then what we decide you know what I've been determined to be
normative level these children should get it from 11 to 13 or 14 dollars a
night some of our early data suggests that they're only getting about 9 hours
of sleep at night and the basic premise of our project is that sleep
difficulties begin early in life and that they may persist over the lifetime
we know that precision sleep difficulties are associated with
negative health outcomes across the lifespan for children we know that they
have a negative impact on behavior school performance mental health and
there's increasing evidence that poor sleep over the lifespan is resulted with
obesity metabolic disorder and risk of injury and so the basic premise of this
project is if we could do better with leap promotion at an early age
improve other outcomes over the longer term so we know that economically
distressed areas are more vulnerable to difficulties and that there's enormous
disparities in sleep health as well as health care these are just diffuse and
publications there are quite a few more that are beginning to show that we also
know that existing promotion strategies may or may not be relevant and feasible
for some of these families for example a major focus of promotion on modifying
the environment depending on the family that may or may what we're proposing in
a standardized way there may not be possible there are also a lot of
cultural variations in how people sleep or what they think about so-so so the
idea here is that we're reaching out to it another seniority there are already
quite a lot of promotion interventions out there but most of us know it's being
the answer is middle and upper middle class family so our suffering
disproportionately so our work is really friends with in the social social
ecological model that suggests the child sleep patterns occur within context and
the context that we focus on here are the family and we know that sleep is an
important part of parenting it's a part of where parents interact with children
especially at a young age there are families leave rituals and parenting
practices beyond that we have community factors such as the environment for
deadly families homeless is live in crowded housing
noisy families families have already told us that some of them have a regular
work schedule this mom for example does shift work and have to leave the kids
around at night how does that impact on their sleep and also the idea of bed
sharing are there enough beds in the house are they comfortable and quiet all
of those kinds of issues and then beyond that we see that there
are differences and cultural or religious child conditions that might
influence sleep and putting practices that may help were not
help sleep singing praying at bedtime giving a bath dodging the skin or both
kind of thing may go into what we learn as during our youth and how we employ
reason in children so the focus of our study which has many qualitative
component is on understanding context so the American Academy of Sleep Medicine
has produced practice parameters for pediatric sleep and not to go into the
glory gory detail here but basically the idea is what do you do at that time the
child doesn't want to go to sleep what do you do do you leave them in a
room and hasn't cried you do it suddenly you do it gradually what do you need in
terms of the bedtime routine things like taking a warm bath reading a story
saying a prayer and then and included the idea of parental education that
prevents negative behaviors now these are practice parameters based on some
pretty good science but the question we have is how beautiful are these and how
can we deliver these kinds of known interventions to families that may be of
limited resources and limited means aware there might be cultural parameters
that influence their ability to do these things or even their awareness that
these things are important so really our question is under what conditions would
be to work and how should they be delivered to this feeling so we you know
just to give you a brief overview they're happiest that we'll reasonably
conducted clinical trials that have looked at sleep promotion again all of
these the first two year have been done primarily in middle and upper middle
income families with me the first study done by men we were two
papers reporting the same study one was short-term alone with longer-term
outcomes they internet-based sleep education for families with young
children and show that they were able to increase the duration and continuity of
sleep that is people that children slept longer and the sleepless left
that means fewer awakening an interesting Li enough and the second
paper they reported that the changes persisted at one year again this was
middle and upper middle-income families the second study they used graduate the
extinction and bedtime skating basically the ideas that gradually get the child
needs to go into bed at a certain time and so forth so this was a small
randomized control trial the three problems were not very well defined but
what they did show was that they were able to improve sleep latency in other
words the kids fell asleep more quickly in the third study which was simply an
education class and a head start program they showed short her benefit again so
this was more similar to the population that we're interested in they showed
shorter benefits in in sleep but there but there was no persistent improvement
one of the possibilities why there was no improvement was simply an education
course without a lot without any continued interaction or guidance to the
family so we had we built this project on some preliminary work that we had
done I had worked with a colleague in Newark New Jersey for another years when
I worked there and we conducted two studies looking at a population that
where the moms were the first study was simply of women and we were looking at
three patterns and mental health issues as well as stress in women recruited
through the women infants and children's program in north New Jersey and what we
showed - not to what anybody's great surprises their sleep patterns poor
sleep with closely and with monstrous as well as powers of PTSD and depression in
the second stage we were interested in not only the moms but how does mom sleep
influence asleep of the children and in this fairly small study we recruited
three school children and we measured their sleep increased activity and to
end moms report and in fact the moms mental health and psychological tests
were closely aligned with the children that is monstrous had one mental health
issue their children had one poor sleep this victim is kind of been a number of
studies that showed that and really goes to the point that sleep did the family
affair and mom's house is closely aligned with the kids home and their
Lois's project she's been doing ongoing work with improve with parenting and she
can tell you a little bit more about her parenting intervention which consists of
home visiting with young economically stress elements which represent the same
population in which were interested and has looked at another mental health and
other important outcomes in these family so what we're doing here - and addict
sleep - this myth David II have others on our team who have clinical and
related experience that really goes to the strength of our team doctor spinach
banana and benezia or pediatric primary care providers they have of course been
intimately involved in providing pediatric care to our community
population and dr. Kenneth Perry is our president mentioned earlier and then dr.
Crowley has done a number of projects with headstart and other child care
programs of acuity looking at things like safety and training of intervention
as a child care personnel and then of course our community partners and we'll
talk to you a lot more about what our community partners have said about this
project and how they formed it so basically the purpose of this study is
to bring parent provider and community perspectives to the development of the
promotion program that tailored specifically to the needs of family
living and economically stress urban environments the specific aims are to
exam and the parents knowledge and perceptions about sleep in the six and
thirty six month old children and to look at their perceptions about we've
have it difficulties the factors that are related to sleep including those
things guided by the social social ecological model the consequences of
sleep difficulties and perhaps most importantly their preferences
regarding how we like the health weekly promotion and then secondly so we're
looking at it from the perspective of the parents but also from the
perspective of the pediatric primary care and child care providers now
initially our project was designed only to look at the pediatric primary care
providers but in our very first meeting with the community they informed us that
we really should look at the child care provider and you'll see in a few minutes
that this has been an amazing contribution Julie important work and so
we're looking at similar things in this population sample importance how
important do they believe it sleep is what are the factors and what are some
of the successful and unsuccessful approaches to sleep promotion that
they've tried to be family so those of you in the audience clinicians know that
in pediatric and other forms of primary care there's very little time to spend
with families or individuals only issues and so how does one find appropriate
time and expertise to address day-to-day concerns about late so that's been a
primary point of our interview and then finally the third aim and we're moving
into that now if you get near the end of the funding period is to collaborate
with parents and providers to develop a feasible food promotion program and then
ultimately of course our goal will be to develop a community-based RCT to to
address that so as mentioned with the specialist and logical model we are
using a community engaged approach in which for blending advice from families
providers in the literature and the role of the community and the stakeholders
will be key is key to our ongoing success but we believe key to our future
so when we were thinking about early on
we were able to can I ask you a little closer to the mic that's right yeah
that's much better thank you all right so initially we had gone to that
cultural ambassador group for their advice and in their direction and after
hearing from them and after understanding from them that it was
going to be important to include not just providers and families but also
childcare providers and also to think about how we could include Hispanic and
Latino families on both families who were fluent enough in English but also
families who were Spanish speak and so we were able to add those components to
the to the project we also convened Community Advisory Committee the CAC and
this was a group sort of subgroup of the fasteners where we could actually run
the whole study and interview Ivan and sort of get their input get
their advice they need lots of suggestions and we were able to modify
things so that we had a much more community friendly project with their
input they were also helpful in identifying
participants and ways in which we could recruit people into the study and they
were very helpful in linking us with not just center-based childcare providers
Early Head Start centers other childcare centers but also in New Haven we have
family childcare licensed and with childcare and they have a consortium
that's called all our kin and they put us in touch with representatives of that
agency so it was very very helpful
all right well okay so let me just go over the study design so this is a mixed
method study and reusing convergent parallel design we are we have
participated in qualitative interviews with our providers and with parents and
we are also administering parent surveys and conducting actigraphy with the older
infants and the toddlers in our families sample so the sample is purposive we
were deliberately looking to recruit about 30 or so multicultural parents of
children between the ages of six and thirty six months of age we also have an
original target of 38 pediatric providers and child care providers but
as we were both interviewing and analyzing more qualitative data
simultaneously we determined that we really reach saturation we were hearing
the same things over and over again from our provider sample after about 16 or so
interviews we recruited primarily from the young human Hospital pediatric
primary care center and we have also recruited from five childcare centers in
the New Haven region including home-based and center-based childcare
one of those center-based childcare centers is in a high school and serve
specific reserves of teen parents and their children so that actor gave us an
additional insight we obviously had to get a RP approval through various layers
of video system the pediatric primary care system and have important set
all right our slides are having oh there we go okay in terms of quantitative data
collection with parents and children we are giving them surveys on collecting
some background demographic data and health information for the parents we're
asking them to complete the short form of the parenting stress index and the
brief system inventory which is a mental health inventory we are giving the suite
questionnaire the brief and sleep questionnaire to all the parents with
the children we are using actigraphy which where a watch is placed
around their ankle for seven days and nights ideally and so that we have a way
to really look at the activity data around the clock or for seven days or
also keeping asking parents to keep the sleep diary so that we can compare the
actigraphy data with retire information
interestingly in this age children for safety reasons the watches need to be
placed on the ankle and what we have tried to also do is make them a little
bit more appealing looking with using tape with gummy bears with our providers
we are just collecting information about their demographics their training and
how long they've been practice our qualitative interviews asked parents and
providers about their perceptions our sodium sleep sleep habits that they if
there are providers we asked about you know what carrots and what patterns do
they see in their patients and what about bedtime routines and time we asked
specifically about any problems or difficulties with sleep apnea to mention
really are asking people to tell us what they think would be helpful in terms of
promoting healthier sleep because this is a mixed-methods approach we're going
to be integrating both our quantitative and on qualitative findings and we are
you know I'll be sharing with you some of our initial qualitative findings but
what we've what I have found in the past when I've done these types of mixed
methods study the qualitative descriptive findings oftentimes will
give great insight to what you find out when you are using surveys or certainly
when we're looking at the sleep-wake patterns that we can see on children's
activity data so we'll be using a descriptive analysis of survey data and
it would be recorded food characteristics when using a descriptive
qualitative approach we transcribed all the interviews we coded the interview
data both from parents and providers we're using at work to manage our data
we have a coding group and a qualitative group of about six on individuals which
has been very helpful we're in the midst of a thematic analysis and we are
looking to describe and compare the patterns and the things that we see both
within our provider interviews as well as our parents so this is just another
way to depict the way that we're integrating our quantitative and
qualitative findings to hopefully come up with some culturally and
family-friendly approaches or or healthy sleep once we come up with those with
the help of our community advisory committee and our community partners we
will begin to put some interventions together
to the into trial for that very very way again using our committee usually our
parents using some of the stakeholders either in individual sessions or focus
group meetings to check in with them about about the intervention whether
it's working so the ongoing role of our Community Advisory Committee we're in
the process of this right now and I mentioned the data we are about to
meet with them and bring our findings to them so that they can help interpret the
findings maybe ask questions and think about what next steps might be from what
we're hearing providers parents in the community and so we are hoping to come
up with some creative approaches to individualize approaches the next step
that we hope to be able to do our testing these approaches and because
this is a community engaged process we have offered and will continue to offer
co-authorship with our partners we have
okay okay so where we are today we have engaged on our our community members we
have refined and developed and used our interview schedules because it's a
positive interview it keeps being refined and that's perfectly approached
we translated the Spanish and I mentioned we did reach saturation with
our nurse practitioners and registered nurses all of the boring active practice
in various community health centers as well as the primary care center on that
yeomen given hospital so far we have interviewed and collected data from 21
parents and that is an ongoing process and we have not we are in the midst of
interviewing I'm sorry of penalizing those data and need more data
so just to summarize a little bit about what we've learned so far there's really
quite remarkable agreement among all the parents we've been interviewed and the
providers about the importance of sleep for family members and young children
and there's a very high level of interest in addressing the issue I can
give you more specifics on that all providers both child care providers and
pediatric providers really do see the need for increasing their own their own
knowledge and skill and parents sleep knowledge and skill building on how to
recognize sleep problems and trying out solutions when we were interviewing not
so much the pediatric providers but definitely the childcare providers they
use the best they can they get a lot of continuing education about the children
they care for but they only get sleep in terms of the amount of information to
get it up sleep it has to do with sleep safety and keep the inference safe in
terms of that sharing and coastal et cetera so really they don't get any
information about other aspects of healthy sleep and most of them are sort
of using their own experience with raising their own children in terms
trying to help their parents that they work with and trying to give advice
pediatric providers have more basic knowledge but acknowledge that they
really did need more information and was welcomed more information about
pediatric sleep so the importance of the training and disseminating information
is really something that we are hearing loudly and clearly and we really have
been able to understand that childcare providers especially are crucial in in
doing this work they are the people who see parents and children daily and have
a a better chance to get to know each family situation
certainly pediatric providers have a number of visits especially infancy and
toddlerhood the well child visits that they conduct with parents and families
however these are so clearly the child care providers who are working with
parents on a daily basis into position so what I'm going to tell you tell you
about now are some things that we've got to understand from our interviews so
when the provider interviews we were able to sort of break that down into how
providers understand their families sleep issues and children's issues and
what they advise you know in terms of approaches that we might consider so in
terms of their understanding they told us that it's really important to get to
know each family and one of our coaches here that many families that certainly
who are in that community and are experiencing a lot of stress have many
individualized kinds of things going on in their family in their home and was
important to try and get a sense of what was going on with each individual family
that might affect the children sleep might have to do with the home situation
space the environment etc stressors that were particularly important that came
out in this world maternal mental health stressors safety
of household and neighborhood and sometimes stressors that were just so
overwhelming to the family that became
we also another interesting balance between the balance between whether to
net when to that how long to that and obviously that changes with the child's
age another finding that we had found where that screams were everywhere TV
screams I had laptops phones and while in many cases they providers told us
that they thought that these screens really interfere greatly with sleep for
parents and children in some cases parents
parents were likely using some of these screams watching TV having movies on etc
a service isn't so soothing or distracting mechanism or as a way to
screen out other environmental voices that they didn't want she listens so
well screens are everywhere we're also hoping that maybe we can use screen apps
ways in which we can another pattern that was that came out of that bedtime
routine is for an issue and this was this was not just for the children but
it was around parents at times and what it's like for them trying to settle down
and going to sleep and so looking at ways in which we might think of that
providing templates for different ways to help the child to settle down
different templates that parents might consider for their own their own bedtime
routines helping parents recognize cues and children that they work in avoiding
them getting into that overtired time and situation the other thing that we
are hearing is that that parents might actually welcome earlier at times for
their children if it paid them more time for themselves or time to catch up with
things that otherwise they weren't listen to do negotiating bedtimes came
through as a microcosm of parenting and parenting issues helping parents reframe
healthy sleep routines and bedtimes and be not only helpful physically for their
children in terms of their development their brain growth but also as a way to
set some limits to create a soothing time together on etc parent schedules
and ship work or really something that came through as being very difficult so
there were some providers who just described parents as having very little
in terms of the wage schedules they were not working outside the home or their
kids were not all to be employed yet and so family was not really on a strict
schedule and and in that case they providers saw sleep schedules or being
all over the place whereas other parents who were either working late shifts
working double shifts in some cases would create really very challenging
situations for young children maybe needed to sleep in a relative's
house and there was a bus driver and together or morning to try her bus and
the child her father had to get on and was with her in the bus in the car seat
so lots of lots of different constraints we learned from teen parents or the
providers who serve teen parents that there are medications unique and
probably need tailored approach to help them with this issue they think
differently they recently they are more likely to be living in their parents
home most likely a grandma with a baby's grandmother and so that clearly means
the three generational approach to sleep under sleep routines is going to be
probably most appropriate and the teams that we heard about we're spending even
more time with streams than parents
from the parent interviews and I just want to make a point of this is really
preliminary we're still conducting these interviews we have two really
interesting interviews where both parents were present and there was
clearly disagreement between mothers and fathers about bedtimes and when they're
identical things should be in battery and that or whether it's important to
have a routine or not have a routine there was also disagreement that the
parents told us about between what they the way they structured their children's
patterns and bedtimes and what their children's pediatric
providers advised now in terms of having an earlier bedtime or trying to get
their children down for math so that they would have the most recommended
program a child we heard about or hearing about common patterns of
co-sleeping and the family bed some parents were fearful that if they talked
about this for example to their pediatric providers that they might be
reported to Child Protective Services because everybody is very aware of the
information about the dangers of co-sleeping with infants under 12 months
definitely something that we're hearing a lot of both providers and most parents
were very quick to describe cranky behavioral behavior if their child
doesn't have a good night's sleep and so they are in that way very invested in
thinking about how can we do this better how can we how can we help our child
sleep more effectively and parents were also describing a pattern that they saw
that children called biting their sleep so you know the child trying to stay
awake and getting crankier and crankier well he really
retired so I think that holds a lot of promise as well because the parents are
are able to identify that kind of behavior that's probably a time when the
child maybe really needs to be put down or for that time the providers also have
lots of advice for us in terms of how we might how you might get the word out
about healthy sleep both in terms of educating pediatric providers as well as
child care providers and how we might reach parents and the various ways they
might approach that again we we are thinking that our first steps are
probably going to be focused on in child care centers and home-based child care
providers because they have structure they have a wonderful population of
parents that they know very well and this just seems like a great first place
to start so we're going to try and probably use a train the trainer
approach where we will train the child care providers to be the interventionist
or the approach that we use with families our our interviewees have lots
and lots of ideas about ways in which we could try and get the word out and also
coach and help parents with health years lots of them electronic approaches would
be would be useful and we're also starting to hear that from parents as
well so apps on a smartphone or YouTube videos that might you know provide a
template or demonstration of a bedtime routine for different age children
videos for teen parents to watch so lots of different ideas about
electronic approaches also ideas about more community-based approaches public
service announcements there's been so much success in getting the word out
about safe sleep for instance and so the thinking is that this might also be a
way using public service announcements and a campaign to get out the word about
healthy sleep or or young children teaching approaches and database
approaches will also recommend it and again with the idea that one size does
not fit all so some providers and some parents were very much in favor of
electronic approaches a lot of parents and a lot of providers also we're saying
no I need to I need to be in a class where I need to be able to talk to
someone else my questions so thinking about face to face teaching approaches
that would be helpful and useful and again thinking about the childcare
centers as a place to start because these are community agencies that
already have a built in structure and in fact have continuing education
opportunities as well as parent workshops so that's try and take
advantage written materials were advice were suggested to us something prepared
to take with them to what catacombs refrigerator who are going to bed board
books to be able to use which between parents and children we have a reach out
and Read program in which where parents of young children are provided age
appropriate board works I teach pediatric visit when they bring
their children in prepare and so this is something that could be coordinated as
well as more written materials for child care providers to have and to refer to
and then finally just a few words about in a moment session that an intervention
the childcare providers some of the senator centers especially early start
centers had parent has parent advocates who go into the homes make home visits
and feel like this is a really wonderful way to be able to assess the sleep
environment as well as family's unique situation I have to see in our
experience working with home visiting on in our other project the money the baby
program has been our experience as well that I'm getting to visit families in
their home is a very wonderful way to learn so our overall impressions rate
this importance and that seems to be
that we're learning there's not one size fits all that this requires a
multi-dimensional effort and in terms of thinking about how we're going to set up
our train the trainer approach giving people knowledge making aware of the
issue helping them with behavior understanding
behaviour understanding attitudes and then helping them to provide the
education of parents and supporting them in that way and then also follow those
errands so variety of formats and as I mentioned looking at to start in the
childcare centers and then going out from there so finish
our committee and we're sittin put into their input into our intervention set up
training materials and parent education materials and then the into pilot test
interventions and eventually funding for community engaged randomized control
trial this is a project that represents one component of program research
looking at including sleeping young families and I think we mention other
related projects are funded project on stress measuring taking biomarkers of
toxic stress she is doing measures and
data from from parents and then we are finishing up a study with Barbara
Coldwell that I think Nancy also mentioned in Newark looking at parent
perspectives on sleep among the children's so a similar kind of study
from different parents with different cultural backgrounds living in a
different community but I have to say the very same types of themes and
patterns so sleep help sleep health interventions at primary care
environments we hope to move in that direction using electronic parents help
their children with health
thank you so let me just start off I think we
already have a question or two so I'll just remind people to put that in the
question and answer box let me begin first of all thank you because it's a
really nice example of community-based participatory research and also a nice
example of mixed methods from focus groups that one in the continuum to
exceed your fee at the other so nice to see I wanted to get your thoughts about
sort of the balances you're beginning to see you now know this early conjecture
because you're still in the process of collecting data but how much of this is
a problem of not knowing what to do which is what's longer educational based
things whether they're with primary care providers or others are about and how
much of it is adherence to doing what you know is the right thing to do
especially that's I think we're laid to some of your advocacy work about people
in the homes and getting people you know in there at night to help especially
disorganized parents learn how to produce a bedtime routine or parents who
disagree about whether puts your child down early or late or let them cry it
out or not those kinds of things what's your sense of how much of this in terms
of where the where the change could potentially happen and how much of its
the result of what we need to do in terms of skills training and what we
need to do in terms of adherence or performance to those skills
I think it's oh I think it's both and one is prerequisite to the neck I mean
so what a family did this project and some of those smaller projects we did in
Newark for example told us is death families because this is very important
most of them seem aware that sleep isn't important right and that having enough
sleep very factual information they need like how much we could you have
and ink like that but are you know there is one study that we cited where they
did a training in a head start program which didn't have very good stand back
and my suspicion for that is because they provided the information that they
didn't follow it up with the counseling and the appearance p people need
problem-solving I mean as Louis pointed out
each family is sort of unique and has their own sort of issues and we're never
going to change the fact that people live in environments that are not great
environment but we could help them to problem-solve to make the environment
more conducive to sleep and so the bats ongoing you know it's like so big here
is people I think becomes very important I mean sleep I have other projects that
are about behavioural change in sleep and it's like everything else you know
you know we are here with a miracle and it was a very simple intervention and
they they just weren't sort of thinking about they could set that limit and that
was okay for them to do as parents and you know everyone
was a lot happier in that particular family situation I mean that's a
simplistic example kind of argues for stepped care model that's one quick
question while we have a little time one of the participants attendees asked
about where which data is coming from the child care providers versus the pre
attrition there are you combining that data in some way interestingly we well I
think the child care providers were much more likely to know family more
intimately and sort of think about their specific issues and understand maybe
their specific stresses because of their daily contact and they would talk about
and they were doing some really impressive work with families the health
care providers were more likely to give sleep advice based on the general
guidelines established guidelines they were not as individualized or intensive
as the work that the childcare providers were trying to do even though the
childcare folks needed needed a little more information about health care
providers were ultimately seen as having the authority and this was sort of
knowledge book by both groups that child care providers would be very willing to
refer parents to the child's pediatric provider if the parents really had an
ongoing question or concern about this we we found that child
I'm sorry health care providers function
necessarily thank you we can squeeze in in two seconds or another quick question
which has to do with time I want to thank both doctors Redeker and Sadler
for presenting and joining us today next month our webinar will be on Tuesday
February the 27th and it will be dr. Warren Bickle and dr. Sam McClure
discussing translational research programs on basic behavioral finding so
this concludes today's webinar thank you very much for attending yeah thank you
dude
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