Improving Future Thinking Among Mothers to Reduce Harsh Parenting and Improve Child Outcomes

Not Applicable

Completed

Conditions: Behavioral Health

Interventions: Behavioral: Episodic Future Thinking

Registration Number: NCT05229146

Lead Sponsor: Henry Ford Health System

Brief Summary: Parents of children from impoverished communities are disproportionately more likely to engage in harsh physical discipline, which can lead to serious clinical outcomes, including suicidal ideation and attempts. One mechanism linking low resource environments and maladaptive parenting strategies is maternal delay discounting, or the tendency to value smaller, immediate rewards (such as stopping children's misbehavior via physical means) relative to larger, but delayed rewards (like improving the parent-child relationship). This study will examine the efficacy of implementing a low-cost, brief intervention targeting the reduction of maternal delay discounting to inform broader public health efforts aimed at improving adolescent mental health outcomes in traditionally underserved communities.

Detailed Description: 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), known as delay discounting. This case series will examine the efficacy of episodic future thinking (EFT) to target reduction of parenting-related delay discounting. Outcomes will evaluate the effect of EFT on reducing maternal delay discounting and harsh parenting, and improving child clinical outcomes.

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 48

Inclusion Criteria

Be the mother from the Flint area of a child between the ages of 5-10 who can provide legal consent for that child to participate in this study
Self-report that the child lives with them for at least 50% of the time
Willing to participate in the study
Able to participate in written assessments and an intervention conducted in English
Have a working cell phone that can receive and send text messages and be willing to receive/send text messages as part of the study
Have a phone or device that's able to use video conferencing software

Exclusion Criteria

Self-disclosed active suicidality/homicidality
Self-disclosed current bipolar disorder, schizophrenia, or psychosis
Current and ongoing involvement with child protective services

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Episodic Future Thinking	Episodic Future Thinking	Mothers will receive episodic future thinking (EFT). Mothers will meet with a "peer mother" who will administer the EFT intervention, including generation of several specific future events reflecting positive interactions with their child. We will also teach each parent a behavioral parent training element called Special Play Time. Following this session, mothers will receive daily text messages over the course of two weeks including a reminder cue generated as part of the EFT and a prompt to remember these episodes in vivid detail.

Primary Outcome Measures

Name	Time	Method
Change in Monetary Choice Questionnaire	Baseline, 1 week, 4 weeks	The brief Monetary Choice Questionnaire (MCQ) is a 21-item binary-choice task that asks participants to select between two hypothetical monetary amounts: a smaller reward available immediately (e.g. $49 today) or a larger reward available after a delay (e.g. $60 in 89 days). "Larger later" amounts are separated into small, medium and large magnitudes. For the purposes of this study, to limit participant burden, we administered only small and large magnitude subscales, resulting in a total number of 14 items. The measure is scored to derive a single "total score" discounting rate k, with larger values reflecting greater preference for smaller sooner reward. Because k distributions are typically skewed, post-hoc natural logarithmic transformations were performed, resulting in normal distributions; thus, there is no maximum and minimum value. The MCQ has been shown to have strong psychometric properties among adults and correlates with real rewards, as well as real-world risk behaviors.
Change in Consideration of Future Consequences Scale-Parenting Score	Baseline, 4 weeks	The Consideration of Future Consequences Scale-Parenting Adapted (CFCS-14-PA) is a 14-item self-report questionnaire composed of two subscales reflecting either immediate or future orientation related to parents interactions with their children. Items range from "not at all like me" (1) to "very much like me" (5) and are summed to create future or immediate orientation subscale, each composed of 7 items with score ranges from 7-35. Lower scores on the future orientation and higher scores on the immediate orientation subscales are associated with less future orientation and predictive of less engagement in health behaviors. The measure has been used extensively among adult samples and demonstrates strong reliability and validity. Change in CFCS-14-PA score is measured by comparing scores at the post-intervention assessment (approximately 4 weeks after baseline) with baseline scores.

Secondary Outcome Measures

Name	Time	Method
Change in Dyadic Parent-Child Interaction Coding System Scores	Baseline, 4 weeks	Parents and their children will complete a 20-minute interaction task, including 5 min. of free play, a 10 min. "homework" task, and a 5 min. clean up task. Wualitvey of parent-childre interactions were coded using the Dyadic Parent-Child Interaction Coding System (DPICS). The task has 7 subscales, yielding 2 composite scores: positive parenting (a sum of: unlabeled praise, labeled praise, positive touch, reflection, and behavior description) and negative parenting (a sum of: negative talk and negative touch). Each instance of a behaviors described in the subscale (e.g., a parent giving unlabeled praise) is coded as one "point" and summed into a subscale (no max or min values). Higher values indicate greater positive or negative parenting. A score is given to the dyad (not individuals scores for parent/child). Change in parenting is calculated by comparing baseline scores with scores at the post-intervention sessions (approximately 4 weeks after baseline).
Change in Alabama Parenting Questionnaire Score	Baseline, 4 weeks	The Alabama Parenting Questionnaire (APQ) is a 42-item self-report measure of parenting behaviors which yields five subscales: (1) positive involvement with children (range 10-50, higher = more involvement), (2) use of positive parenting strategies (range 6-30, higher = more positive strategies), (3) poor parental monitoring/supervision (range 10-50, higher = worse supervision), (4) inconsistent discipline (range 6-30, higher = more inconsistent discipline), and (5) use of corporal punishment (higher = more corporal punishment). Items are summed to create subscale scores. Change in each of the five APQ subscale scores will be measured by comparing post-intervention scores (approximately 4 weeks after baseline) with baseline scores.
Change in Emotion Regulation Checklist	Baseline, 4 weeks	Parents will report on children's emotion regulation using the Emotion Regulation Checklist (ERC). Items are rated from 1 to 4 and summed to create subscales. The ECR includes 24 items. 23 items are used in computing two subscales: (1) emotion regulation (range 8 to 32, higher = greater emotion regulation) and (2) lability/negativity (range 15 to 60, higher = greater lability/negativity); the 24th item does not load onto either subscale and is not used in the current analyses. The measure is widely used and validated for parent-report of older children and young adolescents.
Client Satisfaction Questionnaire	4 weeks	Following the completion of the intervention, mothers will complete the Client Satisfaction Questionnaire (CSQ), which evaluates participant satisfaction with the intervention. Nine items are ranked from 1 to 4 and summed to create a total score (range 9-36, higher = greater satisfaction). The measure is used across a number of intervention studies and has been shown to be reliable and valid in adult samples.