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Moderators of Intervention Effects on ParentingPractices in a Randomized Controlled Trial in EarlyChildhoodRachelle Theise a , Keng-Yen Huang a , Dimitra Kamboukos a , Greta L. Doctoroff b , SpringDawson-McClure a , Joseph J. Palamar a & Laurie Miller Brotman aa Department of Population Health , New York University School of Medicineb Ferkauf Graduate School of Psychology , Yeshiva UniversityPublished online: 24 Sep 2013.

To cite this article: Rachelle Theise , Keng-Yen Huang , Dimitra Kamboukos , Greta L. Doctoroff , Spring Dawson-McClure , Joseph J. Palamar & Laurie Miller Brotman (2014) Moderators of Intervention Effects on Parenting Practices ina Randomized Controlled Trial in Early Childhood, Journal of Clinical Child & Adolescent Psychology, 43:3, 501-509, DOI:10.1080/15374416.2013.833095

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Moderators of Intervention Effects on Parenting Practices in aRandomized Controlled Trial in Early Childhood

Rachelle Theise, Keng-Yen Huang, and Dimitra Kamboukos

Department of Population Health, New York University School of Medicine

Greta L. Doctoroff

Ferkauf Graduate School of Psychology, Yeshiva University

Spring Dawson-McClure, Joseph J. Palamar, and Laurie Miller Brotman

Department of Population Health, New York University School of Medicine

The current study examined whether parent psychological resources (parenting stress,depression, and social support from friends and family) moderated the effects of earlyfamily preventive intervention on parenting among high-risk families. Ninety-two pre-school-age children (M age¼ 3.94 years) at familial risk for conduct problems partici-pated in a randomized controlled trial of a family intervention to prevent conductproblems. The majority of families were African American or Latino and experiencedmultiple stressors associated with poverty and familial antisocial behavior. Families wererandomized to a 22-session group-based intervention or to a no-intervention, assessment-only control condition. Parents reported on their psychological resources (parentingstress, depression and social support from friends and family) at baseline. Parenting(responsive, harsh, stimulation for learning) was assessed through self-report and obser-vational measures four times over 24 months. Previously-reported intervention effects onresponsive parenting and stimulation for learning were moderated by depression andsocial support from friends, respectively, such that benefits were concentrated amongthose at greatest risk (i.e., depressed, limited support from friends). The intervention effecton harsh parenting was notmoderated by any of the parent psychological resources exam-ined, such that parents with high and low resources benefited comparably. Considerationof moderators of preventive intervention effects on parenting provides importantinformation about intervention impact among families experiencing multiple barriersto engagement and effective parenting. Findings suggest that parents with diminishedpsychological resources are just as likely to benefit. Family-focused, group-based inter-vention is promising for strengthening parenting among the highest risk families.

Compelling evidence supports the causal role ofparenting for child mental health problems, includingconduct problems (Sandler, Schoenfelder, Wolchik, &

MacKinnon, 2011). Studies have shown that povertyand stress often negatively impact parenting and jeopar-dize children’s successful development (Blair & Raver,2012). As highlighted in a meta-analysis of parentinginterventions, poverty not only interferes with parentingand child development, but also decreases the likelihoodthat families will engage in and benefit from parentinginterventions (Lundahl, Risser, & Lovejoy, 2006).

Fortunately, a number of family-focused interven-tions delivered early in development have been effective

The RCT was supported by Grant R01 MH55188 from the

National Institute of Mental Health.Correspondence should be addressed to Laurie Miller Brotman,

Center for Early Childhood Health and Development, New York

University Langone Medical Center, New York University Langone

Medical Center, One Park Avenue, 7th Floor, New York, NY

10016. E-mail: laurie.brotman@nyumc.org

Journal of Clinical Child & Adolescent Psychology, 43(3), 501–509, 2014

Copyright # Taylor & Francis Group, LLC

ISSN: 1537-4416 print=1537-4424 online

DOI: 10.1080/15374416.2013.833095

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in targeting conduct problems in low-income families(e.g., Gardner et al., 2009; Olds et al., 1998; Webster-Stratton, Reid, & Hammond, 2001). These preventiveinterventions were developed specifically to engagelow-income families. The Family Stress Model (Congeret al., 2002; McLoyd, 1998) posits that financial hard-ship impacts child development through its interactionwith family factors, such as parent psychological res-ources (e.g., parenting stress, depression, support), tomake parenting more difficult. Thus, the effects of pre-ventive interventions on parenting among those experi-encing financial hardship may vary based on parentpsychological resources. It is plausible that preventiveintervention may not be sufficient for parents withdepleted resources, or alternatively, that these parentsare most in need of preventive services and thereforemost likely to benefit.

Indeed, the few prevention trials that have consideredmoderators of parenting outcomes show comparable oreven greater benefits for high-risk parents. In rando-mized controlled trials (RCTs) of the Nurse–FamilyPartnership with low-income families, mothers withfewer resources (e.g., low social support) benefited themost (e.g., Cole, Kitzman, Olds, & Sidora, 1998). A studyof the Triple-P Positive Parenting Programme demon-strated that parents were successful in altering negativeparenting strategies regardless of initial stress levels(McTaggart & Sanders, 2007). In addition, in an RCTwith low-income families, the impact of the IncredibleYears Series (IYS) was similar or greater for motherswith fewer resources (e.g., depression, anger, substanceuse), although the pattern of results differed somewhatacross moderator and domains of parenting (e.g.,benefits for depressed mothers were comparable to non-depressed mothers; mothers with anger problems showedsimilar changes in positive parenting and even greaterreductions in harsh parenting, relative to mothers with-out anger problems; Baydar, Reid, & Webster-Stratton,2003). Thus, the small body of work that has examinedmoderators of program effects on parenting suggeststhat benefits are just as likely to occur among parentswith fewer psychological resources. This is in contrastto the mixed results from the broader literature thathas examined moderators of program effects on childoutcomes. For example, parental depression has beenconsidered as a moderator of child outcomes, yieldingsome evidence that children of depressed parents donot benefit as much as those of nondepressed parents,and questioning whether preventive interventions aresufficient for depressed parents (e.g., Lundahl et al.,2006). The current study aims to add to the literatureon moderators of impact on parenting by examiningpsychological resources among very high-risk families.

In the context of an RCT with families of preschoo-lers at very high risk for negative outcomes based on

poverty and sibling antisocial behavior, Brotman andcolleagues reported that family-focused preventiveintervention (an augmented version of IYS; Webster-Stratton, 1989) resulted in immediate and 1-year effectson parenting and child conduct problems (Brotmanet al., 2005; Brotman et al., 2008). Intervention led toimprovements on the three key aspects of parentingspecified by developmental theory and the theory ofchange for the intervention: responsive parenting, harshparenting, and stimulation for learning. Findings werebased on observations by masked raters of parent–childinteractions in the home and laboratory settings. In thisvery high-risk sample, the study found fivefold groupdifferences on observed physical aggression prior toschool entry (Brotman et al., 2008). Moreover, consist-ent with the theory of change, intervention-inducedimprovements in parenting accounted for a largeportion of variance in the intervention effect on childphysical aggression (Brotman et al., 2009). Additionalfindings for this high-risk sample highlight the complexrelations among parenting, stress, and behavior in fam-ilies; for example, early family intervention increasedand normalized cortisol levels in these high-risk children(Brotman et al., 2007) and intervention-induced changesin cortisol mediated changes in aggression among chil-dren whose parents showed low baseline responsiveness(O’Neal et al., 2010).

To understand if this group-based preventive inter-vention impacted parenting broadly in this high-risk sam-ple or for certain subgroups, the current study examineswhether initial levels of parent psychological resourcesmoderate previously-reported intervention effects on threeaspects of parenting (responsive parenting, harsh parent-ing, and stimulation for learning). The Family StressModel suggests that the following psychological resourcesare associated with parenting and potentially relevantmoderators: parenting stress, depression, and social sup-port. Based on the extant literature on moderators ofpreventive intervention effects on parenting in high-risksamples, we hypothesized that parents with lower psycho-logical resources at baseline (i.e., high parenting stress,high depression, low social support from families andfriends) would benefit to a comparable or greater extentthan parents with higher psychological resources.

METHOD

Participants

Staff reviewed family court records of adjudicated youthin Manhattan and the Bronx, New York, and identified1,228 cases with some indication that a 3- to 5-year-oldsibling lived in the home. Parents were mailed a studydescription and then called to assess for eligibility. Themajority of families (n¼ 1.038) were ineligible (e.g.,

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English language limitations, no younger sibling living inthe home) or could not be reached (e.g., nonworking num-ber). Of 190 remaining families, 98 refused and 92 enrolledin the trial (Figure 1). On average, children were 3.94 yearsold (SD¼ 0.7), and ranged from ages 3 to 5. Eighty-threepercent of parents were biological mothers, 10% weregrandmothers, 3% were adoptive mothers, 2% were otherfemale relatives, and 2% were biological fathers. Sixty-onepercent of parents self-identified as non-Latino AfricanAmerican, 24% Latino, and 15% were from other racial=ethnic backgrounds (e.g., biracial). Regarding householdannual gross income, 60% reported income less than$15,000, and 34% reported an income between $15,000and $40,000. Almost half of parents (45%) did notcomplete high school.

Procedure

Participants were recruited in five cohorts and rando-mized to intervention (n¼ 47) or no-intervention,

assessment-only control (n¼ 45) conditions. A statis-tician unfamiliar with the study design randomizedfamilies to condition after baseline assessments werecompleted in each cohort. Informed consent was pro-vided in person, and families were assessed at four timepoints over a 2-year period at home and in the studycenter: baseline (T1) and postintervention 8-month(T2), 16-month (T3), and 24-month (T4) follow-up.Assessors were masked to intervention assignment.Parents were compensated for completing assessments(T1: $100, T2–4: $50). The School of MedicineInstitutional Review Board approved this study.

Intervention

The intervention was an adaptation of IYS, augmentedto meet the needs of very high-risk families experiencingmultiple stressors related to urban disadvantage andfamilial history of antisocial behavior. The interventionextended IYS with additional 2-hr concurrent groups

FIGURE 1 Flow diagram of enrollment, randomization, and follow-up of participants.

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for parents and children (total groups¼ 22), with 30minduring each group focused on parent–child interactions.In addition, 10 biweekly 90-min home visits were added.Families could also request up to six additional visits.Parenting groups encouraged the use of non-harsh,consistent disciplinary strategies, positive reinforcementand parent–child play interactions to promote res-ponsiveness and children’s social competence. In childgroups, leaders taught social skills, reinforced positivebehaviors, and provided consequences for negative beha-viors. During guided parent–child interactions, leaderscoached, modeled, and reinforced the use of effectiveparenting strategies. The average attendance at groupswas 13 of 22 sessions (SD¼ 7), and the average numberof completed home visits was six of 10 planned visits(SD¼ 3). Families in both the intervention and controlconditions received monthly telephone calls to assessservice utilization, update contact information, and pro-vide referral and linkage as needed.

Measures

Parenting stress. Parenting stress was measuredthrough the Parenting Stress Index- Short Form(Abidin, 1995), a 36-item parent report measure withresponse options on a 5-point Likert scale. The measureincludes three subscales: Parental Distress (e.g., ‘‘I feeltrapped by my responsibilities as a parent’’), Parent–Child Dysfunctional Interaction (e.g., ‘‘My child rarelydoes things for me that make me feel good’’), and Diffi-cult Child (e.g., ‘‘My child does a few things whichbother me a great deal’’). Subscales were moderatelycorrelated (r¼ .40–.47). The mean of the subscales wasused as an indicator of overall parenting stress (a¼ .86).

Parent depression. The Beck DepressionInventory–Second Edition (BDI-II; Beck, Steer, &Brown, 1996), a 21-item self-report measure, was usedto assess depressive symptoms over the past 2 weeks.Nineteen items (e.g., ‘‘crying,’’ ‘‘worthlessness’’) inclu-ded ordinal response options ranging in severity from0 to 3. Two items assessing changes in sleeping patternsand appetite included seven response options, signifyingno change (0) and differing degrees of ‘‘more’’ or ‘‘less’’sleep or appetite. A total sum scale (a¼ .92) was dicoho-tomized at 20 to create an indicator of moderate tosevere depression (moderate to severe; Beck et al., 1996).

Parent social support. Social support was measu-red through the Perceived Social Support from Friendsand Family measure (Procidano & Heller, 1983). Par-ents responded ‘‘Yes’’ or ‘‘No’’ to 40 items (e.g., ‘‘I relyon my friends for emotional support’’) assessing theirperception of support. Items were summed to create

two continuous scale scores (friends, family). The word-ing of the questions in each scale is nearly identical (i.e.,the root of each item is the same except for the words‘‘friend’’ and ‘‘family’’). The scales were notsignificantly correlated (r¼ .09); therefore, separatemeasures were retained to assess support from Friends(20 items; a¼ .92) and Family (20 items; a¼ .94).

Parenting

Responsiveness. Structured parent–child interac-tions on three standard tasks (free play, puzzle, andclean-up) were conducted in the family’s home and inthe laboratory. Observers masked to condition ratedlive home interactions and videotaped laboratoryinteractions using two systems: Dyadic Parent-ChildInteractive Coding System-Revised (DPICS-R; Webster-Stratton et al., 2001), a microanalytic behavioral codingsystem, and the Global Impressions of Parent ChildInteractions (GIPCI; Brotman, 2003). The DPICS-RPraise scale was used as an indicator of responsiveness(e.g., ‘‘Thanks for putting the blocks away as soon asI asked’’). Interrater agreement (ICC) was high (.85 forin-person interactions, .84 for videotaped interactions).Three GIPCI scales were used: Valence (emotionaltone), Responsiveness (verbal and nonverbal attentionand mirroring of parent toward child), and Affection(verbal and nonverbal behaviors that give a sense ofwarmth and affection). A total GIPCI score was calcula-ted (a¼ .84, ICC¼ .79). Ratings from the DPICS-R andGICPI were moderately correlated (r¼ .45, p< .001)and combined to form the Responsiveness composite(a¼ .88).

Harsh parenting. Harsh parenting was based onmasked observational ratings on the DPICS-R andGIPCI and parent self-report. Parents completed twosubscales from the Parenting Practices Interview(Webster-Stratton, 1998), including four closed-endeditems (e.g., ‘‘How often do you yell at your child’’ ratedfrom never to frequently; a¼ .76) and nine open-endeditems (e.g., ‘‘What would you do if your child hitanother child?’’). Open-ended responses were coded bymasked raters as harsh or not harsh (ICC¼ .87). TheDPICS-R Critical Statements subscale (e.g., ‘‘You arenot trying,’’ ‘‘That is stupid’’; ICC¼ .80) and the GIPCIHarsh global rating (e.g., ‘‘Mother is negative, critical,intrusive, and=or punitive towards the child’’; ICC¼.61) were averaged to form a mean composite scale(a¼ .71).

Stimulation for learning. Stimulation for children’sacademic learning in the home was measured throughthe Home Observation for the Measurement of

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Environment-Early Childhood Version (HOME;Caldwell & Bradley, 1984). The HOME assesses thefrequency of home environment conditions from a listof 55—11 items on learning, language, and academicstimulation were used in this study (a¼ .82). Sampleitems include, ‘‘Child has toys or games which helpteach numbers’’ and ‘‘Child has at least 10 children’sbooks.’’

Baseline characteristics. During face-to-faceinterviews, parents reported on demographic character-istics, including race=ethnicity, age, household income,educational status, and marital status.

Analyses

Attrition and imputation strategies. Overall, theretention rate was high; 87%, 77%, and 77% had dataat T2, T3, and T4, respectively. No significant differ-ences by intervention status emerged regarding caseswith missing data at any time point. In addition, therewere no baseline differences between participants withcomplete data versus missing data at later time points,and there were no significant Baseline� Interventioninteractions that predicted missingness. To account formissing data, we used multiple imputation methods(Schafer & Graham, 2002), assuming data were missingat random, with 10 replicated imputations using theSAS1 Multiple Imputation procedure. The imputationmade use of the joint distribution of child sex, race=ethnicity, age, parenting practices, and moderators andwas conducted separately for the control and inter-vention conditions to account for the possibility of dif-ferent missing data patterns by condition (Little &Rubin, 2002). SAS PROC MIANALYZE was used tocombine the results for the final inference testing (SAS9.1.3).

Moderation of intervention effects. Analyses ofintervention effects included the full sample of 92families and followed intention-to-treat principles.Moderation of intervention effects on parenting prac-tices was evaluated via multilevel modeling (Singer,1998; Willett, Singer, & Martin, 1998) using SAS PROCMIXED. We modeled postintervention outcome scores(three time points for Responsiveness and Harsh Parent-ing and two time points for Stimulation were available)as a function of baseline level, intervention status, time,moderator, and the Moderator� Intervention interac-tion. In addition, for Stimulation, the model includedthe Time� Intervention interaction term because prioranalyses indicated that the intervention effect increasedin magnitude over time (Brotman et al., 2008); forResponsiveness and Harsh Parenting, the Time�

Intervention interaction was not significant, indicatingthat the intervention effect was maintained over time,so this term was not included in the model. All analysesadjusted for the nesting of multiple time points withinindividuals by modeling time as a random effect (cen-tered at T3). Significant Moderator� Intervention inter-actions reflected the overall or average moderation effectacross time. Intercorrelations among the dependentvariables at baseline were low; r ranged from .12 to.25. Baseline correlations among the moderators (stress,depression, support) were small to moderate (rs¼ .09–.46), supporting consideration of each moderator in aseparate model.

RESULTS

Descriptive Statistics and Equivalence ofIntervention Conditions

Table 1 includes baseline mean scores and standarddeviations of the moderators and outcomes. There wereno significant differences between intervention and con-trol groups on any baseline measure.

Moderation of Intervention Effects

As shown in Table 2, there was some indication ofmoderation of intervention effects on two of the three

TABLE 1

Demographics and Baseline Levels of Moderator and Outcome

Variables by Intervention Condition

Interventiona% Controlb%

Child Sex (Female) 47.0% 60.0%

Parent Race=Ethnicity

African American 60.9% 60.0%

Latina=o 26.1% 24.4%

Other (Biracial) 13.1% 15.5%

M (SD) M (SD)

Responsive Parenting 1.70 (0.53) 1.50 (0.59)

Harsh Parenting 1.07 (0.46) 0.91 (0.36)

Stimulation for Learning 0.68 (0.29) 0.76 (0.21)

Parenting Stress 79.31 (16.29) 78.53 (13.19)

Parent Depression 13.38 (12.03) 10.36 (8.58)

Social Support—Friends 15.81 (5.11) 15.73 (4.80)

Social Support—Family 13.30 (6.21) 13.55 (6.30)

Note: There were no significant group differences (p> .05) on all

listed baseline family and parenting characteristics. In the study sam-

ple, 20.7% of parents had moderate or severe depression (23.4% for

intervention and 17.8% for control, p¼ .51). The mean parenting stress

level in this sample was more than 1 SD above the norm mean.an¼ 47.bn¼ 45.

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aspects of parenting. For Responsiveness and Stimu-lation for Learning, intervention effects were moderatedby parent depression and friend-support, respectively.Specifically, the intervention effect on Responsivenesswas concentrated among depressed parents, with increa-ses to levels that were even greater than those observedfor nondepressed parents (Figure 2). The interactioneffect explained 2.24% of variance in Responsiveness,above and beyond the main effects of intervention anddepression (shown in Table 2). Similarly, the inter-vention effect on Stimulation was concentrated amongparents with low levels of friend-support (Figure 3).

The interaction effect explained 3.34% of variance,above and beyond the significant main effects of inter-vention and friend-support. There was also a marginallysignificant effect (p¼ .09) for friend-support as a moder-ator of the intervention effect on Responsiveness, withgreater benefits for parents with limited friend-support.Parenting stress and family-support were not significantmoderators of intervention effects on any domain ofparenting. Notably, parents in this sample reportedexperiencing high parenting stress (M¼ 79,> 1 SDabove the mean in the normative sample). The inter-vention effect on Harsh Parenting was not moderated

TABLE 2

Parenting Stress, Depression, and Social Support as Moderators of Intervention Effects on Parenting Over Time

Responsive Parenting Harsh Parenting Stimulation for Learning

b (SE) p b (SE) p b (SE) p

Parenting Stress 0.00 (0.01) .506 0.01 (0.01) .209 0.00 (0.00) .542

Intervention 0.35 (0.12) .005 –0.22 (0.10) .035 0.24 (0.07) <.001

Stress� Intervention 0.00 (0.01) .673 –0.01 (0.01) .423 0.00 (0.01) .605

Parent Depression –0.40 (0.23) .087 0.17 (0.20) .403 0.00 (0.13) .969

Intervention 0.20 (0.13) .123 –0.18 (0.12) .125 0.23 (0.07) .001

Depression� Intervention 0.68 (0.29) .019� –0.22 (0.22) .332 0.04 (0.16) .804

Family Support 0.02 (0.02) .278 0.00 (0.01) .865 0.01 (0.01) .480

Intervention 0.35 (0.12) .004 –0.22 (0.10) .036 0.18 (0.06) .003

Support� Intervention –0.03 (0.02) .208 0.00 (0.02) .802 –0.01 (0.01) .588

Friend Support 0.02 (0.02) .203 0.00 (0.01) .979 0.02 (0.01) .026

Intervention 0.35 (0.12) .004 –0.22 (0.10) .036 0.24 (0.06) <.001

Support� Intervention –0.04 (0.02) .092 –0.01 (0.02) .740 –0.03 (0.01) .017�

Note: The previously-reported effect sizes for the main effect of intervention (across three postintervention time points) are as follows: Responsive

Parenting b (SE)¼ 0.35 (0.12), p¼ .004, d¼ .63; Harsh Parenting b (SE)¼�0.22 (0.10), p¼ .035, d¼ .51; Stimulation for Learning b (SE)¼ 0.18

(0.06), p¼ .004, d¼ .69. Betas presented in the table are nonstandardized. All moderators were measured on a continuous scale except for parent

depression, which was dichotomized based on normative data for the Beck Depression Inventory (1¼moderate to severe depression). In addition

to the terms shown in the table, the model included time (centered at T3) and the corresponding baseline measure for each outcome (not shown). For

Stimulation for Learning, analyses also controlled for Time� Intervention as this interaction was significant in prior analyses. The reference category

was the control group.�p< .05.

FIGURE 2 Parent depression as a moderator of intervention effect on responsive parenting. Note. Parent depression was based on a dichotomized

indicator (Beck Depression Inventory �20).

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by any of the parent psychological resources measuredin the current study.

To explore the possibility that the significant moder-ation effects were attributable to differences in dose(e.g., depressed parents or those with little supportattended more sessions), we examined whether attend-ance was related to parent psychological resources.These factors did not predict the number of sessionsattended (all ps> .05), and notably, average attendancerates were high and comparable for higher risk andlower risk parents (e.g., 13 of 22 sessions attended bydepressed parents vs. 11 for nondepressed parents,p¼ .30).

DISCUSSION

The present study investigated whether parent psycho-logical resources (i.e., parenting stress, depression, andsocial support from friends and family) moderated inter-vention effects on parenting practices in low-income,high-risk families of preschool-aged children. TheFamily Stress Model (Conger et al., 2002; McLoyd,1998) posits that living in poverty diminishes parents’psychological resources, which in turn compromiseparents’ capacity to effectively respond to their children.In previous reports (Brotman et al., 2005; Brotman et al.,2008), we found that family-focused preventive inter-vention resulted in immediate and sustained effects onthree aspects of parenting: responsive parenting, harshparenting, and stimulation for learning. In the currentstudy, intervention effects on responsiveness and stimu-lation for learning were concentrated among depressedparents and those with low levels of support, respect-ively. Intervention effects on harsh parenting held acrossvarying levels of initial psychological resources. In alldomains of parenting, parents with fewer psychologicalresources benefitted at least as much or to a greater ext-ent than families with greater psychological resources.

For both responsiveness and stimulation for learning,the intervention effects reported were found to be con-centrated primarily among parents with depressionand weak support from friends. For parents with fewerpsychological resources, the intervention resulted inlarge effects (Cohen’s d¼ 1.57 and 1.20; shown inFigures 2 and 3), whereas the intervention effects forparents with more resources were evident, but muchsmaller in size (d¼ 0.36 and 0.19). This pattern is strik-ing, but the magnitude of the moderation is small.Nevertheless, the pattern is consistent with other preven-tion trials that have considered moderation of inter-vention effects on parenting and have found similar orgreater impact for parents with fewer resources (e.g.,Baydar et al., 2003; Cole et al., 1998; McTaggart &Sanders, 2007). We speculate that depressed parents inour sample had been experiencing strain or discomfortin their relationships with their children (Lovejoy, Grac-zyk, O’Hare, & Neuman, 2000) and therefore may havereaped the greatest benefits from the interventiondesigned to increase parents’ responsiveness and attune-ment in parent–child interactions. The intervention’songoing skill-building (e.g., increases in praise, attend-ing, affection) may have been especially helpful forparents whose depression had interfered with their exp-ressions of responsiveness.

As with parent depression, support from friendsseems to be a salient influence on the efficacy of preven-tive parenting programs, with evidence in the presentstudy that social support moderated intervention effectson both stimulation for learning and responsive parent-ing (albeit a trend). Limited friend support may be animportant indicator of isolation and insularity thatdiminishes both aspects of parenting, such that havingless support from friends rendered parents especiallyresponsive to the group-based intervention that pro-vided ongoing support for making positive changes inparenting practices.

In contrast to depression and support from friends,intervention effects on parenting were not moderatedby parenting stress or support from family members.Overall, the sample showed very high levels of stress;the restricted range in the data precluded the assessmentof differential intervention effects for those with lowerlevels of parenting stress. Regarding family support, itis possible that effects were obscured because therelation between current family support and one’s ownparenting is particularly complex for those with a his-tory of strained family relationships and stressorsrelated to poverty.

The present study extends our prior findings forharsh parenting by demonstrating that a substantial int-ervention effect (an approximate .5 standard deviationdifference between intervention and control conditions)occurred for parents with high and low psychological

FIGURE 3 Friend support as a moderator of intervention effect on

stimulation for learning. Note. Line graph is presented because Friend

Support was measured on a continuous scale.

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resources. This pattern is consistent with evidence thatstressed parents reduced negative parenting followingparticipation in Triple-P as much as nonstressed parents(McTaggart & Sanders, 2007). Although it hasbeen suggested that parents with lower psychologicalresources are more likely to use harsh practices (e.g.,Baydar et al., 2003), none of the resources examined inthe current study were related to harsh parenting atbaseline or over time. Instead, it may be that parentsresponded harshly to children’s misbehavior primarilybecause they did not have alternative discipline strate-gies, and not because they were stressed, depressed, orlacking support. Thus, the intervention’s expansion ofparents’ repertoire of behavior management strategieswas equally beneficial for all parents, regardless of theirpsychological resources. The robust impact on harshparenting is particularly meaningful in the context ofprior work demonstrating that intervention-inducedreductions in harsh parenting mediated interventioneffects on child conduct problems in this very high-risksample (Brotman et al., 2009).

Strengths of this study include that parenting out-comes were assessed by masked observers during par-ent–child interactions in laboratory and home settings,whereas moderators were assessed via parent interview,eliminating confounds between measures. Limitationsinclude the relatively small sample size (resulting in lim-ited power to detect small moderation effects), and lackof control for Type I error (allowing for the possibilitythat significant results were due to chance, althoughbased on a¼ .05, fewer than one of the 12 models wereexpected to be significant by chance). Accordingly,results should be viewed as suggestive and require repli-cation. The unique sample is both a strength and aweakness; although results may not generalize to lessdisadvantaged populations, this sample provided a greatopportunity to examine a set of psychological resourcesthat are often clustered in high-risk families.

Conclusions

Group-based, family-centered preventive intervention inearly childhood resulted in reductions in harsh parentingand increases in responsive parenting and stimulationfor learning, especially among parents with diminishedpsychological resources. The breadth of benefits amonghigh-risk families suggests the potential for population-level impact. In addition, findings suggest that research-ers and clinicians should optimistically consider theinfluence of parent psychological resources on respon-siveness to intervention, based on a small but growingliterature showing that disadvantaged parents are justas likely to engage in and benefit from preventiveintervention.

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