A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn

• Author: Danielle M. Mitnick,Michael F. Lorber,Katherine J. W. Baucom,Richard E. Heyman,Amy M. Smith Slep
• DOI: http://doi.org/10.1111/famp.12428
• Date: 01 September 2019
• Published date: 01 September 2019

A Research Program Testing the Effectiveness of a

Preventive Intervention for Couples with a Newborn

RICHARD E. HEYMAN*

KATHERINE J. W. BAUCOM

†

AMY M. SMITH SLEP*

DANIELLE M. MITNICK*

MICHAEL F. LORBER*

Noxious family environments are associated with a wide range of adverse child out-

comes. In order to prevent couple and parent–child relationship problems, a number of pro-

grams have been developed for couples with newborns. The current paper describes a

program of research evaluating the American version of couple CARE for parents of new-

borns. This version of CCP was administered to low-income, unmarried couples with a

new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist

control condition in a randomized controlled trial (Study 2), and evaluated with low-

income parents recruited from urban hospitals in two major metrop olitan areas of the Uni-

ted States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventiv e

effects of the program were limited and there was one potential iatrogenic effect. Results

were likely impacted by major challenges with recruiting participants and maintaining

their engagement in CCP for the duration of the program. We discuss methodological dif-

ferences between this series of studies and previous trials of prevention programs and make

recommendations for improving service delivery to at-risk new parents. These results have

implications for public policies that aim to benefit children and families.

Keywords: Couple Relationship; Prevention; Socioeconomic Status; Randomized

Controlled Trial; Intimate Partner Violence

Fam Proc 58:669–684, 2019

Healthy, stable couple and parent–child relationships are widely touted as the bedrock

of societies (e.g., Peterson & Bush, 2013). However, reality often falls short of aspira-

tions for such relationships given the high prevalences of divorce (Teachman, Tedrow, &

Kim, 2013), intimate partner violence (IPV; Heyman, Slep, & Foran, 2015), and child mal-

treatment (Slep, Heyman, & Foran, 2015). These noxious home environments are a public

health concern of substantial magnitude for both children and their parents. A meta-ana-

lysis of 118 studies found that children in noxious environments, compared with controls,

fared significantly worse on a host of outcomes (Kitzmann, Gaylord, Holt, & Kenny, 2003).

Such environments may be more the rule than the exception, with nearly two thirds of

young children living in homes with parental emotional or physical IPV (Slep & O’Leary,

2005).

*Family Translational Research Group, New York University, New York, NY.

†

Department of Psychology, University of Utah, Salt Lake City, Utah.

Correspondence concerning this article should be addressed to Richard E. Heyman, Family Transla-

tional Research Group, New York University, New York, NY 10010. E-mail: richard.heyman@Nyu.edu

669

Family Process, Vol. 58, No. 3, 2019 ©2019 Family Process Institute

doi: 10.1111/famp.12428

Around the turn of the century, stakeholders in high-income countries—politicians, pol-

icy makers, researchers, religious leaders, social service agencies, advocates—joined to try

to turn the tide and avoid raising yet another generation in noxious homes (see Cowan &

Cowan, 2014). Given antipathy in the United States toward European-style social services

for young parents and U.S. norms emphasizing individual responsibility for behavior,

momentum built toward investing in relationship education programs (Giele, 2013). Sup-

port for programs promoting respectful, nonviolent intimate partner and parent- child

relationships reached its apex in the mid-2000s with the massive federal funding of the

building strong families (BSF) study (Wood, Moore, Clarkwest, Hsueh, & McConnell,

2010) and Healthy Marriage Initiatives (HMI; see Cowan & Cowan, 2014).

The United States has spent nearly $1 billion in the last decade to propagate and evalu-

ate prevention programs for couples and parents, frequently targeting couples with new-

borns. The logic behind prevention programs held that if healthy, stable relationships are

due to partners’/parents’ behavior, then prevention programs at key developmental mile-

stones that teach and/or bolster skills could reduce the emotional and financial cost of

problems, improve public health, and more broadly, the commonwealth.

The birth of a child is a propitious prevention crossroad that was explicitly targeted by

both U.S. policymakers (Cowan & Cowan, 2014; Johnson, 2012) and preventionists (Fein-

berg, 2002).First, new parents recognize the challenges facingthem, providing a critical per-

iod for optimal openness to learning/improving relationship and parenting skills (Halford,

Markman, Kline, & Stanley, 2003). Second, high-risk couples agree to participate in preven-

tion prior to the birth of a child at rates higher than do such couples prior tomarriage (Petch,

Halford, Creedy, & Gamble, 2012a). Third, the perinatal period is an important one for pre-

vention, as partners are at slightly elevated risk for IPV (Charles & Perreira, 2007) and sub-

stantial relationship satisfaction decline (see meta-analysis by Mitnick, Heyman, & Smith

Slep, 2009). Yet, effectiveness studies of such programs have been decidedly mixed (e.g.,

Mayer, Kalil, Oreopoulos, & Gallegos, 2015; Moore, Avellar, Patnaik, Covington, & Wu,

2018; Pinquart & Teubert, 2010; Wood et al., 2010) and, of greater concern, there have been

indications of iatrogenic effects, especially around IPV (e.g., Moore, Wood, Clarkwest, Kille-

wald, & Monahan, 2012). Thus, despite some promising results and the possible openness of

parents to prevention during the perinatal period, further research is needed to test both

effectiveness and iatrogenic effects.

In summary, noxious home environments are endemic and are especially harmful to pub-

lic health, with direct and lasting effects on childhood well-being while modeling harmful

behaviors for children to repeat in their own adult homes. Programs that could effectively

instill respectful, nonviolent behavior between parents and from parents toward children

would likely improve adult and child health and well-being now and provide a large down

payment toward future generations’ safety, stability, and satisfaction in their homes.

This paper will describe a program of research testing a prevention intervention—cou-

ple CARE for parents (CCP), originally developed in Australia—that targets both couple

and parent behaviors during the perinatal period. We first describe the theoretical and

empirical justification for CCP and the development of the U.S. adaptation. We then sum-

marize four trials: (Study 1) an uncontrolled trial with exurban low-income, unmarri ed

parents of a newborn; (Study 2) a randomized controlled trial (RCT) with exurban parents

of a newborn as a primary prevention agent for clinically significant IPV; (Studies 3 and 4)

small trials with mostly minority, low-income urban parents of a newborns.

Theoretical and Empirical Justification for Couple CARE for Parents

Couple CARE for parents targets interpersonal processes within relationships and pro-

motes skills-based changes in behavior among couples with a newborn. It bears some

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