Reducing Maternal Delay Discounting as a Target Mechanism to Decrease Harsh Parenting and Improve Child Mental Health Outcomes in a Traditionally Underserved Community

减少产妇延误折扣作为目标机制，以减少传统上服务不足的社区中的严厉养育行为并改善儿童心理健康结果

• 批准号: 10460563
• 负责人: JULIA W FELTON
• 金额: $ 23.44万
• 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: 2021-08-16 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10460563
• 关键词: Address; Adolescent; Age; Area; Behavior; Behavioral; Caregivers; Case Series; Child; Child Behavior; Child Mental Health; Child Rearing; Choice Behavior; Cities; Clinical; Cognitive deficits; Communities; Complex; Data; Decision Making; Development; Disadvantaged; Discipline; Disease; Economics; Educational Curriculum; Effectiveness; Environment; Evaluation; Event; Evidence based intervention; Exposure to; Family; Feeling suicidal; Future; Goals; Health; Hybrids; Impairment; Individual; Instruction; Intervention; Intervention Trial; Interview; Investigational Therapies; Lead; Link; Literature; Low income; Manuals; Measures; Memory; Mental Depression; Mental Health; Methods; Michigan; Minority; Modeling; Mood Disorders; Mothers; National Institute of Mental Health; Obesity; Outcome; Parent-Child Relations; Parents; Participant; Pathway interactions; Patient Self-Report; Pattern; Play; Poverty; Prevention; Prevention approach; Problem behavior; Psychopathology; Public Health; Punishment; Randomized; Reporting; Research; Research Design; Resource-limited setting; Resources; Rewards; Risk; Risk Behaviors; Safety; Science; Shapes; Suicide attempt; Taxes; Techniques; Text Messaging; Thinking; Time; Training Technics; Work; Youth; addiction; base; behavior change; brief intervention; comparison intervention; cost; discounting; dosage; effectiveness implementation trial; effectiveness outcome; effectiveness trial; efficacy evaluation; emotion regulation; evidence base; follow-up; implementation evaluation; implementation outcomes; improved; innovation; neighborhood disadvantage; novel; peer; poor communities; post intervention; recruit; skills; social stigma; substance use; suicidal behavior; underserved community; uptake; visual imagery; vulnerable community

Abstract Harsh parenting is associated with serious and costly mental health problems among youth, including substance use, mood disorders, and suicidal ideation and behaviors. Of concern, these parenting practices are most common among families from impoverished communities; however, many behaviorally-based parenting interventions do not take into account the unique mechanisms linking environmental disadvantage to parenting approaches. While the causes of harsh parenting are complex and varied, one such mechanism may be parents' tendencies to prioritize immediate rewards (such as stopping a child's misbehavior via physical punishment like spanking and hitting) relative to larger, but delayed rewards (including improved parent-child relationship quality). This behavioral tendency is known as delay discounting and recent findings from this study team suggest that rates of delay discounting predict parents' use of harsh physical discipline. Existing research also indicates a strong link between exposure to disadvantaged environments and the development of delay discounting. Specifically, unstable and low-resource communities may reinforce opportunistic choice behaviors, such that individuals exposed to these environments demonstrate an exaggerated tendency to devalue rewards that are delayed in their receipt. Thus, delay discounting may be an important pathway linking impoverished environments and harsh parenting. Utilizing an experimental therapeutics framework, the current project aims to adapt an episodic future thinking (EFT) intervention to target the reduction of parenting-related delay discounting. This application proposes to evaluate preliminary implementation and effectiveness outcomes using a Hybrid Type I research design. Following a deployment-focused model, we will conduct iterative small case-series trials and collect data from community-partners regarding necessary intervention dosage and critical implementation outcomes (including acceptability, tolerability, and safety). Results from this aim will inform manual adaptation. We will then recruit 72 mothers of children between the ages of 5 and 10 from community-serving organizations in the low resource, majority-minority, city of Flint, Michigan. Participants will be randomized to receive EFT or a memory-focused comparison intervention. Outcomes will evaluate the effect of EFT on reducing maternal delay discounting and harsh parenting, and improving child clinical outcomes. Exploratory analyses will also consider the utility of the adapted intervention for improving engagement and uptake of behavioral parent training techniques. Findings from this study will be used to plan a large-scale (R01), Hybrid Type II intervention trial and will inform public health approaches for improving youth mental health in vulnerable communities.

抽象的 严厉的养育方式与青少年严重且代价高昂的心理健康问题有关，包括 物质使用、情绪障碍以及自杀意念和行为。值得关注的是，这些养育方式 在贫困社区的家庭中最为常见；然而，许多基于行为的养育方式 干预措施没有考虑到将环境劣势与养育子女联系起来的独特机制 接近。虽然严厉养育的原因复杂多样，但其中一种机制可能是 父母倾向于优先考虑立即奖励（例如通过身体行为阻止孩子的不当行为） 相对于更大但延迟的奖励（包括改善亲子关系）的惩罚（如打屁股和殴打） 关系质量）。这种行为倾向被称为延迟贴现，最近的发现 研究小组认为，延迟折扣率预示着父母会使用严厉的体罚。现存的 研究还表明，暴露于不利环境与发展之间存在密切联系。 延迟折扣。具体来说，不稳定和资源匮乏的社区可能会强化机会主义选择 行为，使得暴露于这些环境的个体表现出夸大的倾向 延迟收到的奖励会贬值。因此，延迟贴现可能是连接 贫困的环境和严厉的教养。利用实验治疗框架，当前 该项目旨在采用情景式未来思维（EFT）干预措施，以减少与养育相关的行为 延迟打折。本申请拟评估初步实施情况和有效性 使用混合 I 型研究设计的结果。遵循以部署为中心的模型，我们将进行 迭代小型病例系列试验并从社区合作伙伴收集有关必要干预的数据 剂量和关键实施结果（包括可接受性、耐受性和安全性）。结果由此 目标将通知手动适应。然后我们将招募 72 名 5 至 10 岁儿童的母亲 来自资源匮乏、少数族裔占多数的密歇根州弗林特市的社区服务组织。 参与者将被随机分配接受 EFT 或以记忆为重点的比较干预。结果将 评估 EFT 对减少母亲延迟贴现和严厉养育以及改善儿童的效果 临床结果。探索性分析还将考虑调整后的干预措施对于改善 参与和采用行为家长培训技术。这项研究的结果将用于制定计划 一项大规模 (R01)、混合 II 型干预试验，将为改善公共卫生的方法提供信息 弱势社区的青少年心理健康。