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However, there has been little focus upon potential predictors of change and analysis of mechanisms of change. This study aims to identify mediators and moderators of change in a pragmatic, multi\u2010site, randomized controlled trial of the Parents under Pressure (PuP) programme, a family\u2010focused intervention for parents with substance use and other problems, and treatment\u2010as\u2010usual (TAU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of data: multi\u2010level modelling was used to investigate moderators of treatment outcome; mediation was tested with cross\u2010lagged models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Community\u2010based family support services in the United Kingdom.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Parents (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0100) attending community\u2010based addiction services with children aged 2.5\u00a0years or younger.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Predictors of the primary outcome, child abuse potential, were: baseline child age and gender, composite family risk score, parental substance use and parental emotional dysregulation. Mediation was tested across three time\u2010points with the observed variables parental emotion dysregulation and child abuse potential.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Increased child age [\n                      <jats:italic>Z<\/jats:italic>\n                      \u00a0=\u00a02.14, 95% confidence interval (CI)\u00a0=\u00a00.01, 0.33] at baseline was associated with greater reductions in child abuse potential for PuP programme participants compared with TAU. Poorer parental emotional regulation (\n                      <jats:italic>Z<\/jats:italic>\n                      \u00a0=\u00a02.48, 95% CI\u00a0=\u00a0\u20132.76, \u22120.32) was associated with greater reductions in child abuse potential for all participants. Parental substance use (either recent use or primary substance of concern) did not alter any treatment effects on child abuse potential. The mediation analysis showed that PuP produced greater improvements in emotional regulation at post\u2010treatment (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) compared with TAU, which predicted lower child abuse potential at 6\u2010month follow up (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For UK parents enrolled in a family\u2010focused intervention, baseline measurements of higher child age appear to be associated with greater reductions in child abuse potential at 6\u2010month follow\u2010up in PuP participants compared with treatment as usual (TAU). Poorer parental emotional regulation and, potentially, higher family risk, appears to be associated with greater reductions in child abuse potential at 6\u2010month follow\u2010up in PuP and TAU. Emotional regulation appeared to act as a mediator as improvements in parental emotional regulation post\u2010treatment appeared to be associated with greater reductions in child abuse potential at 6\u2010month follow up. Notably, participation in the PuP programme led to better parental emotional regulation compared with TAU.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.15579","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T09:13:01Z","timestamp":1621933981000},"page":"3206-3218","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Moderators and mediators of outcomes of parents with substance use problems: further evaluation of the Parents under Pressure programme"],"prefix":"10.1111","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3533-1101","authenticated-orcid":false,"given":"Sharon","family":"Dawe","sequence":"first","affiliation":[{"name":"School of Psychology Griffith University  Brisbane 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