Purpose: To examine the influence of caregiver stress on attendance among urban families involved in a multiple family group (MFG) intervention, as well as pre/post changes in childhood behavioral difficulties, caregiver stress, caregiver depressive symptoms, caregiver coping by substance use, and caregiver motivation to change. Methods: Univariate analyses assessed pre/post differences in outcomes between and within stress groups. Post hoc analyses accounted for missing data and the potential influence of regression to the mean. Results: High caregiver stress was associated with lower rates of attendance in MFG over time. Despite attending the fewest sessions, highest stressed caregivers experienced the most pre/post improvement on measures of caregiver stress and childhood behavioral difficulties. Discussion: Involvement in an MFG intervention is associated with high rates of attendance and meaningful improvements in child and caregiver outcomes, with the most distressed families reporting the greatest reduction in both caregiver stress and childhood behavioral difficulties.