The transition to parenthood is a stressful period for most parents as individuals and as couples, with variability in parent mental health and couple relationship functioning linked to children’s long-term emotional, mental health, and academic outcomes. Few couple-focused prevention programs targeting this period have been shown to be effective. The purpose of this study was to test the short-term efficacy of a brief, universal, transition-to-parenthood intervention (Family Foundations) and report the results of this randomized trial at 10 months postpartum. This was a randomized controlled trial; 399 couples expecting their first child were randomly assigned to intervention or control conditions after pretest. Intervention couples received a manualized nine-session (five prenatal and four postnatal classes) psychoeducational program delivered in small groups. Intent-to-treat analyses indicated that intervention couples demonstrated better posttest levels than control couples on more than two thirds of measures of coparenting, parent mental health, parenting, child adjustment, and family violence. Program effects on family violence were particularly large. Of eight outcome variables that did not demonstrate main effects, seven showed moderated intervention impact; such that, intervention couples at higher levels of risk during pregnancy showed better outcomes than control couples at similar levels of risk. These findings replicate a prior smaller study of Family Foundations, indicating that the Family Foundations approach to supporting couples making the transition to parenthood can have broad impact for parents, family relationships, and children’s adjustment. Program effects are consistent and benefit all families, with particularly notable effects for families at elevated prenatal risk.
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We appreciate the assistance of Mary Metzger, Stephanie Rogers, and Becky Law and the facilitators in implementing the program. This study was funded by a grant from the National Institute of Child Health and Development (HD058529), Mark Feinberg, PI.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The views expressed in this article are those of the authors and do not necessarily represent the views of NICHD or Penn State University.
Conflict of interest
Dr. Feinberg created Family Foundations and is the owner of a private company that disseminates the program. Dr. Feinberg’s company has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at Pennsylvania State University for potential financial gain. The other authors declare no potential conflict of interest.
Observed Family Interaction Procedures
Family interaction was videotaped at both pretest and posttest. At pretest, expectant parents engaged in two couple relationship discussion tasks. In the first task, couples were asked to talk about their day or a concern on their mind not related to their relationship. Each partner took turns with 6 min as the focal talker and 6 min as the listener. For the second task, couples were asked to talk for 120 min about three problems in their relationship that they had rated highly from a list of desired changes; they were asked to discuss the conflict and if possible to problem solve. At posttest, the couples engaged in only the second conflict-focused discussion for 12 min.
At posttest, families engaged in two interactions as a triad. First, parents and the child engaged in 12 min of joint free play on the floor with a limited set of toys provided by the interviewer. Second, parents were asked to teach their child for 6 min to accomplish a set of tasks designed to be at the limit of most infants’ developmental capacity (e.g., rolling a ball back and forth with a parent, building a tower of blocks).
Parent-Report Questionnaire Measures
Coparenting quality as perceived by parents at posttest was represented through a total score on the Coparenting Relationship Scale (Feinberg et al. 2012). The overall score was calculated as the average of the following six subscales: coparental agreement, support, partner’s parenting, closeness while parenting, undermining, and exposure of the child to conflict (α = 0.85 for mothers, α = 0.83 for fathers). A total score from the Quality of Marriage Index (Norton 1983) provided a measure of relationship satisfaction. Using a Likert response scale with six items, parents were asked about their relationship in terms of stability, feeling of partnership, and overall happiness in the relationship (α = 0.96 for mothers and fathers). Items for this measure had slightly different scales; thus, we standardized (mean = 0) before combining.
Depressive symptoms was gauged by a total score from Center for Epidemiological Studies Depression Scale (Radloff 1977). Questions are asked regarding the respondent’s feelings and outlook within the past week (Radloff 1977). We used an abbreviated 14-item scale from the original 20-item version that was been highly correlated in prior research with the full scale. Items were rated using a four-level response scale ranging from rarely/none of the time to always/most of the time, covering issues such as degree of loneliness and whether people were perceived as unfriendly (α = 0.85 for mothers, α = 0.83 for fathers).
Anxiety was assessed using the 10-Item Trait Scale from the State-Trait Anxiety Inventory Scale (Spielberger et al. 1983). Questions cover topics such as how much the respondent feels nervous, pleasant, or content, with responses given on a four-item scale ranging from “almost never” to “almost always.” The scale has good internal consistency (α = 0.90 for mothers, α = 0.88 for fathers). A measure of anxiety was utilized from an average of the seven items in the Penn State Worry Questionnaire, reduced from the original 16-item survey (Beck et al. 1995; Meyer et al. 1990) to seven items for this project (α = 0.94 for mothers and α = 0.93 for fathers). Questions covered assessment of the generality, excessiveness, and uncontrollability of worries. Responses were made on a five-point scale ranging from “not at all typical” to “very typical.”
Parental efficacy was measured using a total score from the Being a Parent Scale (Gibaud-Wallston and Wandersman 1978; Pedersen et al. 1989) measured at posttest. The 10-item pretest version assesses expected capability of being a parent and potential stressors about the responsibility. Two items were dropped at posttest (α = 0.77 for mothers, α = 0.78 for fathers). To measure parenting stress at posttest, we used a total score on the Parenting Stress Index (Abidin 1995) abbreviated from 36 to 27 items for this study. Parents provided responses using a five-point Likert scale, indicating level of agreement with statements about issues such as perceived problems associated with caring for a child and overall satisfaction with parenthood (α = 0.91 for mothers and for fathers).
Measures of child soothability and duration of orientation were each derived from six items in the Infant Behavior Questionnaire (Gartstein and Rothbart 2003). Soothability was comprised of items regarding how well the infant responds to parental behaviors like holding or singing. Duration of orientation was assessed with items regarding how attentive the baby was to objects such as mobiles and books. Alphas for soothability and duration of orientation were 0.77 and 0.78 among mothers and 0.75 and 0.83 among fathers, respectively. Three outcomes representing child sleep characteristics were taken from the Child Sleep Questionnaire (Seifer et al. Jul 1996), reported at posttest by mothers only.
The revised Conflict Tactics Scale (CTS2) (Straus et al. 1996) provided measures of interpartner physical and psychological aggression behaviors in the past year reported by each parent. Both parents reported on the same behaviors twice, once as perpetrator and once as victim. We utilized the highest report by either parent to represent the score for each behavior (e.g., mother hit father; father yelled at mother). Physical assault consisted of eight items such as punching, arm twisting, or throwing something at the partner. Psychological aggression was comprised of four items such as name calling or insulting the partner. Parent-child physical and psychological aggression was reported by both parents using the Parent-Child Conflict Tactics Scale (Straus et al. 1998), adapted from the Conflict Tactics Scale. The physical violence total combined seven items including shaking, pinching, and spanking. Parent-child psychological aggression consisted of five items including screaming at the child, threatening to spank, or calling the child names. Response options involved ranges of amounts (e.g., this happened 4–10 times in the past year). We utilized the midpoint count of each range in order to create average scale scores.
Control variables used in all analytic models included basic demographics such as income, age, and marital status, reported by parents at baseline. In addition, a measure of economic strain was created from three items asking how much a respondent has had to reduce standard of living recently, inability to afford certain essentials, and difficulty living on current income (α = 0.69 for mothers and 0.65 for fathers) (Howe et al. 1995; Kessler et al. 1988). A measure of social desirability was included to control for potential bias in models for self-report outcomes. We derived this score from 13 items taken from the Marlowe-Crowne short form (Crowne and Marlow 1960; Marlow and Crowne 1961). Respondents were asked whether they endorsed items such as always being courteous and willingness to admit making a mistake (α = 0.64 for mothers and 0.65 for fathers). For coparenting and dyadic measures, a seven-item measure of pretest couple efficacy (Fincham and Bradbury 1987) was used to control for the couple’s ability to manage interpersonal conflict (α = 0.85 for mothers and 0.84 for fathers).
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Feinberg, M.E., Jones, D.E., Hostetler, M.L. et al. Couple-Focused Prevention at the Transition to Parenthood, a Randomized Trial: Effects on Coparenting, Parenting, Family Violence, and Parent and Child Adjustment. Prev Sci 17, 751–764 (2016). https://doi.org/10.1007/s11121-016-0674-z
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