Abstract Introduction Sleep and Adjustment in Foster Environments for Toddlers and Preschoolers (SAFE-T), a brief, trauma-informed pediatric sleep intervention has shown efficacy for improving sleep among 2 to 5 year old children in foster care. Recently, SAFE was modified for use with school-age children (SAFE-C) and evaluated in a randomized controlled trial among 6 to 10 year olds previously placed in foster care. Based on the presence of pervasive sleep problems in this population and because, unlike young children, school-aged children participated in treatment sessions, we were interested in examining treatment feasibility, along with parent and child treatment expectancy and satisfaction. Methods N=68 children (M=7.9, SD=1.4) adopted from foster care and their parent were randomized to SAFE-C (n=32) or waitlist control group (n=36). The intervention was delivered via telehealth over 4 session that included both the parent and child. At baseline, parents and children completed demographic and clinical questionnaires as well as the Credibility and Expectancy Questionnaire (CEQ) after receiving their treatment assignment. At post-treatment, the SAFE-C group completed the Client Satisfaction Questionnaire (CSQ). Results A total of 29/32 families (91%) assigned to SAFE-C completed all treatment sessions. Average time to complete 4 weekly sessions was less than one month (M=26.1 days) and most children actively participated in all treatment sessions. Both parents and children assigned to SAFE-C reported high rates of treatment expectancy. Higher treatment expectancy was associated with older child age (r=.27, p=.031) and lower parenting stress (r=–.31, p=.012) but not severity of child sleep problems. Both parents and children were highly satisfied with the treatment based on CSQ scores as well as qualitative feedback at post-treatment. Conclusion Findings suggest SAFE-C is a feasible and acceptable intervention for school-aged children with a history of adversity and/or trauma associated with foster care placement. Because severity of child sleep problems or sleep-related impairment was not associated with either parent or child treatment expectancy, future research should seek to better understand the factors/variables that shape treatment expectations. Support (if any) This research was supported by NIMH grant #R34MH128598 awarded to C. Alfano.
Leonard et al. (2026) studied this question.