Evaluating a Couples Group to Enhance Father Involvement in Low-Income Families Using a Benchmark Comparison

Studies using randomized clinical trial designs (RCTs) to evaluate effects of intervention pro- grams are relatively rare, even rarer in programs to promote fathers' involvement with their chil- dren (Knox, Cowan, Cowan, & Bildner, 2011). Typically, once an RCT has produced evidence of efficacy, it is adopted by social service agen- cies without further systematic examination of whether the effects can be replicated in agency settings with more diverse clients.In 2009, four of the authors of this article and a fifth colleague published a report of the Supporting Father Involvement (SFI) project - an RCT study of two variations of a group-based approach to strengthening relationships in low-income families, with a focus on encouraging fathers' involvement with their children (P. A. Cowan, Cowan, Pruett, Pruett, & Wong, 2009). That study compared three conditions: one 3-hour meeting in which couples discussed the importance of fathers (low-dose control), a 16-week couples group, and a 16-week fathers group, all led by the same mental health professionals. We found specific advantages for participants in the fathers group compared with those in the low-dose control condition, and even more advantages for couples group participants. Before moving beyond the efficacy study to launch a larger trial of the SFI approach in community settings, we set out to establish whether (a) the initial positive results could be replicated, (b) the intervention was effective with a more diverse set of families, and (c) participant characteristics on entering the study predicted postintervention changes.We faced a dilemma about offering a ran- domized control condition in this study because our earlier results revealed no improvement and some negative changes over time for partici- pants meeting only once. In the literature on the ethics of medical research, the principle of ''clinical equipoise'' endorses the use of randomized no-treatment, placebo, or low-dose intervention controls only when there is uncer- tainty about whether the experimenter-preferred treatment has potential advantages for the par- ticipants (Freedman, 1987). In consultation with the intervention staff, we concluded that there was an ethical issue in recruiting participants for a study condition in which the reasonable expectation was that they would experience no change or negative change over time. We considered a randomized control condition of parents assigned to community treatment as usual, but because there were no community services designed to enhance father involvement in the counties involved, we had no treatment- as-usual condition with which to compare the present intervention. We chose to use a ''bench- mark'' approach by comparing the results of our new replication with already published data from our earlier Supporting Father Involvement RCT.The Benchmark ApproachBenchmarking is one assessment strategy recommended as an approach for evaluating outcomes of interventions implemented in com- munity settings (i.e., an effectiveness design; Hunsley & Lee, 2007). The benchmark term refers to the use of comparator values that serve as best practice standards for judging the impact of a service, in which either a single-point estimate or a range of acceptable values can be used. Hunsley and Lee strongly recommended that benchmarks be derived from sources such as meta-analyses that combine treatment results from multiple studies, though it is acknowledged that using data from a single RCT may be warranted in some circumstances. At the time the current study was conducted, the earlier SFI study was the only existing couple-focused inter- vention designed to promote father involvement and evaluate outcomes for the children, so mul- tiple studies were not available for comparison.The best chance of replication occurs when a new trial of an intervention approach is imple- mented with fidelity to a successful RCT. On the one hand, the more similar the features of the new study to those of the benchmark study, the more directly relevant the benchmark findings will be to the current evaluation. …