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

Abstract

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent–child relationship problems, a number of programs 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 newborns. 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 metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive 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 differences 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.

An Uncontrolled Trial of Flexibly Delivered Relationship Education With Low‐Income, Unmarried Perinatal Couples

“…Yet effectiveness studies of such programs have been decidedly mixed (Pinquart & Teubert, 2010;Wood et al, 2010), with a recent meta-analysis finding an exceedingly small effect size (d = 0.09) for low-income new parents (Arnold & Beelmann, 2018). Of greater concern, there have been indications of iatrogenic effects, especially around IPV (e.g., Heyman et al, 2019;Moore et al, 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.…”

“…This approach is empowering because individuals have no direct control over their partners' behavior but do have control over their own behavior. See Heyman et al (2019) for detailed information about CCP and for effect sizes for the Australian trials.…”

“…Certainly, if there were beneficial effects of participation, they could be due to factors beyond true CCP efficaciousness, for example (a) our and their own belief in the efficacy of CCP (i.e., placebo effect) or (b) the nonspecific effects of attention focused on them (i.e., Hawthorne effect). For results of a concurrent randomized, controlled study of CCP with American couples that included a broad range of income groups, see Heyman, Slep, et al (2019).…”

“…For more information, please see supporting information in "A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn" article. a Heyman, Slep, et al, 2019.…”

“…Without randomization, it is unknown whether changes in outcome over time are due to the intervention or to natural change that occurs following the birth of a child (e.g., Mitnick et al, 2009). Although published randomized trials of CCP have documented within-person declines in relationship satisfaction for couples who did not receive CCP (see Table S1 in Heyman et al, 2019), only one (pilot) study has been published that focused specifically on low-income couples (Baucom et al, 2018). Further investigation of a wider range of relationship and parenting outcomes in a larger randomized trial of low-income couples is needed.…”