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

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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.