“I Don't Get No Sleep”: Social Work Opportunities to Improve Sleep of Children Exposed to Interpersonal Violence

Background and Purpose:

Yearly, approximately 60% of U.S. children are exposed to at least one incident of interpersonal violence, and many experience psychological trauma. One important, but overlooked, implication for trauma-focused care is the need to assess for sleep problems, as sleep issues are considered to be core features of posttraumatic stress symptomatology. This paper addresses a research gap by examining four cases of trauma-exposed children and the range of issues around traumatic stress and sleep faced by children and their families. Highlighting how the children’s sleep environments facilitated or hindered their restful sleep, implications are identified for social workers engaging at varying levels with families affected by psychological trauma.

Methods:

The cases discussed come from interviews and observations collected in a larger study of the effects of children’s exposure to violence on their sleep behavior. The study sample was generated from families receiving services from three community-based agencies who had a child age 8-16 years old exposed to interpersonal or family violence as witness, victim, or both. Data collected at baseline, six, and 12 months post-trauma included: child and caregiver interviews; children’s sleep environment observations; social and physical neighborhood aspects; Trauma Symptoms Checklist for Children scores; and actigraphy data (mean sleep onset, mean wake time, mean total nightly sleep duration, and nighttime exposure to light) measured over seven days by small, wristwatch-like devices with accelerometers. The four cases were selected for their highlighting of issues relevant to children’s sleep; only cases with sub-clinical trauma scores were considered. Interviews and investigator observations were subjected to case study analysis by three researchers, with actigraphy data complementing this analysis by providing additional information about the children’s sleep disturbance.

Findings:

Examination of actigraphy data revealed, for all children, later sleep onset and shorter-than-desired sleep duration than is typical of their ages, and nighttime light exposure more intense than what is optimal for restful sleep. Individual case analysis revealed four primary domains of environmental barriers impeding restful sleep for trauma-exposed children. One case highlighted the impact of physical sleep environment factors (i.e., inadequate sleep furniture, fears about home security, and ambient noise and light) on sleep disruption. Another case underscored the comforting capacity of co-sleeping with parents or siblings in temporarily alleviating trauma-related distress, while a third case emphasized the particularly disruptive impact of neighborhood-level environmental nuisance on trauma-exposed children’s restful sleep. The final case illuminated potential impacts of post-traumatic cultural ostracization on children’s sleep problems, including nightmares and sleep avoidance. In each case, families implemented small, tangible changes (e.g., adding fans, furniture, white noise, light-level changes) to improve the sleep environment.

Conclusions and Implications:

For trauma-exposed children, findings suggest the usefulness of culturally-sensitive psychosocial assessments that address sleep hygiene and history. Social workers are in a unique position to collaborate with such families to implement small sleep environment changes facilitative of children’s sense of personal control. Such partnerships between social workers and caregivers might be safe, non-threatening, and concrete points of collaboration that subsequently translate into other more difficult case goals.