Who Benefits More in Group-Based and Individual Telehealth Parenting Programs: Moderators and Distal Child Outcomes among Military Families

Telehealth has emerged as a feasible means for delivering evidence-based parenting interventions, but studies of which families benefit from individual telehealth versus traditional in-person groups, as well as long-term effects for children, are lacking. In this comparative effectiveness trial, 166 military families were randomized to the individual telehealth or in-person group-based ADAPT intervention. Moderated mediation models tested whether baseline parent and child factors moderated the impact of delivery format on parenting at a one-year follow-up and whether parenting changes mediated child adjustment changes at a two-year follow-up. Both mothers and fathers who perceived intitially lower child maladjustment problems showed greater gains following the in-person group condition as opposed to the telehealth condition. Fathers with higher initial mental health risk and perceived child maladjustment problems showed greater gains in the individual telehealth condition as opposed to the in-person group condition. Improvements in mothers' parenting were associated with reductions in child internalizing and externalizing symptoms at two-year follow-up. Findings may guide tailored intervention delivery and scale-up of ADAPT and related programs.