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Improving Sleep Disturbance Screening and Management in a Pediatric Mental Health Outpatient Setting
Dissertation

Improving Sleep Disturbance Screening and Management in a Pediatric Mental Health Outpatient Setting

Lauren Pothitakis
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: Sleep disturbances affect nearly half of children in the United States and are strongly associated with adverse developmental, behavioral, and psychiatric outcomes. Despite these risks, pediatric sleep concerns are often underrecognized in clinical practice, particularly in rural mental health settings where access to sleep specialists may be limited. At Imperfectly Enough Psychiatry, no standardized screening tool existed to routinely assess pediatric sleep, creating a gap in identifying sleep problems among children with mental health diagnoses. Purpose: The purpose of this quality improvement project was to improve sleep disturbance screening in a pediatric mental health outpatient setting. Methods: Guided by the Iowa Implementation for Sustainability Framework within the Iowa Model of Evidence-Based Practice, this project was conducted in a rural outpatient clinic and focused on children ages 4–12 with mental health disorders. The Children’s Sleep Habits Questionnaire (CSHQ), a validated parent-reported screening tool, was implemented as part of routine care to assess common sleep disturbances in children. From August 2025 to January 2026, parents received an evidence-based, nonpharmacologic sleep intervention handout with sleep hygiene and behavioral strategies. Findings: All twelve eligible children completed baseline CSHQ screening, demonstrating successful implementation of the screening process within the clinic workflow. Ten of the twelve children met or exceeded the clinical cutoff score (≥41) with a mean baseline score of 49. All children who screened positive received the sleep intervention handout. No participants completed the post-intervention CSHQ; therefore, changes in sleep quality could not be evaluated. Discussion: Implementation of the CSHQ facilitated standardized sleep screening and early identification of sleep concerns in pediatric mental health care. Although outcome evaluation was limited, the project demonstrated that integrating sleep screening into routine visits is feasible and may support earlier recognition and management of sleep disturbances.
 children’s sleep habits questionnaire pediatric sleep rural mental health quality improvement sleep hygiene

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