# Presentation: 087710

## Building Strong Families:  Implementation AnalysisM. Robin DionHeather H. Zaveri10th Annual ACF Welfare Research and Evaluation ConferenceJune 4, 2007

## What is Building Strong Families?

**Demonstration and evaluation of the effectiveness of a healthy marriage program for unwed parents**
**Random assignment of at least 4,300 couples to program or control group**
**In-depth study of program implementation**
**Evaluation of impacts on couples and their children  based on 15- and 36-month follow-ups**
**Outcome measures include healthy marriage, relationship quality, parental well-being, parenting, and children’s social, emotional, cognitive development**

## Why Focus on Marriage Among Unwed Parents?

**Research shows that **
**at the time of their child’s birth, many unmarried couples aspire to marriage – but have numerous challenges to that goal **
**children do better when raised by their biological parents in a healthy marriage**

## BSF Program Purpose

**To help unwed parents build stronger relationships and fulfill their hopes for marriage**
**Target population**
**Unwed, romantically involved biological parents at or around the time of their baby’s birth**

## Where Are We Now in BSF?

**Pilot period completed, report on “early lessons”**
**Evaluation enrollment began 2005-2006 in 7 sites    (12 locations)**
**More than half the evaluation sample is enrolled (2,684 couples)**
**First round of site visit data collection completed; report forthcoming**
**15-month survey of BSF parents under way**

## The BSF Intervention Model

**Marriage and **
**Relationship**
**Skills Education**
**Group Sessions**
**Male and Female **
**Co-Facilitator Teams**
**30-44 Hours**

**Family **
**Support  **
**Services**
**Address Marriage**
** ****Barriers**
**Use Existing **
**Resources**

**Family**
**Coordinators**
**Encourage Group**
** ****Attendance**
**Assess for Needs and**
** ****Link to **
**Other Services**

## BSF Sites Chose Three Marriage Education Curricula

| Curriculum  | Number of Sessions | Intended Group Size (Couples) | Session Length (Hours) | Total Hours |
| --- | --- | --- | --- | --- |
| Loving Couples, Loving Children 
(5 sites) | 21 | 4-6 | 2.0 | 42 |
| Becoming Parents 
(1 site) | 6 or 10 | 10-15 | 5 or 3 | 30 |
| Love’s Cradle 
(1 site) | 21 | 6-8 | 2.0 | 42 |

## The BSF Sites

| Site | Supporting Organization | State Involvement |
| --- | --- | --- |
| Atlanta, GA | Georgia State University; Latin American Association | N/A |
| Baltimore, MD | Center for Fathers, Families, and Workforce Development | N/A |
| Baton Rouge, LA
 | Family Road of Greater Baton Rouge | N/A
 |
| Florida | Healthy Families Florida | Florida Department of Children and Families |
| Indiana | Healthy Families Indiana | Indiana Department of Child Services |
| Oklahoma  | Public Strategies, Inc. | Oklahoma Department of Human Services |
| Texas | Healthy Families Texas | Texas Attorney General’s Office |

## Three Different Organizational Structures Are Used  in BSF

- Three sites integrated BSF into the services of another program for low-income families (HF)
- Florida, Indiana, Texas
- Two multi-program agencies added BSF to their menu of other services for low-income families
- Baltimore, Baton Rouge
- Two sites created BSF “from scratch”
- Oklahoma, Atlanta

## The Couples:  Who Enrolls? 

## BSF Couples Are in Mid-20s, Racially Diverse, with Multiple Children

|  | Mothers | Fathers |
| --- | --- | --- |
| Age (average) | 23 | 26 |
| African American
Hispanic
White | 57%
23%
16% | 60%
23%
13% |
| Number of Children | 1.9 | 1.9 |
| Multiple Partner Fertility | 
31% | 
29% |

**Notes:**
Study participants were typically in their mid-20s with women about two years younger than men.  There was more than a ten-year age difference between partners in about 7 percent of couples

The BSF focal child was the first child for about half of parents.  Average was about 2 kids.  One-quarter had another child with current partner.
In 46% of couples, one or both partners had a child from a previous relationship.  In 14% both mothers and fathers had MPF; in 15%only fathers did; in 17% only moms did. 

55% of couples were pregnant at enrollment.

## Most Sites Tend to Primarily Serve a Specific Racial/Ethnic Group

**Percentage Race/Ethnicity, by Site**

## Most Have H/S Education, Many Fathers Work, but Earnings Are Low at Baseline

|  | Mothers | Fathers |
| --- | --- | --- |
| High School Diploma or GED | 67% | 66% |
| Currently Employed | 29% | 75% |
| Earnings past year 
--Below $15,000
--$15,000-$25,000 | 
62%
11% | 
53%
26% |

**Notes:**
About 2/3 of men and women had at least a high school degree or equivalent.  In about half of all couples, both the man and woman had a HS degree or GED.

Combining the earnings of each member of the couple results in joint earnings of less than $15,000/year for over one-third of couples.  Not all couples live together or share earnings, but this is an estimate of the level of income that may be available to them as a family around the time their child is born.

## At Baseline, Most Mothers Receive Public Assistance, but Few on TANF

|  | Mothers | Fathers |
| --- | --- | --- |
| Any Public Assistance | 81% | 44% |
| TANF | 10% | 3% |
| Food Stamps | 40% | 17% |
| Medicaid/SCHIP | 69% | 31% |
| WIC | 65% | 33% |
| SSI, SSDI, UC | 10% | 6% |

## Most BSF Couples Cohabit, Expect to Marry, and Have History at Baseline

|  | Mothers | Fathers |
| --- | --- | --- |
| Time Known One Another | 3.4 Years | 3.4 Years |
| Cohabiting  | 72% | 73% |
| Relationship Quality Score (8-32) | 25 | 26 |
| High Chance of Marriage | 65% | 70% |
| Birth Intended  | 31% | 42% |

**Notes:**
70% lived togehr all or most of the time; another 11% cohabited some of the time. 
About 6% married post-conception.

## How Much Do Experimental Group Couples Participate in Program Activities? 

## Not All Couples Attend Group Sessions—But Dosage is Substantial Among Attenders

**61% of program group couples initiate attendance at curriculum groups**
**Among those who initiate attendance, total average attendance is about 21 hours**
**Most group attendance is by both partners**

## Participation in Topic Areas Varied by Curriculum Emphasis and Module Sequence

**Percentage of Attender Couples Receiving Instruction in Major Content Areas, by Curriculum**

## ...But Most Attenders Got Instruction in the Key Areas Regardless of Curriculum 

**Percentage of Attender Couples Receiving Instruction in Major Content Areas**

## Group Attenders Believe the Program Benefits Their Relationships

**   ****145 randomly selected focus group participants from all sites...**
**Nearly universal in their positive assessments of group sessions**
**Cited communication, compromise, conflict management skills as especially useful**
**Reported losing any initial nervousness after experiencing two or three sessions**
**Some wanted to continue group sessions beyond curriculum’s end**

## Reasons Given for Nonattendance Involve Logistical and Couple Issues

**Non-participants (no group sessions)**
**Scheduling or logistical issues**
**Mothers going back to work**
**Changes to fathers’ work schedules**
**Transportation issues**
**Relationship or family issues**
**Partner changed his mind or broke up**
**Baby too young to take out of house**
**Low participants (1-2 group sessions)**
**Pleased with the sessions, but similar issues interfered, plus health problems **
**Pregnancy complications**
**Sick children or partners**

## Timing of Enrollment is a Factor in Group Attendance

**In general, couples recruited prenatally were more likely to ever attend group sessions than those recruited postnatally**
**It’s easier to get out of the house before the baby comes**
**Prenatal participation may lead to greater attendance after birth of baby**

## Couples Had Other Contact With the Program Outside the Group Setting

**Couples contacted by program staff from 1-10 times per month**
**Contacts involved**
**Assessments for other family needs**
**Follow up on referrals to other services**
**Home visits about parenting/child development**
**Reminders about upcoming group meetings/events**
**Discussions about relationship issues or curriculum topics**
**Some portion of the 39 percent of non-group attenders received these services**

## The Sites: Practices, Challenges, and Resources

## Steps in Implementing the BSF Model 

**Find recruitment sources and develop effective practices**
**Develop and refine strategies for delivering group workshops**
**Define the family coordinator component to provide individual-level support**
**Implement a process for assessing and linking couples to family support services**

## Most Couples Were Identified through the Maternal Health Care System

|  | ATL | BALT | BR | FL | IN | OK | TX |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Recruitment Sources |  |  |  |  |  |  |  |
| Birthing Hospitals |  |  |  |  |  |  |  |
| Prenatal Clinics |  |  |  |  |  |  |  |
| Social Service Programs |  |  |  |  |  |  |  |
| Public Health Clinics |  |  |  |  |  |  |  |
| Broad Outreach |  |  |  |  |  |  |  |
| Timing of Recruitment |  |  |  |  |  |  |  |
| Prenatal |  |  |  |  |  |  |  |
| Postnatal |  |  |  |  |  |  |  |

**Recruitment Sources and Timing, by Site**

## Sites Were Challenged By Need to Recruit Two Instead of One

**Sites most effective at recruitment were flexible and opportunistic in their enrollment process**
**Most expedient method was to identify opportunities for conducting outreach and intake in a single step—with both members of the couple simultaneously**
**Some sites favored mixed gender recruitment teams to reinforce the message that the program is for couples, rather than mothers or fathers**

## Couples Screened for Domestic Violence Before Enrollment and Throughout Participation

**All sites screened couples for domestic violence prior to and after enrollment**
**Four sites used a formal screening tool to detect violence**
**Three sites used a conversational method to look for common signs of violence**
**Sites reassessed and revised their screening or monitoring policies, as needed**

## Sites Were Challenged By Couples’ Often Limited or Changing Availability

**Sites worked to accommodate couples’ schedules for attendance at group sessions**
**Offering group on weeknights and weekends was essential**
**Identifying couples’ availability prior to assigning a group series helpful**
**Sites addressed anticipated barriers**
**Transportation**
**Child care**

## Sites Implemented Strategies to Promote Initial Group Participation

| Practice | ATL | BALT | BR | FL | IN | OK | TX |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Social Activities with Other BSF Couples |  |  |  |  |  |  |  |
| Meetings with BSF Family Coordinators |  |  |  |  |  |  |  |
| Meetings with Group Facilitators |  |  |  |  |  |  |  |
| Parenting-Focused Home Visits |  |  |  |  |  |  |  |
| Group Orientation Sessions |  |  |  |  |  |  |  |
| Incentive for Attending First Group Session |  |  |  |  |  |  |  |

## Sites Continually Targeted Ongoing Group Attendance

| Practice | ATL | BALT | BR | FL | IN | OK | TX |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Ongoing Social Activities |  |  |  |  |  |  |  |
| Staff Reminder Before Session |  |  |  |  |  |  |  |
| Flexibility in Group Schedule |  |  |  |  |  |  |  |
| Telephone Contact After Group Absence |  |  |  |  |  |  |  |
| Home Visit After Group Absence |  |  |  |  |  |  |  |
| Incentives for Attendance and/or Completion |  |  |  |  |  |  |  |
| Comfortable Setting for Group Sessions |  |  |  |  |  |  |  |

## The Emphasis on Participation Incentives Differed Across Sites

**Sites crafted incentive strategies that match their philosophies**
**Gift cards, baby items, and cash were common type of incentives**
**Incentives distributed in different ways and with different frequency--**
**To all couples attending a session**
**To the winner of a raffle at a session**
**As an award for reaching an attendance milestone**

## Family Coordinator (FC) Functions Were Specified in the BSF Model ...

**Reinforcing marriage and relationship skills learned in group**
**Encouraging group attendance**
**Providing ongoing emotional support**
**Assessing and linking couples to family support services**

## ...But Functions Were Implemented Unevenly Across Sites

**In some sites, FC staff were stretched to cover several roles or functions**
**Some FCs had additional BSF responsibilities that took most of their time**
**Other FCs had to fulfill preexisting service roles and provide other curricula**
**Defining the FC role and preparing staff did not come quickly **
**Sites did not immediately have a clear set of standards for frequency, purpose of FC contacts**
**Some FC staff did not at first feel prepared to reinforce relationship skills**

## Sites’ Standards for FC Contact With Couples Varied Widely

|  | ATL | BALT | BR | FL | IN | OK | TX |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Primary Mode or Location for Contacting Couples |  |  |  |  |  |  |  |
| Telephone Call |  |  |  |  |  |  |  |
| Home Visit |  |  |  |  |  |  |  |
| Office Visit |  |  |  |  |  |  |  |
| Intended Frequency of Contact |  |  |  |  |  |  |  |
| Regular Meetings at Set Frequency |  |  |  |  |  |  |  |
| As Needed |  |  |  |  |  |  |  |

## Specialized Training Was Needed for FCs to Reinforce Skills with Couples

**Those FCs who were not also Group Leaders struggled at first in how to reinforce marriage skills with couples**
**Sites requested training and guidance for FCs from the curriculum developers **
**About half of the sites now have structured ways for supporting skill reinforcement**
**Reinforcement often occurred during home visits, though some sites used telephone calls or office visits**

## FCs Found It Easier to Encourage Attendance and Provide Support

**Staff required limited guidance on how to encourage attendance and provide ongoing emotional support**
**Sites encouraged attendance through telephone contact and during regularly scheduled home visits**
**Sites tailored frequency of reminders to couples’ level of attendance**
**Couple’s circumstances often guided the frequency and type of emotional support provided**

## Mothers Were Assessed for Needs  by FCs More Frequently Than Fathers

|  | Mothers |  |  | Fathers |  |  |
| --- | --- | --- | --- | --- | --- | --- |
| 
Site | Prior to RA | Shortly After Enrollment | During Service Period | Prior to RA | Shortly After Enrollment | During Service Period |
| Atlanta |  |  |  |  |  |  |
| Baltimore |  |  |  |  |  |  |
| Baton Rouge |  |  |  |  |  |  |
| Florida |  |  |  |  |  |  |
| Indiana |  |  |  |  |  |  |
| Oklahoma |  |  |  |  |  |  |
| Texas |  |  |  |  |  |  |

## FC Assessments Helped Prioritize Needs and Identify Goals

**Sites used structured tools or completed in-depth but informally structured assessments**
**Couples often prioritized their needs and identified goals after completing assessments **
**Sites assessed parents for a wide variety of areas, including:**

| - Housing | - Budgeting / finances | - Personal health |
| --- | --- | --- |
| - Transportation | - Parenting knowledge | - Employment / education |
| - Nutrition | - Infant health / safety | - Social support |

## Sites Linked Couples To Support Services Through Referrals

**Referrals reflected couples’ needs and goals**
**Sites provided referrals to couples, often through an informal process**
**Follow-up provided by BSF staff varied by site and couples’ circumstances**

## Summary of What’s Going Well...

**Sites are successfully enrolling target population at a steady pace**
**Organizations succeeded in shifting unit of service from lone parents to couples **
**Attending couples get substantial exposure to marriage/relationship skills instruction**
**Couples attending group sessions see them as beneficial to their relationships**

## ...And Not So Well

**Need to improve rate of ever attending group sessions**
**Family coordinator component needs strengthening in some sites**
**Some sites need to increase focus on assessing and referring fathers, especially for employment needs**

## (Practical) Lessons Learned

**Many low-income unwed parents are interested in learning skills to improve their relationships and consider marriage**
**To simplify recruitment, plan to engage both parents from the beginning**
**The magic moment for recruitment may be during pregnancy rather than childbirth**
**Use multiple methods to encourage initial and ongoing group attendance—but recognize that some may not ever attend**

## For More Information

**BSF Website:**
**www.buildingstrongfamilies.info**
**New report to be released Fall 2007**