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Intervention Summary

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Bringing Baby Home

Bringing Baby Home (BBH), a psychoeducational intervention for couples who are expecting a baby or recently had a baby, is designed to prevent or minimize postpartum difficulties for wives and husbands, promote positive couple relationships during the transition to parenthood, increase positive parenting, and improve family functioning. Participating couples can be first-time parents or parents who already have one or more children. The core component of BBH is a 2-day psychoeducational workshop for couples that uses lectures, demonstrations, videos, role-plays, and communication exercises to explore the following aspects of marital relationships:

  • Coparenting: Working together as parents to make decisions with regard to children, not engaging in marital conflict in front of children or otherwise involving them in marital conflict, and coordinating rather than competing during family play.
  • Father involvement: Recognizing the importance of fathers and planning specific ways that fathers can get involved and stay involved with their children.
  • Infant development: Understanding infant developmental milestones, recognizing infant states, and recognizing and responding sensitively to infant signals.

Following the workshop, parents can participate in a series of 12 support group meetings conducted every other week over a 6-month period. During the meetings, which are intended to maintain improvements made as a result of the workshop, couples discuss issues they are facing at the time and they provide each other with emotional support. The educators that deliver the intervention draw connections between the couples' experience and the lessons learned in the workshop. The educators (professionals such as nurses, midwives, doulas, and clergy) must undergo training and pass an exam before delivering the intervention.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: October 2013
1: Postpartum depression (wives) and postbirth mood difficulties (husbands)
2: Quality of marital relationship
3: Competitive coparenting
Outcome Categories Family/relationships
Mental health
Ages 26-55 (Adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Outpatient
Other community settings
Geographic Locations Urban
Suburban
Implementation History Thousands of couples have participated in the BBH workshop since it was made available in 2003. The workshop is currently available in approximately 200 hospitals and community centers in 28 States and in countries outside of the United States. Internationally, the workshop has been used in Australia, Canada, England, Germany, Iceland, Israel, Korea, and Spain.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations The BBH workshop has been translated into Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal
Selective

Quality of Research
Review Date: October 2013

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

Shapiro, A. F., & Gottman, J. M. (2005). Effects on marriage of a psycho-communicative-educational intervention with couples undergoing the transition to parenthood, evaluation at 1-year post intervention. Journal of Family Communication, 5(1), 1-24.

Study 2

Shapiro, A. F., Nahm, E. Y., Gottman, J. M., & Content, K. (2011). Bringing Baby Home together: Examining the impact of a couple-focused intervention on the dynamics within family play. American Journal of Orthopsychiatry, 81(3), 337-350.  Pub Med icon

Supplementary Materials

Derogatis, L. R., Rickels, K., & Rock, A. F. (1976). The SCL-90 and the MMPI: A step in the validation of a new self-report scale. British Journal of Psychiatry, 128, 280-289.  Pub Med icon

Locke, H. J., & Wallace, K. M. (1959). Short marital-adjustment and prediction tests: Their reliability and validity. Marriage and Family Living, 21(3), 251-255.

Outcomes

Outcome 1: Postpartum depression (wives) and postbirth mood difficulties (husbands)
Description of Measures The Symptom Checklist-90 (SCL-90) was administered to assess postpartum depression for wives and postbirth mood difficulties for husbands. Participants reported their symptoms on each of the SCL-90 scales: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, anger-hostile affect, phobic anxiety, paranoid ideation, psychoticism, poor appetite, overeating, trouble falling asleep, awakening in early morning, restless or disturbed sleep, thoughts of death or dying, and feelings of guilt. The total score was used.
Key Findings Married couples who were expecting a baby or had a baby within the past 3 months were randomly assigned to the intervention group (which participated in the BBH workshop) or a wait-list control group. Assessments were conducted at pretest, posttest (when the baby was 3 months old), and follow-up (when the baby was approximately 1 year old). Results included the following:

  • Among wives, there was no statistically significant difference between the intervention and control group from pre- to posttest. From posttest to follow-up, however, postpartum depression decreased in the intervention group and increased in the control group (p < .05).
  • Among husbands, postbirth mood difficulties decreased in the intervention group from pre- to posttest and increased slightly from posttest to follow-up, whereas it increased during both periods in the control group. At follow-up, mood difficulties were significantly lower in the intervention than control group (p < .05).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.6 (0.0-4.0 scale)
Outcome 2: Quality of marital relationship
Description of Measures Quality of marital relationship was assessed using 4 items of global happiness from the Locke-Wallace Marital Adjustment Test (MAT). These items asked participants to assess their relationship with their spouse in terms of overall degree of happiness, who gives in when decisions are made, whether they engage in outside interests together, and the extent to which they spend leisure time together. Scores on each item were summed to create a marital quality score.
Key Findings Married couples who were expecting a baby or had a baby within the past 3 months were randomly assigned to the intervention group (which participated in the BBH workshop) or a wait-list control group. Assessments were conducted at pretest, posttest (when the baby was 3 months old), and follow-up (when the baby was approximately 1 year old). There was a significant difference in quality of marital relationship across time between the intervention and control group and between wives and husbands (p < .01). Among wives, relationship quality remained stable in the intervention group and declined steadily in the control group over time (p < .02). Among husbands, relationship quality declined sharply in the control group between posttest and follow-up and increased in the intervention group during this time (p < .01).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.5 (0.0-4.0 scale)
Outcome 3: Competitive coparenting
Description of Measures Competitive coparenting was assessed using observational coding of mother-father-baby interactions in the home during the Lausanne Triadic Play (LTP) procedure. The LTP procedure is a videotaped, semistructured situation that facilitates the examination of the triad as a whole as well as an organization of its parts. Parents were asked to play with their infants naturally as a threesome without anyone else in the room. The interactions were videotaped using two portable video cameras, one aimed at the parents and one aimed at the baby. The Triadic Interaction Coding System (TICS) was used to measure various dimensions of the interaction. Principal component analysis was used to produce the following family dynamic factors from the behavioral coding:

  • Father engaged and competitive factor. This combination of variables reflects interactions in which the father and baby are positively engaged with each other and the father is competing for the baby's attention. The mother is relatively disengaged and complementary, with some probing for the baby's attention.
  • Mother engaged and competitive factor. These variables appear to reflect interactions in which the mother and baby are highly engaged with each other and the mother is competing for the baby's attention. The mother is positive in affect, and the baby is neutral. The father is complementary in his coparenting, and the baby appears disengaged from the father.
Higher scores indicate more competitive coparenting between the father and mother for the baby's attention.
Key Findings Couples who were expecting a baby were randomly assigned to one of two intervention groups (BBH workshop only or BBH workshop plus support group) or a control group that did not receive an intervention. The intervention groups received the workshop during the third trimester of pregnancy or shortly after birth; support groups were scheduled to begin around the time babies were 3 months old. Competitive coparenting was assessed in the home when babies were approximately 3 months old. In the analyses, the two intervention groups were combined and compared with the control group. Relative to the control group, the combined intervention group demonstrated less competitive coparenting on the part of fathers (p = .005) and mothers (p = .036), after adjustment for baseline marital satisfaction, age, and parity (i.e., first or subsequent birth).
Studies Measuring Outcome Study 2
Study Designs Experimental
Quality of Research Rating 2.8 (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 26-55 (Adult) 50% Female
50% Male
78% White
12% Asian
5% Hispanic or Latino
5% Race/ethnicity unspecified
Study 2 26-55 (Adult) 50% Female
50% Male
70% White
10% Asian
9% Hispanic or Latino
7% Black or African American
2% American Indian or Alaska Native
2% 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: Postpartum depression (wives) and postbirth mood difficulties (husbands) 4.0 3.0 2.0 1.5 2.3 3.0 2.6
2: Quality of marital relationship 3.0 3.0 2.0 1.5 2.3 3.0 2.5
3: Competitive coparenting 3.0 3.0 3.0 2.0 2.5 3.0 2.8

Study Strengths

The studies used measures with well-researched and documented reliability and validity. The manualized intervention was delivered by the clinicians who developed it. The intervention sessions were videotaped, and the implementer's assessment of videotapes showed that the sessions were of appropriate length and quality, indicating a high degree of fidelity. Both studies had minimal attrition, and both used a randomized experimental design. One study established baseline equivalence between the intervention and control groups by adjusting for marital satisfaction, age, and parity (i.e., first or subsequent birth). The studies used appropriate analyses.

Study Weaknesses

No quantitative data demonstrating intervention fidelity were provided. There is no evidence that independent reviewers assessed the videotaped sessions. Both studies had considerable missing data due, in many cases, to participants not returning questionnaires. In one study, investigators replaced missing data with the mean for each group at each time point; this approach may have introduced bias if the number of nonresponders differed by group or if outcomes differed between responders and nonresponders. For the other study, missing data were a concern at the 3-month assessment, in spite of efforts made to model missing data. The Hawthorne effect (i.e., observer effect) is a potential confounding variable in both studies. In the study that used two intervention groups and one control group, the combined effect of various confounds (i.e., attrition, difficulties conducting all follow-up visits with all families, difficulties with participant compliance) was a concern.

Readiness for Dissemination
Review Date: October 2013

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.

Assessment battery

Card decks (exercise card deck and kid love map card deck)

Gottman, J. M., & Gottman, J. S. (2012). Bringing Baby Home certified training materials: BBH workshop presentation [DVD]. Seattle, WA: Gottman Institute.

Gottman, J. M., & Gottman, J. S. (2012). Bringing Baby Home certified training materials: Couples workshop [four-DVD set]. Seattle, WA: Gottman Institute.

Gottman, J. M., & Gottman, J. S. (2012). Bringing Baby Home certified training materials: What's baby saying? [DVD]. Seattle, WA: Gottman Institute.

Gottman, J. M., & Gottman, J. S. (2012). Bringing Baby Home, a program for new parents experiencing the transition to parenthood: Couples workbook. Seattle, WA: Relationship Research Institute.

Gottman, J. M., Gottman, J. S., Pirak, C., Parthemer, J., & Relationship Research Institute. (2000). Bringing Baby Home, a program for new parents experiencing the transition to parenthood: Instructors manual. Seattle, WA: Relationship Research Institute.

Pirak, C., & Gottman, J. M. (2007). Children and parents, a delicate relationship: Parent handbook. Seattle, WA: Relationship Research Institute.

Pirak, C., & Gottman, J. M. (2007). Creating a shared family legacy: Parent handbook. Seattle, WA: Relationship Research Institute.

Pirak, C., & Gottman, J. M. (2007). Emotional communication and children: Parent handbook. Seattle, WA: Relationship Research Institute.

Pirak, C., & Gottman, J. M. (2007). Making the magic last after becoming parents: Parent handbook. Seattle, WA: Relationship Research Institute.

Pirak, C., & Gottman, J. M. (2007). Managing stress and conflict regulation: Parent handbook. Seattle, WA: Relationship Research Institute.

Pirak, C., & Gottman, J. M. (2007). The transition to parenthood: Parent handbook. Seattle, WA: Relationship Research Institute.

Program Web site, http://www.bbhonline.org

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
3.5 3.5 3.0 3.3

Dissemination Strengths

A comprehensive array of materials is available in a variety of formats, including high-quality written materials and videos depicting program lessons. The program Web site provides access to information about available resources as well as upcoming trainings for implementers and workshops for couples. Materials are appropriate for use with couples of all relationship statuses and sexual orientations. Implementers must attend training and pass an exam to be certified in the model, and ongoing technical assistance via phone and email is available to further support implementation. A large collection of measures is provided to support assessment of program impact and effectiveness, and measures are accompanied by clear protocols for their use.

Dissemination Weaknesses

Little written guidance is provided in the implementation or training materials on the proper sequencing and timing of intervention components. There are no measures or protocols available for monitoring fidelity to the program model.

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
Couples workbook $33.99 per couple Yes
2-day, on- or off-site educator training (includes instructors manual, couples workbook, exercise card decks, PowerPoint for educators, and What's Baby Saying? DVD) $525 per participant, plus travel expenses if on site Yes
Workshop presentation (DVD) $89.99 each No
Couples workshop (four-DVD set) $99.99 each No
Kid love map card deck $3.99 per couple No
Marketing brochures Free No
Parent handbooks (set of six) $24 per set No
And Baby Makes 3 (book) $13.95 each No
Technical assistance via phone or email Varies depending on site needs No
Assessment battery (22 instruments) $35 per set No
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Debaecker, J., & Christie, J. (2012, October). The Bringing Baby Home program: Outcomes from an evidence-based psychoeducational antenatal program in Australian couples. Paper presented at a meeting of the National Association of Childbirth Educators.

* Shapiro, A. F., Nahm, E. Y., Gottman, J. M., & Content, K. (2011). Bringing Baby Home together: Examining the impact of a couple-focused intervention on the dynamics within family play. American Journal of Orthopsychiatry, 81(3), 337-350.  Pub Med icon

Contact Information

To learn more about implementation, contact:
Alan Kunovsky
(206) 607-8691
alan@gottman.com

To learn more about research, contact:
Alyson Shapiro, Ph.D.
(480) 727-3117
alyson.shapiro@asu.edu

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

Web Site(s):