Behavioral Health
Conditions
Keywords
episodic future thinking, delay discounting, parent-child relations, low income, substance use treatment, peer recovery coach
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.
Interventions
Episodic future thinking (EFT) includes a focus on generating detailed and vivid descriptions of future events. For the current intervention, EFT will be modified to have mothers describe specific events with their children.
Sponsors
Study design
Eligibility
Inclusion criteria
1. 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 2. Self-report that the child lives with them for at least 50% of the time 3. Willing to participate in the study 4. Able to participate in written assessments and an intervention conducted in English 5. 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 6. Have a phone or device that's able to use video conferencing software
Exclusion criteria
1. Self-disclosed active suicidality/homicidality 2. Self-disclosed current bipolar disorder, schizophrenia, or psychosis 3. Current and ongoing involvement with child protective services
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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
| Measure | Time frame | Description |
|---|---|---|
| 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. |
Countries
United States
Participant flow
Recruitment details
24 mothers of children ages 5-10 provided informed consent for themselves and (n=24) their children.
Participants by arm
| Arm | Count |
|---|---|
| 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.
Episodic Future Thinking: Episodic future thinking (EFT) includes a focus on generating detailed and vivid descriptions of future events. For the current intervention, EFT will be modified to have mothers describe specific events with their children. | 48 |
| Total | 48 |
Baseline characteristics
| Characteristic | Episodic Future Thinking |
|---|---|
| Age, Categorical Children <=18 years | 24 Participants |
| Age, Categorical Children >=65 years | 0 Participants |
| Age, Categorical Children Between 18 and 65 years | 0 Participants |
| Age, Categorical Mothers <=18 years | 0 Participants |
| Age, Categorical Mothers >=65 years | 0 Participants |
| Age, Categorical Mothers Between 18 and 65 years | 24 Participants |
| Age, Continuous Children | 7.3 years STANDARD_DEVIATION 1.6 |
| Age, Continuous Mothers | 35.5 years STANDARD_DEVIATION 6.1 |
| Ethnicity (NIH/OMB) Children Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Children Not Hispanic or Latino | 23 Participants |
| Ethnicity (NIH/OMB) Children Unknown or Not Reported | 0 Participants |
| Ethnicity (NIH/OMB) Mothers Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Mothers Not Hispanic or Latino | 24 Participants |
| Ethnicity (NIH/OMB) Mothers Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) Children American Indian or Alaska Native | 1 Participants |
| Race (NIH/OMB) Children Asian | 0 Participants |
| Race (NIH/OMB) Children Black or African American | 8 Participants |
| Race (NIH/OMB) Children More than one race | 0 Participants |
| Race (NIH/OMB) Children Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Children Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) Children White | 15 Participants |
| Race (NIH/OMB) Mothers American Indian or Alaska Native | 1 Participants |
| Race (NIH/OMB) Mothers Asian | 0 Participants |
| Race (NIH/OMB) Mothers Black or African American | 8 Participants |
| Race (NIH/OMB) Mothers More than one race | 0 Participants |
| Race (NIH/OMB) Mothers Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Mothers Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) Mothers White | 15 Participants |
| Sex: Female, Male Children Female | 10 Participants |
| Sex: Female, Male Children Male | 14 Participants |
| Sex: Female, Male Mothers Female | 24 Participants |
| Sex: Female, Male Mothers Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 48 |
| other Total, other adverse events | 0 / 48 |
| serious Total, serious adverse events | 0 / 48 |
Outcome results
Change in Consideration of Future Consequences Scale-Parenting Score
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.
Time frame: Baseline, 4 weeks
Population: All mothers (participants) that completed this measure at baseline assessment (one participant did not complete this measure).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Episodic Future Thinking | Change in Consideration of Future Consequences Scale-Parenting Score | Baseline Future Orientation Subscale | 29.7 score on a scale | Standard Deviation 4.5 |
| Episodic Future Thinking | Change in Consideration of Future Consequences Scale-Parenting Score | Baseline Immediate Orientation Subscale | 15.7 score on a scale | Standard Deviation 4.5 |
| Episodic Future Thinking | Change in Consideration of Future Consequences Scale-Parenting Score | Follow-up Future Orientation Subscale | 31.3 score on a scale | Standard Deviation 2.7 |
| Episodic Future Thinking | Change in Consideration of Future Consequences Scale-Parenting Score | Follow-up Immediate Orientation Subscale | 16.3 score on a scale | Standard Deviation 3.5 |
Change in Monetary Choice Questionnaire
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.
Time frame: Baseline, 1 week, 4 weeks
Population: Mothers who completed the the MCQ both at baseline and immediately following the intervention (approximately 1 week later).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Episodic Future Thinking | Change in Monetary Choice Questionnaire | Baseline Assessment | -3.86 score on a scale | Standard Deviation 1.42 |
| Episodic Future Thinking | Change in Monetary Choice Questionnaire | Immediately Post-Intervention (1 week) | -4.13 score on a scale | Standard Deviation 1.19 |
| Episodic Future Thinking | Change in Monetary Choice Questionnaire | Post-intervention (2 weeks after intervention, 4 weeks after baseline) | -4.33 score on a scale | Standard Deviation 1.68 |
Change in Alabama Parenting Questionnaire Score
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.
Time frame: Baseline, 4 weeks
Population: Mothers who completed the APQ measure at baseline and at follow-up (approximately four weeks later).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Involvement Subscale Pre-Intervention | 40.13 score on a scale | Standard Deviation 4.47 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Involvement Subscale Post-intervention | 43 score on a scale | Standard Deviation 4.93 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Positive Parenting Subscale Pre-Intervention | 25.89 score on a scale | Standard Deviation 3.55 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Positive Parenting Subscale Post-Intervention | 26.50 score on a scale | Standard Deviation 2.99 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Inconsistent Parenting Subscale Pre-Intervention | 15.44 score on a scale | Standard Deviation 3.68 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Inconsistent Parenting Subscale Post-Intervention | 13.59 score on a scale | Standard Deviation 4.25 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Corporal Punishment Subscale Pre-Intervention | 5.94 score on a scale | Standard Deviation 2.05 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Corporal Punishment Subscale Post-Intervention | 5.00 score on a scale | Standard Deviation 1.86 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Poor parental monitoring Subscale Pre-Intervention | 12.81 score on a scale | Standard Deviation 2.64 |
| Episodic Future Thinking | Change in Alabama Parenting Questionnaire Score | Poor parental monitoring Subscale Post-Intervention | 11.72 score on a scale | Standard Deviation 2.22 |
Change in Dyadic Parent-Child Interaction Coding System Scores
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).
Time frame: Baseline, 4 weeks
Population: 11 dyads , including mothers (n=11) and their children (n=11), participated in the parent child interaction task at both the pre-intervention and post-intervention assessment. Please note that scores are given at the dyadic level (in other words, there is a single score for each dyad).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Episodic Future Thinking | Change in Dyadic Parent-Child Interaction Coding System Scores | Positive Parenting Composite Score Pre-Intervention | 10.73 score on a scale | Standard Deviation 7.96 |
| Episodic Future Thinking | Change in Dyadic Parent-Child Interaction Coding System Scores | Positive Parenting Composite Score Post-Intervention | 9.91 score on a scale | Standard Deviation 8.68 |
| Episodic Future Thinking | Change in Dyadic Parent-Child Interaction Coding System Scores | Negative Parenting Composite Score Pre-Intervention | 8.82 score on a scale | Standard Deviation 7.48 |
| Episodic Future Thinking | Change in Dyadic Parent-Child Interaction Coding System Scores | Negative Parenting Composite Score Post-Intervention | 9.18 score on a scale | Standard Deviation 6.55 |
Change in Emotion Regulation Checklist
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.
Time frame: Baseline, 4 weeks
Population: Mothers who completed Emotion Regulation Checklist and pre- and post-intervention (approximately 4 weeks later).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Episodic Future Thinking | Change in Emotion Regulation Checklist | Emotion Regulation Subscale Pre-Intervention | 25.63 score on a scale | Standard Deviation 3.61 |
| Episodic Future Thinking | Change in Emotion Regulation Checklist | Emotion Regulation Subscale Post-Intervention | 25.00 score on a scale | Standard Deviation 3.06 |
| Episodic Future Thinking | Change in Emotion Regulation Checklist | Lability/Negativity Subscale Pre-Intervention | 30.13 score on a scale | Standard Deviation 8.88 |
| Episodic Future Thinking | Change in Emotion Regulation Checklist | Lability/Negativity Subscale Post-Intervention | 29.00 score on a scale | Standard Deviation 6.58 |
Client Satisfaction Questionnaire
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.
Time frame: 4 weeks
Population: Participants who completed the CSQ measure at follow-up (approximately 4 weeks after the intervention).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Episodic Future Thinking | Client Satisfaction Questionnaire | 29.73 score on a scale | Standard Deviation 5.38 |