Impact of a Home Visiting Program on Sleep Problems Among Young Children Experiencing Adversity




Jonika B. Hash, Monica L. Oxford, Charles B. Fleming, Teresa M. Ward, Susan J. Spieker, and Mary Jane Lohr

Brief Type

Journal Publication


  • Other Models


Background: Adversity may negatively impact young children’s sleep but receiving home visitation services could buffer children from this potential consequence of adversity. Objective: This study examined whether young children’s adverse experiences increased their risk for sleep problems and if Promoting First Relationships® (PFR), a home visitation program, reduced children’s risk for sleep problems both directly and indirectly through increased parenting sensitivity. Participants and setting: Participants were 247 parents and their 10- to 24-month-old child recruited from Child Protective Services offices. Methods: A secondary analysis of a randomized controlled trial comparing PFR to a resource and referral control condition was conducted. Four time points of data were collected from baseline to 6 months post-intervention. Parenting sensitivity was measured at all time points using a parent-child interaction tool. Children’s adversities were measured at various time points using caregiver report tools and official state records. Children’s sleep problems were reported by parents at 6 months post-intervention. Results: The likelihood of having a sleep problem increased as children’s adversities increased (=.23, SE=.08, p=.005). There was no effect (direct or indirect) of treatment assignment on children’s sleep problems (ps>.05). Post hoc analyses showed a treatment assignment by adversity interaction such that children’s odds of having a sleep problem increased as their adversities increased, but only among children in the control condition (b = -0.37, SE = 0.17, p =.030). Conclusions: Experiencing more adversities associated with a greater risk for sleep problems, but PFR buffered children from this risk. (author abstract)

Data Collection Methods

  • Home Visit Observations
  • Parent-child observations
  • Program administrative record reviews
  • Standardized assessment tools
  • Surveys or questionnaires



For More Information

Hash, J. B., Oxford, M. L., Fleming, C. B., Ward, T. M., Spieker, S. J., & Lohr, M. J. (2019). Impact of a home visiting program on sleep problems among young children experiencing adversity. Child Abuse & Neglect, 89, 143–154. https://doi.org/10.1016/j.chiabu.2018.12.016
Author Contact Information:
Jonika B. Hash


  • Participant Characteristics
  • Participant, Family, and Program Outcomes