Evaluation of home‐based Family Foundations targeting perinatal mental health and couple conflict in Australia

• Published date: 01 July 2022
• Author: Rebecca Giallo,Monique Seymour,Lorraine Skinner,Alison Fogarty,Karen Field,Jemma Mead,Helen Rimington,Kate Galea,Tom Talevski,Claire Ruthven,Stephanie Brown,Mark Feinberg
• Date: 01 July 2022
• DOI: http://doi.org/10.1111/fare.12647

RESEARCH

Evaluation of home-based Family Foundations

targeting perinatal mental health and couple conflict

in Australia

Rebecca Giallo

1,2,3

| Monique Seymour

1

| Lorraine Skinner

1

|

Alison Fogarty

1

| Karen Field

4

| Jemma Mead

4

|

Helen Rimington

4

| Kate Galea

4

| Tom Talevski

5

|

Claire Ruthven

5

| Stephanie Brown

1,2,6

| Mark Feinberg

7

1

Murdoch Children’s Research Institute,

Parkville, Australia

2

Department of Paediatrics, The University of

Melbourne, Melbourne, Australia

3

School of Psychology and Public Health, La

Trobe University, Bundoora, Australia

4

Drummond Street Services, Carlton,

Australia

5

Merri Health, Coburg, Australia

6

Department of General Practice, The

University of Melbourne, Melbourne,

Australia

7

Prevention Research Center, The

Pennsylvania State University, University

Park, Pennsylvania, United States

Correspondence

Rebecca Giallo, Murdoch Children’s Research

Institute, Royal Children’s Hospital,

Flemington Road, Parkville, Victoria 3052,

Australia.

Email: rebecca.giallo@mcri.edu.au

Funding information

National Health and Medical Research

Council; Department of Health and Human

Services, State Government of Victoria

Abstract

Objectives: A formative evaluation of a home-based family

intervention, Family Foundations (FF), targeting parent

mental health and conflict in the perinatal period was con-

ducted. The aims were to (a) assess parent satisfaction and

recommendations for improvement, (b) identify perceived

enablers and barriers to engagement, and (c) obtain pre-

liminary outcome data related to parent mental health,

conflict, and coparenting.

Methods: A mixed-methods evaluation was conducted

with 41 families at risk of or experiencing parental conflict.

FF was delivered by two organizations in Australia. Quali-

tative interviews with parents and FF clinicians were con-

ducted, and intervention outcomes were assessed using

parent survey.

Results: Feasibility of reach and recruitment of the target

population was demonstrated. Parents’indicated a high

level of satisfaction with all aspects of FF and offered rec-

ommendations for improvements to resources and deliv-

ery. Service, program, clinician, and family characteristics

as enablers and barriers to engagement in FF were identi-

fied. Both mothers and partners reported a decrease in

their child’s exposure to conflict. Mothers also reported a

decrease in mental health symptoms and parenting hostil-

ity and an increase in positive coparenting behavior.

Conclusion: Feasibility and acceptability of home-based

FF in the perinatal period had been established, with pre-

liminary evidence of positive outcomes for families.

Received: 9 October 2020 Revised: 31 March 2021 Accepted: 20 May 2021

DOI: 10.1111/fare.12647

© 2022 National Council on Family Relations.

1036 Family Relations. 2022;71:1036–1057.wileyonlinelibrary.com/journal/fare

Implications: The current findings generate evidence to

inform further development of home-based FF and wider

implementation in health and social care services in

Australia.

KEYWORDS

Family Foundations, intervention, parent conflict, parent mental health,

perinatal

In the first postnatal year approximately one in four women (Dennis et al., 2017; Gavin

et al., 2005) and one in 10 men experience mental health difficulties (Giallo et al., 2012;

Paulson & Bazemore, 2010), and many parents experience a decline in relationship satisfaction

(Mitnick et al., 2009). Although estimates are wide-ranging across studies, 20% to 35% of par-

ents experience frequent and serious arguments and conflict (Liu & Tronick, 2013; Westrupp

et al., 2015; Yelland et al., 2010). For some parents, particularly those experiencing economic

and social disadvantage, mental health difficulties and conflict can escalate and persist well

beyond the postnatal period (Giallo et al., 2014; Wajid et al., 2020). The negative effects of

mental health difficulties and conflict on parenting behavior (Giallo et al., 2015;

Krishnakumar & Buehler, 2000) and a range of emotional, social, and learning outcomes for

children are well established (Kingston et al., 2012; Rhoades, 2008; van Eldik et al., 2020).

Interventions targeting parent mental health difficulties and conflict during the critical early

years of children’s lives are paramount.

A range of prevention and early interventions have been developed to promote parent men-

tal health and relationship functioning after having a baby. Universal prevention approaches

often include written or online psychoeducation that parents can work through independently,

as well as group-based prevention programs such as What Were We Thinking? (Fisher

et al., 2016). Prevention programs tend to be brief, focusing on early infant care and strategies

for coping, self-care, mutual support, and communication (Pinquart & Teubert, 2010). Targeted

counseling interventions (i.e., Couples CARE for parents; Petch et al., 2012) are also available

for parents with more complex and long-standing relationship difficulties. Evidence for the

effectiveness of couple-based interventions during the transition to parenthood was demon-

strated in a meta-analysis of 24 controlled studies representing 21 universal (n=18) and

targeted (n=3) interventions (Pinquart & Teubert, 2010). Small effects for couple communica-

tion, couple adjustment, and parent mental health were found, and stronger effects were dem-

onstrated for interventions that included both antenatal and postnatal sessions, were longer

than five sessions, and were delivered over a 3- to 6-month period.

Family Foundations (FF) is an example of a universal group intervention spanning several

months across the antenatal and postnatal periods (Feinberg & Kan, 2008). It is generally set apart

from the couple-based interventions mentioned earlier because it focuses on the coparenting rela-

tionship or “parenting partnership”rather than the parents’intimate or romantic relationship

(Feinberg & Kan, 2008). This focus means it is appropriate for parents and other caregivers parent-

ing in diverse family contexts (e.g., foster or extended families; single parents; parents living else;

stepfamilies; LGBTQIA+families). The eight manualized sessions focus on building skills to

(a) manage common challenges in raising children (life stress, differences in parenting), (b) decrease

anxiety and stress (relaxation, self-care), (c) strengthen coparenting relationships (decision-making,

mutual support), and (d) reduce conflict (conflict management, problem-solving).

Figure 1provides an overview of the FF content, approaches, and intended outcomes for

parents and children. The intervention content and delivery is underpinned by family stress

theory (Conger & Conger, 2007), which proposes that economic and social hardships and dis-

parities strain couple and parent–child relationships, and by emotional security theory

PILOT EVALUATION OF HOME-BASED FAMILY FOUNDATIONS 1037