Trial Outcomes & Findings for Implementing and Sustaining a Sleep Treatment to Improve Community Mental Health Part 2: Train-the-Trainer (NCT NCT05805657)

Last Updated: 2025-10-23

Results Overview

Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale. The 8-item short version scale assesses perceived sleep problems (e.g., sleep quality, perception of sleep difficulties) over a 7-day period. Items are rated on a 5-point scale ranging from 1 (not at all) to 5 (very much). Raw scores are summed to produce a single score, resulting in a range from 8 to 40. Raw scores are converted to t-scores using treatment manuals. T-scores range from 30.5 to 77.5. A T-score of 50 indicates the population mean with a standard deviation of 10. Higher scores indicate worse sleep disturbance.

Recruitment status

COMPLETED

Study phase

Target enrollment

196 participants

Primary outcome timeframe

Baseline, mid-treatment (2/4 weeks post-baseline), post-treatment (4/8 weeks post-baseline - the UC-DT post-assessment follows the same timeframe post-usual care and delayed treatment) for Adapted/Standard TranS-C, respectively, and 6-month follow-up.

Results posted on

2025-10-23

Participant Flow

CMHCs (the units) were randomized to "Standard TranS-C" or "Adapted TranS-C" but CMHCs were not further randomized to UC-DT or Immediate TranS-C. Patients within a CMHC were randomized to UC-DT or immediate TranS-C. Therefore, only "Standard TranS-C" and "Adapted TranS-C" are reported in the participant flow so that units (i.e., CMHCS) are not counted more than once across a row.

Unit of analysis: CMHC Sites

Participant milestones

Participant milestones
Measure	Standard TranS-C Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation.	Adapted TranS-C Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the Community Mental Health Center (CMHC) context.
Overall Study STARTED	22 3	174 5
Overall Study Providers	6 3	47 5
Overall Study Patients - Immediate	8 3	70 5
Overall Study Patients - UC-DT	8 3	57 5
Overall Study COMPLETED	10 3	110 5
Overall Study NOT COMPLETED	12 0	64 0

Reasons for withdrawal

Reasons for withdrawal
Measure	Standard TranS-C Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation.	Adapted TranS-C Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the Community Mental Health Center (CMHC) context.
Overall Study Patients lost to post or 6-month follow-up	12	64

Baseline Characteristics

Age for patients

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Standard TranS-C (Immediate) n=8 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=70 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=8 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) n=57 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Standard TranS-C - Providers n=6 Participants Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. These data reflect the characteristics of providers who delivered Standard TranS-C.	Adapted TranS-C - Providers n=47 Participants The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. These data reflect the characteristics of providers who delivered Adapted TranS-C.	Total n=196 Participants Total of all reporting groups
Age, Continuous	43.75 Years STANDARD_DEVIATION 13.18 • n=8 Participants • Age for patients	43.26 Years STANDARD_DEVIATION 15.35 • n=70 Participants • Age for patients	46.25 Years STANDARD_DEVIATION 8.21 • n=8 Participants • Age for patients	43.43 Years STANDARD_DEVIATION 14.43 • n=57 Participants • Age for patients	39.50 Years STANDARD_DEVIATION 12.40 • n=6 Participants • Data not collected for this Baseline Measure from patients.	40.21 Years STANDARD_DEVIATION 10.19 • n=47 Participants • Data not collected for this Baseline Measure from patients.	40.13 Years STANDARD_DEVIATION 10.33 • n=53 Participants • Data not collected for this Baseline Measure from patients.
Sex/Gender, Customized Female	5 Participants n=8 Participants	42 Participants n=70 Participants	4 Participants n=8 Participants	39 Participants n=57 Participants	5 Participants n=6 Participants	33 Participants n=47 Participants	128 Participants n=196 Participants
Sex/Gender, Customized Male	3 Participants n=8 Participants	28 Participants n=70 Participants	4 Participants n=8 Participants	18 Participants n=57 Participants	0 Participants n=6 Participants	2 Participants n=47 Participants	55 Participants n=196 Participants
Sex/Gender, Customized Missing/declined to answer	0 Participants n=8 Participants	0 Participants n=70 Participants	0 Participants n=8 Participants	0 Participants n=57 Participants	1 Participants n=6 Participants	12 Participants n=47 Participants	13 Participants n=196 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	4 Participants n=8 Participants	18 Participants n=70 Participants	1 Participants n=8 Participants	8 Participants n=57 Participants	1 Participants n=6 Participants	8 Participants n=47 Participants	40 Participants n=196 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	4 Participants n=8 Participants	52 Participants n=70 Participants	6 Participants n=8 Participants	49 Participants n=57 Participants	4 Participants n=6 Participants	25 Participants n=47 Participants	140 Participants n=196 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants n=8 Participants	0 Participants n=70 Participants	1 Participants n=8 Participants	0 Participants n=57 Participants	1 Participants n=6 Participants	14 Participants n=47 Participants	16 Participants n=196 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=8 Participants	5 Participants n=70 Participants	0 Participants n=8 Participants	2 Participants n=57 Participants	0 Participants n=6 Participants	0 Participants n=47 Participants	7 Participants n=196 Participants
Race (NIH/OMB) Asian	0 Participants n=8 Participants	0 Participants n=70 Participants	0 Participants n=8 Participants	3 Participants n=57 Participants	1 Participants n=6 Participants	7 Participants n=47 Participants	11 Participants n=196 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=8 Participants	6 Participants n=70 Participants	2 Participants n=8 Participants	7 Participants n=57 Participants	0 Participants n=6 Participants	0 Participants n=47 Participants	15 Participants n=196 Participants
Race (NIH/OMB) Black or African American	3 Participants n=8 Participants	12 Participants n=70 Participants	2 Participants n=8 Participants	12 Participants n=57 Participants	2 Participants n=6 Participants	1 Participants n=47 Participants	32 Participants n=196 Participants
Race (NIH/OMB) White	2 Participants n=8 Participants	32 Participants n=70 Participants	2 Participants n=8 Participants	22 Participants n=57 Participants	1 Participants n=6 Participants	24 Participants n=47 Participants	83 Participants n=196 Participants
Race (NIH/OMB) More than one race	0 Participants n=8 Participants	12 Participants n=70 Participants	1 Participants n=8 Participants	8 Participants n=57 Participants	1 Participants n=6 Participants	1 Participants n=47 Participants	23 Participants n=196 Participants
Race (NIH/OMB) Unknown or Not Reported	3 Participants n=8 Participants	3 Participants n=70 Participants	1 Participants n=8 Participants	3 Participants n=57 Participants	1 Participants n=6 Participants	14 Participants n=47 Participants	25 Participants n=196 Participants
Region of Enrollment United States	8 participants n=8 Participants	70 participants n=70 Participants	8 participants n=8 Participants	57 participants n=57 Participants	6 participants n=6 Participants	47 participants n=47 Participants	196 participants n=196 Participants
Education High school graduate or below	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	6 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	5 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	14 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Education Some or completed college or vocational school	4 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	45 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	4 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	34 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	87 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Education Some or completed graduate school	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	17 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	17 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	38 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Education Other/ category not listed	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	1 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Education Missing/ declined to answer	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	3 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Employment Full-time	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	13 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	11 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	28 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Employment Part-time	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	10 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	9 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	22 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Employment Not employed	5 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	45 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	34 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	86 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Employment Other/ category not listed	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	3 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	7 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Civil Status Partnered	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	16 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	9 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	28 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Civil Status Unpartnered	7 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	54 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	5 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	47 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	113 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Civil Status Other/ category not listed	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	1 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Civil Status Missing/ declined to answer	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	1 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Living Arrangement Alone	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	14 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	11 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	27 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Living Arrangement With family	5 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	38 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	7 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	31 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	81 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Living Arrangement With friend or roommate or With friend or roommate or pet	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	13 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	7 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	22 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Living Arrangement Supportive housing	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	4 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	6 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	10 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Living Arrangement Other/ category not listed	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	3 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Living Arrangement Missing/ declined to answer	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	0 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Unemployment	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	3 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Medicare	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	8 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	3 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	12 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Medicaid	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	26 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	20 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	50 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Social Security	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	6 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	7 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	16 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Food Stamps	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	14 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	13 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	30 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Supplemental Security Income/ Social Security Disability Insurance	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	15 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	10 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	27 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Supplemental Nutrition Assistance Program	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	8 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	6 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	15 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Other/category not listed	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	10 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	7 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	21 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Government Assistance Missing/declined to answer	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	21 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	4 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	17 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	43 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Annual Household Income <$10,000	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	7 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	13 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	21 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Annual Household Income $10,000-$20,000	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	14 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	9 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	27 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Annual Household Income $20,000-$30,000	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	6 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	4 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	15 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Annual Household Income $30,000-$40,000	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	5 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	7 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Annual Household Income $40,000-$50,000	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	4 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	7 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Annual Household Income >= $50,000	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	14 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	17 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	32 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Annual Household Income I don't know my income	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	18 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	11 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	32 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Annual Household Income Missing/ declined to answer	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	2 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Neurodevelopmental disorders	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	10 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	11 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	22 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Psychosis	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	20 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	13 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	36 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Bipolar Disorder	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	15 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	8 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	25 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Major Depressive Disorder	4 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	31 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	28 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	66 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Anxiety disorders	3 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	30 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	5 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	34 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	72 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Obsessive- compulsive and related disorders	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	3 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	5 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Trauma and stressor-related disorders	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	14 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	17 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	33 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Dissociative disorders	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	0 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Personality disorders	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	2 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Feeding and eating disorders	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	0 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Substance-related and addictive disorders	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	3 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	5 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Other/category not listed	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	1 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	2 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	3 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Self-reported Diagnosis Missing/declined to answer	1 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	7 Participants n=70 Participants • Data not collected for this Baseline Measure from providers.	0 Participants n=8 Participants • Data not collected for this Baseline Measure from providers.	7 Participants n=57 Participants • Data not collected for this Baseline Measure from providers.	—	—	15 Participants n=143 Participants • Data not collected for this Baseline Measure from providers.
Degree Type Marriage and Family Therapy	—	—	—	—	0 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	4 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	4 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Degree Type Psychology	—	—	—	—	1 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	4 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	5 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Degree Type Social Work	—	—	—	—	4 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	15 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	19 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Degree Type Nursing	—	—	—	—	0 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	8 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	8 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Degree Type Medical	—	—	—	—	0 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	1 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	1 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Degree Type Other/category not listed	—	—	—	—	0 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	4 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	4 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Degree Type Missing/declined to answer	—	—	—	—	1 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	12 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	13 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Therapeutic Approach Client Centered	—	—	—	—	5 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	29 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	34 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Therapeutic Approach Family Systems	—	—	—	—	0 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	8 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	8 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Therapeutic Approach Cognitive Behavioral Therapy	—	—	—	—	2 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	20 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	22 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Therapeutic Approach Psychodynamic	—	—	—	—	1 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	11 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	12 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Therapeutic Approach Humanistic	—	—	—	—	1 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	7 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	8 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Therapeutic Approach Integrative/Holistic	—	—	—	—	0 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	2 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	2 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Therapeutic Approach Missing/declined to answer	—	—	—	—	1 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	13 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	14 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Licensure Licensed	—	—	—	—	3 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	24 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	27 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Licensure Not Licensed	—	—	—	—	2 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	11 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	13 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Licensure Missing/ declined to answer	—	—	—	—	1 Participants n=6 Participants • Data not collected for this Baseline Measure from patients.	12 Participants n=47 Participants • Data not collected for this Baseline Measure from patients.	13 Participants n=53 Participants • Data not collected for this Baseline Measure from patients.
Caseload	—	—	—	—	33.00 Number of patients STANDARD_DEVIATION 37.24 • n=6 Participants • Data not collected for this Baseline Measure from patients.	33.29 Number of patients STANDARD_DEVIATION 40.18 • n=47 Participants • Data not collected for this Baseline Measure from patients.	33.26 Number of patients STANDARD_DEVIATION 39.17 • n=53 Participants • Data not collected for this Baseline Measure from patients.
Employment Duration	—	—	—	—	1.20 Years STANDARD_DEVIATION 1.10 • n=6 Participants • Data not collected for this Baseline Measure from patients.	5.41 Years STANDARD_DEVIATION 6.23 • n=47 Participants • Data not collected for this Baseline Measure from patients.	4.86 Years STANDARD_DEVIATION 5.98 • n=53 Participants • Data not collected for this Baseline Measure from patients.
Years Since Degree Earned	—	—	—	—	6.40 Years STANDARD_DEVIATION 6.43 • n=6 Participants • Data not collected for this Baseline Measure from patients.	9.63 Years STANDARD_DEVIATION 9.69 • n=47 Participants • Data not collected for this Baseline Measure from patients.	9.26 Years STANDARD_DEVIATION 9.39 • n=53 Participants • Data not collected for this Baseline Measure from patients.

PRIMARY outcome

Timeframe: Baseline, mid-treatment (2/4 weeks post-baseline), post-treatment (4/8 weeks post-baseline - the UC-DT post-assessment follows the same timeframe post-usual care and delayed treatment) for Adapted/Standard TranS-C, respectively, and 6-month follow-up.

Population: Mid-treatment and 6-month follow-up assessments were collected following TranS-C but were not collected following Usual Care (UC-DT). To increase the sample size, analyses comparing Standard vs. Adapted TranS-C collapsed over immediate and UC-DT conditions (using the assessments collected after the UC-DT group started TranS-C at mid-treatment, post-treatment, and 6-month follow-up). An additional analysis also collapsed across all conditions.

Outcome measures

Outcome measures
Measure	Standard TranS-C (Immediate) n=8 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=70 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=8 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) n=57 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Immediate TranS-C n=78 Participants Standard and Adapted TranS-C combined for participants randomized to the immediate condition.	UC-DT n=65 Participants Standard and Adapted TranS-C combined for participants randomized to the UC-DT condition.	Standard TranS-C n=16 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately or after usual-care delayed treatment.	Adapted TranS-C n=127 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately or after usual-care delayed treatment.	TranS-C n=143 Participants Collapsed across TranS-C condition (Standard, Adapted) and treatment condition (Immediate, UC-DT)
Patient-level Outcome: Patient-Reported Outcomes Measurement Information System - Sleep DisturbanceMeasurement Information System - Sleep Disturbance Baseline	66.67 T-score Standard Deviation 6.44	62.21 T-score Standard Deviation 7.73	60.54 T-score Standard Deviation 5.63	62.24 T-score Standard Deviation 7.34	62.71 T-score Standard Deviation 7.69	62.05 T-score Standard Deviation 7.14	63.81 T-score Standard Deviation 6.66	62.23 T-score Standard Deviation 7.52	62.40 T-score Standard Deviation 7.42
Patient-level Outcome: Patient-Reported Outcomes Measurement Information System - Sleep DisturbanceMeasurement Information System - Sleep Disturbance Mid-treatment	49.55 T-score Standard Deviation 2.33	53.81 T-score Standard Deviation 9.58	—	—	53.60 T-score Standard Deviation 9.39	—	50.08 T-score Standard Deviation 2.65	55.10 T-score Standard Deviation 9.27	54.80 T-score Standard Deviation 9.08
Patient-level Outcome: Patient-Reported Outcomes Measurement Information System - Sleep DisturbanceMeasurement Information System - Sleep Disturbance Post-treatment	51.05 T-score Standard Deviation 15.23	55.06 T-score Standard Deviation 10.76	61.48 T-score Standard Deviation 10.37	61.04 T-score Standard Deviation 8.52	54.74 T-score Standard Deviation 11.04	61.08 T-score Standard Deviation 8.59	54.21 T-score Standard Deviation 12.22	55.21 T-score Standard Deviation 11.18	55.12 T-score Standard Deviation 11.19
Patient-level Outcome: Patient-Reported Outcomes Measurement Information System - Sleep DisturbanceMeasurement Information System - Sleep Disturbance 6-month follow-up	52.35 T-score Standard Deviation 5.83	52.48 T-score Standard Deviation 10.34	—	—	52.47 T-score Standard Deviation 10.07	—	54.86 T-score Standard Deviation 6.74	53.54 T-score Standard Deviation 10.05	53.63 T-score Standard Deviation 9.84

PRIMARY outcome

Timeframe: Baseline, mid-treatment (2 weeks post-baseline for Adapted TranS-C and 4 weeks post-baseline for Standard TranS- C), post-treatment (4 weeks post-baseline for Adapted TranS-C and 8 weeks post-baseline for Standard TranS-C).

Population: Acceptability Intervention Measure was collected only from providers. To increase the sample size, and because providers treated patients who could have been in either the immediate or UC-DT conditions, we analyzed by collapsing across immediate and UC-DT for providers. For some analyses, data were collapsed across Standard and Adapted TranS-C. This measure was not assessed following usual care.

Assesses provider perceptions of the acceptability of the treatment intervention using a self-report questionnaire. The 4-item scale is rated on a 5-point scale from 1 (completely disagree) to 5 (completely agree). A total score is calculated by averaging all four items. Total scores range from 1 to 5, with higher scores indicating greater perceptions of acceptability.

Outcome measures

Outcome measures
Measure	Standard TranS-C (Immediate) n=6 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=47 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=53 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Immediate TranS-C Standard and Adapted TranS-C combined for participants randomized to the immediate condition.	UC-DT Standard and Adapted TranS-C combined for participants randomized to the UC-DT condition.	Standard TranS-C Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately or after usual-care delayed treatment.	Adapted TranS-C Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately or after usual-care delayed treatment.	TranS-C Collapsed across TranS-C condition (Standard, Adapted) and treatment condition (Immediate, UC-DT)
Provider-level Outcome: Acceptability Intervention Measure Baseline	4.90 score on a scale Standard Deviation 0.22	4.74 score on a scale Standard Deviation 0.41	4.76 score on a scale Standard Deviation 0.39	—	—	—	—	—	—
Provider-level Outcome: Acceptability Intervention Measure Mid-treatment	5.00 score on a scale Standard Deviation 0.00	4.64 score on a scale Standard Deviation 0.44	4.65 score on a scale Standard Deviation 0.44	—	—	—	—	—	—
Provider-level Outcome: Acceptability Intervention Measure Post-treatment	5.00 score on a scale Standard Deviation 0.00	4.54 score on a scale Standard Deviation 0.58	4.56 score on a scale Standard Deviation 0.57	—	—	—	—	—	—

SECONDARY outcome

Population: Mid-treatment and 6-month follow-up assessments were collected following TranS-C but were not collected following Usual Care (UC-DT). To increase the sample size, analyses comparing Standard vs. Adapted TranS-C collapsed over immediate and UC-DT conditions (using the assessments collected post TranS-C for the UC-DT group). An additional analysis also collapsed across all conditions.

Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Impairment Scale. The 8-item short version scale assesses perceived sleep problems during waking hours (e.g., alertness, sleepiness, tiredness) over a 7-day period. Items are rated on a 5-point scale ranging from 1 (not at all) to 5 (very much). Raw scores are summed to produce a single score, resulting in a range from 8 to 40. Raw scores are converted to t-scores using treatment manuals. T-scores range from 30.1 to 80.1. A T-score of 50 indicates the population mean with a standard deviation of 10. Higher scores indicate worse sleep-related impairment.

Outcome measures

Outcome measures
Measure	Standard TranS-C (Immediate) n=8 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=70 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=8 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) n=57 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Immediate TranS-C n=78 Participants Standard and Adapted TranS-C combined for participants randomized to the immediate condition.	UC-DT n=65 Participants Standard and Adapted TranS-C combined for participants randomized to the UC-DT condition.	Standard TranS-C n=16 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately or after usual-care delayed treatment.	Adapted TranS-C n=127 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately or after usual-care delayed treatment.	TranS-C n=143 Participants Collapsed across TranS-C condition (Standard, Adapted) and treatment condition (Immediate, UC-DT)
Patient-level Outcome: Patient-Reported Outcomes Measurement Information System - Sleep Related Impairment Baseline	63.12 T-score Standard Deviation 10.63	60.30 T-score Standard Deviation 8.57	59.24 T-score Standard Deviation 10.79	60.09 T-score Standard Deviation 8.58	60.59 T-score Standard Deviation 8.76	59.98 T-score Standard Deviation 8.79	61.18 T-score Standard Deviation 10.54	60.20 T-score Standard Deviation 8.54	60.31 T-score Standard Deviation 8.75
Patient-level Outcome: Patient-Reported Outcomes Measurement Information System - Sleep Related Impairment Mid-treatment	60.20 T-score Standard Deviation 5.80	55.67 T-score Standard Deviation 10.66	—	—	55.89 T-score Standard Deviation 10.47	—	55.83 T-score Standard Deviation 8.82	56.76 T-score Standard Deviation 10.45	56.70 T-score Standard Deviation 10.30
Patient-level Outcome: Patient-Reported Outcomes Measurement Information System - Sleep Related Impairment Post-treatment	48.65 T-score Standard Deviation 12.87	52.80 T-score Standard Deviation 11.90	59.66 T-score Standard Deviation 6.61	57.71 T-score Standard Deviation 8.58	52.46 T-score Standard Deviation 11.90	57.88 T-score Standard Deviation 8.39	52.74 T-score Standard Deviation 10.56	53.54 T-score Standard Deviation 11.14	53.48 T-score Standard Deviation 11.03
Patient-level Outcome: Patient-Reported Outcomes Measurement Information System - Sleep Related Impairment 6-month follow-up	50.75 T-score Standard Deviation 9.05	53.82 T-score Standard Deviation 11.29	—	—	53.62 T-score Standard Deviation 11.12	—	54.27 T-score Standard Deviation 9.82	54.71 T-score Standard Deviation 10.90	54.68 T-score Standard Deviation 10.79

SECONDARY outcome

Composite Sleep Health Score is defined as the sum of scores on 6 sleep health dimensions: Regularity (Midpoint sleep fluctuation across a 7-day sleep diary \< 1 hour), Satisfaction (Sleep quality question on PROMIS-Sleep Disturbance (PROMIS = Patient-Reported Outcomes Measurement Information System)), Alertness (Daytime sleepiness question on PROMIS-Sleep Related Impairment (PROMIS = Patient-Reported Outcomes Measurement Information System)), Timing (Mean midpoint sleep across the 7 day sleep diary between 2 and 4 AM), Efficiency (Average sleep efficiency based on the 7 day sleep diary ≥ 85%), and Duration (Total Sleep Time average based on 7 day sleep diary between 7 and 9 hours). Each dimension was dichotomized such that 1 = good /yes; 0 = poor/no). Total composite sleep health score ranges from 0 to 6, with larger values indicating better sleep health.

Outcome measures

Outcome measures
Measure	Standard TranS-C (Immediate) n=8 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=70 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=8 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) n=57 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Immediate TranS-C n=78 Participants Standard and Adapted TranS-C combined for participants randomized to the immediate condition.	UC-DT n=65 Participants Standard and Adapted TranS-C combined for participants randomized to the UC-DT condition.	Standard TranS-C n=16 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately or after usual-care delayed treatment.	Adapted TranS-C n=127 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately or after usual-care delayed treatment.	TranS-C n=143 Participants Collapsed across TranS-C condition (Standard, Adapted) and treatment condition (Immediate, UC-DT)
Patient-level Outcome: Composite Sleep Health Score Baseline	3.00 score on a scale Standard Deviation 1.10	2.25 score on a scale Standard Deviation 1.29	2.29 score on a scale Standard Deviation 1.50	2.45 score on a scale Standard Deviation 1.47	2.31 score on a scale Standard Deviation 1.28	2.43 score on a scale Standard Deviation 1.46	2.62 score on a scale Standard Deviation 1.33	2.33 score on a scale Standard Deviation 1.37	2.36 score on a scale Standard Deviation 1.36
Patient-level Outcome: Composite Sleep Health Score Mid-treatment	3.50 score on a scale Standard Deviation 2.12	3.28 score on a scale Standard Deviation 1.54	—	—	3.29 score on a scale Standard Deviation 1.54	—	3.50 score on a scale Standard Deviation 1.73	3.05 score on a scale Standard Deviation 1.54	3.08 score on a scale Standard Deviation 1.55
Patient-level Outcome: Composite Sleep Health Score Post-treatment	3.33 score on a scale Standard Deviation 2.52	3.07 score on a scale Standard Deviation 1.59	3.00 score on a scale Standard Deviation 1.41	2.66 score on a scale Standard Deviation 1.45	3.09 score on a scale Standard Deviation 1.63	2.69 score on a scale Standard Deviation 1.44	2.50 score on a scale Standard Deviation 2.07	3.07 score on a scale Standard Deviation 1.52	3.03 score on a scale Standard Deviation 1.56
Patient-level Outcome: Composite Sleep Health Score 6-month follow-up	4.00 score on a scale Standard Deviation 1.41	2.94 score on a scale Standard Deviation 1.62	—	—	3.02 score on a scale Standard Deviation 1.62	—	3.57 score on a scale Standard Deviation 1.62	2.90 score on a scale Standard Deviation 1.52	2.95 score on a scale Standard Deviation 1.53

SECONDARY outcome

Timeframe: Baseline, post-treatment (4/8 weeks post-baseline - the UC-DT post-assessment follows the same timeframe post-usual care and delayed treatment) for Adapted/Standard TranS-C, respectively, and 6-month follow-up.

Population: 6-month follow-up assessments were collected following TranS-C but were not collected following Usual Care (UC-DT). To increase the sample size, analyses comparing Standard vs. Adapted TranS-C collapsed over immediate and UC-DT conditions (using the assessments collected after the UC-DT group started TranS-C at post-treatment, and 6-month follow-up). An additional analysis also collapsed across all conditions.

The Sheehan Disability Scale (SDS) assesses impairment in work/school, social, and family life. Items are rated on a scale from 0 (not at all) to 10 (extremely). Items are summed to produce a single score. Scores range from 0 to 30, with higher scores indicating higher functional impairment.

Outcome measures

Outcome measures
Measure	Standard TranS-C (Immediate) n=8 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=70 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=8 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) n=57 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Immediate TranS-C n=78 Participants Standard and Adapted TranS-C combined for participants randomized to the immediate condition.	UC-DT n=65 Participants Standard and Adapted TranS-C combined for participants randomized to the UC-DT condition.	Standard TranS-C n=16 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately or after usual-care delayed treatment.	Adapted TranS-C n=127 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately or after usual-care delayed treatment.	TranS-C n=143 Participants Collapsed across TranS-C condition (Standard, Adapted) and treatment condition (Immediate, UC-DT)
Patient-level Outcome: Sheehan Disability Scale Baseline	15.25 score on a scale Standard Deviation 6.63	12.49 score on a scale Standard Deviation 7.72	11.75 score on a scale Standard Deviation 10.07	11.88 score on a scale Standard Deviation 7.04	12.77 score on a scale Standard Deviation 7.62	11.86 score on a scale Standard Deviation 7.38	13.50 score on a scale Standard Deviation 8.43	12.21 score on a scale Standard Deviation 7.40	12.36 score on a scale Standard Deviation 7.50
Patient-level Outcome: Sheehan Disability Scale Post-treatment	6.50 score on a scale Standard Deviation 6.35	7.98 score on a scale Standard Deviation 7.06	10.80 score on a scale Standard Deviation 7.66	11.10 score on a scale Standard Deviation 7.51	7.86 score on a scale Standard Deviation 6.95	11.07 score on a scale Standard Deviation 7.46	8.86 score on a scale Standard Deviation 7.73	8.36 score on a scale Standard Deviation 6.47	8.40 score on a scale Standard Deviation 6.54
Patient-level Outcome: Sheehan Disability Scale 6-month follow-up	9.75 score on a scale Standard Deviation 8.26	8.51 score on a scale Standard Deviation 7.06	—	—	8.59 score on a scale Standard Deviation 7.07	—	9.71 score on a scale Standard Deviation 8.46	8.70 score on a scale Standard Deviation 7.05	8.77 score on a scale Standard Deviation 7.11

SECONDARY outcome

Population: 6-month follow-up assessments were collected following TranS-C but were not collected following Usual Care (UC-DT). To increase the sample size, analyses comparing Standard vs. Adapted TranS-C collapsed over immediate and UC-DT conditions (using the assessments collected after the UC-DT group started TranS-C at mid-treatment, post-treatment, and 6-month follow-up). An additional analysis also collapsed across all conditions.

The Diagnostic and Statistical Manual of Mental Disorders Cross-Cutting Symptom Measure (DSM-5) assesses psychiatric symptoms across 13 mental health domains. Participants rate on a 5-point scale how often they were bothered by each symptom on a scale from 0 (not at all) to 4 (nearly every day). Scores range from 0 to 52, with higher scores indicating more severe symptoms.

Outcome measures

Outcome measures
Measure	Standard TranS-C (Immediate) n=8 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=70 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=8 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) n=57 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Immediate TranS-C n=78 Participants Standard and Adapted TranS-C combined for participants randomized to the immediate condition.	UC-DT n=65 Participants Standard and Adapted TranS-C combined for participants randomized to the UC-DT condition.	Standard TranS-C n=16 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately or after usual-care delayed treatment.	Adapted TranS-C n=127 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately or after usual-care delayed treatment.	TranS-C n=143 Participants Collapsed across TranS-C condition (Standard, Adapted) and treatment condition (Immediate, UC-DT)
Patient-level Outcome: The Diagnostic and Statistical Manual of Mental Disorders Cross-Cutting Symptom Measure Baseline	25.38 score on a scale Standard Deviation 8.93	23.48 score on a scale Standard Deviation 8.70	18.75 score on a scale Standard Deviation 5.18	23.25 score on a scale Standard Deviation 9.48	22.69 score on a scale Standard Deviation 9.15	23.68 score on a scale Standard Deviation 8.69	22.06 score on a scale Standard Deviation 7.84	23.37 score on a scale Standard Deviation 9.03	23.23 score on a scale Standard Deviation 8.89
Patient-level Outcome: The Diagnostic and Statistical Manual of Mental Disorders Cross-Cutting Symptom Measure Post-treatment	14.00 score on a scale Standard Deviation 10.68	17.91 score on a scale Standard Deviation 9.61	20.60 score on a scale Standard Deviation 5.32	20.67 score on a scale Standard Deviation 8.74	17.59 score on a scale Standard Deviation 9.64	20.67 score on a scale Standard Deviation 8.46	16.14 score on a scale Standard Deviation 8.07	18.00 score on a scale Standard Deviation 9.34	17.84 score on a scale Standard Deviation 9.20
Patient-level Outcome: The Diagnostic and Statistical Manual of Mental Disorders Cross-Cutting Symptom Measure 6-month follow-up	14.25 score on a scale Standard Deviation 8.30	18.47 score on a scale Standard Deviation 10.16	—	—	18.19 score on a scale Standard Deviation 10.04	—	17.29 score on a scale Standard Deviation 7.20	18.24 score on a scale Standard Deviation 9.51	18.18 score on a scale Standard Deviation 9.34

SECONDARY outcome

Population: Intervention Appropriateness Measure was collected only from providers. To increase the sample size, and because providers treated patients who could have been in either the immediate or UC-DT conditions, we analyzed by collapsing across immediate and UC-DT for providers. For some analyses, data were collapsed across Standard and Adapted TranS-C. This measure was not assessed following usual care.

Assesses provider perceptions of the appropriateness of the treatment intervention using a self-report questionnaire. The 4-item scale is rated on a 5-point scale from 1 (completely disagree) to 5 (completely agree). A total score is calculated by averaging all four items. Total scores range from 1 to 5, with higher scores indicating greater perceptions of appropriateness.

Outcome measures

Outcome measures
Measure	Standard TranS-C (Immediate) n=6 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=47 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=53 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Immediate TranS-C Standard and Adapted TranS-C combined for participants randomized to the immediate condition.	UC-DT Standard and Adapted TranS-C combined for participants randomized to the UC-DT condition.	Standard TranS-C Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately or after usual-care delayed treatment.	Adapted TranS-C Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately or after usual-care delayed treatment.	TranS-C Collapsed across TranS-C condition (Standard, Adapted) and treatment condition (Immediate, UC-DT)
Provider-level Outcome: Intervention Appropriateness Measure Baseline	5.00 score on a scale Standard Deviation 0.00	4.79 score on a scale Standard Deviation 0.35	4.82 score on a scale Standard Deviation 0.33	—	—	—	—	—	—
Provider-level Outcome: Intervention Appropriateness Measure Mid-treatment	4.83 score on a scale Standard Deviation 0.29	4.56 score on a scale Standard Deviation 0.52	4.58 score on a scale Standard Deviation 0.51	—	—	—	—	—	—
Provider-level Outcome: Intervention Appropriateness Measure Post-treatment	4.75 score on a scale Standard Deviation 0.50	4.39 score on a scale Standard Deviation 0.67	4.41 score on a scale Standard Deviation 0.67	—	—	—	—	—	—

SECONDARY outcome

Timeframe: Baseline, mid-treatment (2 weeks post-baseline for Adapted TranS-C and 4 weeks post-baseline for Standard TranS-C), post-treatment (4 weeks post-baseline for Adapted TranS-C and 8 weeks post-baseline for Standard TranS-C).

Population: Feasibility of Intervention Measure was collected only from providers. To increase the sample size, and because providers treated patients who could have been in either the immediate or UC-DT conditions, we analyzed by collapsing across immediate and UC-DT for providers. For some analyses, data were collapsed across Standard and Adapted TranS-C. This measure was not assessed following usual care.

Assesses provider perceptions of the feasibility of the treatment intervention using a self-report questionnaire. The 4- item scale is rated on a 5-point scale from 1 (completely disagree) to 5 (completely agree). A total score is calculated by averaging all four items. Total scores range from 1 to 5, with higher scores indicating greater perceptions of feasibility.

Outcome measures

Outcome measures
Measure	Standard TranS-C (Immediate) n=6 Participants Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately.	Adapted TranS-C (Immediate) n=47 Participants Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately.	Standard TranS-C (UC-DT) n=53 Participants Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Standard TranS-C.	Adapted TranS-C (UC-DT) Usual Care Delayed Treatment. Usual care in the partner CMHCs starts with a case manager who co-ordinates care and refers each client for a medication review and to various rehabilitation programs (e.g., health care, housing, nutrition, finding a job, peer monitoring). Participants in this group received usual care followed by delayed treatment with Adapted TranS-C.	Immediate TranS-C Standard and Adapted TranS-C combined for participants randomized to the immediate condition.	UC-DT Standard and Adapted TranS-C combined for participants randomized to the UC-DT condition.	Standard TranS-C Standard Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): TranS-C is a psychosocial treatment designed to improve sleep and circadian functioning. It is a modular, psychosocial, skills-based approach. In this study, two version of TranS-C will be tested: Standard and Adapted. Standard TranS-C is modularized and delivered across eight 50-minute, weekly, individual sessions. It is comprised of 4 cross-cutting interventions featured in every session; 4 core modules that apply to the vast majority of patients; and 7 optional modules used less commonly, depending on the presentation. Participants in this group received Standard TranS-C immediately or after usual-care delayed treatment.	Adapted TranS-C Adapted Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): The Adapted version was derived from Standard TranS-C. It was developed to improve the fit of the treatment with the CMHC context. The process for developing Adapted TranS-C has been iterative and grounded in theory, data and stakeholder feedback. The core elements of the evidence-based theory of change underpinning TranS-C have been retained. Adapted TranS-C is delivered in four 20-minute, weekly, individual sessions. Participants in this group received Adapted TranS-C immediately or after usual-care delayed treatment.	TranS-C Collapsed across TranS-C condition (Standard, Adapted) and treatment condition (Immediate, UC-DT)
Provider-level Outcome: Feasibility of Intervention Measure Mid-treatment	4.83 score on a scale Standard Deviation 0.29	4.60 score on a scale Standard Deviation 0.54	4.61 score on a scale Standard Deviation 0.53	—	—	—	—	—	—
Provider-level Outcome: Feasibility of Intervention Measure Post-treatment	4.44 score on a scale Standard Deviation 0.72	4.42 score on a scale Standard Deviation 0.65	4.43 score on a scale Standard Deviation 0.65	—	—	—	—	—	—
Provider-level Outcome: Feasibility of Intervention Measure Baseline	4.95 score on a scale Standard Deviation 0.11	4.59 score on a scale Standard Deviation 0.57	4.64 score on a scale Standard Deviation 0.54	—	—	—	—	—	—

Other adverse events

Adverse event data not reported

Additional Information

Dr. Allison Harvey, Professor of Clinical Psychology

University of California, Berkeley

Phone: 5104736490

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place