An evaluation of the effectivness of a staff-focused intervention approach for treating sleep problems in children with developmental disabilities who live in residential care (2020)
Type of ContentTheses / Dissertations
Thesis DisciplineHealth Sciences
Degree NameMaster of Science
PublisherUniversity of Canterbury
AuthorsMazey-Richardson, Mollyshow all
Sleep problems are highly prevalent among children and adolescents with developmental disabilities. As these sleep problems can significantly impact the overall wellbeing of an individual, the availability of effective intervention is imperative. Current research has identified a number of effective behavioural interventions to treat sleep problems in children and adolescents with developmental disabilities. These interventions have employed a number of antecedent and consequence-based strategies, as well as the use of parent group-training programmes. However, while there is evidence to support the use of behavioural interventions for sleep problems that are implemented by parents, there is a scarcity of research investigating these interventions by staff. As it is staff members, rather than parents, who support the proportion of children and adolescents with developmental disabilities living in residential care, it is important that a staff-focused intervention approach for sleep problems in this population be investigated. Despite empirical support for behavioural sleep interventions, research suggests that low levels of knowledge and attributional biases related to sleep problems may prevent parents from accessing treatment for their children’s sleep problems. As these factors may represent treatment barriers among parents, it is important that these factors be assessed among residential staff. This thesis comprises two studies. Study One evaluated the impact of a group-delivered, staff-training workshop on the sleep knowledge and attributions held by 24 staff members working at a residential care facility. The brief, two-hour workshop provided staff members with information related to the prevalence, cause, assessment and treatment of sleep problems. Questionnaires administered both before and after the workshop were used to measure staff members’ knowledge of sleep problems, as well as their attributions regarding locus, stability and controllability. Pre-and post-workshop data from questionnaires administered during Study One showed that the workshop increased the knowledge of 22 out of the 24 staff members who took part. Furthermore, participation in the workshop altered staff members’ attributions of sleep problems in this population to the extent that following the workshop, staff were more likely to attribute sleep problems to factors that were of external locus, stable (without treatment) and controllable. Study Two used single-case, multiple baseline design to evaluate the effectiveness of staff-delivered, Functional Behavioural Assessment (FBA)- informed, sleep interventions delivered to three children with ASD (11-17 years of age). These children were under the care of staff members included in Study One. Child participants presented with a variety of sleep problems, including sleep onset delay, curtain calls and early morning waking. Following a comprehensive assessment, individualized, FBA-informed treatment plans were developed by the research team and implemented by residential care staff. The effectiveness of interventions was measured via staff-reported sleep diaries. Study Two findings indicate that intervention resulted in reduced curtain calls and sleep onset in one participant, and reduced early morning waking in another. However, Study Two failed to find consistent improvements in the children’s sleep outcomes in response to treatment, and treatment effects could not be measured for one participant due to the absence of intervention data. The present findings build on the paucity of research that has investigated the effectiveness of staff-implemented treatments for sleep problems in children with developmental disabilities living in residential care. The implications of these findings for the delivery of staff training and the implementation of behavioural sleep interventions within this setting are discussed. Future research into the effectiveness of a staff-focused sleep intervention programme, as well as the long-term impact of this intervention approach is warranted. Furthermore, given the complexity of these environments, future research should also explore factors that may facilitate the delivery of both group-training programmes and staff-implemented sleep interventions for staff working with children with developmental disabilities living in residential care.