Mentorship Model

Build a future worth protecting

Sleep Hygiene

Week 1: Initial Assessment

Defining Objectives

What insights do we expect the client to attain? What actions will he take this week, both in and out of session?

  • Client will recognize the negative impact that poor sleep has in other areas, connecting the behavior (poor sleep) to at least one tangible or emotional consequence (lack of energy, falling asleep in class, missing important events). Client will also explore the associated feelings surrounding the consequences of poor sleep
  • Client will be able to connect good sleep habits to improved mental health, will talk through a visualized future where sleep supports other aspects of recovery and wellness
  • Client will express openness to changing his routine based on the conclusions drawn through dialogue and reflection

Taking Action

What will you look for in this session? What actions will you take to facilitate the desired outcomes for the client?

  • Provider will gauge client’s motivation and willingness to change in order to best support the client’s progress. Consider ways to reframe the conversation in terms of factors the client can control
  • Provider will use motivational interviewing to help the client make a connection between sleep habits and desired outcomes, addressing ambivalence and resistance along the way
  • Provider will help the client to identify one tangible behavioral change to improve his sleep and assign a sleep report for the upcoming week to assess progress
Questions to Consider Resistant Client Corner
  • What sorts of references, examples, or resources will be most helpful for this client?
  • What motivates this client?
  • What is attainable for this client? What would be a stretch goal?

If a client has identified the problem but presents resistance when thinking of potential solutions, step back and reflect on what might be keeping them attached to an outwardly harmful pattern. Remember OARS; Open Ended Questions, Affirmation Statements, Reflections of Feelings and Summarizations

Pro Tip: Meet the client where they are. Getting their grades up might feel less urgent to a client than gaining more freedom in their schedule - and that’s alright!

Breaking down the process into smaller milestones can help to make a significant long-term change feel more attainable.

Refer to evidence based practice to support goal-setting.

When to Check In

In this phase, your role as a provider is primarily to gather information. The more insight you have into the client’s personal treatment goals as well as his particular life circumstances, the more effective subsequent sessions will be. Consider ways to manage resistance based on the client’s personality and motivations before looping in your supervisor.

  • Be ready for clients who do not see sleep as an issue, who feel as though they have “tried everything”, or who view themselves as an anomaly, noting that sleep hygiene “just doesn’t work for me”.
  • Don’t pivot too quickly away to another goal when faced with resistance. Instead, reflect on when and where resistance manifests in order to better anticipate it in future sessions.
  • Consult with a supervisor if the resistance is more than you know how to handle, but in session, remain curious, affirm, reflect and summarize.

Week 2: Reflect and Adjust

Defining Objectives

What will the client do to build on his analysis? What change to his routine will he implement or build on?

  • Client will reflect on the changes he noticed in his energy, attention, and performance following an adjustment to his sleep habit(s) 
  • Client will be able design an ideal sleep routine and environment based on the impact of environmental factors, his ability to make changes to his schedule, and tools he prefers to employ
  • Client will demonstrate more willingness to make behavioral changes. If he was unsuccessful in making an adjustment or sticking to his goal this week, the client will be able to identify what caused the setback

Taking Action

What roadblocks did the client encounter this week? What adjustments will you make to support the client in reaching their goals?

  • Provider will assess measurable and observable changes in the client’s presentation and demeanor as well as the client’s ability to implement changes independently outside of session time
  • Provider will review the client’s progress to draw attention towards successes as well as areas for improvement and assess the client’s mindset towards their own efforts out of session
  • Provider will re-evaluate plans for future sessions based the client’s ability to follow through on commitments and motivation to implement changes
  • Provider will encourage the client to reflect on his sleep environment and share resources supporting the importance of the environment in relation to sleep quality. Provider will share strategies and propose adjustments based on client’s description of their current environment
  • Provider will, with permission, schedule a visit to the client’s house for next session to assess his room and overall sleep environment and gain insight into the client’s ability to accurately self-reflect
Questions to Consider Resistant Client Corner
  • How successful was the client at implementing and tracking his goal over the past week?
  • How does the client respond to failure? What about success?
  • What does the client’s description of his sleep environment tell you about his home life?
  • How much is the client able to take on for the next session? How confident are you in his ability to follow through on future commitments?

If the client is reluctant to schedule a home visit, emphasize the direct benefits of an improved sleep environment such as more independence, less parental involvement in his sleep habits, or better performance in sports

For those clients who fail to meet their objective and shut down or engage in negative self-talk in response, step back and explore the client’s relationship to failure an evaluate resistance to change using MI and a Stages of Change model

When to Check In

As clients begin working to change their sleep habits, they are likely to encounter setbacks and shortcomings. Your role in this stage is to encourage the client, draw his attention to areas of change worth celebrating and away from  the areas that did go according to plan, and engage in forward-thinking problem solving to support ongoing growth. Reframing the clients mindset around failure can promote improved self-concept, particularly in a stage where failure is normal and even expected. However, if you run into situations like those listed below, it may be time to enlist further support from your supervisor:

  • If you’re unsure about how to request or position a home visit, talk to your supervisor about what techniques they would recommend 
  • If the client’s behavior in-session or description of his life at home raises any safety concerns, be sure to consult with a supervisor to make a plan and manage any risks 
  • Consult with your supervisor around evidenced based interventions and strategies if you’re struggling to feel competent when working with sleep related issues (ie: CBT-I) 

Week 3: Home Assessment

Defining Objectives

What will the client take away from the home assessment? What changes will the client make during the visit in order to provide an immediate impact? 

  • Client will feel respected and in control during the home visit. Client will be able to share his personal space and preferred routines as well as his vulnerabilities and challenges without fear of judgment 
  • Client will be able to make immediate improvements to his sleep environment – such as a cleaner, cooler, or darker space – and identify further refinements to his sleep routine to continue working on over time
  • Client will feel a stronger connection and sense of trust with his provider a sense of confidence that his provider is willing to go above and beyond to support them in other areas as well

Taking Action

How will you ensure a positive and impactful home session? What will you look out for both with regard to the client’s sleep environment as well as their home life?

  • Provider will maintain a respectful, curious attitude and defer to the client’s comfort level when entering his space. Provider will remember that entering the client’s home is privilege and remain mindful of cultural, legal, ethical and clinical implications during the visit
  • Provider will assess the environment and propose at least one environmental change that the client can make during the visit to improve his sleep quality. Provider will use declarative language and refer to previous resources shared with the client to prompt self-directed problem solving
  • Provider will note any factors in the client’s home life that are outside the client’s control – such as a shared room, loud housemates, or street facing window – and adjust recommendations based on real life conditions
  • Provider will reflect on any discrepancies between the client’s descriptions and the conditions the provider observes
  • Provider will roll with resistance by drawing connections between environmental changes to the client’s room and the broader goals the client has identified for themselves as well as his overall motivation for change. 
Questions to Consider Resistant Client Corner
  • What low-hanging fruit is available to the client with regard to making immediate changes?
  • How closely does the client’s environment and routines match up his descriptions?
  • What does the client’s room tell you about his interests, organization skills, and general cleanliness?
  • What challenges might the client be confronting that are outside of his control?

If the client is feeling overwhelmed or resistant to making changes to their space, help the client to prioritize changes like discarding leftover food and trash, installing black out curtains, or changing his sheets that will have an immediate impact.

Invite clients to begin the visit by sharing their favorite posters, keepsakes, and other possessions to establish trust before pivoting to making changes

Pro Tip: For clients who struggle to maintain an orderly sleeping space, taking a photograph of their room after cleaning it can help the client form a clearer mental image of what “clean” actually looks like

When to Check In

When meeting their client in his own home, the provider is able to gain firsthand knowledge of the client’s living conditions and home life. If you note any causes for concern that the client or family hasn’t mentioned or spot any bright red flags like those listed below, communicate with your supervisor to ensure the every effort is being made to keep the client safe and healthy:

  • Illicit drugs, drug paraphernalia, or other hazards that might be endangering the client or the family
  • Any evidence that would suggest abuse or neglect occuring to the client or to others within the home
  • Weapons that the clinician deems are improperly or unsafely stored or concealed

Week 4: Lessons Learned

Defining Objectives

What key takeaways will the client walk away with about his sleep habits? What ongoing changes will the client continue working on even as session time pivots to other areas?

  • Client will discuss the results of previous interventions in terms of his sleep habits, energy levels, and sense of autonomy. Client will be able to point to specific areas of life that have benefited from addressing his sleep hygiene
  • Client will state which behavioral changes he intends to continue and build using commitment language like “I will…” and “I plan to” and specific, measurable, achievable, realistic, and time-bound goals
  • Client will have developed the knowledge base to summarize in his own words the importance of sleep and their plan for maintaining a healthier sleep pattern

Taking Action

How will you support the client’s goal-setting and attitude towards change going forward? What ongoing support systems will the client need to maintain and build on their progress?

  • Provider will engage the client in reflective discussion around growth and changes, spotlighting areas of progress and identifying any areas where the client is in need of more support
  • Provider will elicit firm commitments to keep sleep hygiene front of mind for the client outside of session and model effective goal-setting. 
  • Provider will engage in motivational interviewing to challenge the client to build his plans for the future based on past results and reflect on potential responses to setbacks in the future
  • Provider will encourage the client to summarize the changes that have taken place, the successes the client has experienced, and the challenges that the client has faced to ensure comprehension
  • Provider will identify a means of checking in on sleep habits as the focus of sessions moves to other areas, such as a regular sleep status report or a weekly photo assignment to document the status of the client’s sleep environment
Questions to Consider Resistant Client Corner
  • How realistic are the goals that the client is setting for themselves?
  • What will the client likely do in response to a setback? What systems or strategies can the client put into place ahead of time?
  • How has the client’s progress aligned with your initial impressions? What techniques on your part yielded the most buy-in from the client?
  • How might you be able to work to address sleep using other mentorship interventions?

Consider multiple methods for tracking progress. Some clients may prefer a sleep tracking app, while others would rather keep a journal or send a daily text. Remember, not all data is measurable, and qualitative (observable) data is just as valuable as quantitative.

When applicable for clients still living at home, work with the client’s family to ensure that genuine effort towards improving sleep patterns is met with a desirable outcome in their daily life, such as more control of their schedule or a designated “cheat day” for the client to sleep in.

When to Check In

If the client reaches session 4 having made little meaningful progress, this is a great juncture to re-assess the client’s capacity for self-initiated changes outside of session time. The following indicators may be signs that the client’s overall treatment goals may need to be revisited in concert with your supervisor and any other members of the client’s team:

  • If you have yet to make a visit to the house, meet with your supervisor to understand why it hasn’t happened and what roadblocks you are navigating
  • If your client continues to struggle to initiate strategies dedicated to resolving sleep, consult with your supervisor and be ready to provide your conceptualization as to why that might be the case
  • Think more holistically as to what the client is motivated to achieve: did your aim to address sleep miss the mark because you thought it was more important than the client did?  How well were you able to tie this intervention to the client’s motivations? Consult with your supervisor if you feel like you’re striking out in this domain