Carolyn Pape Cowan and Philip A. Cowan, University of California, Berkeley, USA
Couples groups, father involvement interventions, and parenting classes have all been promoted as programs that will improve the lives of children. This article describes the evolution and evaluation of a parent education program that invites couples to work in groups with clinically trained co-leaders and has positive effects on children from 18 months to 10 years after the intervention ends. The authors’ intention is that this evidence-based approach to working with mothers and fathers as co-parents, and emphasizing fathers’ family involvement, can broaden the definition of what should be included in parent education programs.
There is ample evidence in both the USA and Great Britain that many contemporary families are in trouble. Divorce rates, while not rising, continue to be very high. Primary custody of children continues to be awarded more often to mothers, despite vigorous protests by some fathers. These trends mean that fathers are less likely to be involved with their children, a concern because of ample evidence that children of non-resident or absent fathers are at higher risk for the development of academic, social, and behavior problems than children living with two parents. With an eye on the wellbeing of young children, government and health service providers have attempted to address these problems by creating preventive interventions - to help deal with relationship issues before parents head for divorce courts, or to enhance father involvement in both single-parent and two-parent families. A third alternative - parenting classes to strengthen parent-child relationships and encourage more effective parenting strategies - has been offered by various community agencies for more than a century.
In our view, the main problem with these approaches is that they have been designed, delivered, and funded in separate departmental or agency silos. Couple Relationship Education most often occurs in couples groups that target couple issues and include both fathers and mothers, but rarely address parenting issues. Father involvement interventions most often involve men meeting in groups led by men, which may include discussions of parenting strategies but rarely deal with fathers’ relationships with the mothers of their children. Parenting classes are open to both mothers and fathers, but except for childbirth preparation classes focused on labor and delivery, the vast majority of attendees are women. This emphasis tends to relegate fathers to a diminished role and marginalize their potential as important resources for both mother and child. Most important from our point of view is that parenting classes and self-help parenting books almost never address how parents can deal with each other effectively when they are in conflict. We believe that an intervention approach is needed that considers the family as a dynamic system in which individual characteristics and qualities of the central family relationships interact to affect parents, key family relationships, and the developing child.
Parent education needs to address couple conflict
A theoretical framework for family-strengthening interventions
The science of prevention (Coie et al., 1993) dictates that to create intervention programs, we should start by identifying risk and protective factors related to the outcomes we have in mind, design an intervention with a curriculum that addresses these factors, and assess whether the intervention actually reduces risk and enhances protective strengths in the participants. Based on many correlational studies and our own research in three intervention evaluation studies of middle-income, working-class, and low-income parents, we developed an empirically validated 5-domain risk model of the family factors associated with how successfully children or adolescents cope with the academic, social, and emotional challenges in their lives. The domains are:
(1) The level of adaptation of each family member - self-perceptions and indicators of mental health and psychological distress
(2) The quality of the relationship between the parents - problem solving and co-parenting strategies, regulation of emotion, commitment, and satisfaction
(3) Both couple- and parent-child relationship patterns as transmitted across the generations
(4) The quality of the mother-child and father-child relationships and their parenting strategies
(5) The balance between life stressors and social supports outside the immediate family.
An extensive body of research shows that for both middle-class and low-income couples, the transition to parenthood poses similar challenges and represents a period of disequilibrium that leads to distress for many parents. More than 50 studies conducted in many countries have shown that on the average, marital satisfaction declines over many years (Twenge et al., 2003) with greater declines after having a child. Marital conflict and distress between partners and increasing negative relationship quality over time are correlated with less effective parenting, less collaborative co-parenting, and a variety of negative outcomes for children and adolescents (Cummings & Schatz, 2012).
These factors also help to explain what leads to fathers’ active involvement with their children. We know from many studies that when fathers are positively engaged in day-to-day relationships with their children, children fare better as youngsters and young adults, mothers are less depressed and more satisfied with their relationships as couples, and fathers themselves are both healthier and happier (Lamb & Lewis, 2013; Tamis-LeMonda & Cabrera, 2013; Parke, 2002). These five aspects of life also predict how involved fathers are likely to be. For example, men who report few symptoms of psychological distress or substance abuse, positive relationships with their fathers, low life stress (poverty or job loss), and involvement in supportive social networks are more likely to spend quality time with their children. ‘The most salient predictor of father involvement for both married and unmarried parents is the quality of the father’s relationship with the mother’ (Cowan et al., 2008).
The father’s relationship with the mother predicts his involvement with the child
Much of the early research supporting this 5-domain model was conducted with middle-class families. Our working hypothesis was that our risk model would also apply to low-income families, and the results of our most recent intervention studies are bearing this out. Studies of low-income married couples find that poverty exacerbates the strain for couples and parent-child relationships, and that strain is linked with more negative outcomes for the children, as it is in middle-income families (Cowan & Cowan, 2005). Difficulties associated with inadequate financial resources raise additional challenges for poor parents who are attempting to cope with all the stressors of any new parents who must find ways to balance the cumulative demands of a puzzling new infant, lack of sleep, new financial demands on the family, work pressures or loss of work, less contact with friends, and complex interactions with extended family and kin.
Our program and results
In the 1970s, we began by designing a curriculum that attempted to address the family factors that affect children’s development, particularly the quality of relationship between the parents, and the active role of the father in daily family life. The modality we chose for intervention was a group of four to seven couples meeting weekly over a period of months with clinically trained co-leaders. Our three intervention programs had different names and eventually a more explicitly manualized curriculum, but the essential core of the approach has continued from the late 1970s to the present day.
Becoming a family (Cowan & Cowan, 2000)
In this study, 96 couples were randomly assigned to a couples group intervention or a no-group condition. Faculty and graduate students in clinical psychology formed male-female, co-leader teams who met weekly for six months with small groups of working-class and middle-class couples - from mid-pregnancy to three months after the birth of their first baby (48 hrs total contact time). Through interviews, questionnaires and observations before and after birth, all couples, with and without the intervention, were assessed on each of the five family domains in late pregnancy, and 9 months, 1.5 years, 3.5 years, and 5.5 years postpartum when the children made their transition to primary school. The group intervention with the parents had a long-term significant effect over six years on the parents’ marital satisfaction (Schulz et al., 2006) demonstrating that working on challenging family issues during the transition to parenthood prevented the normative decline of relationship satisfaction over time.
Schoolchildren and their families
(Cowan et al., 2005)
In our second intervention study, 100 couples were recruited to participate in a randomized clinical trial of a program for couples with a first child about to make the transition to primary school. One-third of the parents were randomly assigned to a low-dose control condition, in which they had the option of consulting with the clinically trained male-female staff teams (psychologists and social workers) who had interviewed them when they entered the study - once in the pre-kindergarten, kindergarten, and first grade years (3 hrs total contact time). The remaining two-thirds were offered couples groups that met for 16 weeks before the children entered kindergarten (32 hrs total contact time). Each group meeting began with an open-ended check-in followed by an agenda that focused on one of the five aspects of life in our risk-protective model of family functioning. Couples were randomly assigned to one of two variations of the couples groups, all conducted by the same co-leader pairs. In the open-ended part of each meeting to which parents were free to bring their own personal issues, the co-leaders helped parents in one set of groups focus on parenting issues, and in the other set of groups, on issues in their relationships as couples. The rest of the curriculum was identical in both sets of groups.
Two years after the couples groups ended, when the children had completed 1st grade, our staff observations of the parents and children working and playing together revealed that parents in the groups that focused more on parenting were significantly warmer and more structured with their children than parents in the control condition. Their children showed fewer internalizing behaviors in their 1st grade classrooms and reported a greater sense of wellbeing in a puppet interview (Cowan et al., 2005). Parents in the groups that emphasized the couple and co-parenting relationship also showed significantly more effective parenting strategies than parents in the control condition - and in contrast with couples in the control group, showed no increase in their level of couple conflict. Reports from 1st grade teachers revealed that these children were less aggressive, and when tested individually by a member of the research team, showed significantly higher levels of academic achievement than children of the control participants. Finally, in an unusually long-term follow-up assessment 10 years later, as the same children made the transition to high school in 9th grade, positive intervention effects on mothers, fathers, and children were still apparent (Cowan et al, 2011).
Supporting father involvement
(Cowan et al., 2009)
We were invited to evaluate our group interventions with a large set of low-income families to see whether working together in groups on the same five aspects of family life would be effective for families with even fewer resources and greater relationship challenges. In collaboration with Marsha Kline Pruett and Kyle Pruett, the Supporting Father Involvement (SFI) program represented the first randomized, controlled clinical trial focused on father involvement in low to middle-income families. The SFI program was located in existing Family Resource Centers in five, mostly rural counties of California, and all families were also offered a Case Manager to refer them to services for help with serious family challenges (health, housing, legal etc.).
During the first phase of the SFI study, 279 couples were invited to take part in one of the following on a randomly assigned basis, all with the same staff and focusing on the same five aspects of family life as the earlier two interventions had:
(1) a one-time informational meeting for a group of couples (3 contact hrs)
(2) a group for fathers that met for 16 weeks (32 contact hrs)
(3) a group for couples that met for 16 weeks (32 contact hrs).
The families, whose backgrounds were Mexican American, European American, and African American, had children ranging in age from 0-7, with the typical age of the youngest child being 2-2.5 years, and some having older children as well. About two-thirds of the couples were married, with most of the rest cohabiting and a few who did not live together but were committed to collaborating in raising their child. Two-thirds of the families were at the lower end of the income scale. In this first phase, none of the families was involved with the Child Protective Welfare System (CPS) when they entered the study.
The results from the first phase of 279 families showed that fathers or mothers who participated in the one-time informational meeting revealed no positive changes and some negative changes over 18 months – as individuals, couples, and parents, and they described increases in acting out, aggressive or shy, withdrawn, depressed behaviors in their children. Those who participated in fathers-only or couples groups showed significant positive changes over 18 months - increased father involvement, and no increases in their children’s problematic behaviors, but parents in the fathers-only groups showed declining satisfaction as a couple in contrast to couples group participants whose satisfaction remained stable. The early 2000s was a period of economic growth in the U.S. and on average, couples in all three conditions showed statistically significant increases in family income (Cowan et al., 2009).
Parenting interventions for couples may reduce risk factors associated with domestic violence
In the second phase of the SFI program, with 239 new families (Cowan et al., 2014), we conducted a replication of the first phase without the one-time meeting, which had led to no positive and some negative shifts. As in phase 1, none of the phase 2 families had been referred to the Child Protective System in the year before they entered the study, and most were low-income. We used the first phase results as a benchmark to compare the second phase results. Phase 2 families showed similar positive changes as the earlier phase 1 families had experienced on six measures (declines in psychological symptoms and parenting stress, and children’s hyperactivity and social withdrawal, stability in couple relationship satisfaction and increased household income) and greater positive change on two measures (reductions in parents’ violent problem-solving and children’s aggression). Despite a period of economic decline in 2007-2009, household incomes rose significantly.
We are still analyzing data from the third phase of the Supporting Father Involvement study. The new feature of this recent trial was that half of the 230 new families, recruited in the same five counties, had already come to the attention of Child Protective Services because of concerns about domestic violence, child abuse or neglect. As not all families could be offered groups at once, after careful assessment had established that there was no current domestic violence or child abuse or neglect, the new families were randomly offered a fathers-only group or a couples group that would start (a) immediately or (b) seven months after the initial assessments (a delay control condition).
The intervention effects in phase 3 were tested by examining the differences at the 18-month post-test between families who took part in an SFI group immediately and those who were not offered a group until seven months after their initial assessments (the delay control). Preliminary analyses are showing that the earlier results hold up with these families too, with even stronger positive results for couples referred by Child Protective Services staff. The intervention appears to reduce risk factors commonly associated with domestic violence and child abuse: parents’ symptoms of depression, alcohol use, couple conflict, violent problem solving (yelling, throwing things, hitting), parenting stress, harsh parenting, and children’s behavior problems. And, here too, the CPS-referred couples who participated in the intervention increased their annual household incomes, whereas those in the delay condition did not. The results of all three phases confirm that both the couples and fathers group interventions that we designed - especially the couples groups - are effective with families from a range of ethnic backgrounds, income levels and levels of risk.
Our approach to creating healthier environments for children involves combining aspects of interventions to strengthen couple relationships, father involvement and parenting. The initial 24-week curriculum, now 16 weeks, pays attention to five family domains identified in our risk and protective model. In contrast with almost all parenting classes and father involvement interventions, our approach has a central focus on the couple and co-parenting relationships for parents who are married, cohabiting, or living apart. In three projects involving more than 1,000 couples and five clinical trials over the years, we have found that a focus on the couple and co-parenting relationship has substantial benefits for mothers, fathers and children, and for the quality of their key family relationships. More specifically, each trial of the intervention for families across economic levels, marital status and ethnic background revealed statistically significant changes in individual, couple and parent-child domains. It seems noteworthy that although we have not documented a reduction in life stress events, mothers and fathers report more effective and satisfying relationship strategies after attending the weekly groups. That is, the improvements taking place within the families are occurring in spite of the fact that families across the economic spectrum continue to be faced with the challenges and stresses that are common in most families with young children.
In conclusion, we note a curious fact. The key justification for offering interventions for couple relationships, father involvement and parenting is that working with parents will ultimately benefit their children’s development and wellbeing. Despite this fact, studies of couple relationship and father involvement programs rarely look at outcomes for the children. In a new review of the intervention literatures, we convey our concern that family policy decisions are often based on limited evidence of intervention effectiveness, especially in terms of the children (Cowan & Cowan, 2014).
At this time, the Supporting Father Involvement program is being disseminated in three locations. The California Department of Child Abuse Prevention has funded a training organization called Strategies to train group leaders in new counties throughout California. In Alberta, Canada, Marsha Kline Pruett and Kyle Pruett, our collaborators on the SFI program, have trained group leaders who offer SFI groups in four locations. And in the U.K., the British Government is funding a trial of the Supporting Father Involvement program for low-income families, called Parents as Partners. Couples groups with clinically trained co-leaders are being offered in London and Manchester and early results are very encouraging. Our hope is that this evidence-based approach to working with mothers and fathers as partners and co-parents can encourage a broadening of the definition of what to include in parent education programs.
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