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Intervention Summary

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Family Foundations

Family Foundations, a program for adult couples expecting their first child, is designed to help them establish positive parenting skills and adjust to the physical, social, and emotional challenges of parenthood. Program topics include coping with postpartum depression and stress, creating a caring environment, and developing the child's social and emotional competence.

Family Foundations is delivered to groups of couples through four prenatal and four postnatal classes of 2 hours each. Prenatal classes are started during the fifth or sixth month of pregnancy, and the postnatal classes end when the children are 6 months old. The classes are designed to foster and enhance the coparenting relationship, and they include conflict resolution strategies, information and communication exercises to help develop realistic and positive expectations about parenthood, and videos presenting couples discussing the family and personal stresses they have experienced as well as the successful strategies they have employed. Key aspects of parenting that are addressed include fostering child emotional security, attending to infant cues, and promoting infant sleep.

Family Foundations is delivered in a community setting by childbirth educators who have received 3 days of training from Family Foundations staff. It is recommended, but not required, that classes be codelivered by a male and a female.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: September 2011
1: Coparenting
2: Parental adjustment
3: Parent-child interaction
4: Child adjustment
Outcome Categories Family/relationships
Mental health
Social functioning
Ages 0-5 (Early childhood)
18-25 (Young adult)
26-55 (Adult)
Genders Male
Female
Races/Ethnicities White
Race/ethnicity unspecified
Settings Other community settings
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Family Foundations has been implemented in about 10 sites since it was first developed in a research context in 2005, and it has served hundreds of expectant couples.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations Family Foundations has been adapted for teenage parents. Also, a version of Family Foundations featuring a DVD/workbook package has been developed for home use by couples who encounter barriers to class participation (e.g., transportation issues, conflict with work hours).
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: September 2011

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Feinberg, M. E., Jones, D. E., Kan, M. L., & Goslin, M. C. (2010). Effects of Family Foundations on parents and children: 3.5 years after baseline. Journal of Family Psychology, 24(5), 532-542.  Pub Med icon

Feinberg, M. E., & Kan, M. L. (2008). Establishing Family Foundations: Intervention effects on coparenting, parent/infant well-being, and parent-child relations. Journal of Family Psychology, 22(2), 253-263.  Pub Med icon

Feinberg, M. E., Kan, M. L., & Goslin, M. C. (2009). Enhancing coparenting, parenting, and child self-regulation: Effects of Family Foundations 1 year after birth. Prevention Science, 10(3), 276-285.  Pub Med icon

Outcomes

Outcome 1: Coparenting
Description of Measures Coparenting, defined as how parents coordinate their parenting, support or undermine each other, and manage conflict regarding child rearing, was assessed with three measures:

  • A 15-item coparenting scale, which was developed for this study partly from an adaptation of existing measures and was used to assess multiple dimensions of the coparenting relationship. Participants responded to 5 items on each of three scales: coparental support (e.g., "My partner supports my parenting decisions"), parenting-based closeness (e.g., "I feel close to my partner when I see him or her play with our child"), and coparental undermining (e.g., "My partner sometimes makes jokes or sarcastic comments about the way I am as a parent").
  • Videotaped interaction of free play between parents and their child at their home. An interviewer provided a limited set of toys and asked the parents to engage with their child (approximately 1 year old) in 12 minutes of joint free play on the floor. Interviewers then asked the parents to teach their child to accomplish a set of tasks designed to be at the limit of most infants' developmental capacity (e.g., rolling a ball back and forth with a parent, building a tower of blocks). This interaction lasted for 6 minutes and was videotaped. Coparenting behaviors (competition, triangulations, warmth, inclusion, and active cooperation) were then coded from the videotape by trained raters who were blind to the experimental condition.
  • The 31-item Coparenting Scale, which was created on the basis of prior work. Participants responded to items regarding coparental agreement, support and undermining of each other, and exposure of the child to conflict.
The 15-item coparenting scale was used to collect data from both parents at posttest (i.e., after parents had completed their last postnatal class, when their baby was around 6 months old). Parents responded to the questionnaires and mailed them to the researchers.

Videotaped interactions were used to collect follow-up data when the parents' baby was approximately 1 year old.

The 31-item Coparenting Scale was used to collect follow-up data from both parents when their child was approximately 3 years old. Researchers administered the questionnaires during a home visit.
Key Findings Couples who were expecting their first child were randomly assigned to the intervention group, which received Family Foundations, or the comparison group, which received a mailed brochure with information about selecting quality child care.

At the 6-month follow-up, mothers and fathers in the intervention group exhibited higher coparental support relative to mothers and fathers in the comparison group (p < .05 and p < .05, respectively). In addition, fathers in the intervention group had a higher level of parenting-based closeness relative to fathers in the comparison group (p < .05); there was no significant difference in parenting-based closeness between mothers in each group.

At the 1-year follow-up, mothers and fathers in the intervention group exhibited lower levels of negative coparenting behaviors (competition and triangulation) relative to mothers and fathers in the comparison group (p < .05 and p < .05, respectively). Mothers in the intervention group exhibited a higher level of inclusion relative to mothers in the comparison group (p < .05); there was no significant difference in level of inclusion between fathers in each group.

At the 3-year follow-up, parents in the intervention group exhibited a higher level of positive coparenting overall relative to parents in the comparison group (p = .011).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.6 (0.0-4.0 scale)
Outcome 2: Parental adjustment
Description of Measures Parental adjustment was assessed with four measures:

  • The 20-item short form of the Taylor Manifest Anxiety Scale (TMAS), which measures chronic anxiety. Participants responded to items (e.g., "I am a high-strung person") following a dichotomous yes/no format.
  • A subset of 7 items from the Center for Epidemiological Studies Depression Scale (CES-D), which measures depressive symptoms. Using a 4-point frequency scale, participants responded to items regarding depressive symptoms experienced during the past week (e.g., "How often did you feel sad?").
  • The 16-item Parenting Sense of Competence Scale (PSOC). Using a 7-point Likert scale, participants responded to items asking how they feel about their competence in a parental role (e.g., "I feel confident in my role as a parent").
  • The 27-item Parenting Stress Index (PSI), which measures self-reported parental stress. Using a 5-point Likert scale, participants rated their agreement with each item (e.g., "I feel trapped by my responsibilities as a parent").
The TMAS and the CES-D were used to collect data from both parents at posttest (i.e., after parents had completed their last postnatal class, when their baby was around 6 months old). Parents responded to the questionnaires and mailed them to the researchers.

The TMAS, the CES-D, the PSOC, and the PSI were used to collect follow-up data from both parents when their child was approximately 3 years old. Researchers administered the questionnaires during a home visit.
Key Findings Couples who were expecting their first child were randomly assigned to the intervention group, which received Family Foundations, or the comparison group, which received a mailed brochure with information about selecting quality child care.

At the 6-month follow-up, mothers in the intervention group had lower levels of anxiety (p < .01) and depressive symptoms (p < .01) relative to mothers in the comparison group; there were no significant differences in anxiety or depressive symptoms between fathers in each group.

At the 3-year follow-up, parents in the intervention group had a higher sense of competence in their parental role (p = .024) and a lower level of parenting stress (p = .031) relative to parents in the comparison group.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.7 (0.0-4.0 scale)
Outcome 3: Parent-child interaction
Description of Measures Parent-child interaction was assessed with three measures:

  • The 6-item Dysfunctional Interaction scale from the Parenting Stress Index. Participants responded to items regarding distress in the parent-child relationship (e.g., "My child smiles at me much less than I expected").
  • Videotaped interaction of free play between parents and their child at their home. An interviewer provided a limited set of toys and asked the parents to engage with their child (approximately 1 year old) in 12 minutes of joint free play on the floor. Interviewers then asked the parents to teach their child to accomplish a set of tasks designed to be at the limit of most infants' developmental capacity (e.g., rolling a ball back and forth with a parent, building a tower of blocks). This interaction lasted for 6 minutes and was videotaped. Parenting behaviors (sensitivity, positive affect, support of exploration, irritability, anger, and hostility toward the child) were then coded from the videotape by trained raters who were blind to the experimental condition.
  • 21 items from the Parenting Scale, which were used to assess the discipline practices of parents of children 18-48 months old. Parents responded to 11 items assessing permissive parenting (laxness), 9 items assessing the degree of authoritarian parenting (overreactivity), and 1 item assessing the likelihood of the parent to "spank, slap, grab, or hit" a misbehaving child (physical punishment).
The Dysfunctional Interaction scale was used to collect data from both parents at posttest (i.e., after parents had completed their last postnatal class, when their baby was around 6 months old). Parents responded to the questionnaires and mailed them to the researchers.

Videotaped interactions were used to collect follow-up data when the parents' baby was approximately 1 year old.

Items from the Parenting Scale were used to collect follow-up data from both parents when their child was approximately 3 years old. Researchers administered the questionnaires during a home visit.
Key Findings Couples who were expecting their first child were randomly assigned to the intervention group, which received Family Foundations, or the comparison group, which received a mailed brochure with information about selecting quality child care.

At the 6-month follow-up, fathers in the intervention group had fewer parent-child dysfunctional interactions relative to fathers in the comparison group (p < .05); there was no significant difference in parent-child dysfunctional interactions between mothers in each group.

At the 1-year follow-up, parents in the intervention group exhibited more positive parenting behaviors relative to parents in the comparison group (p < .05).

At the 3-year follow-up, parents in the intervention group exhibited fewer negative parenting behaviors relative to parents in the comparison group in regard to overreactivity (p = .019), laxness (p = .049), and physical punishment (p = .014).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.6 (0.0-4.0 scale)
Outcome 4: Child adjustment
Description of Measures Child adjustment was assessed with four measures:

  • The Infant Behavior Questionnaire. Participants responded to 9 subscale items assessing soothability (e.g., "When your baby was upset, how often were you able to comfort him/her by rocking?") and 10 subscale items assessing duration of orienting (e.g., "How often during the last week did your baby play with one toy/object for 5-10 minutes?").
  • Videotaped interaction of free play between parents and their child at their home. An interviewer provided a limited set of toys and asked the parents to engage with their child (approximately 1 year old) in 12 minutes of joint free play on the floor. Interviewers then asked the parents to teach their child to accomplish a set of tasks designed to be at the limit of most infants' developmental capacity (e.g., rolling a ball back and forth with a parent, building a tower of blocks). This interaction lasted for 6 minutes and was videotaped. Self-soothing (self-directed comforting, stroking, and sucking) was then coded from the videotape by trained raters who were blind to the experimental condition.
  • The Child Behavior Checklist (CBCL). From mothers' responses to the 100-item questionnaire, three overall scores (total problems, externalizing problems, and internalizing problems) and scores for two subscales (aggression and attention/hyperactivity) were calculated.
  • The Head Start Competence Scale, a measure designed for assessing behaviors of young children. Mothers responded to 8 items composing the Social Competence subscale (e.g., "resolves problems with friends on his/her own") and 6 items composing the Emotional Competence subscale (e.g., "copes with sadness").
The Infant Behavior Questionnaire was used to collect data from both parents at posttest (i.e., after parents had completed their last postnatal class, when their baby was around 6 months old). Parents responded to the questionnaires and mailed them to the researchers.

Videotaped interactions were used to collect follow-up data when the parents' baby was approximately 1 year old.

The CBCL and the Head Start Competence Scale were used to collect follow-up data from only mothers when the parents' child was approximately 3 years old. Researchers administered the questionnaires during a home visit.
Key Findings Couples who were expecting their first child were randomly assigned to the intervention group, which received Family Foundations program, or the comparison group, which received a mailed brochure with information about selecting quality child care.

At the 6-month follow-up, fathers in the intervention group had better infant soothability relative to fathers in the comparison group (p < .05); there was no significant difference in infant soothability between mothers in each group.

At the 1-year follow-up, children of parents in the intervention group demonstrated higher levels of self-soothing behaviors relative to children of parents in the comparison group (p < .05).

At the 3-year follow-up, children of mothers in the intervention group exhibited lower levels of problem behaviors relative to children of mothers in the comparison group (p = .022).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.7 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 0-5 (Early childhood)
18-25 (Young adult)
26-55 (Adult)
50% Female
50% Male
90.5% White
9.5% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Coparenting 3.5 4.0 4.0 4.0 2.5 3.5 3.6
2: Parental adjustment 4.0 4.0 4.0 4.0 2.5 3.5 3.7
3: Parent-child interaction 4.0 3.5 4.0 4.0 2.5 3.5 3.6
4: Child adjustment 4.0 4.0 4.0 4.0 2.5 3.5 3.7

Study Strengths

The measures have excellent reliability and validity. The coparenting measure created by the researchers demonstrates criterion-related validity. The researchers demonstrate that intervention fidelity was assured and measured in several ways: the intervention is manualized; group leaders received 3 days of training; and ongoing observations of sessions were conducted, along with regular supervision. In addition, observers assessed whether the program was implemented as planned, and they gave this aspect a very high overall rating. An intent-to-treat analysis was used with all data. Analysis of data from the 3-year follow-up includes an explanation of imputed data. Overall attrition was low for this longitudinal study. By the 3-year follow-up, attrition caused a between-group difference for the education variable, but the researchers accounted for this appropriately in their models. All of the analyses seem to be appropriate, including the methods used to account for time differentials and the nesting of family members within the family. Appropriate types and numbers of data analysis were conducted.

Study Weaknesses

Per the researchers, between-group differences could be related to factors beyond the intervention. Although an intent-to-treat analysis was used, it may mask a dose effect that was not tested.

Readiness for Dissemination
Review Date: September 2011

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Group leader handbook. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Instructional examples #1 [DVD]. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Instructional examples #2 [DVD]. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Postnatal classes instructional DVD [DVD]. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Postnatal parent handbook. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Postnatal parent handbook DVD for home viewing [DVD]. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Prenatal classes instructional DVD [DVD]. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Prenatal parent handbook. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Prenatal parent handbook DVD for home viewing [DVD]. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Program management handbook. University Park: Pennsylvania State University.

Feinberg, M. E. (2011). Family Foundations: A Strong Start--Supplemental material [DVD]. University Park: Pennsylvania State University.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.8 3.8 4.0 3.8

Dissemination Strengths

The group leader handbook is well organized and of high quality, and it contains detailed implementation guidance, including scripted text, instructions for administering outcome measures, and materials checklists. Participant materials include DVDs with video clips of parents engaged in parenting activities, which serve as a helpful implementation tool to promote learning. The training materials are comprehensive and include easy-to-understand information about the program as well as video clips to demonstrate effective facilitator delivery. Implementers can contact the developer via phone or email for ongoing support or submit tapes of their group facilitation for critique. The quality assurance tools represent the perspectives of participants, facilitators, and observers at multiple points in the intervention. Interactive spreadsheets are available for implementers to easily record data on fidelity and outcome measures, helping them to monitor program effectiveness and quality of implementation and provide feedback to facilitators.

Dissemination Weaknesses

Although the materials contain vast implementation guidance, there is no information concerning the organizational-level preparation needed to start implementing the program. There is no set training calendar or information on the frequency and availability of trainings.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Facilitator manual (includes PowerPoint slides, facilitator DVDs, and participant feedback forms) $325 each Yes
Pre- and postnatal parent handbooks (includes DVDs) $300 for materials for 10 couples Yes
3-day facilitator training $375 per person No
Videotape review $100 per session No
On-site consultation $500-$750 per day plus travel expenses No
Phone and email support Free for the first hour and $50-$100 for each subsequent hour No
Program manager package (includes group leader handbook, promotional material templates, facilitator and observer rating forms, participant pre- and posttest questionnaire, and data entry template) $550 per package No
Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Susan Sulami
(310) 455-2305
communitystrategies@yahoo.com

To learn more about research, contact:
Mark Feinberg, Ph.D.
(814) 865-5205
love@psu.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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