Good News about Innovative Delivery of Brief RE Programs

by Alan J. Hawkins

The Bottom Line:  If relationship education (RE) programs are to help make a dent in the problem of family instability, they will need to reach more in-need participants. Making programs more accessible and less intensive should help with that. Two recent studies – one testing the effectiveness of online RE programs and a second study testing a brief intervention delivered at home – show that innovative programs can be effective for lower income couples.

Even though a large body of research has shown that relationship education (RE) can be effective,[1] this doesn’t mean that relationship educators are having a large impact on the need to help couples form and sustain healthy marriages and relationships and create more stable families for children. As I wrote about in a previous blog, despite our recent successes at getting effective programs to diverse, at-risk participants, we are still only reaching a fraction of the need. We need innovative approaches to reach more if we are going to make a measurable dent in family instability rates.

There is some good news on this front. In this blog, I will highlight recent evaluation work on two programs that show promise for reaching greater numbers of at-risk individuals.

The first study tests whether online delivery of two evidence-based programs – ePREP and OurRelationship – were effective.[2] The study was successful in targeting lower income couples through a variety of recruitment methods, enrolling nearly 1,500 couples. The couples were randomly assigned to one of three equal-size groups: an ePREP treatment group, an OurRelationship treatment group; and a wait-list control group (they were offered a program at the completion of the 6-month study). The treatment-group couples received about 7 hours of online RE content over 6-8 weeks and were supported by coaches who called a few times during the intervention to encourage the couples and answer questions. About 40% of the participants were below the federal poverty level, with another 42% were below 200% of the federal poverty level (but above the FPL). About half were already married; another 25% were engaged, with the rest cohabiting. About half were White.

So, what did this study find?

  • Both the ePREP and OurRelationship groups showed greater improvement in such relationship outcomes as relationship satisfaction, conflict, positive communication skills, and relationship knowledge compared to the wait-list control group. These gains generally were maintained 4 months after the program.
  • The positive effects generally were larger than previous rigorous studies with lower income couples.[3] The researchers speculate that those who participated in the programs were more likely to be actively seeking help rather than just responding to an opportunity to participate in a RE program to strengthen their relationship.
  • Interestingly, initial distress did not impact the results. That is, those couples who reported more distress at the beginning of the program experienced as much improvement, on average, as less distressed couples.
  • Also, despite some important differences between the two online programs (ePREP and OurRelationship), there were few differences in outcomes between them. The ePREP program appeared to produce quicker improvements than the OurRelationship program, but at the end of the study (4 months since end of treatment), outcomes were comparable.
  • In a different set of analyses looking at individual health outcomes rather than relationship outcomes, treatment-group participants also showed greater gains in mental and physical health.[4] Note that these curricula did not directly address mental and physical health, so the derived health benefits likely came through improved relationship functioning.

In the second study, a group of researchers tested the effectiveness of the Marriage Checkup (MC) intervention.[5] (We blogged about this innovative program previously.) The Marriage Checkup involves couples filling out an extensive questionnaire about their relationship, then an in-person assessment with a trained facilitator, followed by a feedback session with the facilitator. Thus, it is a brief, low-intensity intervention. And ideally, couples will do regular marital checkups, not just once (like dental exams). While previous rigorous studies have shown that this brief intervention can be effective, it has not been tested with low-income, at-risk couples. And in this study, the researchers decided to diminish barriers to participation by going to couples’ homes (or another couple-designated site) for in-person facilitation. About 1,300 couples enrolled in the program. (They did not include a control group in this study.)  90% completed the assessment and feedback parts of the intervention, but only 60% remained in the study to provide a 6-month follow-up assessment. Again, most couples in the study were below 200% of the federal poverty level.

So, what did this second study find?

  • Participants in the home-visiting MC program reported small but significant improvements in relationship satisfaction, positive communication, and couple intimacy. They also reported small but significant decreases in relationship aggression.
  • While the average gain was relatively small, the more distressed couples at the beginning of the program gained the most from the intervention.

Here are some implications of these two studies:

  • Think accessibility. Online RE (with low levels of facilitator contact and support) can work, making RE programs more accessible. Importantly, lower income couples seek them out and benefit from them.
  • Think briefer. Each of these RE interventions were briefer than most traditional programs that are offered (about 7 hours for ePREP and OurRelationship, and less than 4 hours for Marriage Checkup). The more intensive and longer the intervention, the more barriers there are to reaching and retaining participants, especially lower income couples. Low dosage and less intensive programs can work.
  • Think need. These more accessible and less intensive programs can work well for distressed couples at-need for relationship strengthening services. And in fact, a lot studies, including the Marriage Checkup study highlighted here, suggest that more distressed couples benefit the most,[6] probably because they are more motivated.

I find these studies encouraging. To make an impact on the problem of family instability, we need effective intervention tools that can reach more disadvantaged and distressed couples. I think reaching them will require that programs be more accessible and less intensive. These studies show that is possible to do.

 

Endnotes:

[1] For reviews of this large body of work, see: Blanchard, V. L., Hawkins, A., Baldwin, S., & Fawcett, E. (2009). Investigating the effects of marriage and relationship education on couples’ communication skills: A meta-analytic study. Journal of Family Psychology, 23, 203–214. doi:10.1037/a0015211; Fawcett, E., Hawkins, A., Blanchard, V., & Carroll, J. (2010). Do premarital education programs really work? A meta-analytic study. Family Relations, 59, 232–239. doi:10.1111.j.1741-3729.2010.00598.x; Hawkins, A., Blanchard, V., Baldwin, S., & Fawcett, E. (2008). Does marriage and relationship education work? A meta-analytic study. Journal of Consulting and Clinical Psychology, 76, 723–734. doi:10.1037.a0012584; Hawkins, A., & Erickson, S. (2015). Is couple and relationship education effective for lower income participants? A meta-analytic study. Journal of Family Psychology, 29, 59–68. doi:10.1037.fam0000045; Hawkins, A. J., Stanley, S. M., Blanchard, V. L., & Albright, M. (2012). Exploring programmatic moderators of the effectiveness of marriage and relationship education: A meta-analytic study. Behavior Therapy, 43, 77-87; Lucier‐Greer, M., & Adler‐Baeder, F. (2012). Does couple and relationship education work for individuals in stepfamilies? A meta‐analytic study. Family Relations, 61, 756–769. doi:10.1111/j.1741-3729.2012.00728.x; Pinquart, M., & Teubert, D. (2010). A meta-analytic study of couple interventions during the transition to parenthood. Family Relations, 59, 221–231. doi:10.1111/j.1741-3729.2010.00597.x; Simpson, D. M., Leonhardt, N. D., & Hawkins, A. J. (2017). Learning about love: A meta-analytic study of individually oriented relationship education programs for adolescents and emerging adults. Journal of Youth and Adolescence. doi: 10.1007/s10964-017-0725-1

[2] Knopp, K., & Rhoades, G. (2018). Effectiveness of online relationship interventions in a randomized controlled trial. Presentation at the Association of Behavioral and Cognitive Therapies, Washington D.C., November 16.

[3] For instance, see: Lundquist, E., Hsueh, J., Lowenstein, A., Faucetta, K., Gubits, D., Michalopoulos, C., & Knox, V. (2014). A family-strengthening program for low-income families: Final impacts from the Supporting Healthy Marriage evaluation. OPRE Report 2013-49A. Washington, D.C.: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services; Avellar, S., Patnaik, A., Covington, R., & Wu, A. (2018). Parents and Children Together: Effects of two healthy marriage programs for low-income couples. OPRE Report Number 2018-58. Washington D.C.: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

[4] Roddy, M. K., Rothman, K., & Doss, B. D. (2018). Presentation at the Association of Behavioral and Cognitive Therapies, Washington D.C., November 16.

[5] Gordon, K. C., et al. (2018). An implementation study of relationship checkups as home visitations for low-income at-risk couples. Family Process. doi: 10.1111/famp.12396.

[6] For a summary, see: Hawkins, A. J., Erickson Allen, S. E., & Yang, C. (2017). How does couple and relationship education affect relationship hope? An intervention-process study with lower income couples. Family Relations. doi: 10.1111/fare.12268