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26/06/2019
1
Results
0
0.5
1
1.5
2
2.5
Baseline Post-intervention 12 month FU
Av time to fall asleep (hrs)
5
5.5
6
6.5
7
7.5
8
8.5
9
Baseline Post-intervention 12 month FU
Av total sleep (hrs)
12 months after the intervention had finished, children were still getting an average of 1.8 hours sleep per night more than at baseline.
Children gained on average an extra 2.4 hours sleep a night = nearly 2 nights extra sleep a week!
Mood of the Child on Wakening
Impact on Parental Wellbeing
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
Feeling isolated Feeling stressed Relationship with child Relationship withfamily members
Relationship withpartner
Driving General falls/trips
Par
enta
l sco
re (
1-5
)
Mean Baseline Mean Post-intervention
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“More support than I ever expected. I have been asking for support since age 2 and have struggled for years unsupported and not listened to. This programme has been amazing, life changing and just loved being listened to and believed”
What helped parents … Top 3’s
Learning About Sleep
Practical Ideas
Follow on Support
• Workshop
• 1 to 1 Clinic
• In this scenario …
• Bespoke sleep plan
• Tel. Call; Text; Email
62%
46%
41%
33%
23%
15%
13%
10%
10%
10%
10%
0% 10% 20% 30% 40% 50% 60% 70%
Child’s resistance
Tiredness
Events happened
Other children
Time
Really hard going
Being at work
Lack of support - Partner
No support- others
Wrong time
Not enough confidence What was a barrier?
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Wider Value
• Value for patient: – Seeing appropriate specialist
and receiving the right support – Holistic approach – Inter-agency communication
• Value for money: – Consultant time savings – Waiting list targets – Potential to reduce placement
breakdown, improve engagement, reduce contact with other services
67% Reported
illnesses for parent/carer
51%
46% Reported
illnesses for child
35%
99 Visits to HCP or non-HCP 68
Using resources effectively …
Cost of primary care
melatonin prescribing for
children in Sheffield
per month
Increase in hospital
attendances for children
with sleep disorders
in the last 10 years
Average cost
of a sleep study carried out in
tertiary care
Child aged 6 years – diagnosed with ADHD, cost
of 10 years melatonin prescription =
£3093.60
Average cost of direct sleep
intervention per family
£300 - £400
Commissioning is Changing Historically commissioning has been: Commissioning is becoming:
Based on activity and volume – tariff or block contracts
Based on outcomes, using different levers (e.g. risk/gain share)
Done in isolation More integrated – across different organisations (e.g. NHS/LA) and different geographies (e.g. STP/ICS)
Focussed on treatment and cure Focussed on early intervention and prevention
Concentrated around more specialist services (e.g. hospitals)
About development of more community based services
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Provide and Commission - Complementary
LA provides support for Foster Cares; Residential Care,
virtual school support..
CCG Commission: SC NHS FT Sleep
Clinic; LAC Health Assessments and
CAMHS services …
LA Commission: Sleep training for
services LA provides; SN’s; HV’s CAMHS
services …
Example: Children in Care
Commission the charity to deliver the service
Service specification outlines we offer sleep clinics, workshops, CPD training for staff and drop in sessions
KPI are reported on a monthly basis and quarterly reports produced
Doncaster Sleep Service
Sleep Clinics Self referral system
One hour appointment in community setting
On-going support to implement programme up to 5 weeks
Families to be offered appointment within 6 weeks of referral
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Success
100% of families were satisfied with the service
100% were offered appointment within 6 weeks of referral
Over 90% accessed on-going support – some choose not to
Over 90% success rate in resolving sleep issues
Cost saving
SCH Nurse-Led Model
Consultant
Sleep nurse
Sleep practitioner
Sleep nurse
Sleep practitioner
Sleep nurse
Sleep practitioner
Senior sleep nurse
Link with LA Sleep practitioners and
other services
Physiological sleep disorders: supra-regional service with
sleep diagnostic unit
Sleep support for children with
complex medical problems
NURSE-LED CLINIC: In a complex patient group (84% with medical co-morbidities, 54% of which were neuro-disability):
• 65% successfully discharged without melatonin (23% with neurodisability; 42% without neurodisability) – 35% weaned off melatonin and 30% avoided melatonin prescriptions.
Melatonin prescribing
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Building capacity in the workforce
• Around 40 members of staff trained as sleep practitioners across the key services: Parenting, Health visiting, Inclusion, SEND, Children’s Residential Homes.
• ALL early help staff given awareness training
• 24 Schools trained in Sleep School
Initial Reach Figures:
• In Sheffield around 1000 parents attended a parenting group / seminar last year
• Sleep workshops integrated into some groups where need identified
• 98 parents attended a sleep clinic or workshop provided by the team
• 93% of these saw an improvement in their goal
• Many more received generalised support through early help
Level 5 – Specialist Provision
SCH Sleep Studies/Clinic
Level 4 – Targeted Sleep Interventions
Residential, Children with Disabilities,
Short Breaks, SCH nurse-led
Level 3 – Sleep Workshops & Clinics
CIL Service, 0-19 Health
Level 2 – Universal Support in Schools & Other Services
Sleep School, Generic Advice for Parents
Level 1 – Media & Publicity
Public Information & Awareness Raising
Breadth of Reach
Co
mp
lexi
ty o
f n
ee
d
Our Vision
Training Needs
Workforce training
Awareness raising of services and
resources
Signposting
Resource Gaps
Expansion of SCH service into CDC / CAMHS
Sleep Coordinator Role
Time within usual role
Training, implementation
and mentorship materials
Leaflets, website
materials
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Another angle …
Many parents and carers were also employees The NHS and LA’s are 2 of the largest employers …how
many of our staff are …
Driving to work or for work
Maintaining our city or parks …
Undertaking assessments Making key decisions
Administering health care or medical interventions
and are sleep deprived?
What wakes you from sleep?
0 5 10 15 20 25 30 35
Noise (husband snoring)
Alarm Clock
Trip to the Bathroom
Children (coming home)
Pets
Light
Wake up naturally
Temperature (hot sweats)
Things on my mind /…
Bed partner getting up
Pain
Dreams
Clockwatching
Bed covers coming off
How many hours of sleep did you get last night?
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9 10 11 12 13
Fre
qu
en
cy
Hours of Sleep
How many hours of sleep did you get last night?
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Are you an Owl or a Lark?
0
5
10
15
20
25
30
35
Morning Type Neither Types Evening Type
Fre
qu
en
cy
Morningness-Eveningness Results
