Improving Delay Discounting to Decrease Harsh Parenting among Parents Receiving Substance Use Treatment in a Low Resource Community

改善延迟折扣以减少在资源匮乏社区接受药物滥用治疗的父母的严厉养育行为

• 批准号: 10450097
• 负责人: JULIA W FELTON
• 金额: $ 21.76万
• 依托单位: HENRY FORD HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10450097
• 关键词: Age; Aggressive behavior; Alcohol consumption; Alcohols; Attention; Behavioral; Caring; Case Series; Child; Child Abuse and Neglect; Child Behavior; Child Rearing; Cities; Clinical; Complex; Data; Decision Making; Discipline; Distress; Drug usage; Effectiveness; Emotional; Enrollment; Event; Family; Fathers; Future; Health; Illicit Drugs; Individual; Inpatients; Interruption; Intervention; Intervention Trial; Interview; Lead; Life Cycle Stages; Link; Longevity; Manuals; Measures; Memory; Methods; Michigan; Minority; Modeling; Mothers; Outcome; Parent-Child Relations; Parents; Participant; Patient Self-Report; Pattern; Population; Public Health; Punishment; Randomized; Recovery; Research; Residential Treatment; Resource-limited setting; Resources; Rewards; Risk; Risk Behaviors; Science; Severities; Shapes; Substance Use Disorder; Substance abuse problem; Surveys; Techniques; Thinking; Time; abuse neglect; addiction; base; behavior change; behavioral outcome; brief intervention; comparison intervention; contingency management; cost; cost effectiveness; discounting; dosage; effectiveness implementation design; effectiveness implementation study; effectiveness testing; efficacy evaluation; efficacy testing; evidence base; experience; feasibility testing; feasibility trial; flexibility; follow-up; high risk; illicit drug use; implementation outcomes; implementation trial; improved; intergenerational; intervention cost; maltreatment; peer; physical abuse; pilot test; pilot trial; prevent; programs; recruit; residence; skills; social stigma; substance use; substance use treatment; tailored messaging; transmission process; treatment program; underserved community; uptake; visual imagery

Abstract Parents with substance use disorders (SUD) are significantly more likely to engage in harsh parenting practices, including spanking, hitting, and belittling their children, than parents without SUD. Punitive physical and emotional discipline is, in turn, associated with increased rates of child maltreatment and the subsequent intergenerational transmission of substance use disorders. Parents in residential substance use treatment facilities are among those at highest risk for perpetrating harsh and abusive parenting; yet most behaviorally- based parenting interventions available within inpatient settings do not take into account the unique mechanisms linking parental substance use to harsh parenting. Specifically, parents with SUD may be at heightened risk for engaging in maladaptive parenting approaches given a tendency to prioritize immediate rewards (such as stopping a child’s misbehavior using physical punishment) relative to larger, but delayed rewards (including shaping positive child behavior over a longer term). This behavioral tendency is known as delay discounting and recent findings suggest that rates of delay discounting predict parents’ use of harsh physical discipline. Existing research also indicates a strong link between steeper (more problematic) rates of delay discounting and the severity of alcohol and illicit drug use across the lifespan. Thus, delay discounting may represent a specific vulnerability underlying both harsh parenting and disordered substance use. The current project proposes to pilot and feasibility test an adapted episodic future thinking (EFT) intervention to target the reduction of parenting-related delay discounting and examine its effects on parenting practices among families in a residential substance use treatment setting. EFT may be particularly well-suited for dissemination in a residential SUD setting because it is brief, flexible, and can be delivered by peer recovery coaches (PRCs), individuals with lived substance use and recovery experiences. Utilizing PRCs, who are already widely employed in SUD treatment settings, increases the scalability, acceptability and cost- effectiveness of this approach and may reduce stigma, a critical barrier to participation in parenting programs among individuals with SUD. Following a deployment-focused model, we will conduct a small case-series trial and collect data regarding critical implementation outcomes (including acceptability, tolerability, and dosage). Results from this aim will inform manual adaptation. We will then recruit 72 parents of children between the ages of 6 and 10 receiving inpatient substance use treatment in the low resource, majority-minority, city of Flint, Michigan. Participants will be randomized to receive EFT or a comparison intervention. Findings from this study will be used to plan a large-scale (R01) intervention trial and will inform public health approaches for reducing child maltreatment and preventing intergenerational cycles of addiction.

抽象的 患有物质使用障碍（SUD）的父母更有可能采取严厉的养育方式 与没有 SUD 的父母相比，他们的做法包括打屁股、殴打和贬低孩子。 反过来，情感管教又与虐待儿童的发生率增加以及随后发生的事件有关。 药物滥用障碍的代际传播。 设施是实施严厉和虐待性养育行为的最高风险之一； 住院环境中可用的基于育儿的干预措施没有考虑到独特的情况 具体而言，患有 SUD 的父母可能存在将父母物质使用与严厉养育联系起来的机制。 鉴于倾向于优先考虑眼前的事情，采取适应不良的养育方法存在巨大风险 相对较大但延迟的奖励（例如通过体罚制止孩子的不当行为） 奖励（包括长期塑造积极的儿童行为）。 延迟折扣和最近的研究结果表明，延迟折扣率可以预测父母使用严厉的 现有的研究还表明，更陡峭（更有问题）的比率之间存在密切联系。 延迟折扣以及整个生命周期内酒精和非法药物使用的严重程度因此，延迟折扣。 可能代表了严厉的养育和药物滥用背后的特定脆弱性。 当前的项目建议试点和可行性测试一种适应的情景未来思维（EFT）干预措施 以减少与育儿相关的延迟贴现为目标，并研究其对育儿实践的影响 EFT 可能特别适合居住在药物滥用治疗环境中的家庭。 在住宅 SUD 环境中传播，因为它简短、灵活，并且可以通过同伴恢复来提供 教练（PRC），具有物质使用和恢复经验的个人，他们是。 已广泛应用于 SUD 治疗环境，提高了可扩展性、可接受性和成本 这种方法的有效性，可以减少耻辱感，这是参与育儿计划的一个关键障碍 根据以部署为中心的模型，我们将在患有 SUD 的个体中进行小型病例系列试验。 收集有关关键结果实施的数据（包括可接受性、耐受性和剂量）。 该目标的结果将为手动调整提供信息，然后我们将在 2017 年和 2017 年之间招募 72 名儿童家长。 在资源匮乏、少数民族人口占多数的城市中接受住院药物滥用治疗的 6 岁和 10 岁儿童 密歇根州弗林特，参与者将被随机分配接受 EFT 或比较干预。 研究将用于计划大规模（R01）干预试验，并将为公共卫生方法提供信息 减少虐待儿童并防止成瘾的代际循环。