Connect to Baby: A Pilot Study of a Parenting and Coparenting Program for New Parents
Phase: NA
Conditions: Parenting
Sponsor: Georgetown University

 
Study Title: Connect to Baby: A Pilot Study of a Parenting and Coparenting Program for New Parents 
FAIN: R21HD108499  
Date: June 26, 2023 
 
 
 

Specific Aims 
 
Responsive, contingent interactions between parents and infants (i.e., “serve and return” exchanges) 
profoundly shape infant brain architecture and thus children’s socioemotional, language, and cognitive 
development.1 Poverty, and its associated contextual stressors, can undermine parents’ capacity to engage in 
contingent interactions by negatively affecting parents’ mental health2–4; as a result, children growing up in low-
income families without strong buffering relationships may experience lifelong repercussions.5–7 Although 
parenting interventions can increase parenting quality and improve child development in low-income contexts,8 
— such as the ones funded by the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) 
program — the vast majority of programs for parents in poverty yield only modest effects that often fade.9 
Existing research suggests that these findings may stem, in part, from three key weaknesses in existing 
parenting programs: 1) a focus on mothers, rather than mothers and fathers; 2) a focus on the parent-child 
relationship to the exclusion of the coparenting relationship; and 3) low program retention rates.  
 
Our team—which includes the developers of Just Beginning (JB) and Family Foundations (FF)—have 
leveraged selected JB and FF content in combination with unique technological features to create a novel 
intervention: Connect to Baby (CTB), a 6-session manualized intervention. Parenting and coparenting quality 
are selected as targets for their strategic influence on infant and child development: contingent, responsive 
interactions between parents and infants are associated with better lifelong socioemotional and cognitive 
outcomes.10 Similarly, supportive coparenting relationships and coordination are associated with enhanced 
parent mental health, parenting quality, and children’s socioemotional and cognitive outcomes.11 CTB thus 
serves mother and father dyads, focuses on the coparenting relationship alongside the parent-child 
relationship, and bolsters recruitment and retention using innovative technological strategies.  
 
A key innovation of CTB lies in the introduction and rehearsal of four interaction skills –– Noticing, 
Following, Talking, and Encouraging (NiFTE, pronounced “nifty”) –– to foster serve and return interactions with 
infants as well as supportive, cooperative coparenting interactions between mothers and fathers. To engage 
both fathers and mothers, CTB recruits parents soon after the child’s birth, capitalizing on the “magic moment” 
of childbirth12 and uses father-inclusive digital media content to engage men.13 To maximize program reach 
and sustainability, CTB is designed to be delivered within Early Head Start (EHS), a family-serving agency 
parents already use and trust. Finally, our approach is innovative in that we propose to test a hybrid in-person 
and remote delivery modality using both video-enabled tablets and a custom-built application to schedule 
sessions and share digital content. Both technology features – hybrid delivery and the custom-built application 
– aim to boost retention and engagement in the program by ameliorating both structural (scheduling and 
logistical) and cognitive barriers to participation that plague many existing parenting interventions. Using a 
randomized controlled trial, we will compare the efficacy of CTB delivered as part of EHS (EHS-CTB hybrid) to 
EHS with the digital content only (EHS-digital only); both groups will be given access to the customized 
application and digital content that CTB offers, but only the EHS-CTB hybrid group will receive program 
sessions with guided practice and feedback on NiFTE skill development. The overarching goal of the present 
study is to assess the efficacy of CTB’s approach to family strengthening through the following aims: 
Aim 1. To assess the efficacy of CTB at improving program targets. Two hundred families will be recruited 
and randomized to one of two conditions: 1) EHS-CTB hybrid or 2) EHS-digital only. We hypothesize EHS-
CTB hybrid will increase coparenting communication quality and parenting quality relative to EHS-digital only at 
3- and 6-months post-random assignment (RA); comparing results at each timepoint will distinguish immediate 
from sustained effects of the program. Analyses will include both intent-to-treat (ITT) and treatment-on-the-
treated (TOT) analyses to determine the importance of program dosage for program efficacy. 
Aim 2. To assess the efficacy of CTB at enhancing secondary program outcomes. CTB will also be assessed 
with regard to parent mental health (assessed using parent self-report and a short diagnostic interview at 3- 
and 6-months post RA), and child socioemotional and language outcomes at 3- and 6-months post RA 
(assessed using parent-report and objective ratings). In exploratory analyses, parenting and coparenting 
quality will be tested as mediators and child sex as moderator of effects on secondary outcomes. 
 
 
If demonstrated to be efficacious, CTB will provide EHS, among the nation’s largest federally-funded early 
education programs, with a brief, cost-effective, manualized preventive intervention that could be used in 
conjunction with EHS center and home-visiting services to improve parenting quality and coparenting, engage 
fathers in programming and caregiving, and, ultimately, enhance child development. This study will also offer 
some of the first evidence as to the feasibility and efficacy of recruiting and retaining fathers, irrespective of 
parents’ relationship status, in parenting programs at every stage of an intervention.  
 
 

A. Significance 
 
Fostering sensitive, contingent responses between parents and infants is a key goal for infant programs in 
low-income communities for two reasons: (1) these interactions are the building blocks of infant brain 
development and impact all domains of child development,14,15 including socioemotional and language 
development1; and (2) because economic strain can undermine parents’ ability to provide contingent 
responses due to the emotional stress that often accompanies this hardship.2–4 The largest public investment 
in enhancing parenting among low-income families are the home visiting programs funded through the federal 
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Although many programs, including 
Early Head Start (EHS), have been shown to improve parenting behavior in the short term,8,16,17 their effects 
are small and often fade.18,19 The CTB program is a short-term, manualized intervention that can be easily 
incorporated into programs like EHS to enhance effects on parenting by addressing the three key weaknesses 
common to early parenting programs. Below, we describe these weaknesses and how CTB redresses them, 
offering a novel approach to enhancing the quality of parent-child interactions and early child development. 
 
A1. Father Engagement is Essential to Success of Parenting Interventions. All large, federally-funded 
home visiting programs primarily target mothers, whereas no large-scale parenting programs are consistently 
successful at engaging fathers.20 This shortcoming persists despite the fact that a large and growing literature 
demonstrates that fathers play important roles in the promotion of healthy development in children,21,22 with 
fathers’ positive involvement in children’s care predicting better socioemotional and cognitive outcomes, 
particularly during the first three years of life.23,24 Positive father involvement, particularly during the transition to 
parenthood, concurrent with a strong working relationship with mothers, can lower maternal stress and 
depression and even offset the negative sequelae of maternal depression as well as insensitive maternal 
parenting in children.25–28 Without including fathers in parenting interventions, programs forego any chance to 
realize the benefits to children and mothers of fathers’ positive involvement.  
 
A2. Enhancing Coparenting Relations is Essential to Success of Parenting Interventions. To integrate 
young, at-risk fathers successfully in a parenting program, it is essential to enhance coparenting relations – the 
extent to which parents support and coordinate their childrearing – alongside parenting skills. Overall, research 
highlights that among high-risk and economically vulnerable populations, positive mother-father coparenting 
relations are crucial for father involvement, maternal adjustment (stress, depression), fathers’ and mothers’ 
positive parenting, and child adjustment.29–31 In Feinberg’s empirically-supported theoretical model, improved 
coparenting relations reduce parent stress and depression, which in turn positively influence parenting quality, 
as undermining and competitive coparenting dynamics can distract a parent from a child’s needs and spillover 
to increased parenting harshness and diminished warmth.32,33 By ignoring coparenting, programs undermine 
gains achieved through the sole focus on parenting skills.29,34 Improvements in coparenting relationship quality 
can improve parents’ own mental health, 40 thereby directly and indirectly (via parenting quality) fostering 
children’s greater socioemotional wellbeing.35–39 
 
A3. Virtual Sessions and Technological Supports Can Increase Program Retention. A final problem 
plaguing many parenting programs is low take-up and retention.19 One reason is that low-income families are 
more likely than affluent ones to work nonstandard hours,33,35 making scheduling and attendance difficult. This 
is especially true for fathers, who often work multiple jobs, which can include irregular shifts that do not non-
overlap with mothers’ work hours.41 There is also evidence that cognitive biases, such as the tendency to focus 
on present versus future rewards, may make parents less likely to participate in home visiting even if they 
intend to do so,36–38 a strong barrier to program engagement for low-income parents for whom the stress of 
parenting amid economic strain makes short-term challenges particularly salient.39   
 
Hybrid delivery combined with technology-assisted prompts addresses these issues and holds promise for 
maintaining higher recruitment and retention rates in parenting programs. A hybrid delivery system, where 
initial sessions are conducted in-person to establish the relationship between facilitator and parents and 
subsequent sessions are conducted remotely, would allow parents to have sessions during non-standard 
hours and remove the logistical hurdles around scheduling in-person sessions. Moreover, evidence collected 
both before and during the pandemic suggests that remote delivery can be effective for both physical42 and 
mental health treatment.43–45 Additionally, if cognitive biases are key barriers to participation, recent research 
indicates they are highly modifiable through a light-touch text messaging approach. For example, weekly text-
message reminders and planning prompts sent to Head Start parents substantially decreased young children’s 
chronic absenteeism from preschool46 and enhanced participation in home visiting.47 
 
B. Innovation 

 
Connect to Baby (CTB) addresses the three major weaknesses described above that plague typical 
parenting programs by building on two evidence-based programs: Just Beginning (JB),48 a psychoeducational 
program for teen fathers, and Family Foundations (FF),11 which together target coparenting relations alongside 
parenting behavior. CTB harnesses the strengths of both programs and adds a hybrid, technology-enhanced 
delivery method to maximize program engagement and retention. 
 
B1. Engaging Both Fathers and Mothers Effectively. A number of parenting programs actively seek to 
include fathers, for instance by inviting them to participate in sessions, including EHS and Dozier’s attachment-
based parenting program, Attachment and Biobehavioral Catch-up (ABC).49 None use recommended 
strategies designed specifically to engage men, however, nor do they include fathers at every stage by design. 
To recruit and retain fathers and mothers, CTB contacts parents at the “magic moment” just after birth when 
parents – fathers, in particular – are uniquely motivated to be involved in caregiving.12 Moreover, fathers are 
recruited directly by facilitators and program staff, rather than through mothers as is the case in many 
programs, ensuring that fathers feel valued and welcomed.20,34 Although EHS prioritizes engaging fathers in 
programming, a study of over 200 early care providers found that only 14% of fathers participate in home visits 
because of resistance they feel from teachers and mothers as well as logistical challenges they face such as 
irregular work schedules. Many fathers also argue they do not know how to become involved because few 
programs explicitly invite them to participate.41,50 Similarly, the ABC program recruits 10-15% fathers into their 
program (Dozier personal communication, February 2022). With a willing population of fathers, alongside 
inclusive strategies, implementing a program to engage fathers is feasible and likely to enhance the success of 
parenting interventions within EHS. 
 
B2. Integration of Coparenting and Parenting Intervention Content. Although many programs exist that 
target parenting behavior, such as ABC,49 and there are a few that target coparenting relations (albeit without 
strong evidence, except for FF), we know of no programs that blend both targets into a conceptually-driven, 
integrated curriculum. Because it draws content from two evidence-based programs, one that targets parenting 
and one that targets coparenting, CTB targets all three inter-related dyadic relationships in the family system – 
mother-father, mother-infant, and father-infant – synergistically optimizing the programs’ efficacy. CTB 
harnesses two key strategies – NiFTE skills and video feedback – to simultaneously and cohesively enhance 
parents’ coparenting behaviors and parenting quality, an innovative integration that is unique to CTB.40 CTB 
uses the same four key interaction skills – NiFTE – to promote positive coparenting and parent-infant 
interactions. For example, in sessions focused on enhancing the quality of parent-infant play, we coach 
parents to notice their baby’s cues and to follow those cues, while in coparenting focused sessions we coach 
parents to notice and follow their parenting partner’s cues. The “NiFTE” curriculum was drawn from the core 
content of the JB program, which has been shown to enhance fathers’ emotional responsivity, warmth, and 
language stimulation with children ages 3–36 months, but also applies those skills to the coparenting 
relationship, which is unique to CTB.13,48,51 CTB also extends and enhances JB’s play-based curriculum by 
incorporating strengths-based video-feedback to reinforce parents’ use of NiFTE skills, which neither JB nor FF 
includes. Evidence suggests that video-feedback (showing parents with videos where they demonstrated 
specific skills), rather than just verbal feedback, is particularly effective at improving parenting among high-risk 
families.52–54 In this way, CTB harnesses two key strategies – NiFTE skills and video feedback – in novel ways 
to simultaneously and cohesively enhance both parenting and coparenting behaviors.  
 
 
B3.  Enhancing Recruitment, Retention and Engagement in Program using Technology.  
B3.1. Hybrid Delivery. The proposed study will evaluate a novel delivery approach to increase scheduling 
flexibility and reduce logistical hurdles and participant burden. The first session will be in-person to build an 
initial connection between the facilitator and co-parents and configure the technological components of the 
program (e.g., download the app onto parents’ phones, conduct a test Zoom session), avoiding initial technical 
barriers that have occurred with other remote delivery and app-based interventions. For remote sessions, CTB 
families will be provided with video-enabled tablets with data plans to obviate device and Wi-Fi issues. A 
handful of parenting interventions for at-risk mothers, including Dozier’s ABC program, have incorporated 
remote sessions via Zoom successfully, 55 suggesting remote delivery is feasible for this population.  CTB’s 
remote sessions will additionally include video content tailored to engage fathers. Specifically, CTB’s digital 
media includes video clips drawn in part from the Sesame Beginnings video series that use images of fathers, 
including Sesame Street’s “Baby Elmo” and his father, to signal the importance of fathers to the program and 
their babies’ development. Parenting interventions that utilize educational videos, such as JB, in combination 

with active practice and video feedback, have been effective at enhancing parenting quality among young, low-
income mothers.51,56–59 Direct recruitment and use of father inclusive content are among strategies 
recommended by fatherhood experts for engaging men in early childhood programming.34 We will also 
incorporate video feedback into this modality using automatic cloud uploads of recorded play sessions and 
immediate play-back via screen-sharing.  
 
B3.2. CTB App. To enhance retention, we will also use an adapted version of an application custom built for 
JB to facilitate and coordinate sessions and facilitate and track home practice.60 The app will reduce the 
difficulty of scheduling sessions by easing communication between the facilitator and co-parents, providing 
reminders for sessions, and embedding links to remote sessions. The scheduling and reminder features 
should, according to existing research on text-message “nudges,”61,62 increase program retention. The app 
also allows mothers and fathers to review program content and encourages them to practice activities between 
sessions. Specifically, through the app parents can review session lessons, re-watch session digital content, 
and track their progress via a visual “progress tree.” The latter tracking feature will also be used by the 
evaluation team to assess program engagement. The use of the app has been transferred to Georgetown and 
modified for the CTB program to allow both parents to have access to the scheduling component.63,64 The 
EHS-digital only group will have access to the digital content through the app but not progress or 
scheduling components.  
C. Approach 
C1. CTB Program Development and Pilot Study. CTB was co-developed by the three co-PIs by drawing 
program content from JB and FF and enhancing it with video-feedback, a custom app, and a hybrid delivery. 
The resulting intervention is an entirely novel, manualized curriculum in both English and Spanish that 
sequentially builds upon each session to teach, train, and coach mothers and fathers on coparenting 
approaches that facilitate cooperation and reduce conflict, and parenting approaches that facilitate serve and 
return interactions. In collaboration with the family engagement team at Martha’s Table (MT), a private non-
profit food assistance and early education provider serving low-income families in Washington, DC, we piloted 
the program between October 2018 and June 2019 with 10 mother-father dyads recruited from MT’s infant 
classrooms. Parents were 90% African-American and living in poverty – and live in many of the same 
neighborhoods as the target population in the proposed study (i.e., families served by EHS in the Washington, 
DC area). Parent-reported measures of coparenting relationship quality,65 father engagement in caregiving,66 
parenting stress (Parenting Stress Index; PSI),67 and depression (Center for Epidemiological Studies 
Depression Scale – Short Form; CES-D-SF)68 were gathered before the first (pretest) and after the sixth 
(posttest) sessions. Even with this underpowered sample, we found significant increases in both mother- and 
father-reported coparenting quality (Mpre = 5.07 vs. Mpost = 5.37, p < .02; d = .31) and fathers’ reports of 
caregiving (Mpre = 2.66 vs. Mpost = 3.44, p < .10; d = .55) from pre to posttest. Mothers’ reports on the Parent-
Child Dysfunctional Interaction subscale of the PSI and on the CESD-SF also decreased (d = .25 and .17, 
respectively), albeit not significantly.  
C2. Randomized Control Trial Design with EHS-CCP 
The present study proposes to test the efficacy of CTB embedded in the services of 16 Early Head Start 
providers in Washington, DC (see EHS-CCP letter of support).   
C2.1. Study Design. Mother-father dyads will be recruited from 16 EHS Child Care Partnership (EHS-CCP) 
providers in Washington, DC. Once recruited, dyads will be randomly assigned to one of two conditions: 1) 
EHS-CTB hybrid; 2) EHS-CTB digital only. Dyads will be randomized within each center to ensure center 
characteristics do not bias estimated effects. Measures of all targets and outcomes will be collected from 
dyads just before random assignment, before any sessions have occurred for treatment group families, and 
again 3- (posttest) and 6-months (follow-up) after random assignment. The posttest will coincide with program 
completion for EHS-CTB families. Families will be recruited from among families enrolled in EHS who have 
recently entered or will soon enter an EHS classroom; thus, infants will be between 2 and 8 months old at 
enrollment. One hundred fifty dyads will be recruited, about 9 from each EHS center. Thus, approximately 4-5 
families will be randomly assigned to each condition at each EHS center each year. This recruitment schedule 
is feasible given the number of families served by EHS-CCP each year (approximately 320 families with infants 
enroll each year). An ongoing trial of FF has a participation rate of about 50% of eligible couples, and 
approximately 50% of contacted parents participated in our CTB pilot. Thus, the projected recruitment rate 
(~25%) is conservative relative to close benchmarks.  
 

C2.2. Recruitment and Participants. EHS staff at each site will facilitate recruitment through flyers, direct 
invitations to families, introductions at drop-off and pick-up to CTB facilitators, and during EHS home visits. 
Each of the 3 CTB facilitators will be assigned to 8 EHS-CCP centers to conduct recruitment and program 
delivery, with the only limitation that one facilitator is assigned to each family. Only EHS-enrolled families will 
be able to enroll. If parents are interested, informed consent will occur, and the pre-test assessment will be 
scheduled. To increase participation, we will conduct assessments via phone or Zoom and use survey 
software. Parents will be eligible for the study who are aged 18-40 years, have an infant between 2 and 8 
months of age enrolled at EHS; parents or partners do not have to be married or in a romantic relationship, but 
both must be committed to working together to raise their child. Father figures can include mothers’ boyfriends 
or cohabiting partners who are not the biological father but are committed to caring for the infant. If the 
mother’s coparenting partner is a same-sex partner or relative (e.g., grandmother), we will include them as co-
parents in lieu of a father figure. Dyads can be English- or Spanish-speaking. Dyads will be ineligible if at the 
pre-test assessment their score on the WAST Interpersonal Violence (IPV) screener69 indicates ongoing sexual 
or physical abuse; these cases will be referred to an EHS caseworker for assistance.  
 
  
C2.3. Procedures. Dyads in the EHS-CTB hybrid condition will receive 6 joint sessions of CTB conducted by 
trained facilitators. Dyads in the EHS-CTB digital only group will receive EHS early education, as well as EHS 
home visitation, and will have access to the CTB content via the CTB app but will receive no CTB sessions. 
Because we theorize guided practice of and video-feedback on NiFTE skills to be the active components of the 
program, EHS-CTB digital content only will provide a suitable control group to test the program’s effectiveness. 
The first session will be at the EHS center, the second through fifth would be remote, and last would be at the 
center as a group session with other families. Sessions will occur approximately one to two weeks apart, 
allowing for program completion by 10 weeks. During the first in-person session, families will receive tablets 
with data plans and with the Zoom and CTB apps preloaded. They will receive a welcome pack that includes 
baby gifts that are used to support each session.   
 
   Facilitators will conduct remote sessions using tablets at EHS centers or another location where 
participant confidentiality can be maintained. Facilitators will use screen sharing to show digital media clips, 
including those from Sesame Workshop’s Baby Elmo series, which are designed to demonstrate the skills of 
Notice, Follow, Talk, and Encourage. Sessions will be recorded by facilitators and automatically saved to the 
Zoom cloud server to be viewed for supervision as well as to assess program fidelity. In order to facilitate video 
feedback during CTB sessions, there will be a session break after the facilitator has recorded the 
communication and play sessions. During the break, the recorded portion of the session will upload. Once the 
break is over, the facilitator and parents will reconnect to the Zoom call to provide short video feedback clips to 
parents via share screen. Each session – in-person and remote – comprises four parts: 1) recap last session’s 
skill (a NiFTE skill); 2) introduce new skill; 3) discuss skill, enabled via digital media; and 4) practice skill. 
Because some participants will not attend all planned sessions, the total number of sessions attended, specific 
sessions attended, and communications within the app will all serve as measures of compliance. The app will 
allow easy tracking of parents’ use of it. 
 
C3. Training, Supervision and Fidelity. Facilitators will be graduates from social work programs at Catholic 
and Howard Universities and the early education program at the University of the District of Columbia. The 
lead facilitator from the pilot study will serve as the lead facilitator and trainer for the two other facilitators. At 
least one facilitator will be fluent in Spanish, and we will recruit candidates who match parents’ cultural 
backgrounds. Each CTB facilitator will participate in a two-day training, led by the lead facilitator and 
developers, to learn to use the manual and the technology to deliver the content remotely. Once facilitators 
complete training, the first six sessions each facilitator delivers will be video recorded for fidelity review. During 
implementation, all sessions will be recorded to allow for video feedback and supervision and 20% of sessions 
will be reviewed for fidelity. The trainer will provide feedback on the extent to which the facilitator followed the 
manual and engaged parents effectively. Feedback will be based on video review and a fidelity coding scheme 
created for CTB in which facilitators are scored for session component completion, as well as 7 positive and 7 
negative engagement criteria every 30 seconds. Pilot data showed that reliability of the fidelity scheme was 
high (kappa > .7) as was session fidelity and facilitator quality. Any facilitator not delivering CTB with fidelity will 
receive a refresher training before resuming program delivery.  
 
C4. Data Collection. For dyads in the program and control groups, all key program targets and outcomes will 
be measured just after enrollment and before random assignment (RA; pretest), at 3 months post RA 

(posttest), which would occur just after program completion for treatment families, and again at a 6-month 
follow-up after RA (approximately 3 months after program completion for EHS-CTB hybrid families). Children 
will thus range from 2 to 8 months at pretest, 5 to 11 months at posttest and 8 to 14 months at follow-up. 
 
C5. Intervention Target and Outcome Measures.  
C5.1. Program Targets. CTB aims to enhance two key targets: parenting and coparenting quality. We will 
assess both outcomes primarily using videotaped family interactions (25 min recorded Zoom) comprising a) 
5 minutes of the mother (or father) playing alone with the infant, b) 10 minutes of triadic family interaction, and 
c) another 5 minutes of the father (or mother) playing alone with the infant using a standard set of toys. The 
order of mother- and father-infant interactions will be counterbalanced across families. In the final 5 minutes, 
one parent will use a standard script designed to elicit child expressive language. The interaction will be coded 
using Datavyu software.51,70–72 Coparenting will be coded using the coding scheme from Feinberg’s FF RCT 
trials,11 with coders trained to meet the specific criteria. In the second RCT of FF,11 roughly 25% of cases were 
coded by at least two raters; interrater intraclass correlations of scores on parenting and coparenting ranged 
from .66 to .85, respectively. Coparenting positivity will combine three codes: coparental warmth, cooperation, 
and inclusiveness (𝛼 = .63 for mothers; .69 for fathers). Coparenting negativity will include separate ratings of 
observed coparental triangulation, competition, withdrawal, hostility, and endorsement of the partner (reverse 
scored). Parenting behaviors will coded using the Individual Growth and Development Indicators for Infants 
and Children (IGDI) Indicator of Parent-Child Interaction (IPCI)47,70 a measure of the sensitivity and 
responsiveness of caregivers to children ages 2 to 42 months. It is reliable, replicable, and sensitive to known 
differences in various at-risk populations of parents and children.47,73 Positive engagement codes include 
acceptance and warmth, following a child’s lead, commenting, labeling, asking questions, modeling, repeating, 
and praise; negative engagement codes include intrusiveness, criticism, and ignoring bids for attention. 
Composite scores ranging from 1 to 4 are used to index positive engagement and negative. We will also gather 
survey measures of key constructs using the Coparenting Relationship Scale, a 35-item scale capturing 
coparental agreement, support, undermining and exposure of the child to conflict (reverse scored) (a = .90)74, 
and the Father Engagement Scale, measuring fathers’ engagement in 11 activities with infants.66 
C5.2. Program Outcomes. The program targets are hypothesized, in turn, to promote parent mental health 
and child language and socioemotional development. Parent mental health will be assessed in terms of 
parenting stress (PSS),67 depression and anxiety symptoms (20-item CES-D and General Anxiety Scale short-
form, respectively),68,75 and parent self-efficacy (Parental Sense of Competence Scale)76,77 gathered at pretest, 
and 3 and 6 months post-RA. Child language will be assessed at 3 (posttest) and 6 months (follow-up) after 
RA by coding the family interactions using the IGDI Early Communication Indicator (ECI),78 which codes 
expressive communication for children between 3 and 36 months. During the pilot of CTB, reliability of the ECI 
with the Preschool Language Scale-3 (PLS-3) and a caregiver report yielded correlations of .75 or higher. 
Overall inter-observer reliability on the ECI was .90.78 At 6 months post RA, child language will also be 
assessed using the MacArthur-Bates Communicative Development Inventories (MCDI), which measures 
vocabulary.79 Finally, child socioemotional development will be measured at 3 and 6 months post RA using 
the Brief Infant Toddler Social Emotional Assessment (BITSEA),80 which assesses behavior problems and 
competencies. 
 
C5.3. Additional Measures will include demographic characteristics (income, education, race/ethnicity), 
pregnancy and childbirth complications, and household/family context changes including changes in co-
residential status, income, employment, siblings, and family moves. We will also survey program parents about 
program satisfaction after sessions 1, 3, and 6 using an adapted version of the survey used in FF trials. 
 
 
 
 
 
 

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