Program Profile: Family Foundations

This is a psychoeducational, skills-based program designed for first-time expectant parents. The program is rated Promising. Findings overall were mixed. Intervention group parents displayed statistically significant better outcomes, compared with control group parents. However, there were only a few statistically significant differences between children in the intervention and control groups.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals/Target Population

Family Foundations is a psycho-educational, skills-based program for first-time expectant parents. The universal prevention program is delivered through childbirth education departments at local hospitals. It is designed to reduce later child problems such as aggressive and antisocial behavior by enhancing the coparenting relationship among cohabiting and married couples expecting their first child.

Program Theory

Family Foundations focuses on improving the quality of coparenting (defined as how parents coordinate their parenting, support or undermine each other, and manage conflict regarding child rearing). The program focuses on coparental support and undermining because these dynamics are linked to parenting and child outcomes, including externalizing and internalizing behaviors (Feinberg et al. 2005). Improvements in coparenting and parenting relationships should improve children’s physiological and emotional self-regulation (Feinberg, Kan, and Goslin 2009).

Program Components

Family Foundations is delivered in a group format across eight sessions. The first four sessions are prenatal classes provided around the fifth or sixth month of pregnancy. The other four sessions are postnatal classes provided when the child is approximately 6 months old. The prenatal classes introduce couples to certain themes and relationship skills. The postnatal classes revisit those themes once the couple has experienced life as parents and coparents.

Most of the program material focuses on enhancing the coparenting relationship, aligning expectant parents’ expectations of each other and of parenthood, and introducing positive childrearing strategies. The material on post-birth expectations familiarizes parents with particular issues they may experience after the birth of their child and the way that these issues may affect coparenting. Parenting strategies discussed in the sessions include an understanding of temperament, fostering children’s self-regulation, and promoting attachment security.

The program includes a combination of didactic presentations, couple communication exercises, written worksheets, videotaped vignettes of other families, and group discussions.

Key Personnel

The classes are led by a male-female co-leader team, so that a role model is offered for each partner. The female leader is usually a childbirth educator.

Study

The follow-up study by Feinberg and colleagues (2010) examined program impacts on the same sample of parents as in Study 1 (Feinberg, Kan, and Goslin 2010). Data was collected from home visits when children were approximately 36 months old (Wave 4). Study attrition was 17 percent for mothers and 23 percent for fathers by Wave 4. There were no significant differences between the intervention and control groups on demographics and pretest variables, except for mother’s level of education. Therefore, parent education level was included as a control variable in all regression models.

Analyses of outcomes included three waves of data from the follow-up at 6 months post-birth through 3 years post-birth, when the data was available. For example, some measures of parenting and child outcomes were only available at the last wave of data collection, as these measures were not appropriate at earlier ages. For measures available at three waves, the data was analyzed in a single model to minimize the number of statistical tests. These models were also examined to see if there was a program effect on change (linear or quadratic) in these outcomes across the three waves. In that manner, it was possible to examine whether initial intervention effects apparent at 6 months post-birth declined (or increased) over the following 2.5 years.

Several outcomes measures were examined in the study. Child outcomes were measured using the Child Behavior Checklist (CBCL). Three overall scores from the CBCL were examined: Total Problems, Externalizing Problems, and Internalizing Problems. Scores from two sub-scales were also examined: Aggression and Hyperactivity. Parenting outcomes were measured using the Parenting Scale, which assess discipline practices in parents of children from 18–48 months. The study focused on three outcomes: the Laxness scale, the Overreactivity scale, and a single item measuring Physical Punishment. Coparenting and couple relationship quality was measured using the Coparenting Scale and the Quality of Marriage Index.

All tests of intervention effects were conducted as intent-to-treat analyses. Analytic models were structured to accommodate the number of waves of data available and the number of respondents per family (both parents versus one parent). Subgroup analyses were conducted to examine the potential impact of gender on program outcomes.

Study

Feinberg, Kan, and Goslin (2009) used a randomized trial involving 169 heterosexual couples to examine the impact of the Family Foundations program. The couples recruited for the study were expecting their first child, at least 18 years of age, and living together (regardless of marital status). Data was collected between 2003 and 2007. Pretest data was collected during home interviews when the mothers were pregnant (Wave 1). After the pretest, couples were randomly assigned to the intervention condition (n = 89) or the no-treatment control condition (n = 80). The intervention condition received the Family Foundations program, and the no-treatment control condition received a brief brochure in the mail about selecting quality childcare.

The couples were recruited from medium-sized cities in Pennsylvania (Altoona and Harrisburg). The majority of the study participants (91 percent of the mothers and 90 percent of the fathers) were non-Hispanic White, and the other participants were African American, Asian, Hispanic, or other. The average age was 28.33 years for the mothers and 29.76 years for the fathers. There were no significant differences between the intervention and control groups on demographics and other pretest variables.

A previous study by Feinberg and Kan (2008) examined follow-up data from mail-in questionnaires when the children were roughly 6 months old (Wave 2). For this study, follow-up data collection occurred during homes visits when the children were an average age of 13.7 months old (Wave 3). Family interactions were videotaped at both pretest and follow-up. At pretest, the expectant parents engaged in two couple relationship discussion tasks. At the follow-up, families engaged in two interactions as a triad. Undergraduate and graduate students were trained to rate the videotapes using a global coding system of 5- to 7-point scales. The codes were developed for this project or adapted from prior work. The coders rated coparenting, parenting, child behavior, and dyadic couple interaction. All coders were blind to experimental condition.

The effects of the Family Foundations intervention were tested using intent-to-treat analyses (meaning data from all parents who completed the follow-up were included regardless of how much they participated in the program). For parallel behaviors by mothers and fathers, analyses were conducted as multivariate multi-level regression models. For child behavior outcomes, analyses were conducted with a general linear model regression approach. No subgroup analyses were conducted.

Additional information about Family Foundations is available on the program’s website.

Subgroup Analysis

Feinberg and colleagues (2010) conducted subgroup analyses to determine the potential impact of gender on program outcomes. They found that boys in the Family Foundations intervention group demonstrated a statistically significant fewer number of overall behavior problems, externalizing behaviors, internalizing behaviors, hyperactivity, and aggression, compared with control group boys, at the 36-month follow up. However, there were no statistically significant differences in any of the outcomes between girls in the intervention group and girls in the control group, at the 36-month follow up.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: