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

摘要 严厉的父母养育方式与青年中严重和昂贵的心理健康问题有关，包括 物质使用，情绪障碍，自杀意念和行为。令人担忧的是，这些育儿做法 最常见于贫困社区的家庭;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不利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是复杂多样的，其中一个机制可能是 父母倾向于优先考虑立即奖励（例如通过身体阻止孩子的不良行为）。 惩罚，如打屁股和打）相对于较大，但延迟奖励（包括改善亲子关系） 关系质量）。这种行为倾向被称为延迟折扣，最近的研究结果表明， 研究小组认为，延迟折扣率预示着父母使用严厉体罚。现有 研究还表明，暴露于不利的环境和发展之间的密切联系 延迟折扣。具体而言，不稳定和低资源社区可能会强化机会主义选择 行为，例如暴露于这些环境中的个体表现出夸大的倾向， 贬低延迟收到的奖励。因此，延迟折扣可能是一个重要的途径， 贫困的环境和严厉的养育。利用实验治疗框架，目前 一个项目的目的是调整一个情节性的未来思维（EFT）干预，以减少与父母有关的 延迟折扣本申请旨在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。按照以部署为中心的模式，我们将 迭代的小病例系列试验，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）。结果从这个 aim将通知手动调整。然后我们将招募72名5到10岁孩子的母亲 来自密歇根州弗林特市的社区服务组织。 参与者将随机接受EFT或以记忆为中心的比较干预。成果将 评估EFT在减少母亲延迟折扣和严厉养育方面的作用， 临床结果。探索性分析还将考虑调整后的干预措施对改善 参与和吸收行为父母培训技术。这项研究的结果将用于计划 大规模（R 01），混合II型干预试验，并将告知公共卫生方法，以改善 弱势群体中的青年心理健康。

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.