Reducing Maternal Delay Discounting as a Target Mechanism to Decrease Harsh Parenting and Improve Child Mental Health Outcomes in a Traditionally Underserved Community
Phase: NA
Conditions: Behavioral Health
Sponsor: Henry Ford Health System

 
 
 
 
 
Study Title: Improving Future Thinking Among Mothers to Reduce Harsh Parenting and Improve Child 
Outcomes 
NCT #:  NCT05229146 
 
 
 
 
Protocol Title: The Parent-Child Memory Study: Improving Future Thinking among Mothers from a 
Traditionally Underserved Community to Reduce Harsh Parenting and Improve Child Outcomes 
21 April 2023 
Dr. Julia Felton 

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STUDY TITLE: The Parent-Child Memory Study: Improving Future Thinking among Mothers from a 
Traditionally Underserved Community to Reduce Harsh Parenting and Improve Child Outcomes
1. STUDY AIM, BACKGROUND, AND DESIGN ABSTRACT 
The aims of this study are to conduct a small case series (n = up to 60) to evaluate the preliminary 
feasibility of implementing a brief, episodic future thinking (EFT) intervention with mothers from a 
lowincome community. 
Episodic future thinking (EFT) refers to the ability to imagine, in vivid detail, events that may occur in the 
future (Lin & Epstein, 2014). EFT relies on episodic memory, which allows for recollection of past, 
personal experiences. Research has shown that episodic memory supports the creation of positive, 
future events by combining past experiences with vivid detail of events that may occur in the future. 
Recent studies have shown that EFT intervention can decrease delay discounting (DD), which is a 
facet of impulsivity (Dassen et al., 2015; Snider et al., 2019; Stein et al., 2016). 
The overarching goal of this EFT intervention is to increase mothers’ focus on positive, future events 
associated with enhancing the parent-child relationship. Rather than trying to decrease negative 
parenting practices, the focus of this study is to promote positive parent-child relationships by 
envisioning future-directed events. To date, no research has examined EFT in relation to parenting 
behaviors. Moreover, the intervention requires limited time and financial resources to implement, 
suggesting it may be effectively delivered in a disadvantaged community. 
The current application of EFT proposes to examine the efficacy of EFT in improving parent-child 
relationships in the low-resource, minority-majority community of Flint, Michigan. Results from this case 
series will inform a revision of the intervention with respect to dosage and feasibility outcomes. Aims of 
this case series include: (1) determining the implementation potential of this intervention (including 
feasibility, acceptability, and satisfaction) and (2a) examine preliminary efficacy of this intervention in 
reducing parental delay discounting (focus on immediate relative to long-term rewards) and (2b) 
improvements in parent-child relationships/parenting quality and related constructs.
2. SUBJECT POPULATION AND ELIGIBILITY
Subject Population
Up to 60 mothers of children ages 5-10 years old will be recruited from community-serving Flint, MI, 
agencies such as the R.L. Jones Community Outreach Center and/or Latinx Tech Community Center, 
or through snowball sampling in which interested participants will provide study information to other 
parents. 
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 

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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
Vulnerable Populations
Children will not directly take part in the intervention; however, they will be included in the observational 
tasks with enrolled mothers that are part of the larger assessment battery to evaluate changes in 
parenting. Children above age 7 will be verbally assented prior to participating in the observation.  
Outside of the assent procedures, research team members will not directly interact with children that 
are participating in the observation.
The current project targets this developmental period (ages 5 –10 years old) given changes in parenting 
immediately prior to adolescence and the subsequent increases in rates of psychopathology reported 
during adolescence. Based on demographics from the Flint community, we expect to enroll 
approximately equal numbers of boys and girls. The current research team has completed numerous 
studies with participants under the age of 18 and their guardians and are well-suited to work with these 
populations. The PI received her doctoral degree in child clinical psychology and has worked with both 
the recruitment/intervention and assessment sites.  See Supplement A for additional information on 
inclusion of minors in this project.
Recruitment and Screening
Participants will be recruited in the following ways: 
•
RAs and/or study staff will hand out study flyers in the RL Jones and/or LatinX Centers’ food 
and water distribution line or in food pick up bags
•
Flyer distribution will occur at area community-serving agencies 
•
Presentations to parents and/or staff at community serving agencies
•
Social media posts and targeted social media advertisements
•
Targeted social media ads
•
Snowball recruitment in which interested participants or community members will share the 
study flyer, social media posts or basic study information and contact information of study staff 
to other potential participants
We will work to maintain all Covid precautions and safety procedures as directed by the RL Jones 
Center, Latinx Center, or other agencies that we work with.  Screening, consent, and study procedures 
will take place virtually or in-person, depending on the participant’s preference
Interested individuals will reach out to study staff using the contact information provided on the study 
flyer; will indicate their interest through completing an online interest survey; or will complete a screener 
with a study staff in-person in a private area from the recruitment location, such as a private room at the 

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RL Jones or LatinX Community Centers. The online interest survey can be accessed through a QR 
code or web link on recruitment materials and will lead the participant to a REDCap survey that says: 
Hi! Thank you for your interest in our parenting program. This program features an intervention that 
seeks to help mothers of children ages 5-10 years old improve their parent-child relationship, learn new 
parenting skills, and work with a peer in their community.  
This project is funded by Henry Ford Health in collaboration with Mothers of Joy Institute for Parenting 
and Family Wellness and the R.L. Jones Community Outreach Center.  
If you are interested in learning more about our program and seeing if you are eligible to take part, 
please provide your first name and phone number below. Someone from our team will reach out to you 
soon. Your contact information will be stored on a secure server and will only be used to reach you. 
Your information will not be shared or used for any other purpose. If you would prefer to reach out to 
the team, you may text or call (313) 623-5657. Please look out for this number if you fill out the 
information below.  First name: _________ 
Phone number: ________
Adding the following logos to the landing page: 
 

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Once an individual expresses interest in taking part in the study (either in-person, over the phone, or by 
completing the online interest survey), the RA will speak with them to briefly explain the study and go 
through screening procedures at a time that is convenient for the parent.   At screening, mothers will be 
asked several questions to determine eligibility (see revised Screening Script and Consent Overview). 
The RA will document whether the participant meets eligibility criteria and record this information in a 
secure REDCap database only accessible to study team members. No data beyond eligibility will be 
collected prior to enrolling in the study. No medical records will be accessed as part of this study. If the 
interested individual does not meet inclusion/exclusion criteria (“screens out”), they will be offered a 
resource list of free or reduced cost resources in the Flint area.
If eligible, the RA will review the consent information with the participant and allow time for questions.  
Participants will then be sent an electronic copy of the consent form via REDCap to review and 
document their consent electronically. Screening and consent processes will be conducted remotely – 
over the phone and through REDCap – or in-person, depending on the parent’s preference and COVID 
safety protocols at participating agencies. During the screening and consent process, all individuals will 
be informed that participation is completely voluntary, will be kept confidential, and will not impact their 
access to services in any way. 
   
3. STUDY PROCEDURES
See workflow document for a visual of this process called Study Workflow.
Introductory study procedures will happen over the phone or web-conferencing platform, or in-person in 
a private room at a public location. 
Immediately following screening, the RA will review the consent information with eligible and interested 
participants. The RA will review the key information in the informed consent document with the 
participant (see Screening Script and Consent Overview) and allow enough time for any questions to 
be answered. During the consent process, all individuals will be informed that participation is 
completely voluntary, will be kept confidential, and will not impact their access to services in any way. 
The participant will also be informed that the intervention session, observation sessions, and key 
information interview will be recorded for research purposes. After reviewing the consent information 
with the participant and answering any questions, the RA will do one of the following: 
1) For participants that are screened over the phone, the RA will send a link to the consent form via 
text or email, using REDCap’s e-consent framework, for the participant to review and electronically 
sign prior to starting any study procedures. A PDF of the completed consent form will be available 
to the participant for download after they provide their consent. 
2) For participants that are screened in person, the RA will pull up the e-consent form in REDCap for 
the participant to complete on a study computer.
Once consent is provided, the participant can immediately begin the online questionnaires that are part 
of the baseline assessment.
If the interested individual has more than one child in the age range (5-10 years old) we will ask them to 
complete the observation session with the child they identify as wanting to improve their relationship 
with or their youngest child in that age range.  Verbal child assent will be obtained from participating 

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children aged 7 and older during the scheduled online observation meeting (via video conferencing 
platform) with the parent and child. 
For those that complete screening and consent procedures remotely, once screening and consent 
procedures are complete, we will send a link (via text or email, depending on the parent’s preference) 
to a short video that reviews all study procedures. 
Pre-intervention Assessment
The pre-intervention assessment includes both online surveys, hosted in REDCap, and a parent-child 
interaction observation that will be conducted through a web-based conferencing software such as 
Zoom or in-person in a private room at a local agency (such as the RL Jones or LatinX Centers), 
depending on the parent’s preference. After screening and consent procedures, the RA and the parent 
will schedule a time convenient for the parent and their child that will be participating with them to 
conduct the observation session that is part of the pre-intervention assessment. At this time, 
participants will also be asked to take a pre-intervention assessment battery (see Assessment Battery) 
online. The surveys will be housed in the study’s REDCap database.  Parents who wish to complete the 
online surveys on their own device/remotely will be sent a link to the assessment battery shortly after 
screening via text or email. Participants who wish to complete the online surveys in person will 
complete the surveys online using a study computer in a private room at a public location (e.g., RL 
Jones or LatinX Community Centers, a Flint Public Library Branch, a Flint MSU pediatrics clinic, etc.  
We will only utilize facilities at locations where we have permission from the agency to utilize the 
space). The participant will first need to provide their consent electronically and then will be directed to 
start the questionnaires. 
Assessment battery
The online assessment battery will include measures of (1) delay discounting (DD) (Aim 2a), (2) 
consideration of future consequences (Aim 2a), (3) child behavior (Aim 2b), (4) parenting variables (Aim 
2b), and (5) current alcohol and drug use (Aim 2b). To measure DD, we will use a Monetary Choice 
Questionnaire, in which participants will be asked to select between two amounts of money, one 
available immediately and the other available after a variable delay. The task includes 14 items and is 
the most widely used measure of delay discounting. 
To assess how the participant considers the future while making decisions (both in general and with 
their child), an adapted version of the Consideration of Future Consequences Scale (CFC) will be used 
that focuses specifically on parenting. To assess child behavior, we will use the Eyberg Child Behavior 
Inventory (ECBI), Emotion Regulation Checklist, Revised Children’s Anxiety and Depression Scale 
(RCADS-25) (limited to age 8+), Strengths and Difficulties Questionnaire (SDQ), and the DSM-5 Self-
Rated Level 1 Cross-Cutting Symptom Measure – age 6-17 (limited to age 6+). To assess parenting 
characteristics, we will use the Aggravation in Parenting Scale (APS; a measure of parents' perceived 
aggravation related to parenting), the Alabama Parenting Questionnaire (APQ; a measure of different 
parenting behaviors), the Parenting Joy scale, Parenting Laxness (from the Parenting Scale), and 
revised Conflict Tactics Scale. Parents' use of alcohol and drugs will be assessed using the Alcohol 
Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). We 
will also include the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) 

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demographic measures of the mother (e.g., age, income, race/ethnicity) and child (e.g., age, sex at 
birth), and behavioral health questions from the Children’s Health Questionnaire. At the last 
assessment only, parents will also complete a client satisfaction questionnaire (CSQ). 
A table of the assessments and timepoints for each assessment is included below:
Measure
Reporter
Screening
Pre-
Intervention
Post-
 Monetary Choice Questionnaire 
(MCQ)
Mother
X
X
X
Consideration of Future 
Consequences Scale-Parenting 
Mother
X
X
Alabama Parenting Questionnaire
Mother
X
X
Aggravation in Parenting Scale
Mother
X
X
Parenting Laxness (from the 
Parenting Scale)
Mother
X
X
Parenting Joy
Mother
X
X
Revised Conflict Tactics Scale
Mother
X
X
Eyberg Child Behavior Inventory
Mother
X
X
Emotion Regulation Checklist
Mother
X
X
Strengths and Difficulties 
Questionnaire 
Mother
X
X
RCADS (only kids age 8+)
Mother
X
X
APA_DSM5 Cross-Cutting 
Symptoms (only kids age 6+)
Mother
X
X
Demographics, socio-economic 
indicators, NDA elements, and 
items from the Children’s Health 
Questionnaire
Mother
X
Behavior Rating Inventory of 
Executive Functioning
Mother
X
Client Satisfaction Questionnaire
Mother
X
AUDIT
Mother
X

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DUDIT
Mother
X
EFT Rating
Interventionist
X
All measures have proven psychometric properties and are validated for the parents of children ages 
510, except where noted. Assessments will be housed on HFHS’s REDCap in a study-specific 
database. REDCap (Remote Electronic Data Capture) is a secure, HIPAA compliant, web-based 
application for building and managing online surveys and databases. All surveys will be completed by 
the participant online via one of two options: 1) through a link sent to their phone (via text) or email, 
depending on the participant’s preference, directly through REDCap or 2) online directly through 
REDCap on a study computer.
Observation session 
As part of both the pre- and post- assessments, after the participant provides consent and if the 
participant’s child assents to participate, we will complete a 20-minute observation of the parent and 
their child that will be videotaped. This will occur remotely (through a secure web-based conferencing 
software such as Zoom) or in-person in a private room at a public location, depending on the 
preference of the mom.  Prior to starting the observation, verbal assent will be obtained from children 
age 7 and older and the date and person obtaining assent will be documented. During the observation, 
the mom and their child will complete a clean-up, homework, and play task and an RA will observe 
them and code their behavior using a standardized coding procedure (the DPICS). Although the 
observation will only last approximately 20 minutes, we will ask to schedule these sessions for 40 
minutes to allow time for child assent and instructions.  
We plan to supply each enrolled parent with a bag of toys, Bluetooth headset, math worksheets for the 
homework task, “where things go” worksheet for the cleanup task, and instructions for completing the 
observational assessment. For parents that are completing the observation virtually, these bags will be 
delivered before the assessment at an address that is most convenient for them.  The bag will also 
include a copy of the consent form.
Compensation for the pre-assessment (surveys and observation session) will be $40. 
Intervention Session
As soon as possible after the observation task is completed the participant (mom only) will take part in 
the EFT intervention, led by a trained peer parent, a trained member of the research team. The 
intervention will be completed either via secure web conferencing platform or in-person in a private 
room at a public location, depending on the parent’s preference, and will be recorded. The intervention 
session will last 75-90 minutes, and participants will receive $25 for completing the session. The 
session will begin by the interventionist providing a general overview of the session and reviewing 
confidentiality. The participant will be asked to discuss their relationship with their child and to give 
examples of both positive and negative parenting from their personal experience. The interventionist 
will ask the participant to think about their long-term parenting goals and will discuss how to create a 
vivid event that will be easy to remember. Finally, several timepoints (six months, five years, ten years, 

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and twenty years) will be used to create EFT events of future scenes that the parent envisions with their 
child. The interviewer will complete the EFT rating sheet with each mother.  After identifying each 
event, the interviewer will ask the mother to rate the event on several dimensions (see EFT Rating 
Sheet in the Assessment Battery).  Data from the EFT rating scales will be used with the baseline 
assessments. The interventionist will create short cues from these events which will be entered into the 
REDCap database and incorporated in the text reminders (referenced to as “EFT CUE” in the Text 
Message Template).  
During the intervention, immediately after completing the EFT section, the interventionist will read 
participants items from the Monetary Choice Questionnaire and ask them to respond to each item. The 
interventionist will then record the participants’ responses and enter them into REDCap.
Finally, mothers will also be briefly instructed in a widely-used evidence-based parenting technique 
called special play time and given a pamphlet on this technique.  They will be asked to practice special 
playtime with their child every day for the next two weeks.
Post-intervention Practice and Text Messaging
Once a day over the two weeks following the intervention session, participants will be sent brief text 
messages including the EFT event cue phrase (designed to trigger recall of a future scene or event with 
their child that they identified during the intervention) and a reminder to think about the scene they 
envisioned. Each time the participant replies to this text message within 24 hours indicating that they 
thought about the scene they envisioned, they will be compensated an additional $1.00 for a possible 
total of $14 over the course of the two weeks. The cumulative earned incentive amount will be paid at 
the end of the two weeks. Following confirmation of receipt of the EFT, participants will then be sent a 
second daily text message asking whether they practiced special playtime with their child that day.  
Following their response to the special play time text, participants will then be sent a third daily text 
message asking if they are interested in receiving additional tips for conducting special playtime.  If they 
respond yes, they will receive a short text with a tip for special playtime.  The texts with tips for special 
playtime are completely optional.
Post-Intervention Assessment
Two weeks after the intervention, participants will complete a post-intervention assessment. This 
assessment will include the same surveys as the pre-assessment battery, with the exception of the 
demographics and items from the Children’s Health Questionnaire, the RCADS-25, the BRIEF-2, and 
the alcohol and drug screen measures.  Additionally, participants will complete a brief measure of 
intervention satisfaction. Like the baseline assessment, these will either be conducted online through a 
link sent via email or text (depending on patient preference) directly from REDCap, or in-person in a 
private room at a public location using a study computer depending on the mother’s preference.  The 
participant does not have to choose the same mode of completion as the baseline surveys.
The post-assessment will also include a second observation session with the parent and the same child 
with similar tasks to the initial observation session. 

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Participants will be given $40 for completing the post-assessment activities (surveys and observation).
Reminders
Participants will be reminded of their scheduled meetings prior to the observation, intervention and final 
interview and will be contacted to reschedule, if a meeting time is missed, up to 3 times.
Key Informant Interview
Following completion of the intervention, participants will take part in a 30-minute key informant 
interview (KII; see KII script) that gauges participants’ views on their perceived acceptability and 
satisfaction with the intervention. This is the final study task.  Participants will receive $15 for 
completion of the KII.
KIIs with participants will focus on: (1) difficulties with parenting in a low-resource environment and 
perceptions of harsh parenting; (2) acceptability of recruitment and retention procedures as well as 
content and delivery modality of the intervention: and (3) level of engagement and feasibility of taking 
part in the intervention. Given the payments for responding to text reminders, we also plan to ask 
parents how often they “really” completed the EFT following text reminders as part of these interviews 
as a useful check on this process measure. Answers given will not affect payments parents received for 
their text responses during the post-intervention period.
KII guides will specify open-ended questions and process. Feedback will be used to modify the 
intervention and ensure that the protocol is acceptable and feasible for delivery by peer interventionists 
in a community setting, as well as issues related to scalability and wider dissemination. These 
interviews will also provide insight regarding barriers and facilitators to implementation at the 
organizational level and will inform wider dissemination and subsequent clinical trials.
After completing all study procedures, all participants will be offered a resource guide of free and 
lowcost resources in the Flint area. 
Thus, in total, there will be five study visits/interactions: (1) the initial (baseline) assessment (including 
the online survey and observational task); (2) the intervention (including the delay discounting and 
parenting joy online surveys); (3) daily text messages with the EFT cue and special playtime reminder; 
(4) the post-intervention assessment; and (5) the key informant interview. 
The interventions will be conducted by a peer parent or trained member of the research team. Peer 
parents not already trained in the intervention will be trained by the PI (Felton) and provided weekly and 
as-needed supervision, including individual review of recorded sessions for fidelity and training 
purposes. Recordings of peer-participant interactions will be labeled with the participants study ID and 
will be stored on password protected servers and will be destroyed following the three-year requirement 
for data storage. The peer parent will be added to the IRB as key personnel and complete all required 
human subjects training. We elected to utilize peer parents given strong evidence that peers are 
perceived as less stigmatizing and, with training, are able to implement straight-forward interventions 
with fidelity. We estimate that it will take 2-4 months to recruit and train peer parents, 2-4 months for 
recruitment of participants, 2-4 months for running the study, and 2-4 months for project wrap-up and 
data analysis from the time of grant award.  

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Incentive schedule
Study 
Visit/Interaction
1
2
3
4
5
Activity
Assessment 1 
(online surveys and 
parent-child 
observation)
Intervention session 
+ Monetary 
Choice 
Questionnaire
Daily text 
messages sent 
over 2 weeks
Assessment 
2 (online 
surveys and  
parent-child 
observation)
Key 
Informant 
Interview
Incentives
$40
$25
$1/ positive EFT 
cue text 
message 
response 
(possible total 
=$14)
$40
$15
Additional Information:
* Since this is a pilot feasibility study, the sample size was selected to provide sufficient information 
regarding implementation outcomes and detect signal on outcomes. Findings from this project will be 
used to adapt the intervention for a larger RCT.
*The PI will conduct all analyses. She received a minor-specialization in qualitative methods as part of 
her doctoral studies and serves as the statistical consultant on two NIH-funded treatment development 
grants.
This project is funded by NIMH
National Data Archive
We are required by the funding agency, NIMH, to submit de-identified study data to the National 
Institute of Mental Health Data Archive (NDA) quarterly throughout the life of the study.  De-identified 
data will be coded using a unique code known as a Global Unique Identifier (GUID). Use of the GUID 
minimizes risks to study participants because it keeps one individual’s information separate from that of 
another person without using names, addresses, or other identifying information. The unique code also 
allows the NDA to link together all submitted information on a single participant, giving researchers 
access to information that may have been collected elsewhere. The GUID is a computer-generated 
alphanumeric code [example: NDA-1A462BS] that is unique to each research participant (i.e., each 
person’s information in the NDA—or each subject’s record—has a different GUID).  In order to generate 
the GUID, we will need to collect PHI from the participant, including: full legal name, date of birth, place 
of birth, and address.  The GUID is generated on HFHS computers; thus, the PHI required to generate 
the GUID is maintained securely at HFHS, is only available to the study team, and is never shared 
outside of HFHS.  PHI to generate the GUID will be destroyed as soon as possible, but no later than 
the completion of data collection. For any parent that opts out of sharing their data with the repository, 
either at consent or prior to baseline surveys (via alerting study staff), information for generating the 
GUID will not be collected.
 
The NDA provides basic descriptive and aggregate summary information for general public use. Such 
summary information may include summary counts and general statistics on completed assessment 
instruments.  Access to subject level datasets submitted and stored in the NDA will only be provided for 

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research purposes through the completion of the NDA Data Use Certification: OMB Control Number: 
0925-0667. For the majority of the data available in the NDA, Data Use Certifications will only be 
accepted from researchers who are sponsored by an institution registered in the NIH’s eRA Commons 
with an active Federal-wide Assurance issued through the Office for Human Research Protections 
(OHRP). Additionally, the application must include a reason for access related to scientific investigation, 
scholarship or teaching, or other form of research.  Based upon this information, an appropriate Data 
Access Committee (DAC) with relevant expertise may authorize access.
Participants will be provided with information about the NDA during the consent process, both verbally 
and in the written consent form.  Participants are able to opt out of the NDA by checking a box in the 
consent form or contacting the study team and letting them know that they would like to opt out.  In 
such cases, opt out will be documented in REDCap and that participant’s data will not be uploaded to 
the NDA.  
4. ANTICIPATED RISKS 
One foreseeable risk to participants in this study is possible discomfort (such as frustration or 
embarrassment) in answering questions about their own or their child’s behaviors or their parenting 
methods.  If participants report feeling uncomfortable answering certain questions at any point, they will 
be reminded that they are allowed to skip items and still be compensated for participation or can stop 
participation at any time with no penalty. Based on previous experiences collecting data from 
lowincome adults, we anticipate very low levels of non-response. We will also discuss with all 
participants the nature of the Certificate of Confidentiality during the consent procedures and clearly 
outline what information the Certificate protects.
Another possible risk is boredom or tiredness while completing the study assessments.  Participants will 
be able to stop the assessment and come back to it at a later time if needed.  We will also remind 
participants that they can skip any questions they don’t want to answer and still be compensated.  
There is a small risk that parents may feel frustrated with their child during the observation session.  If 
this happens, we will remind the parent that they can stop at any time without penalty.
We expect any discomfort participants may feel while completing assessment questionnaires, 
intervention, or parent-child interaction sessions to be short-lived. However, in the event that 
participants are either disturbed or concerned about reactions to the questionnaires or parent-child 
interaction, we will encourage them to discuss these concerns with the research staff. They will be put 
in touch with mental health staff at Latinx Tech Center, the Community Center, and/or the PI (Felton), a 
licensed clinical psychologist, if concerns are not satisfactorily addressed. 
Finally, there is a small risk of loss of confidentiality. To mitigate this risk, all research staff, including 
peer parents, will be trained in the protection of human subjects, and will be instructed in maintaining 
confidentiality. We will assign each participant a random identification number and only these numbers 
will be associated with the assessment materials. One master document that links participant names 
and numbers will be retained in a password protected computer file accessible only to study staff. Only 
study staff will have access to the REDCap database and other study materials.  Community Center 
staff will not have access to any assessment materials and will not be informed of anyone’s 

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participation in the study. Peer parents will be trained to take reasonable precautions to prevent 
revealing parents’ participation in the program, including not referring to participants’ status in the 
intervention. While participation in the program can involve receiving daily texts reminders (thus making 
it possible for other individuals to observe participants receiving study-related communications), we 
believe this risk is minimal.
In the event that a person answers that they are currently having thoughts of harming themselves or 
others on the screening form, they will be immediately provided with the Suicide Prevention Lifeline or a 
Crisis Line number and encouraged to call. Screening procedures will immediately end.  
In the event that an enrolled participant discloses suicidal ideation or intent, involvement in physical 
abuse/neglect, and/or urgent physical and mental health concerns arise for the parent or child, the RA 
or interventionist will confer with Dr. Felton to determine next steps. Dr. Felton, along with Drs. 
ChronisTuscano (Co-I and licensed clinical psychologist), and O’Connell (Co-I and board-certified 
developmental pediatrician) if needed, will determine the appropriate course of action. In extreme 
circumstances, this may involve contacting authorities. The PI (Felton) and Co-Is Chronis-Tuscano and 
O’Connell have all conducted similar clinical trials and Drs. Felton and O’Connell have also used similar 
methods and interventions with Flint, MI-based samples and, from this experience, believe the 
possibility of having to report participants to authorities is extremely rare. Given that we are not 
specifically asking about suicidality beyond the screening form, we also expect any spontaneous 
disclosure of suicidality by an enrolled participant to be extremely rare. Nevertheless, any enrolled 
participant disclosure of harm to self or others will be treated seriously and the PI will directly follow-up 
with the participant within 24 hours to clarify their report of harm to self/others and gather more 
information. In the rare event that such disclosures are determined to be required by law, we will report 
only information directly provided by the participant related to child maltreatment (defined as physical or 
mental injury, sexual abuse, neglect, or other circumstance whether the welfare of the child is 
threatened). Prior to participation, participants will be given clear verbal and written details (during 
consent procedures) around these requirements and informed of the research team’s ethical and legal 
obligations to protect the safety of vulnerable individuals. Participants will also be given multiple 
opportunities to ask questions regarding both reporting requirements and the reporting process and 
encouraged to reach out to the PI (a licensed clinical psychologist) to address any concerns that they 
may have. Participants who are reported to authorities under these circumstances will be allowed to 
remain in the study, but their data will not be used and a replacement participant will be recruited. The 
research team has already fully discussed these reporting requirements and received support for these 
procedures from agency leadership at both recruitment sites. Researchers have worked extensively to 
forge strong relationships with community partners and will continue to work together on the 
development of research procedures, including addressing any concerns the community may have that 
may arise during the completion of this project. 
5. ANTICIPATED BENEFITS
There are no known direct benefits to participants.  It is possible that mothers participating in the current 
study could have improvement in delay discounting and subsequent improvement in their relationship 
with their child. 

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More broadly, knowledge gained from this study will be used to inform future parenting interventions 
and will also help to refine dissemination procedures. Thus, the primary benefit to the community is to 
inform future interventions that may reduce rates of harsh parenting and child mental health problems 
and improve public health in a traditionally underserved area.
6. RENUMERATION/COMPENSATION
Participants will be offered payment for taking part in each assessment (assessment questionnaires 
and key informant interviews), as well as completing daily practices of the intervention over two weeks. 
Participants will be provided a ClinCard and money will be loaded onto that ClinCard at five time points: 
(1) after completing the first assessment (online surveys and parent-child observation), (2) after 
completing the intervention; (3) after completing the text messages (loaded at the end of 2 weeks; sum 
dependent on the number of text responses received); (4) after completion of the second assessment 
(surveys and observation); and (5) after completing the key informant interview.
Weeks 
from 
Enrollment
1
2
3
4
5-6
Activity
Assessment 1 
(baseline surveys 
and observation)
Intervention 
Session + Monetary 
Choice 
Questionnaire
Daily text messages sent 
over 2 weeks 
Assessment 
2 (surveys 
and 
observation)
Key 
Informant 
Interview
Incentives
$40
$25
$1/text message 
response (possible total 
=$14)
$40
$15
For any participants that complete in-person study tasks, we can offer a round trip MTA Flint bus pass 
for either the mother (for any study task outside of an observation session) or for both the mother and 
the child participating in the study (for completing an observation session).  For the mother only, in most 
cases the bus pass would total $6 ($3 each way). For the mother and participating child, the bus pass 
in most cases would total $12 ($3 each way per person).
7. COSTS
There are no costs to the participant to take part in this study outside of possible messaging rates for 
sending and receiving text messages.  While text messaging is included in most modern phone plans 
without additional charges, it is possible that the participant could incur small charges for text messages 
if this is not included in their phone plan. Participants will be asked at screening if they are willing to 
send and receive text messages as part of the study.
8. ALTERNATIVES
The alternative to participants is not participating in this research.

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9. CONSENT PROCESS AND DOCUMENTATION
Immediately following screening, the RA will review the key information from the informed consent 
document with the participant over the phone or in-person (see Screening and Consent Script) and will 
allow time for any questions to be answered. During the consent process, all individuals will be 
informed that participation is completely voluntary, will be kept confidential, and will not impact their 
access to services in any way. The participant will also be informed that the intervention session, 
observation sessions, and key information interview will be recorded for research purposes. The RA will 
also clearly explain situations in which confidentiality would need to be broken. For those that choose to 
complete the consent and online surveys remotely, after reviewing the consent information with the 
participant, the RA will send a link to the consent form, using REDCap’s e-consent framework, via text 
or email for the participant to review and electronically sign prior to any study procedures.  For 
participants that choose to complete the consent and online surveys in-person, a study computer will be 
set up in a private room at a public location and the participant will complete everything directly in 
REDCap.  A study team member will be present if consenting in person.  To maintain consistency 
across all participants, we plan to utilize the REDCap e-consent framework regardless of mode of 
consent (virtual/in-person).  The e-Consent document contains all elements of a paper consent, 
including signature, and is securely stored in REDCap.  A PDF of the completed consent form will be 
available to the participant for download after they provide their consent.  Once the completed consent 
is received through REDCap, the staff member that reviewed the consent information with the 
participant over the phone will verify completion and will document their name, date and signature in 
REDCap.  
All children age 7 and older participating in the observation session will be assented before the 
observation with their mother begins. Prior to taking part in the observational assessment, a research 
assistant will explain their participation in the study (over phone or web conferencing or in-person, 
depending on whether the observation takes place virtually or in-person) and allow for time for the child 
to ask questions.  Verbal assent will be documented in REDCap.
10.WITHDRAWAL OF SUBJECTS
There are no anticipated circumstances under which participants will be withdrawn from the research 
without their consent. Participants who decide to withdraw will not face any penalty or denial of 
services. 
11.PRIVACY AND CONFIDENTIALITY 
We will take extensive precautions to maintain privacy, confidentiality, and security of data and 
participant information. Access to study data and identifiers will be limited to only study staff. All 
participants will be assigned a random study ID. Only one log linking participants names and their IDs 
will exist and access will be limited to a small number of study team members. Contact information (for 
the purposes of sending survey links, providing materials, reminders and study text messages) will be 
destroyed after completion of study activities. Study materials will be kept in encrypted data files on a 
password protected computer. All study materials, including audio and video files will be destroyed no 
later than three years after the completion of the study, consistent with recommended guidelines.

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All video recordings will be saved on a secure folder on HITECH-compliant servers at HFHS. Only 
study personnel will have access to this folder and the video recordings. Videos of the parent-child 
interaction will be shared with the University of Maryland (UMD) for research coding and quality 
assurance purposes.  Videos will be labeled with ID only and will be shared via secure file transfer.  
Once coding and QA procedures are complete, UMD will delete the file.  A data use and material 
transfer agreement will be executed with UMD before videos are transferred.
Similarly, all audio recordings will be saved on a secure folder on HITECH-compliant servers at HFHS. 
Only study personnel will have access to this folder and the audio recordings. Audio files will be 
uploaded to a secure AI-based transcription platform for transcription purposes.  Transcripts will be 
reviewed by the study team and any PHI will be removed before saving to a secure study folder 
accessible only to the research team.  Audio files and transcripts will be saved with a study ID only. 
Once transcribed, audio files will be deleted as soon as possible.
Patient-level data needed for creation of the GUID for de-identified data upload to the National Institute 
of Mental Health Data Archive (NDA) will be stored securely on HITECH-compliant servers at HFHS.  
Only a limited number of study personnel will have access to this data.  Only completely de-identified 
data will be submitted to the NDA.  A data submission agreement will be executed with the NDA before 
data is uploaded.  PHI collected for GUID creation will be deleted as soon as possible but no later than 
the end of study data collection.  
In addition, a Certificate of Confidentiality (CoC) was granted by the National Institutes of Health to 
protect the privacy of research subjects by prohibiting disclosure of identifiable, sensitive research 
information to anyone not connected to the research except when the subject consents, or when 
required by law for reporting medical emergencies, serious threats of harm to self or others, child abuse 
or neglect, or elder abuse.
Important HIPAA Concerns
The study involves video-recorded observations of the parent and their child that will be created for 
research purposes and sent to an external collaborator, the University of Maryland, for coding. The 
video files will be labeled with the study ID but will still contain the video image and voice of the 
participant and their child.  Although we are not asking questions directly of the parent or child during 
this observation, it is possible that the participant or their child could provide personal information (e.g., 
name) unprompted.  
Important information about the collection and sharing of this information is included as part of the 
HIPAA authorization section of the consent form. The RA will review this information during the consent 
process with the participant. The participant will be given sufficient time to ask questions and will ask to 
give their authorization for collection and use of this data verbally.  Consent and authorization will be 
provided by the participant electronically in REDCap.  
Videos will be sent to University of Maryland via secure file transfer only after a Material Transfer 
Agreement and Data Use Agreement are in place.  Videos will be deleted as soon as possible at UMD.  
Coded data will be stored in a password protected computer folder on a secure server at Henry Ford 
Health System. 

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12.DATA AND SAFETY MONITORING PLAN
Dr. Felton will be responsible for overseeing the implementation and execution of the data and safety 
monitoring plan. All research staff (including peer parents) will complete relevant human subjects 
protection training. Dr. Felton will also ensure that all participants in the study meet specified 
inclusion/exclusion criteria by reviewing enrollment with research staff at regular study team meetings. 
Data will be monitored on an ongoing basis and reviewed by the PI at regular intervals to identify any 
problems or concerns. Analyses will be conducted only after all data is collected, deidentified, and 
cleaned, thus limiting the possibility of deidentification. Any findings shared with the community 
stakeholders will be done in aggregate and reflecting mean-level trends. Data will be safeguarded 
against breaches of confidentiality using the procedures outline above. These processes include 
removing identifiable information from data and coding assessment forms with ID numbers only. All 
data will be kept securely in locked file cabinets accessible only to research staff or on secure servers 
in files only accessible to study staff. Community partners will not have access to any assessment 
materials. Any computers containing electronic data files will be password-protected, stored in locked 
cabinets in locked offices, and accessible only by study personnel. Only the research staff will have 
access to the data. A Certificate of Confidentiality was provided by NIH which will protect against 
requests to disclose sensitive research information, within the bounds of the law.
Adverse Events (AEs) and Serious Adverse Events (SAEs), as defined by the DHHP Office of Human 
Research Protections, will be monitored by the PI (Felton). Any AEs will be recorded by research staff 
and discussed by the research team during regularly scheduled meetings. If required per HFHS IRB or 
NIH protocols, the PI will then prepare a written report for submission to the HFHS IRB and/or the 
appropriate NIH program officer. The report will specify all relevant information regarding whether these 
events are expected or unexpected, the severity of the event, a brief narrative of the event, and a 
determination regarding any causal connection between the event and the ongoing research study. Any 
such events will also be included in the annual progress report sent to NIH. In the unlikely event an 
SAE were to occur, research staff will alert the PI immediately. Per IRB and NIH protocols, subsequent 
reports to the HFHS IRB and NIH will be completed within the appropriate timeframe. 
13.QUALIFICATIONS OF THE INVESTIGATOR(S)
Dr. Felton is an Assistant Scientist at Henry Ford Health System located in Detroit, MI. She earned her 
PhD in child clinical psychology from Vanderbilt University with a minor specialization in quantitative 
methods. Her program of research centers on identifying risk factors for the onset of substance use in 
children and adolescents (e.g. Felton et all, 2015) as well as examining the role of early environmental 
and parenting factors associated with the trajectory of drug and alcohol use over time (e.g. Felton et al., 
2020). She has specific expertise in assessment, research design, and data modeling techniques, 
having served as the PI, Co-I, or statistical consultant on a number of NIH-funding grants and published 
over 65 manuscripts and book chapters on development of vulnerabilities to mental and behavioral 
health problems and targeted preventative interventions to reduce these risk factors.

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14.REFERENCES
Dassen, F. C. M., Houben, K., & Jansen, A. (2015). Time orientation and eating behavior: Unhealthy 
eaters consider immediate consequences, while healthy eaters focus on future health. Appetite, 91, 
13–19. https://doi.org/10.1016/j.appet.2015.03.020
Felton, J.W., Collado, A., Cinader, M., Lejuez, C.W., Chronis-Tuscano, A., & Yi, R. (2020). Exposure to 
maternal depressive symptoms and growth in adolescent substance use: The mediating role of delay 
discounting. Development and Psychopathology.
Felton, J.W., Collado, A., Cinader, M., Lejuez, C.W., Chronis-Tuscano, A., & Yi, R. (2020). Exposure 
tomaternal depressive symptoms and growth in adolescent substance use: The mediating role of 
delaydiscounting. Development and Psychopathology.
Felton, J.W., Collado, A., Ingram, K.M., Doran, K., & Yi, R. (2019). Improvement of working memory is 
a mechanism for reductions in delay discounting among mid-age individuals in an urban 
medicallyunderserved area. Annals of Behavioral Medicine.
Lin, H., & Epstein, L. H. (2014). Living in the moment: Effects of time perspective and emotional 
valence of episodic thinking on delay discounting. Behavioral Neuroscience, 128(1), 12–19. 
https://doi.org/10.1037/a0035705 
Moreland, A.M., Felton, J.F., Hanson, R.F., Jackson, C., & Dumas, J.E. (2016). The relation between 
parenting stress and parenting locus of control: Mechanisms of change in parenting interventions. 
Journal of Child and Family Studies, 25, 2046-2054.
Snider, S. E., DeHart, W. B., Epstein, L. H., & Bickel, W. K. (2019). Does delay discounting predict 
maladaptive health and financial behaviors in smokers? Health Psychology, 38(1), 21.
Stein, J. S., Wilson, A. G., Koffarnus, M. N., Daniel, T. O., Epstein, L. H., & Bickel, W. K. (2016). 
Unstuck in time: Episodic future thinking reduces delay discounting and cigarette smoking. 
Psychopharmacology, 233(21), 3771–3778. https://doi.org/10.1007/s00213-016-4410-y