Summary Although there has been considerable research into the effectiveness of individual cognitive behavioral treatment for chronic insomnia, less is known about patients’ perceptions of what constitutes actual improvement. This study utilized 70 outpatients (mean age = 49.7 years, SD = 12.0) with insomnia who completed a 6‐week cognitive behavioral group for sleep. Participants completed a number of primary (Pittsburgh Sleep Quality Index) and secondary measures (the Dysfunctional Beliefs about Sleep Scale, Insomnia Severity Index, Beck Depression Inventory, Penn State Worry Questionnaire) at pre‐ and post‐treatment. Perceived improvement was measured using the Clinical Global Improvement Scale (CGI). Results were analyzed using a combination of Logistic Regression analysis and receiver operating curve characteristic analysis (ROC). Results demonstrated that sleep quality and sleep duration were the most sensitive primary measures, or best predicted perceived improvement, whereas sleep efficiency was the most specific primary measure, or best predicted perceived lack of improvement (defined as only mild improvement). Of the secondary measures, results showed that daytime impairment was the most sensitive predictor of perceived improvement and that mood was the most specific predictor of perceived lack of improvement. Implications of these findings are that sleep quality, sleep duration, and sleep efficiency may offer different types of information and the choice of measure for predicting global improvement in insomnia will depend on the needs of the researcher/clinician.

BACKGROUND Medical students feel they are inadequately trained in caring for patients with developmental disabilities (PWDD) (Troller et al. 2016; Salvador-Carulla et al., 2015). Consequently, PWDD may not receive timely, empathetic care from their future clinicians (Sahin and Akyol, 2010). We developed a preclinical elective, “Developing Skills with Developmental Disabilities” (DSDD), to improve student knowledge, skills, and attitudes toward paediatric PWDD. The first cohorts worked with pre-schoolers; DSDD was effective in improving student confidence working with PWDD (Penner et al. 2017). The current project compared the efficacy of DSDD using a hospital-based day-school for elementary-aged children, to previous cohorts. OBJECTIVES Our goal was to determine if changing the population being observed and the setting in which they are being observed could reproduce improvement in student confidence as seen in past cohorts. DESIGN/METHODS The DSDD module was an elective offered to preclinical medical students for credit. Students were given 6 hours of didactics on child development, assistive technologies, and breaking bad news. Students also participated in 6 clinical hours at the Glenrose Rehabilitation Hospital, where they observed school-aged PWDD in a classroom and interacted with an interdisciplinary team. Students also interviewed children’s families during medical intakes. Students completed pre- and post-elective surveys administered on a 5-point Likert scale. Questions pertained to students’ self-perceived comfort and knowledge regarding PWDD. Scores pre- and post-elective were compared using t-test analysis. This data was compared to data collected from previous cohorts, which used the same survey. RESULTS 24 students registered for DSDD, and 21 surveys were able to be analysed. Statistically significant (p<0.01) increases were present in 9/10 self-reported scores, with the statistically insignificant score pertaining to confidence using positive reinforcement. There was no significant difference in pre- and post-elective score improvement when comparing this cohort with past cohorts, across all scores. The critical components of DSDD were maintained across setting changes with significant (p<0.01) increases in students’ self-reported confidence and knowledge in working with PWDD. CONCLUSION This elective demonstrates effectiveness in different settings and ages. The general structure and principles of this elective may be applied by Paediatricians to improve medical education. Examples include having students attend developmental programmes they might provide support for, using a short set of parent interview questions and/or a child observation to improve developmental teaching, and allocating time for interaction with other allied health professionals to better understand their roles in the management of paediatric PWDD.

receiving a developmental assessment was 27.6 weeks. Mean age of children receiving a developmental assessment was 7.0 years. With respect to mental health impact, 55.9% presented to the school clinic with at least one mental health concern, 13.6% received a new mental health diagnosis including at least one of attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, depression, anxiety disorder, or selective mutism, and 25.7% of the children received a referral to a psychiatrist or psychologist. The wait-time for receiving a mental health diagnosis was 27.1 weeks. CONCLUSION: School-Based Health Clinics are an effective and feasible model to decrease wait-times for receiving developmental assessments and to provide mental health services to inner-city children.