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Sep 4, 2014 - Changing Orientations to Corporal Punishment: A Randomized, Control. Trial of the Efficacy of a Motivational Approach to Psycho-Education.

Psychology of Violence 2016, Vol. 6, No. 2, 233–242

© 2015 American Psychological Association 2152-0828/16/$12.00

Changing Orientations to Corporal Punishment: A Randomized, Control Trial of the Efficacy of a Motivational Approach to Psycho-Education Grant W. O. Holland and George W. Holden

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Southern Methodist University Objective: To evaluate the efficacy of a motivational interviewing (MI) approach in changing positive attitudes toward corporal punishment (CP), behavioral intentions, and behavior. CP has been linked to a variety of negative outcomes for children, and parents’ attitudes toward CP strongly predicts its use. Five brief interventions have been reported in the literature designed to target CP attitudes. The current study adopts a novel approach by evaluating the effects of a brief, psycho-educational intervention incorporating aspects of MI. Method: Forty-three mothers of children ages 3 to 5 completed 1 motivational psycho-education session. Participants were randomly assigned to intervention or waitlist, completing assessments at baseline, postintervention, and 1-month follow-up. After follow-up, the waitlist condition crossed over, completing the intervention and further assessments. Results: The intervention was associated with greater reductions in CP attitudes and intentions versus the waitlist; these effects were replicated in the crossover group. Further, participants’ in-session change-talk predicted greater changes in CP attitudes. The effect size of the current approach was stronger than the prior interventions. Conclusions: MI is a promising approach to address parental use of CP, though this approach needs replication with a larger sample. Several ways of incorporating this approach on a wider scale are considered. Keywords: attitudes, corporal punishment, discipline, intervention, motivational interviewing

hit by their parents (Bender et al., 2007). The purpose of the current study is to evaluate the efficacy of a novel approach, brief motivational psycho-education, in changing parents’ orientations to CP.

The empirical evidence about corporal punishment (CP) and child development is remarkably consistent: parental spanking and slapping contributes to increased negative child outcomes across a variety of domains (Gershoff, 2002) and can precipitate physical child abuse (Ateah & Durrant, 2005). Studies continue to document associations between CP and children’s internalizing and externalizing problems (e.g., Maguire-Jack, Gromoske, & Berger, 2012). These findings hold for international samples (e.g., Gershoff et al., 2010), regardless of levels of parental warmth (Lee, Altschul, & Gershoff, 2013). Despite the overwhelming research evidence, CP remains a commonly endorsed disciplinary technique in the U.S., with 65% of American women and 77% of men continuing to believe that children sometimes need “a good hard spanking” (Child Trends, 2013). The peak age of spanking is between 3 and 5 years (e.g., Zolotor, Theodore, Runyan, Chang, & Laskey, 2011), and by adolescence as many as 84% of American children will have been

Targeting the Determinants of Corporal Punishment Corporal punishment is an entrenched child rearing behavior, thus modifying its widespread acceptance and usage presents a difficult challenge. A large number of variables, both distal and proximate, have been found to be predictors of its use (e.g., Grogan-Kaylor & Otis, 2007). Distal variables, such as parents’ own histories of being physically punished, parental age and education, and the cultural context, cannot be changed (e.g., Barkin, Scheindlin, Ip, Richardson, & Finch, 2007; O’Brien Caughy & Franzini, 2005). However, proximal determinants, such as parental social cognitions and emotional reactions to child behavior, are potentially modifiable (Ateah & Durrant, 2005; Holden, Miller, & Harris, 1999). The Theory of Planned Behavior (TPB; Ajzen & Fishbein, 2005) offers a useful framework to guide efforts at changing attitudes and behavior. According to the theory, behavior is determined by three sets of perceptions: (a) attitudes regarding the utility of the behavior; (b) beliefs about how others view the behavior (i.e., subjective norms); and (c) the ease of engaging in or refraining from the behavior. These perceptions influence the intention to use a behavior. Intentions, in turn, lead to action when there is the opportunity to engage in the behavior. Indeed, many factors contributing to use of CP are consistent with the three primary determinants of intentions and behaviors proposed by TPB. Many parents believe, erroneously, in the in-

This article was published Online First August 3, 2015. Grant W. O. Holland and George W. Holden, Department of Psychology, Southern Methodist University. Grant W. O. Holland is now at Dallas CBT in Dallas, Texas. This study was funded by an SMU University Research Council grant. Special thanks for several students’ help throughout the course of the study, especially Olivia Dossett, Kristin Nguyen, Erin Brannan; thanks to Rose Ashraf and Margaret Smith for their help during preparation of this article. David Rosenfield provided statistical advice. Correspondence concerning this article should be addressed to Grant W. O. Holland, Department of Psychology, Southern Methodist University, Dallas, TX 75275. E-mail: [email protected] 233

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strumentality of CP and that it is effective in correcting misbehavior (Holden et al., 1999). Other parents may not believe in it, but anger, impulsivity, or high stress levels contribute to “emotional” or “out-of-control” spanking (e.g., Lorber, O’Leary, & Smith Slep, 2011; Vittrup, Holden, & Buck, 2006), which can lead to use of CP irrespective of beliefs in the utility of it. The use of CP is also greatly influenced by the culture in which one lives (O’Brien Caughy & Franzini, 2005; Lansford & Dodge, 2008) and thus the perceived norms (Taylor, Hamvas, & Paris, 2011). Additionally, there is strong evidence that behavioral intentions predict behavior in a variety of domains (e.g., Webb & Sheeran, 2006), including CP (Holden, Brown, Baldwin, & Croft Caderao, 2014). Parental attitudes toward CP have been identified as the single most important determinant of CP use. They have been found to explain 32% of the variance in the use of CP and a more superior predictor than seven other cognitive and affective variables (Ateah & Durrant, 2005). Positive attitudes about use of CP generally reflect positive beliefs in its efficacy in promoting short- and long-term outcomes (Holden et al., 1999). The relation between parents’ attitudes and use of CP has been repeatedly found. Positive attitudes toward CP are a strong predictor of parents’ daily reports of CP (Holden, Coleman, & Schmidt, 1995) and of CP behavior up to four years later (Vittrup et al., 2006). The potential tractability of attitudes, as well as their influence on behavioral intentions, makes them a prime target for intervention.

Brief Interventions Targeting CP Attitudes and Intentions To date, five published reports have used brief interventions in an effort to modify positive attitudes toward CP. Each study was based on the view that information presented on problems associated with CP would change attitudes (Griffin, Robinson, & Carpenter, 2000; Holden et al., 2014; Reich, Penner, Duncan, & Auger, 2012; Robinson, Funk, Beth, & Bush, 2005; Scholer, Hamilton, Johnson, & Scott, 2010). Three of these reports involved intervention studies using nonparent samples (Griffin et al., 2000; Holden et al., 2014; Robinson et al., 2005). One report focused on an intervention targeting first-time mothers (Reich et al., 2012). Finally, two reports detailed interventions targeting parents of children during the peak years of CP (Holden et al., 2014; Scholer et al., 2010). Robinson and his colleagues published the first two interventions (Griffin et al., 2000; Robinson et al., 2005). They demonstrated that providing information about the problems with CP, either by completing a CP-focused writing or reading assignment, resulted in a significant decrease in students’ favorable CP attitudes (Cohen’s d ⫽ .43). Though their initial study did not show a significant treatment effect (d ⫽ .21), the second study did, with those in the treatment conditions showing significantly greater reductions in favorable CP attitudes (ds ranging from .56 to .72). A third intervention study contained two samples, one of nonparents and one of parents of young children (Holden et al., 2014). Nonparents who read short research summaries about CP showed significant reductions in positive attitudes (d ⫽ .40) and intentions (d ⫽ .37). However, there were no significant differences between the control (who read about research about the effects of child care) and intervention groups in these outcomes (attitudes: d ⫽ .19; intentions: d ⫽ .14) among nonparents. Similarly, with the

parent sample, the intervention group reported significantly less favorable attitudes toward spanking over time (d ⫽ .40). More importantly, an interaction effect was observed, with the intervention group reporting significantly less favorable attitudes at postintervention assessment (d ⫽ .41) when compared with controls. A fourth approach to intervention involved providing educational books to first time mothers (Reich et al., 2012). Mothers receiving the educational books about CP reported significantly less favorable views toward CP than the other groups. Surprisingly, the largest effect size was found when comparing educational versus noneducational book groups (d ⫽ .67), although a smaller, but significant, effect was also discovered when comparing educational book to no-book controls (d ⫽ .25). The last approach targeting CP attitudes and beliefs, by Scholer and colleagues (2010), relied on a video-based intervention to provide alternative disciplinary approaches to CP. Parents who watched a 20-min psycho-educational video, showed a significant decrease in favorable CP attitudes over time (d ⫽ .44), whereas the control group did not. However, there was no condition by time interaction, indicating that the intervention had little effect over and above the control condition (d ⫽ .27). These five studies reveal that CP psycho-education can change CP attitudes and intentions; each study reported a significant decrease in positive CP attitudes. Though these findings are encouraging, it is important to note that the results were not always attributable to the intervention, and effect sizes are small to moderate. Further investigation is needed to test other, potentially more effective approaches and to relate the attitude change to behavior change.

Motivational Interviewing (MI) Over the last few decades, one intervention approach has been developed with wide applicability in areas where resistance can be expected: motivational interviewing (MI; Miller & Rollnick, 2013). This approach is intended to promote change through two mechanisms: empathic understanding of the client by the clinician and the elicitation of client “change-talk.” The goal of MI is to establish strong rapport with the client to better be able to elicit the client’s own reasons for change, thereby increasing motivation for change. This nonjudgmental approach is from the Rogerian heritage, where the clinician explores the client’s own reasons for change. However, MI is directive in that it seeks to evoke and elaborate clients’ “change-talk,” or the “expression of the client’s [own] desire, ability, reasons, and need for change” (Hettema, Steele, & Miller, 2005, p. 92). Change-talk is elicited, illuminated, and reinforced; “sustain-talk” is acknowledged and reflected empathetically, but not encouraged. The clinician seeks to elicit change-talk while limiting sustain-talk, thus increasing motivation for change. Several meta-analyses of MI have found positive effects when used with clients resistant to change, and MI has established efficacy in reducing maladaptive behaviors (e.g., substance use), improving health behaviors, and increasing treatment adherence (e.g., Burke, Arkowitz, & Dunn, 2002; Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010). Most MI applications are actually “adaptations” of a therapeutic approach, utilizing some other technique in addition to MI or using MI as a lead-in to another program. MI adaptations (AMIs) have shown strong effects on


attitude and behavior change (Burke et al., 2002). MI and AMIs exert their effects quickly, producing effects similar to other treatment programs in substantially less time and cost (Lundahl et al., 2010), with evidence that brief use (1 to 4 sessions) can produce moderate to large effect sizes (Burke et al., 2002).

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Applying MI to Parents MI has been successfully used with parents, as well. One effort has been to use a single session to promote treatment adherence for parents in a behavioral training program for child behavior problems (Chaffin, Funderburk, Bard, Valle, & Gurwitch, 2011; Nock & Kazdin, 2005). It has also been an integral part of the Family Check-Up (Dishion & Stormshak, 2007), which uses MI as part of a brief, 3-session intervention intent on promoting positive parenting behaviors, reducing child behavior problems, and increasing motivation to engage in further services. Although the program increases positive parenting behaviors and decreases child misbehaviors (Dishion et al., 2008), its effects on parents’ CP attitudes and behaviors have not been investigated. MI is well suited for use in changing parents’ CP attitudes and behaviors precisely because (a) it does not seek to dictate a behavioral result, (b) it elicits parents’ own intention and motivation for change, and (c) it places a paramount importance on rapport between clinician and parent and respect for autonomy. There is perhaps no situation which can more surely elicit defensiveness, and thereby sustain-talk, as the well-meaning stranger “telling you what to do with your child.” This is especially true when a parent does not view their behavior as problematic. MI has been successful precisely because the clinician does not push for a specific behavioral outcome, but rather draws out the client’s own reasons for change. The goal of this study was to evaluate the effect of a psychoeducational intervention enhanced by an MI approach on parents’ CP attitudes, behavioral intentions, and reported behavior. We hypothesized that this approach would result in (a) less favorable attitudes toward CP, (b) reduced CP intention, (c) reduction in CP use, and (d) increased motivation to change behaviors. We also expected that (e) more change-talk, a process variable, would predict more change in all four variables.

Method Participants A total of 43 mothers of 3- to 5-year-old children participated. All but two participants were the biological mothers of the children (M ⫽ 32.37 years, SD ⫽ 6.3, range ⫽ 22– 44). The remaining two participants were grandmothers (aged 58 & 61) raising their biological grandchildren. For convenience, all participants will be labeled “mothers.” The women were African American (n ⫽ 21), Caucasian (n ⫽ 15), and Hispanic (n ⫽ 7). Target children included 23 girls and 20 boys. The modal age of the children was 4 years old (n ⫽ 19); 15 were 5 years old and 9 were 3 years old. A mean of 3.2 children resided in each household (SD ⫽ 1.1; range ⫽ 1– 6). Target children were the oldest in their household for 51% of participants; in 12 cases, the target child was an only child. When there was more than one child in the age range, the mothers selected the target child. A majority of the mothers were


married (n ⫽ 21), though 33% were unmarried, 12% divorced, and 6% cohabiting. The median income was between $20,000 and $40,000 (30%), but nine mothers reported annual family income below $20,000, 14 had incomes between $40,000 and $90,000, and seven reported incomes greater than $120,000. About half (47%) of the mothers had attended college (or had an associate’s degree) and 28% held a BA or graduate/professional degree. Four mothers were high school graduates; two mothers had no degree. The final sample of 43 mothers was derived from 396 prospective participants who gave their contact information to recruiters; 150 of these commenced screening (see Figure 1). A total of 46 mothers were randomized; 24 came from Head Start facilities, 16 from other child-care facilities, and six from Craigslist. To guard against the possibility of participants recruited from Head Start being overrepresented in either treatment condition, block randomization (i.e., Head Start vs. non–Head Start) was utilized.

Measures The primary independent variable in this study was group assignment (intervention vs. waitlist), with mothers’ change-talk being the second predictor variable of interest. Four self-report measures served as the dependent variables: (a) CP attitudes, (b) behavioral intention to use CP, (c) use of CP, and (d) motivation for change. Covariates included demographic variables, mothers’ own history of exposure to CP, and frequency of child misbehavior. Attitudes Toward Spanking (ATS). Mothers’ positive CP attitudes were assessed by the ATS (Holden et al., 1995). The ATS consists of 10 statements (e.g., “sometimes a spank is the best way to get my child to listen”) rated on a 7-point agreement scale (1 ⫽ strongly disagree; 7 ⫽ strongly agree). Higher scores indicate more positive CP attitudes. The ATS has adequate test–retest reliability and has been related to daily and weekly (rs [39] ⫽ .54 & .73, ps ⬍ .001, respectively) reports of CP (Holden et al., 1995). In the current sample, the ATS had good internal consistency at all time-points (␣s ⫽ .81 to .91). Analog Parenting Task (APT). Mothers’ intention to use CP was assessed with a modification of the APT (Zaidi, Knutson, & Mehm, 1989). For this study, the instrument was reduced in length to 15 pictures of children engaging in varying misdeeds (e.g., tearing up a book) to reduce administration time. After each picture was displayed, participants indicated their initial and then their secondary response if their own child engaged in the misbehavior. Participants chose from a list of 10 possible parental responses; for example, the mother could select that she would “. . . not mind,” “. . . explain why he/she shouldn’t do this,” or “. . . send him/her to his/her room (e.g., time out).” Pronouns were changed to match the gender of the child in the picture. Embedded in these options were three CP choices: “. . . spank him/her on the buttocks,” “. . . slap him/her on the face,” or “. . . hit him/her with a belt, hairbrush, ruler, or other available object.” The same set of pictures was presented at each time point, though the order of presentation was randomized. An overall CP score was created by summing mothers’ endorsement of CP as a primary or secondary response for each scenario (i.e., 30 total responses). Across the five time-points assessed in the current study, the APT showed adequate internal consistency initially (Times 0 through 2; ␣s ⫽ .63 to .77), with lower consistency with the crossover group (Times 3


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Figure 1.

Study design and participant flow.

and 4; ␣s ⫽ .58 & .51, respectively), likely attributable to a restricted response range. Russa and Rodriguez (2010) reported the measure had strong internal reliability (␣s ⫽ .91 to .93), and strong convergent validity with other CP measures. Parental Responses to Child Misbehavior (PRCM). Mothers’ self-reported use of CP with their own children was assessed using the PRCM (Holden et al., 1995). This measure consisted of 16 parenting behaviors rated on a 7-point scale (1 ⫽ never, 7 ⫽ nine times a week or more). Four items assessed manifestations of CP: slapping on the hand, slapping on the face,

spanking with a hand, and spanking with an object. The PRCM has previously demonstrated good internal (Cronbach’s alpha ⫽ .73) and test–retest reliability (r ⫽ .64), and the CP item correlated highly with mothers’ daily CP reports (r ⫽ .77; Holden et al., 1995). In the initial screening, parents reported how often they engaged in each of the behaviors in an average week; at subsequent time-points, parents indicated their use of each of the behaviors over the previous week. In the current sample, two items (“slapping on the face,” “spanking with an object”) were rarely en-

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dorsed, and negatively affected the scale’s internal consistency; consequently we excluded those two items. The remaining two items (“spanking with a hand” & “slapping the hand”) had adequate internal consistency (␣s ⫽ .69 –.91) across all time points. Change readiness. Mothers’ readiness to change their disciplinary behaviors (i.e., motivation) was assessed using an adapted measure. The University of Rhode Island Change Assessment (URICA; McConnaughy, DiClemente, Prochaska, & Velicer, 1989) was modified to refer to parental disciplinary practices (e.g., “I really think I should work on my approach to discipline”). Mothers rated 12 items assessing motivation to change their disciplinary practices on a 5-point Likert (1 ⫽ strongly disagree; 5 ⫽ strongly agree). Change readiness summary scores were then calculated by summing the scores on items indicating change and subtracting the scores from items indicating movement away from change (e.g., Blanchard, Morgenstern, Morgan, Labouvie, & Bux, 2003). The summary scores had good internal reliability in the current sample (␣s ⫽ .93–.97). Change-talk. Mothers’ in-session statements regarding use of CP were quantified following a coding scheme similar to Amrhein and colleagues (2003). Statements illustrating reasons for, commitment to, or recent steps taken toward the reduction or elimination of CP were coded as “change-talk.” Statements related to increased use of alternative disciplinary strategies were included only if the participant clearly indicated a connection between the alternative strategy and reduced CP. Conversely, statements indicating reasons for, commitment to, or recent steps taken toward continued or increased use of CP were coded as “sustain-talk.” Interview coding was restricted to the “evoking” section of the discussions, as this was the portion intended to elicit and elaborate change-talk. This section of the recording averaged 16.5 min (SD ⫽ 5.0, range ⫽ 7–26), and was transcribed and then coded. Two raters coded 20% of the sample (n ⫽ 7) to evaluate reliability. The mean agreement was 80% (Cohen’s Kappa ⫽ .63). A summary score (change-talk/[change-talk ⫹ sustain-talk]) was created (see Table 1). Discipline Questionnaire (DQ). Mothers’ history of exposure to CP as a child/youth was assessed with four items from the DQ (Graziano, Hamblen, & Plante, 2001). Mothers reported the frequency of CP experienced during four separate time periods, ranging from preschool to high school. Mothers rated these frequencies on a 7-point frequency scale ranging from “never” to “almost daily or daily.” These items were summed to form a Childhood experience with CP subscale (␣ ⫽ .71). Child misbehaviors. Current child behavior problems were assessed using the intensity subscale of a modified Eyberg Child

Table 1 Descriptive Statistics for Baseline Measures and Change-Talk Variable

M (SD)


Attitudes Towards Spanking (ATS) Intention to Use CP (APT) Use of CP (PRCM) Change Readiness (mURICA) Change-Talk % (%⌬⫺Talk) Child Misbehavior (mECBI) Discipline Questionnaire (DQ)

40.8 (11.3) 2.7 (2.3) 5.2 (2.3) 42.5 (8.6) 70.9 (19.3) 47.7 (15.4) 7.2 (4.4)

21–66 0–10 2–11 19–57 29–100 21–85 1–18


Behavior Inventory (ECBI; Eyberg & Pincus, 1999); for current use, the ECBI was shortened to ease the burden of administration. The ECBI is a commonly used measure of child misbehavior with well-established psychometric properties. Current use consisted of 15 statements describing common child problems (e.g., “refusing to go to bed”), rated on a 7-point Likert-type scale (1 ⫽ never, 7 ⫽ always). The mECBI showed good internal consistency in the current sample (␣s ⫽ .88 to .90). Order of presentation. Questionnaires were presented in a fixed order at each time point, with the exception of those measuring information not expected to change. The order was as follows: Demographics (Time 1 only), PRCM, mECBI, ATS, DQ (Time 1 only), mURICA, and APT. This order was chosen to minimize initial references to spanking, intentions to spank, or images of child misbehavior that could conceivably influence retrospective reports (e.g., PRCM, mECBI) and self-reported attitudes.

Procedure Recruitment and screening. Participants were recruited and enrolled in the study over an approximately 20-week period. Flyers were distributed to 51 community child centers and nine Head Start centers, with in-person recruitment at eight child and seven Head Start centers. During recruitment and screening, research was framed as a study of “parenting values and behaviors” involving a one-on-one discussion about their own discipline as well as the scientific literature on this subject; the specific focus on CP was not shared initially. Preliminary power analyses, utilizing data on attitudes from Holden and colleagues (2014), indicated a total sample size as low as 22 would provide 80% power observed. Potential participants were excluded if they (a) did not have a 3to 5-year-old child, (b) did not report using CP with the child at least once a month, (c) were not the primary caregiver, (d) were not comfortable speaking English, (e) reported a current major and untreated mental illness or a substance use problem, or (f) had a child with a history of developmental delay or mental illness. Screening occurred in two steps. First, mothers reported their use of CP via online survey. Eligible mothers then completed a phone screen to evaluate the remaining four participation criteria. Participants received $40 on completion of the study. Treatment conditions and measurement periods. Mothers were randomized to one of two conditions, intervention or waitlist/ crossover. Assessments were made at baseline (Time 0; see Table 1), postintervention (Time 1), and 1-month follow-up (Time 2). Following Time 2 measures, the waitlist group went on to receive the study intervention, with further assessments at Time 3 (postintervention) and Time 4 (1-month follow-up). Links to the Webbased Qualtrics surveys were emailed to participants so they could be completed off-site. One-time individual sessions occurred an average of 10 days following baseline for the intervention group, and an average of 8 days following Time 3 for the crossover group. Sessions were held on a university campus. The postintervention assessments occurred within an average of 48 hours following the session (see Figure 1). Attrition. As can be seen in Figure 1, seven mothers dropped out over the course of the study. Overall, data were collected for 153 of 171 potential time-points (91%), with 36 of 43 mothers completing an intervention session. Dropouts were more likely to be in the waitlist condition, ␹2[1] ⫽ 4.5, p ⬍ .05; no other variable

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was associated with attrition. Multiple efforts (e.g., 3–5) were made to reengage noncommunicative participants once a timepoint was missed. Though these efforts resulted in one participant reengaging and completing a later time-point, most participants remained unresponsive without stating a desire to end participation. Motivational psycho-education session. The one-time intervention session consisted of three parts: (a) engaging, (b) educating, and (c) evoking. Sessions averaged 63.9 min (SD ⫽ 16.2; range ⫽ 41–114). During the initial phase, mothers were engaged in an open-ended values discussion concerning parenting and discipline. In this way, the topic of CP emerged, which led to a discussion of CP research findings. Discussions were tailored to each mother, with the clinician linking pertinent research results to maternal comments. Next, the clinician engaged in MI evoking strategies, including (a) discussion of concerns, (b) discussion of how the research fit with their values and goals, (c) use of importance and/or confidence rulers, and (d) other general MI skills (see Miller & Rollnick, 2013). Because the focus of the study was on evaluating the effects of psycho-education alone in reducing or eliminating CP, alternatives to CP were not provided for three reasons. Such a discussion would require more time, thereby undermining the brevity of the intervention and limiting the ease of translation of the current intervention to other settings. Second, the suggested alternative practices could be rejected by participants and thereby elicit sustain-talk. Third, spending more time on nonpunitive disciplinary practices may have increased the possibility of experimenter demand effects. Consequently, discussion of alternatives was limited to instances where mothers asked for advice about alternatives. In these situations, the clinician engaged them in a discussion of what the mothers had tried or were interested in trying.

Data Analysis Growth modeling. Hypotheses were tested utilizing growthcurve modeling with repeated measures nested within persons (Singer & Willett, 2003) using the HLM 7 program (Raudenbush, Bryk, & Congdon, 2013). Modeling in this manner offers advantages over other data analytic approaches primarily because of its greater ability to handle missing data, as well as its greater statistical power with smaller sets of data (Maas & Hox, 2005). Further, this method allows for evaluation of differences in rate of change (i.e., slope), as well as changes in mean (i.e., level). Preliminary power analyses were conducted utilizing attitudinal (i.e., ATS) data from Holden and colleagues (2014) psycho-educational intervention study; in that study, a small to medium intervention effect was observed (Cohen’s d ⫽ .40). Power analysis for the current study indicated a total sample size as low as 22 would yield 80% power to detect a similar effect size; a sample size greater than 40 was used to ensure adequate power in both legs of the study. Consistent with the recommendations of Liu, Rovine, and Molenaar (2012), the best fitting growth trajectories were evaluated for each outcome measure. Deviance statistics (⫺2 Log Likelihood [⫺2LL], Aikake Information Criterion [AIC], and Bayesian Information Criterion [BIC]) were compared for linear, quadratic, and exponential growth models using maximum likelihood estimation. The linear and exponential outcome models included condition,

time, and the interaction of time and condition as predictors of the intercept and slope for their respective dependent variables: untransformed dependent variables for the linear models, and the natural log of the outcome for the exponential model. The quadratic model was built on the linear model by including a quadratic term (i.e., time2) and the interaction between this and condition. Dependent variables were z-scored before analysis to aid comparisons between models. Because exponential models were not truly nested, deviance statistics for the models were not subjected to significance testing. Hypothesis testing. The four dependent variables (ATS, APT, PRCM, & mURICA) were evaluated across three different sets of analyses. First, the intervention and waitlist conditions were compared. The next set of analyses attempted to replicate intervention effects by comparing the crossover group’s performance at pre-, post-, and follow-up testing (i.e., Times 2, 3, & 4) with the initial intervention group’s performance on the same times (i.e., Times 0, 1, & 2). Here, no significant differences between initial and crossover groups’ trajectories would be evidence of successful replication. Finally, the effect of mothers’ in-session change-talk on these dependent variables was evaluated in a similar set of analyses of mothers’ pre-, post-, and follow-up testing. Three estimates of effect size were used. Raudenbush and XiaoFeng’s (2001) formulations for effect sizes of slopes (dchange) and group differences (draw) in HLM analyses were calculated. The first effect size reflects the size of the observed slope parameter over the variance in all observed slopes (dchange ⫽ b/公 ␶11). The second type of effect size is more directly comparable to traditional Cohen’s d (Feingold, 2009), and reflects the accumulated differences between groups over the standard deviation of the outcome measure (draw ⫽ b/SDraw); in other words, it shows the standardized difference between groups at the final assessment. Finally, pseudo-R2 (Singer & Willett, 2003) was calculated for tests of the effect of change-talk on the dependent variables, as it was a continuous variable and is not suitable for d-statistics.

Results Preliminary Analyses The final sample of 43 participants included 22 mothers assigned to the initial intervention group, and 21 mothers assigned to the waitlist/crossover group. Baseline differences were evaluated for all demographic, outcome, predictor, and potential confounding variables. At baseline, those in the waitlist condition reported significantly higher levels of child misbehavior than those in the intervention group, Ms ⫽ 54.2 (SD ⫽ 14.1) and 41.5 (SD ⫽ 14.3), respectively; F(1, 42) ⫽ 8.6, p ⬍ .01, d ⫽ .91. Consequently, baseline mECBI scores were used as covariates in hypothesis testing. There were no other significant baseline group differences. Exponential models provided the best fit for ATS, APT, and PRCM data. Deviance statistics for each of these outcomes were lowest for exponential models. In contrast, the quadratic model provided the best fit for the mURICA data.

Intervention Effects Within-group effects. The intervention had a significant effect on two of four dependent variables. As expected, following

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the intervention, mothers reported significantly less favorable CP attitudes, b10 ⫽ ⫺0.32, t(41) ⫽ ⫺3.9, p ⬍ .001, draw ⫽ .67, dchange ⫽ 1.88, as well as a reduction in their intention to use CP, b10 ⫽ ⫺0.40, t(41) ⫽ ⫺3.6, p ⫽ .001, draw ⫽ .77, dchange ⫽ 1.07. In contrast, those on the waitlist reported more favorable CP attitudes over the same period, b10 ⫽ 0.14, t(41) ⫽ 2.5, p ⬍ .05, draw ⫽ .30, dchange ⫽ .84, but no significant change in intentions. No within-group intervention effects were found for reported use of CP, b10 ⫽ ⫺0.12, t(41) ⫽ ⫺1.7 or change readiness, Linear: b10 ⫽ 0.06, t(41) ⫽ 0.7; Quadratic: b20 ⫽ ⫺0.02, t(41) ⫽ ⫺0.5 (see Figure 2). Between-groups differences. Although there were no significant differences between groups on the dependent variables at Time 0, the growth curves for two of the four variables were significantly different for the intervention and waitlist groups. Compared with the waitlist, mothers in the intervention group showed greater reductions over time in both positive CP attitudes, b11 ⫽ ⫺0.47, t(41) ⫽ ⫺4.6, p ⬍ .001, draw ⫽ .97, dchange ⫽ 2.72, and intention to use CP, b11 ⫽ ⫺0.31, t(41) ⫽ ⫺2.2, p ⬍ .05, draw ⫽ .61, dchange ⫽ .85. Growth-curves did not significantly differ between groups for mothers’ reported use of CP: b11 ⫽ ⫺0.02, t(41) ⫽ ⫺0.1 or change readiness, Linear: b11 ⫽ ⫺0.07, t(41) ⫽ ⫺0.6; Quadratic: b21 ⫽ ⫺0.01, t(41) ⫽ ⫺0.2. Replication of treatment effects was evaluated for the two significant outcomes. Attitudes and intentions about CP followed similar trajectories in the crossover group as in the initial intervention group. There were nonsignificant effects of condition on estimated slopes, ATS: b11 ⫽ ⫺0.07, t(34) ⫽ ⫺.52, p ⫽ .61; APT: b11 ⫽ ⫺0.19, t(34) ⫽ ⫺.12, p ⫽ .24, as well as nonsignificant


effects of conditions in the overall growth model, ATS: ␹2(2) ⫽ 0.91, p ⫽ .63; APT: ␹2(2) ⫽ 2.2, p ⫽ .34.

Associations With Change-Talk Mothers’ change-talk had a strong association with two of four dependent variables. Overall, greater change-talk was associated with more negative CP attitudes, b10 ⫽ ⫺0.61, t(33) ⫽ ⫺5.2, p ⬍ .001, pseudo-R2 ⫽ .52, and less intention to use CP, b10 ⫽ ⫺0.41, t(33) ⫽ ⫺3.8, p ⬍ .001, pseudo-R2 ⫽ .22. Over time, mothers who engaged in a greater change-talk also showed greater reductions in positive CP attitudes, b11 ⫽ ⫺0.16, t(34) ⫽ ⫺2.5, p ⬍ .05, pseudo-R2 ⫽ .40, although a similar effect was not observed for intention to use CP, b11 ⫽ ⫺0.12, t(34) ⫽ ⫺1.7, p ⫽ .10, pseudo-R2 ⫽ .03. Mothers’ change-talk had no significant association with their reported use of CP, b11 ⫽ ⫺0.02, t(41) ⫽ ⫺0.1 or change readiness, Linear: b11 ⫽ ⫺0.01, t(41) ⫽ ⫺0.1; Quadratic: b21 ⫽ 0.08, t(41) ⫽ 0.6.

Exploratory Analyses A series of exploratory analyses were conducted to further evaluate several nonsignificant outcomes reported above. Differences from pre (T1) to post (T2) and pre (T1) to follow-up (T3) were evaluated by including two dummy-coded time variables and their respective interactions with condition and change-talk as predictors in an HLM model. There were no significant differences between intervention and waitlist groups in outcomes from pre to post on use of CP, b11 ⫽ ⫺0.13, t(41) ⫽ ⫺0.5, or change readiness, b11 ⫽ 0.06, t(41) ⫽ 0.4. Additionally, there were no significant intervention effects observed from pre to follow-up in use of CP, b21 ⫽ ⫺0.11, t(41) ⫽ ⫺0.4, nor change readiness, b21 ⫽ 0.13, t(41) ⫽ 0.7. Change-talk had no significant association with reported use of CP from pre to post, b11 ⫽ 0.03, t(41) ⫽ 0.1, or pre to follow-up, b21 ⫽ 0.02, t(41) ⫽ 0.1. Similarly, change-talk had no significant association with change readiness from pre to post, b11 ⫽ ⫺0.07, t(41) ⫽ ⫺0.4, or from pre to follow-up: b21 ⫽ 0.14, t(41) ⫽ 0.7.


Figure 2. Treatment effects (z scores) for attitudes toward and intention to use CP.

This study demonstrates that a brief in-person intervention, combined with an MI approach, can be effective in changing CP attitudes and behavioral intentions. This is the first study, to our knowledge, to attempt to change parental orientations toward CP through individual discussions. It is also the first study to apply motivational interviewing directly to the problem of CP. Using a diverse sample of mothers, we provided an initial demonstration of the effectiveness of a brief psycho-education for reducing positive attitudes toward and intentions to use CP. These findings are further bolstered by the replication of the crossover group. Though these results are encouraging, it is noted that these positive changes were not accompanied by changes in self-reported use of CP or readiness to change disciplinary behaviors in general; these limitations will be discussed further below. Using a motivational component is especially appropriate for changing CP beliefs, given parents’ resistance to changing their disciplinary beliefs about a culturally entrenched child-rearing behavior (e.g., Benjet & Kazdin, 2003). The MI approach helps

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parents recognize and then verbalize some of their own reasons for change. In turn, this may promote or resolve ambivalent beliefs about CP, allowing them to reorient their own views. Thus, the approach leverages parents’ own views and helps to prompt change in their thinking. Additionally, this study improves on previous attitude change efforts in the area by using growth-curve modeling including a 1-month follow-up, rather than a simpler preand posttest design (e.g., Holden et al., 2014; Scholer et al., 2010). The magnitude of the effect sizes in the present study is noteworthy. Compared with the waitlist group, at the 1-month follow-up the observed treatment effect was large for CP attitudes (draw ⫽ .97) and moderate for behavioral intention (draw ⫽ .61). The effect sizes for attitude change were considerably larger than those observed using a brief Web-based education intervention focusing on research findings (d ⫽ .40; Holden et al., 2014), or a brief video-based training about disciplinary responses (d ⫽ .44; Scholer et al., 2010). Likewise, the current intervention’s effects on CP intentions (d ⫽ .67) substantially outperformed the only other study evaluating this outcome (d ⫽ .14; Holden et al., 2014). Furthermore, the treatment effects here were comparable or greater than those of a longitudinal intervention study on parenting attitudes with first-time parents (d ⫽ .67; Reich et al., 2012). As we hypothesized, mothers’ change-talk played an important role in their outcomes. One mother recognized “this [discussion] just confirms what I’ve always thought [regarding CP], so, it’s like, now I know that I’m going to walk away [from spanking]. I know I am.” A greater proportion of change-talk elicited during the intervention session lead to greater changes in CP attitudes over time, explaining about 40% of the variance in mothers’ slopes on this outcome. This is consistent with prior research emphasizing the importance of change-talk in promoting change (e.g., Hodgins, Ching, & McEwen, 2009). In contrast, sustain-talk (e.g., “some stuff does require a whooping”) reflected resistance to change.

Limitations As with all empirical work, this study had several limitations. Foremost, this was a pilot study of a novel intervention using a relatively small sample. Attrition within the follow-up group further exacerbates this concern. The small sample precluded our ability to investigate subgroup differences on such variables as race/ethnicity or socioeconomic status. Replication of these findings is needed with larger and more diverse samples. Another limitation in the study may actually have reduced the intervention’s effectiveness: characteristics of the clinician. The intervention was administered by a young, White male who was not a parent. It is likely that more experienced practitioners of MI may have even more success with the present approach. In addition, considering the importance of perceived social norms in parents’ use of CP (e.g., Taylor et al., 2011), it is likely that this intervention would be more effective if the clinician shared more similarities with the mothers. Alternatively, we cannot rule out the possibility that mothers’ reports were influenced by demand characteristics. A stronger research design would include corroborating reports of attitude, intention, and behavioral change from the parents’ partners. Methodological issues likely contributed to lack of observed changes in reported use of CP. The PRCM was the outcome measure used to report on practices “over the past week”; all others

constructs were measured at the time of assessment. As such, behavior change was lagged and could only be observed at the follow-up. Also, readiness to change was assessed on “disciplinary behaviors” in general; ratings focusing on readiness to change CP practices specifically would likely yield stronger results. Each of these limitations should be addressed in replication studies.

Research Implications Our study offers a promising intervention method for parents who spank their children. Future studies should seek to expand on this approach, further elucidating the effect of change-talk on attitudes, intentions, and behaviors, and the role of parents’ motivation. To evaluate whether using an MI-based intervention approach is indeed crucial to effect change, it is necessary to compare a simple psycho-education intervention with the current approach. Likewise, it will be important to evaluate intervention effects over a longer time period to test whether the effects are sustained. Future research should also test various approaches to promoting behavior change. One option is including information and perhaps training about appropriate alternatives to CP, such as positive discipline (Durrant et al., 2014). Second, providing a stronger intervention, by using multiple sessions and targeting other social cognition variables, is a promising direction. For example, Bugental and colleagues (2010) used a cognitive reappraisal approach to change parents’ perceptions and interpretations that otherwise would lead to use of CP. The efficacy of utilizing professionals whom parents trust, such as pediatricians and religious leaders to administer the intervention, should also be explored (Taylor et al., 2011).

Clinical and Policy Implications The results have both clinical and policy implications. The use of MI has a strong record in promoting attendance or adherence to more involved treatments (e.g., Chaffin et al., 2011). The single session intervention utilized here may serve as an effective preliminary consultation that could prompt parents to seek more help in addressing their disciplinary challenges with their children. Another strength of this intervention is its transportability. The training can be easily disseminated and used, and with only a modest amount of training, many types of professionals can provide the intervention used here. Recent work developing Web-based MI interventions for physical activity (Friederichs, Bolman, Oenema, Guyaux, & Lechner, 2014) presents a model for improving access and reducing cost of MI-based interventions. Given the current results, developing a similar Web based MI intervention for CP is warranted. Regardless of the method of presentation, motivational psycho-education is a promising approach for addressing a widespread and significant public health concern in a brief and cost-effective manner. The results also speak to the issue of broader social change necessary for addressing a significant public health problem like parental use of CP. Given American views on the preeminence of parental rights to discipline their children as they want, legal prohibitions against the use of CP are unlikely to gain widespread support in the United States in the near future. In the absence of legal reform, the burden of affecting change falls, at least in part, to professionals with direct family contact. This study provides the


promise of an effective approach to changing parents’ cognitions and behavior. Professionals will likely achieve better results if they first establish rapport and are not dogmatic in their efforts to eliminate CP. Rather, explicitly exploring the parents’ own reasons for change can be a powerful instrument for transforming their own attitudes toward this practice.

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Received September 4, 2014 Revision received June 22, 2015 Accepted June 26, 2015 䡲

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