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Intervention Summary

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Children in Between

Children in Between (CIB), formerly known as Children in the Middle, is an educational intervention for divorcing families that aims to reduce the parental conflict, loyalty pressures, and communication problems that can place significant stress on children. CIB consists of one to two 90- to 120-minute classroom sessions and can be tailored to meet specific needs. The intervention teaches specific parenting skills, particularly good communication skills, to reduce the familial conflict experienced by children. Each parent attending classes typically receives two booklets ("What About the Children" and "Children in Between") that give advice for reducing the stress of divorce/separation on children and promote practice of the skills taught in the course. Each parent also watches the intervention video, which illustrates how children often feel caught in the middle of their parents' conflicts.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: August 2006
1: Parental conflict
2: Awareness of effects of divorce on the children
3: Rate of relitigation
4: Communication skills
5: Child-reported stress
Outcome Categories Family/relationships
Mental health
Social functioning
Ages 0-5 (Early childhood)
6-12 (Childhood)
13-17 (Adolescent)
26-55 (Adult)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Other community settings
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Since 1992, this intervention or an adaptation of this intervention has been implemented in approximately 1,200 sites with about 2.5 million parents. Children in Between has been implemented in Australia, Canada, China, Ireland, Japan, the Netherlands, Singapore, South Africa, South Korea, Spain, the United Kingdom, and the United States. In 2012, the name of the intervention was changed from Children in the Middle to Children in Between.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations Spanish-language versions of intervention materials are available.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Selective

Quality of Research
Review Date: August 2006

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

Arbuthnot, J., & Gordon, D. A. (1996). Does mandatory divorce education for parents work? A six-month outcome evaluation. Family and Conciliation Courts Review, 34(1), 60-81.

Study 2

Arbuthnot, J., Kramer, K. M., & Gordon, D. A. (1997). Patterns of relitigation following divorce education. Family and Conciliation Courts Review, 35(3), 269-279.

Study 3

Arbuthnot, J., Poole, C. J., & Gordon, D. A. (1996). Use of educational materials to modify stressful behaviors in post-divorce parenting. Journal of Divorce and Remarriage, 25(1-2), 117-137.

Study 4

Kramer, K. M., Arbuthnot, J., Gordon, D. A., Rousis, N. J., & Hoza, J. (1998). Effects of skill-based versus information-based divorce education programs on domestic violence and parental communication. Family and Conciliation Courts Review, 36(1), 9-31.

Study 5

Kurkowski, K. P., Gordon, D. A., & Arbuthnot, J. (1999). Community-based skills vs. affectively oriented divorce education interventions for families in outpatient therapy. Doctoral dissertation not submitted for publication.

Supplementary Materials

Brandon, D. J. (2006). Can four hours make a difference? Evaluation of a parent education program for divorcing parents. Journal of Divorce and Remarriage, 45(1-2), 171-185.

Children in the Middle Insert (questions referring to each child)

Children in the Middle Parent Survey

Children in the Middle Parent Survey (research form)

Children in the Middle Youth Survey

Children in the Middle II Pack (DVD/video; Working with Divorcing Parents: Discussion Leader's Guide; What About the Children, A Guide for Divorced and Divorcing Parents; Parents' and Children's Guidebook)

Kurkowski, K. P., Gordon, D. A., & Arbuthnot, J. (1993). Children caught in the middle: A brief educational intervention for divorced parents. Journal of Divorce and Remarriage, 20(3-4), 139-151.

Treatment integrity measure

Outcomes

Outcome 1: Parental conflict
Description of Measures This outcome was measured by asking parents what they would do in response to three situations that could cause conflict. Responses were coded on a 5-point continuum of the awareness of the need to keep their children out of parental conflict and respond to one another in a constructive, nonthreatening fashion. This outcome was also measured by asking the parents and the child to report the degree to which the child was being kept out of parental conflict.
Key Findings Compared with parents who participated in alternative divorce education activities or who did not participate in any divorce education program, CIB participants generated solutions to parental conflict scenarios that were rated as healthier and more adaptive (p < .05) and reported that they were more likely to keep their children out of the middle of parental conflicts (p < .05). In one study measuring parents' likelihood of keeping their children out of the middle of their conflicts, the effect size for the comparison between CIB participants and those who did not participate in any divorce education program was small (Cohen's d = 0.25). That same study found a very small effect size (Cohen's d = 0.06) for the comparison between CIB participants and those who participated in alternative divorce education activities. Children of CIB participants said they felt "caught in the middle" less often compared with children of other divorcing parents (p < .01).
Studies Measuring Outcome Study 1, Study 4, Study 5
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.2 (0.0-4.0 scale)
Outcome 2: Awareness of effects of divorce on the children
Description of Measures This outcome was measured by asking parents to rate, using a 5-point scale, (1) their awareness of what their child/children felt about the other parent and the relationship between the parents, and (2) their awareness of what their child/children felt about the divorce.
Key Findings As a group, CIB participants reported increased awareness of their children's feelings about the other parent and about the relationship between the parents than they reported prior to receiving the intervention (p < .05).
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.1 (0.0-4.0 scale)
Outcome 3: Rate of relitigation
Description of Measures Rate of relitigation (additional legal contests) refers to the rate of relitigation over all issues. Data were obtained from court records between 24 and 27 months after the original divorce proceedings and completion of the intervention course.
Key Findings Two years after completing the intervention, parents who participated in the program had relitigated less than half as frequently as similar parents who had not participated (1.61 litigation filings vs. 3.74 filings, p < .01).
Studies Measuring Outcome Study 2
Study Designs Quasi-experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)
Outcome 4: Communication skills
Description of Measures Parent-child communication was measured by the extent to which parents verbally supported the child's relationship with the other parent. This included providing reassurance to the child that the other parent still cared for the child and encouragement to spend time with the other parent.
Key Findings Mothers who received a CIB educational booklet in the mail were more likely to reassure the child that the father still cared about the child and were more likely to encourage the children to spend time with the father, compared with mothers who had not yet received the booklet (p < .04). A similar effect was not reported among fathers. One year later, parents exposed to the CIB material spoke about their ex-spouse more often and voiced more support of the child spending time with the ex-spouse compared with parents who had not received the booklet (p < .01).

Parents who participated in either CIB or in an alternative divorce education program without training in communication and parenting skills had better parental communication than divorcing couples who did not participate in any divorce education program (p < .01). In addition, CIB participants experienced improvement in parental communication between the start of the CIB class and follow-up 3 months after the class; similar improvement did not occur among participants in the alternative divorce education program (p < .05). Effect sizes for these findings were small when comparing CIB participants to divorcing couples who did not participate in any divorce education program (Cohen's d = 0.31) and very small when comparing CIB mothers and fathers to mothers and fathers who participated in an alternative divorce education program (Cohen's d = 0.05 and 0.17, respectively).
Studies Measuring Outcome Study 3, Study 4
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 2.3 (0.0-4.0 scale)
Outcome 5: Child-reported stress
Description of Measures Children were asked to rate, using a 3-point scale, the level of discomfort caused by feeling caught in the middle of their parents' conflicts.
Key Findings Children whose parents viewed the intervention video at home typically reported feeling less stress when placed in the midst of parental conflict in comparison with children whose parents had been asked to watch another divorce education video or whose parents had not received any services (p < .05).
Studies Measuring Outcome Study 5
Study Designs Experimental
Quality of Research Rating 2.0 (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) 53% Female
47% Male
Data not reported/available
Study 2 26-55 (Adult) 53% Female
47% Male
Data not reported/available
Study 3 26-55 (Adult) 57.5% Female
42.5% Male
Data not reported/available
Study 4 26-55 (Adult) 57.7% Female
42.3% Male
78.1% White
16.2% Black or African American
5.7% Race/ethnicity unspecified
Study 5 0-5 (Early childhood)
6-12 (Childhood)
13-17 (Adolescent)
26-55 (Adult)
51.4% Female
48.6% Male
83% White
10% Black or African American
5% Hispanic or Latino
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: Parental conflict 2.4 1.5 1.6 2.2 2.0 3.7 2.2
2: Awareness of effects of divorce on the children 2.0 1.0 1.5 2.5 2.0 3.5 2.1
3: Rate of relitigation 2.5 2.5 1.5 2.0 2.0 4.0 2.4
4: Communication skills 2.0 1.8 1.8 2.3 2.0 3.8 2.3
5: Child-reported stress 2.0 1.5 1.0 2.0 2.0 3.5 2.0

Study Strengths

After extensive study, the intervention has demonstrated successful development of skills, even when compared with other types of interventions. Several of the studies used either standardized instruments or measures that had face validity. In one study, leaders received 2 hours of training. In another study, the researchers documented that the characteristics of participants in each group completing the intervention did not differ significantly from those of participants when they were assessed at baseline; this provides confidence that attrition was not a significant confound.

Study Weaknesses

The survey had face validity, but no information on survey validity was provided by the authors. Measures used to test effectiveness were not adequate. For example, reliability evidence presented was insufficient. Typically, a minimum of three people should be involved in coding qualitative data. In one study that had a limited number of participants (N = 89), attrition was not sufficiently addressed (only 53.9% provided follow-up data). Outside influences, including possible participation in marital counseling or psychotherapy, also were not addressed. Self-reporting of the outcome measures could be confounded by social desirability, as was noted by the authors. There was no control on how the CIB booklet would be used for the intervention parents who only received the booklet. Potential confounds included the variability in length of time of separation not being addressed, other potential outside influences, such as the impact of other family members reading the CIB booklet and participation in psychotherapy during the study, and differences between samples that were not randomly assigned to treatment or comparison condition. Overall intervention fidelity was not clearly documented. Although leaders received 2 hours of training, monitoring of program delivery was not discussed. In a study that compared CIB participants to Children First in Divorce (CFD) participants, CFD facilitators were more experienced than the CIB facilitators, which could have resulted in greater fidelity to the CFD program. In one study, parents watched a CIB video at home, and the fidelity of that video component was not measured. Another weakness is that behaviors were not observed in the home or other places.

Readiness for Dissemination
Review Date: August 2006

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.

Arbuthnot, J., & Gordon, D. (2001). What about the children? A guide for divorced and divorcing parents (5th ed.). Athens, OH: Authors.

Arbuthnot, J., & Gordon, D. (1998). ¿Y los hijos? Una guía para divorciados y padres en proceso de divorcio (5th ed.). Athens, OH: Authors.

Center for Divorce Education. (n.d.). Children in the Middle II [DVD]. Athens, OH: Author.

Center for Divorce Education. (n.d.). Children in the Middle II: Spanish version [DVD]. Athens, OH: Author.

Children in the Middle PowerPoint presentations. Retrieved January 2007 from http://www.divorce-education.com/ppt/ppt.htm

Gordon, D., & Arbuthnot, J. (2005). Children in the Middle II: Parents' and children's guidebook (4th ed.). Athens, OH: Center for Divorce Education.

Gordon, D., & Arbuthnot, J. (2005). Children in the Middle II: Discussion leader's guide parents' version (6th ed.). Athens, OH: Authors.

Implementation of Children in the Middle Treatment Integrity [Handout]

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
3.0 2.3 1.8 2.3

Dissemination Strengths

The DVD is engaging and offers real-life examples using diverse family models and situations to reinforce the written materials. This stand-alone program does not require training for implementers. The developer provides suggestions for group leader qualifications, experience, and personal qualities that will aid in stand-alone implementation. An implementation integrity form is provided to assist quality assurance.

Dissemination Weaknesses

No information is provided about how to approach important implementation components, such as linking with the court system and personnel and ensuring that sessions become mandatory. The manual refers to several parenting programs being potentially useful in conjunction with this program, but none are suggested. While having a stand-alone program eliminates some barriers and costs often associated with face-to-face training requirements, the lack of available supervision and consultation may make it difficult for first-time implementers to use this program. No data-gathering or evaluation guidance is provided. The quality assurance tool provided does not include any explanation or guidance for use.

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
Children in Between kit (includes quality assurance materials) $399 each Yes
Booklets $2-$3 per booklet, one per participant Yes
Online course $39.95 or less per participant No
1-day training $250-$500 per participant No
Telephone consultation Free No

Additional Information

The intervention's online program can be adjusted to fit with the price structure of local in-person classes so that parents are not excluded because of financial concerns. Fee waivers for parents qualifying for court fee waivers are granted for the online program. Quantity discounts for passwords are available.

Replications

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

Independent

Brandon, D. J. (2006). Can four hours make a difference? Evaluation of a parent education program for divorcing parents. Journal of Divorce and Remarriage, 45(1-2), 171-185.

* Kramer, K. M., Arbuthnot, J., Gordon, D. A., Rousis, N. J., & Hoza, J. (1998). Effects of skill-based versus information-based divorce education programs on domestic violence and parental communication. Family and Conciliation Courts Review, 36(1), 9-31.

Self

* Arbuthnot, J., Kramer, K. M., & Gordon, D. A. (1997). Patterns of relitigation following divorce education. Family and Conciliation Courts Review, 35(3), 269-279.

Kurkowski, K. P., Gordon, D. A., & Arbuthnot, J. (1993). Children caught in the middle: A brief educational intervention for divorced parents. Journal of Divorce and Remarriage, 20(3-4), 139-151.

* Kurkowski, K. P., Gordon, D. A., & Arbuthnot, J. (1999). Community-based skills vs. affectively oriented divorce education interventions for families in outpatient therapy. Doctoral dissertation written but not submitted for publication.

Contact Information

To learn more about implementation or research, contact:
Donald Gordon, Ph.D.
(541) 201-7680
gordon@ohio.edu

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

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