An Implementation Study of Relationship Checkups as Home Visitations for Low‐Income At‐Risk Couples

• Published date: 01 March 2019
• Author: James V. Cordova,Tatiana Gray,Kerri Martin,Matt Hawrilenko,Kristina Coop Gordon,Patricia N. E. Roberson,Katherine A. Lenger,Melanie Miller
• Date: 01 March 2019
• DOI: http://doi.org/10.1111/famp.12396

An Implementation Study of Relationship Checkups

as Home Visitations for Low-Income At-Risk

Couples

KRISTINA COOP GORDON*

JAMES V. CORDOVA

†

PATRICIA N. E. ROBERSON

‡

MELANIE MILLER*

TATIANA GRAY

†

KATHERINE A. LENGER*

MATT HAWRILENKO

†

KERRI MARTIN*

Couples with the greatest need for relationship health maintenance and intervention are

often least able to afford and access it; therefore, accessible, affordable, effective, and brief

interventions are needed to improve relationship health for those who need it most. Conse-

quently, this paper examined whether a brief relationship intervention could be effectively

implemented with a low-income, underserved population. All enrolled participants

(N=1,312) received the Relationship Checkup, which consists of an assessmen t and a

feedback session delivered in their homes or at a local clinic at their request. Measures

assessed relationship satisfaction, communication, psychological and physical aggression,

and intimacy at baseline and 1-month follow-up, and program and relationship satisfac-

tion at 6-month follow-up. All participants reported significant improvements on all out-

comes with small effect sizes. However, moderation analyses suggested that distressed

couples reported significantly larger effects across the board. Overall, participants repo rted

that they were highly satisfied with the intervention both immediately after its delivery

and 6 months later. Find ings provide preliminary support for the effectiveness of this brief

checkup and point to the utility of offering these kinds of low-cost brief interventions in flex-

ible formats for those who might have the most difficulty accessing them.

Keywords: Low-Income; Relationship Satisfaction; Brief Couple Intervention

Fam Proc 58:247–265, 2019

Studies often report that the divorce rate is stabilizing or even falling. However, this

decrease only appears to be among highly educated and affluent white couples. Cou-

ples with less education, lower income levels, and ethnic minority couples are marrying at

*Psychology Department, University of Tennessee, Knoxville, TN.

†

Francis L. Hiatt Department of Psychology, Clark University, Worcester, MA.

‡

Human Ecology Department, University of California, Davis, CA.

Correspondence concerning this article should be addressed to Kristina Coop Gordon, Psychology

Department, University of Tennessee, 310B Austin Peay, Knoxville, TN 37996-0900. E-mail: kgordon1@

utk.edu.

Funded by the U.S. Department of Health and Human Services, Administration of Children and Fami-

lies, Office of Family Assistance Grant #90FM0022. We would also like to thank the countless facilitators

and research assistants who made this project possible. Lastly, we are so grateful to the couples who

opened their homes and lives to us. We are forever in your debt.

247

Family Process, Vol. 58, No. 1, 2019 ©2018 Family Process Institute

doi: 10.1111/famp.12396

a lower rate, divorcing at a higher rate, and are more likely to engage in serial cohabita-

tion (Blackwell, 2010; Kennedy & Ruggles, 2014). Unfortunately, this discrepancy has a

host of negative physical and mental health implications for adults in these unstable rela-

tionships (e.g., Robles, Slatcher, Trombello, & McGinn, 2013; Whisman & Uebelacker,

2012). Furthermore, children in relationally discordant and unstable homes are more

likely to experience poverty, child abuse and maltreatment, lower academic achievement ,

and poorer physical and emotional health (e.g., Blackwell, 2010; Cowan & Cowan, 2014).

The effects of relationship distress and instability appear to be substantial and are likely

to continue to grow, given the well-documented intergenerational transmission of rela-

tional discord (e.g., Blackwell, 2010). Relationship education programs could potentially

reach these underserved couples before they are in crisis and stabilize fragile families.

This paper describes findings from a large federally-funded implementation project that

assessed the effectiveness of a brief relationship intervention targeting underserved cou-

ples, the Marriage Checkup (MC; Cordova et al., 2014).

Overview of Existing Relationship Programs

One of the largest projects to date to improve relationship functioning stems from the

Administration for Children and Families’ Healthy Marriage Initiative, which provided

relationship education to primarily economically disadvantaged and minority couples.

Unfortunately, the global findings from these studies have yielded mixed result s (for an

extensive critique, e.g., Johnson, 2012). One of the major critiques was the lack of stan-

dardization of empirically-supported relationship education programs (e.g., Johnson,

2012); however, smaller, tightly controlled relationship education programs developed in

university settings have tended to be more efficacious, most notably in terms of improving

relationship quality and communication skills (Markman & Rhoades, 2012). Thus, Haw-

kins (2014) concludes that although the totality of these programs has found modest,

mixed effects for relationship education, this summation does not mean they are invalid,

but rather they are still in a period of efficacy development.

Many of these programs struggle with the inevitable structural barriers to treatment

that economically disadvantaged populations encounter. These problems can include

logistical issues such as difficulty making time for classes, lack of transportation or unreli-

able transportation, lack of child-care, and cost of services, as well as social barriers such

as stigma regarding professional help seeking and discomfort sharing in a group setting

(e.g., Bradbury & Lavner, 2012; Busby, Larson, Holman, & Halford, 2015). Consequently,

programs wishing to extend their reach into the highest-risk populations require flexible

and briefer delivery (e.g., Halford, 2004). Also, many programs focus on improving commu-

nication skills, which—while helpful to some couples—may not be wholly effective for rela-

tionship education (see Owen, Manthos, & Quirk, 2013; Rogge, Cobb, Lawrence, Johnson,

& Bradbury, 2013, for in-depth discussions of this issue); thus, alternative strategies tar-

geted toward motivational and affective systems may improve these programs’ effective-

ness (e.g., Bradbury & Lavner, 2012). A new relationship intervention, the MC (Cordova

et al., 2014), addresses many of these issues and has the potential to better meet the needs

of a low-income population.

The Marriage Checkup

The Marriage Checkup is a brief intervention designed to be the relationship health

equivalent of an annual physical or dental checkup. The presumption underlying the

checkup healthcare model is that, similar to other health systems, intimate relations hips

require regular preventative care to maintain optimal health and avoid preventable dete-

rioration. The MC is a two-session model comprised first of initial questionnaires, then an

www.FamilyProcess.org

248

/

FAMILY PROCESS