Review of implementation models for children's sleep support services in the UK

Abstract

Sleep deprivation has a serious impact on physical and mental health. Children with neurodevelopmental disorders are frequently affected by chronic insomnia, defined as difficulty in either initiating sleep, maintaining sleep continuity or poor sleep quality which can lead to long-Term detrimental effects on behaviour, learning and development. Interventions to address chronic insomnia in children include both pharmacological and non-pharmacological approaches. While some children unequivocally benefit from pharmacological treatment, recommendations suggest an intervention based on cognitive-behavioural techniques involving a thorough assessment of the child's sleep pattern, environment and psychosocial factors supporting the child to learn to self-soothe as first-line treatment. Evidence from sleep clinics delivered by trained community practitioners supports the efficacy of an intensive programme, whereby education, practical advice and follow-up support were key factors; however, these services are inconsistently resourced. In practice, sleep support interventions range from verbal advice given in clinics to healthy sleep leaflets to tailored and non-Tailored parent-directed interventions. Delivery models include promotion of safe sleep within a wider health promotion context and targeted early intervention within sleep clinics delivered in health and community services or by the third sector but evidence for each model is lacking. We describe a comprehensive whole systems city-wide model of sleep support, ranging from awareness raising, universal settings, targeted support for complex situations to specialist support, delivered according to complexity and breadth of need. By building capacity and quality assurance into the existing workforce, the service has been sustainable and has continued to develop since its initial implementation in 2017. With increasing access to specialist sleep services across the UK, this model could become a widely generalisable approach for delivery of sleep services to children in the UK and lead to improved outcomes in those with severe sleep deprivation.