Recruitment and Retention of Low‐SES Ethnic Minority Couples in Intervention Research at the Transition to Parenthood

Low‐SES couples have limited resources to manage the chronic and acute stressors with which they are disproportionately faced. Although these couples are at greater risk for negative individual and relationship outcomes, evaluations of the impact of couple relationship education (CRE) in low‐SES couples have been plagued by methodological problems, most notably challenges associated with recruitment and retention. We review the literature on challenges couples face associated with low‐SES, as well as on recruitment, retention, and CRE in low‐SES, ethnic minority populations. We illustrate some of these challenges in a case study of CRE for low‐SES couples transitioning to parenthood. In this pilot study, 21 couples were recruited from a community health clinic and randomized to either an experimental treatment condition (EXP; N = 11) or a treatment‐as‐usual control condition (TAU; N = 10). This study sought to mitigate documented challenges with recruitment and retention: We leveraged community partnerships, attempted to build and maintain strong relationships with study participants, provided incentives for assessments as well as intervention meetings, and attempted to reduce potential barriers to enrollment and retention. Nonetheless, we had low rates of recruitment and retention. We integrate these findings and experiences with our review of previous work in this area. We make recommendations for future CRE research and practice that have potential implications for public policy in this area.     

The Effectiveness of Couple and Individual Relationship Education: Distress as a Moderator

Current literature yields mixed results about the effectiveness of relationship education (RE) with low‐income participants and those who experience a high level of individual or relational distress. Scholars have called for research that examines whether initial levels of distress act as a moderator of RE outcomes. To test whether initial levels of relationship and/or individual distress moderate the effectiveness of RE, this study used two samples, one of couples who received couple‐oriented relationship education with their partner (n = 192 couples) and one of individuals in a relationship who received individual‐oriented RE by themselves (n = 60 individuals). We delivered RE in a community‐based setting serving primarily low‐income participants. For those attending with a partner, there was a significant interaction between gender, initial distress, and time. Findings indicate that women who were relationally distressed before RE reported the largest pre‐postgains. Those who attended an individual‐oriented RE program reported significant decreases in individual distress from pre to post, but no significant relationship gains. Findings also suggest that initial levels of distress did not moderate the effectiveness of individual‐oriented RE.     

Informative Disagreements: Associations Between Relationship Distress,Depression, and Discrepancy in Interpersonal Perception Within Couples

This study evaluated the associations between relationship distress, depression symptoms, and discrepancy in interpersonal perception within couples. After completing a series of discussion tasks, couples (N = 88) rated their behavior using the circumplex‐based Structural Analysis of Social Behavior Model (SASB; Benjamin, 1979, 1987, 2000). Overall, couple members were strikingly similar in their interpersonal perceptions, and tended to see themselves as friendly, reciprocal in their focus, and balanced between connection and separateness. As hypothesized, however, perceptual discrepancy was related to relationship distress and depression. Relationship distress was associated with discrepancy regarding transitive behavior focused on the partner, while depression was associated with disagreement about intransitive, self‐focused behavior. Analysis of affiliation and autonomy revealed that relationship distress was associated with seeing oneself as reacting with more hostility than the partner sees, and perceiving one's partner as more hostile, more controlling, and less submissive than he or she does. Partners of depressed individuals viewed themselves as more controlling than their mate did. Men's depression was associated with disagreement between partners regarding men's self‐focused behavior. Results underscore the importance of considering interpersonal perception when conceptualizing relationship distress and depression within intimate relationships.     

Changing Me,Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy

We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale, which assesses relationship quality and collective efficacy. In Study 1 we conducted a waitlist‐control, short‐term couple therapy RCT study (N = 43 couples) with five systemic therapy sessions treating communication and partnership problems; our intent was to provide high external validity. Construct validity of EVOS was assessed by comparison with additionally applied scales (Family Scales; Outcome Questionnaire, OQ‐45.2). In Study 2, N = 332 individuals completed an experiment with high internal validity in order to verify sensitivity to change in three different social contexts. Results from Study 1 revealed a significant increase in relationship quality in the treatment group directly after treatment, as compared to the control group. Sensitivity to change was slightly better for EVOS than for other measures. While this positive change could not be fully sustained between posttreatment and a 4‐week follow‐up, EVOS score did not fall below baseline and pretreatment levels, supporting moderate‐to‐large sensitivity to change. Study 2 supported high sensitivity to change in EVOS for couple relations, family relations, and work‐team relationships. Therefore, EVOS can be used as an outcome measure to monitor the process of systemic interventions focusing on relationship quality and collective efficacy. Due to its sensitivity to change, EVOS can provide evidence for treatment success with regard to relationship aspects.     

Evaluating Supervision Models in Functional Family Therapy: Does Adding Observation Enhance Outcomes?

This study examined the effects of observation‐based supervision Building Outcomes with Observation‐Based Supervision of Therapy (BOOST therapists = 26, families = 105), versus supervision as usual (SAU therapists = 21, families = 59) on (a) youth externalizing behavior problems and (b) the moderating effects of changes in family functioning on youth externalizing behaviors for adolescents receiving Functional Family Therapy (FFT). Exploratory analyses examined the impact of supervision conditions on youth internalizing problems. In 8 community agencies, experienced FFT therapists (M = 1.4 years) received either BOOST or SAU supervision in a quasi‐experimental design. Male (59%) or female (41%) adolescents were referred for the treatment of behavior problems (e.g., delinquency, substance use). Clients were Hispanic (62%), African American (19%), Non‐Hispanic White (12%), or Other (7%) ethnic/racial origins. Therapists (female, 77%) were Hispanic 45%, African American (19%), White Non‐Hispanic (30%), or other (4%) ethnic/racial backgrounds. Analyses controlled for the presence or absence of clinically elevated symptoms on outcome variables. Clinical outcomes were measured at baseline, 5 months, and 12 months after treatment initiation. Clients with externalizing behavior above clinical thresholds had significantly greater reductions in problem behaviors in the BOOST versus the SAU conditions. Clients below thresholds did not respond differentially to conditions. Supervisors in BOOST had more experience with the FFT model; as such, the observed results may be a result of supervisor experience. The BOOST supervision was associated with improved outcomes on problem behaviors that were above clinical thresholds. The findings demonstrate the importance of addressing client case mix in implementation studies in natural environments.     

Mid‐ and Long‐Term Effects of Family Constellation Seminars in a General Population Sample: 8‐ and 12‐Month Follow‐Up

In a previous randomized controlled trial (RCT), short‐term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid‐ and long‐term stability of these effects. Participants were 104 adults (M = 47 years; SD = 9; 84% female) who were part of the intervention group in the original RCT (3‐day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ‐45.2) at 8‐ and 12‐month follow‐up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals’ experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (d = 0.41 at 8‐month follow‐up, p = .000; d = 0.40 at 12‐month follow‐up, p = .000). Results were confirmed for psychological distress, motivational incongruence, the participants’ experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid‐ and long‐term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed.     

Unequally into “Us”: Characteristics of Individuals in Asymmetrically Committed Relationships

This study examined characteristics of individuals that are associated with being in asymmetrically committed relationships (ACRs), defined as romantic relationships in which there was a substantial difference in the commitment levels of the partners. These ACRs were studied in a national sample of unmarried, opposite‐sex romantic relationships (N = 315 couples). Perceiving oneself as having more potential alternative partners was associated with increased odds of being the less committed partner in an ACR compared to not being in an ACR, as was being more attachment avoidant, having more prior relationship partners, and having a history of extradyadic sex during the present relationship. Additionally, having parents who never married was associated with being the less committed partner in an ACR but parental divorce was not. Although fewer characteristics were associated with being the more committed partner within an ACR, more attachment anxiety was associated with increased odds of being in such a position compared to not being in an ACR. We also address how some findings change when controlling for commitment levels. Overall, the findings advance understanding of commitment in romantic relationships, particularly when there are substantial asymmetries involved. Implications for both research on asymmetrical commitment as well as practice (e.g., therapy or relationship education) are discussed.     

Parents Plus Systemic,Solution‐Focused Parent Training Programs: Description,Review of the Evidence Base,and Meta‐Analysis

Parents Plus (PP) programs are systemic, solution‐focused, group‐based interventions. They are designed for delivery in clinical and community settings as treatment programs for families with child‐focused problems, such as behavioral difficulties, disruptive behavior disorders, and emotional disorders in young people with and without developmental disabilities. PP programs have been developed for families of preschoolers, preadolescent children, and teenagers, as well as for separated or divorced families. Seventeen evaluation studies involving over 1,000 families have shown that PP programs have a significant impact on child behavior problems, goal attainment, and parental satisfaction and stress. The effect size of 0.57 (p < .001) from a meta‐analysis of 10 controlled studies for child behavior problems compares favorably with those of meta‐analyses of other well‐established parent training programs with large evidence bases. In controlled studies, PP programs yielded significant (p < .001) effect sizes for goal attainment (d = 1.51), parental satisfaction (d = 0.78), and parental stress reduction (d = 0.54). PP programs may be facilitated by trained front‐line mental health and educational professionals.     

An Implementation Study of Relationship Checkups as Home Visitations for Low‐Income At‐Risk Couples

Couples with the greatest need for relationship health maintenance and intervention are often least able to afford and access it; therefore, accessible, affordable, effective, and brief interventions are needed to improve relationship health for those who need it most. Consequently, this paper examined whether a brief relationship intervention could be effectively implemented with a low‐income, underserved population. All enrolled participants (N = 1,312) received the Relationship Checkup, which consists of an assessment and a feedback session delivered in their homes or at a local clinic at their request. Measures assessed relationship satisfaction, communication, psychological and physical aggression, and intimacy at baseline and 1‐month follow‐up, and program and relationship satisfaction at 6‐month follow‐up. All participants reported significant improvements on all outcomes with small effect sizes. However, moderation analyses suggested that distressed couples reported significantly larger effects across the board. Overall, participants reported that they were highly satisfied with the intervention both immediately after its delivery and 6 months later. Findings provide preliminary support for the effectiveness of this brief checkup and point to the utility of offering these kinds of low‐cost brief interventions in flexible formats for those who might have the most difficulty accessing them.     

The Role of Parents in Emerging Adults’ Psychological Well‐Being: A Person‐Oriented Approach

The purpose of this study was to gain an overview of Spanish emerging adults’ family relationships and their link with psychological well‐being and psychological distress. The sample comprised 1502 undergraduate students (903 women and 599 men) aged between 18 and 29 (M = 20.32 and SD = 2.13), recruited from two universities in Spain. A cluster analysis identified three groups of families based on the centrality of five family variables: parental involvement, parental support for autonomy, parental warmth, behavioral control, and psychological control. The three groups or clusters were labeled high‐quality family relationships (HQ), intermediate‐quality family relationships (IQ), and low‐quality family relationships (LQ). Women were overrepresented in the HQ cluster, whereas men were overrepresented in the IQ cluster. Moreover, emerging adults who perceived better family relationships (high levels of parental involvement, parental support for autonomy and parental warmth, and low levels of behavioral and psychological control) were found to have a higher level of psychological adjustment. Thus, our results indicate that family plays a key role in the psychological well‐being of emerging adults. The discussion focuses on the implications of this finding for the parent‐child relationship, and explores how it extends our knowledge about family relationships during emerging adulthood.     

A Model‐Based Cluster Analysis of Maternal Emotion Regulation and Relations to Parenting Behavior

In a diverse community sample of mothers (N = 108) and their preschool‐aged children (M_age = 3.50 years), this study conducted person‐oriented analyses of maternal emotion regulation (ER) based on a multimethod assessment incorporating physiological, observational, and self‐report indicators. A model‐based cluster analysis was applied to five indicators of maternal ER: maternal self‐report, observed negative affect in a parent–child interaction, baseline respiratory sinus arrhythmia (RSA), and RSA suppression across two laboratory tasks. Model‐based cluster analyses revealed four maternal ER profiles, including a group of mothers with average ER functioning, characterized by socioeconomic advantage and more positive parenting behavior. A dysregulated cluster demonstrated the greatest challenges with parenting and dyadic interactions. Two clusters of intermediate dysregulation were also identified. Implications for assessment and applications to parenting interventions are discussed.     

Longitudinal Effects of Latino Parent Cultural Stress,Depressive Symptoms,and Family Functioning on Youth Emotional Well‐Being and Health Risk Behaviors

U.S. Latino parents can face cultural stressors in the form of acculturative stress, perceived discrimination, and a negative context of reception. It stands to reason that these cultural stressors may negatively impact Latino youth's emotional well‐being and health risk behaviors by increasing parents' depressive symptoms and compromising the overall functioning of the family. To test this possibility, we analyzed data from a six‐wave longitudinal study with 302 recently immigrated (<5 years in the United States) Latino parents (74% mothers, M_age = 41.09 years) and their adolescent children (47% female, M_age = 14.51 years). Results of a cross‐lagged analysis indicated that parent cultural stress predicted greater parent depressive symptoms (and not vice versa). Both parent cultural stress and depressive symptoms, in turn, predicted lower parent‐reported family functioning, which mediated the links from parent cultural stress and depressive symptoms to youth alcohol and cigarette use. Parent cultural stress also predicted lower youth‐reported family functioning, which mediated the link from parent cultural stress to youth self‐esteem. Finally, mediation analyses indicated that parent cultural stress predicted youth alcohol use by a way of parent depressive symptoms and parent‐reported family functioning. Our findings point to parent depressive symptoms and family functioning as key mediators in the links from parent cultural stress to youth emotional well‐being and health risk behaviors. We discuss implications for research and preventive interventions.     

Relationship between Mental Health and Burden among Primary Caregivers of Outpatients with Schizophrenia

There is growing recognition that caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health for caregivers. A quantitative cross‐sectional design and standardized instruments were used to collect data from 355 primary caregivers of adults in outpatient care with schizophrenia in China. Structural equation modeling was used to examine the association between caregiver burden and mental health among primary caregivers and whether this association is influenced by personality, coping style, and family functioning, based on a diathesis–stress perspective. Goodness‐of‐fit indices (χ²/df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmed that the modified model fit the data well. In line with the diathesis–stress model, and with this study's hypotheses, we found that caregiver burden was significantly related to mental health outcomes directly. The final model showed that personality traits, coping style, and family function influenced the relationship between caregiver burden and mental health. The neuroticism personality traits have a direct effect on caregiver burden and family functioning in this sample. Coping style had a direct effect on the caregiver burden, and family functioning had a direct effect on the caregiver burden. Our final model about primary caregivers can be applied clinically to predict mental health outcomes from caregiver burden.     

A Population‐Based Comparison of Female and Male Same‐Sex Parent and Different‐Sex Parent Households

This investigation compared Dutch same‐sex parent and different‐sex parent households on children's psychological well‐being, parenting stress, and support in child rearing. It was also assessed whether associations among children's well‐being, parenting stress, and support in child rearing were different in the two household types. Data were based on a nationally representative survey (N = 25,250). Matching was used to enhance similarity in background characteristics between both types of families. Parental and child characteristics were matched for 43 female same‐sex parent, 52 male same‐sex parent, and 95 different‐sex parent households with offspring between 5 and 18 years old. No significant differences were found on children's well‐being, problems in the parent–child relationship, being worried about the child, or the use of formal and informal support between mothers in same‐sex and different‐sex parent households or for fathers in same‐sex and different‐sex parent households. Regarding perceived confidence in child rearing, fathers in same‐sex parent households and mothers in different‐sex parent households felt less competent than their counterparts. Neither the associations between children's well‐being and the predictors (parenting stress variables) nor those between support and the predictors (parenting stress and children's well‐being) differed along household type. In this population‐based study, the similarity in child outcomes regardless of household type confirms the results of prior investigations based on convenience samples. These findings are pertinent to family therapists, practitioners, court officials, and policymakers who seek information on parenting experiences and child outcomes in female and male same‐sex parent families.     

The Effectiveness of Functional Family Therapy for Adolescent Behavioral and Substance Misuse Problems: A Meta‐Analysis

A systematic review of published and unpublished English language articles identified 14 studies containing 18 comparisons between functional family therapy (FFT) and another condition in the treatment of adolescent disruptive behavior and substance use disorders. In 11 of these comparisons, assignment to conditions was random, while nonrandom assignment occurred in seven studies. For both random and nonrandom comparisons, separate meta‐analyses were conducted for subgroups of studies depending on the type of comparison group used. Data from studies of untreated control groups (CTL), treatment as usual (TAU), and well‐defined alternative treatments (ALTs) were analyzed separately. Effect sizes from these six meta‐analyses were as follows: random assignment FFT versus CTL (k = 3, d = 0.48, p < .01); random assignment FFT versus TAU (k = 3, d = .20, ns); random assignment FFT versus ALT (k = 5, d = .35, p < .05); nonrandom assignment FFT versus CTL (k = 2, d = .90, ns); nonrandom assignment FFT versus TAU (k = 2, d = .08, ns); and nonrandom assignment FFT versus ALT (k = 3, d = .75, p < .001). These results provide support for the effectiveness of FFT compared with untreated controls and well‐defined ALTs, such as cognitive behavior therapy, other models of family therapy, and individual and group therapy for adolescents.     

Mexican‐Origin Parents’ Stress and Satisfaction: The Role of Emotional Support

Guided by a process model of parenting and the integrative model, this study examined sources of emotional support (i.e., partner, maternal, paternal) as related to stress and satisfaction resulting from the parenting role in a sample of Mexican‐origin young adult parents who participated in the National Longitudinal Study of Adolescent to Adult Health (Add Health) during Wave IV. Participants were male and female parents (26–35 years of age; 59% female; N = 737) who had children and a partner. Results from structural equation modeling revealed support from mothers as salient; high levels of maternal support were associated with high levels of parenting satisfaction. Tests of indirect effects suggested that parenting satisfaction played an intervening role in the link between maternal support and parenting stress. The pattern of results held across levels of linguistic acculturation but varied by gender. Understanding the mechanisms that predict parenting stress and satisfaction within the Mexican‐origin population may help in the identification of culturally sensitive intervention strategies.     

Effectiveness of the ‘Hold me Tight’ Relationship Enhancement Program in a Self‐referred and a Clinician‐referred Sample: An Emotionally Focused Couples Therapy‐Based Approach

While evidence‐based couple therapies are available, only a minority of troubled couples seek help and they often do this too late. To reach more couples earlier, the couple relationship education (CRE) group program “Hold me Tight” (HmT) based on Emotionally Focused Couples Therapy (EFCT) was developed. This study is the first to examine the effectiveness of HmT. Using a three‐wave (waiting period, treatment, and follow‐up) within‐subject design, HmT was delivered to 79 self‐referred couples and 50 clinician‐referred couples. We applied a comprehensive outcome measure battery. Our main findings were that (1) self‐referred couples significantly improved during HmT on all measures, that is relationship satisfaction, security of partner‐bond, forgiveness, daily coordination, maintenance behavior, and psychological complaints, with a moderate‐to‐large mean effect size (d = .63), which was maintained (d = .57) during the 3.5 month follow‐up; (2) in clinician‐referred couples, who were vulnerable in terms of insecure attachment status and psychopathology, the improvement during HmT was moderate (d = .42), but this was reduced during the 3.5‐month follow‐up to a small effect (d = .22); (3) emotional functioning (typical HmT target) as well as behavioral functioning (typical Behavioral Couples Therapy‐based CRE target) improved during HmT; and (4) individual psychological complaints, although not specifically targeted, were reduced during HmT. These findings suggest that HmT is a promising intervention for enhancement of relationship functioning. Clinical implications are discussed.     

A Typology of Interactional Patterns Between Youth and Their Stepfathers: Associations with Family Relationship Quality and Youth Well‐Being

Stepfamilies are an increasingly common family form, many of which are headed by a resident mother and stepfather. Stepfather–child relationships exert notable influence on stepfamily stability and individual well‐being. Although various stepfather roles have been observed, more research is warranted by which stepfather–child interactions are explored holistically and across a variety of life domains (e.g., recreational, personal, academic, and disciplinary). Thus, the primary purpose of the current study is to explore varying interactional patterns between youth and their stepfathers. A latent class analysis is conducted using a representative sample of 1,183 youth (53% female; mean age = 15.64 years, SD = 1.70 years; 62% non‐Hispanic White) residing in mother–stepfather families from Wave I of the National Longitudinal Study of Adolescent to Adult Health. Latent‐class enumeration processes support a four‐class solution, with latent classes representing inactive, academically oriented, casually connected, and versatile and involved patterns of youth–stepparent interaction. Notable differences and similarities are evident across patterns with respect to family relationship quality, youth well‐being, and socio‐demographic characteristics. Differences are most stark between the inactive and versatile and involved patterns. Ultimately, the results showcase notable variation in youth–stepparent interactional patterns, and one size does not necessarily fit all stepfamilies. Family practitioners should be mindful of variation in youth–stepparent interactional patterns and assist stepfamilies in seeking out stepparent–child dynamics that are most compatible with the needs and dynamics of the larger family system.