TOGETHER: A Couple's Model to Enhance Relationships and Economic Stability

Study Overview
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Brief Summary
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The current study sought to evaluate an intervention to promote healthy couple relationships and economic stability and mobility for low-income couples living in Northern Virginia (VA) and Montgomery and Prince George's Counties (MD) by improving personal well-being, couple's relationships, parenting and co-parenting, financial literacy and capability, employability, job placement, and retention. The approach proposed integrated two components: (1) a 20-hour evidence-informed couple group workshop called TOGETHER that integrates relationship education and financial literacy skills, followed by an optional three-hour booster session three months after TOGETHER workshop (abbreviated version of TOGETHER workshop) and (2) case management (assessment of participant needs, development of Individual and Couple Development Plan (ICDP), referrals for social and mental health services, and referrals and coordination with job and career enhancement services, linking and coordination of all services as needed). The 20-hour workshop was offered in sessions of 2 1/2 hours each and facilitated by couple and financial experts working together in all the sessions. The workshop included presentation of concepts and skills, hands-on activities to practice skills, and homework. The facilitators completed fidelity forms, were observed by the curriculum developers, and were supervised biweekly by the curriculum developers. The project involved subcontracts with the University of Maryland, Family Services, Inc. (FSI), and The Skillsource Group, Inc. for the delivery of the TOGETHER program and case management and with the SkillSource Group, Inc. for job and career enhancement services. Workshops were conducted at Virginia Tech, University of Maryland, Family Services, Inc., and community organizations that offered space. In addition to service coordination, case managers incorporated the input of TOGETHER group facilitators and employment providers to develop Individual and Couple Development Plans (ICDPs) and assess progress toward meeting goals. The effectiveness of the program was evaluated through a randomized control trial in which half of the couples were randomly assigned to a control group and half of the couples were assigned to the intervention group. Couples in the control group received no intervention but a three-hour financial workshop after the last assessment was completed whereas the intervention couples participated in the 20-hour interventions and received case management. An independent local evaluator (AVAR, Consulting) participated in the design, implementation, and most of the data analysis of the evaluation component. Participants had to be at least 18 years-old, having been living together for at least a year, and had no severe domestic violence issues, or untreated substance abuse or severe psychiatric disorders. If both partners were retired, couples were excluded from participation. After a brief phone screening, couples were invited to participate in an intake and enrollment meeting in which they were more thoroughly screened. After screening, couples were enrolled and randomly assigned by a computer generated system to either the intervention or control group. Couples in both groups completed three sets of self-report measures. The first one (pre-test) was completed on the day of the first workshop session or at intake for control couples, the second one was completed on the day of the day of hte last workshop session, or 8 weeks after the pre-test) for control couples, and the last one six months after the post-test for both intervention and control couples. After the six month follow-up assessment, participation in the program was concluded. Reimbursement to licensed child care providers that provided child care to participants' children was available. The study was largely funded by a Healthy Marriage and Responsible Fatherhood grant awarded by the Office of Family Assistance, Administration of Children and Families, U.S. Department of Health and Human Services from the beginning of the study until May 10, 2018. As of May 10, 2018 the funding agency continued to fund the intervention component but data collection and analysis fro couples that had been randomized by May 10, 2018 and continued to receive services and to complete assessments were funded by Virginia Polytechnic Institute and State University. The study was expected to recruit 360 couples in the control group and 360 couples in the intervention group. However, due to the discontinuation of funding, 147 couples were enrolled for the control group and 145 couples were enrolled for the intervention group.

Detailed Description
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The current project sought to promote healthy couple relationships and economic stability and mobility for low-income couples living in Northern Virginia (VA) and Montgomery and Prince George's Counties (MD) by improving personal well-being, couple's relationships, parenting and co-parenting, financial literacy and capability, employability, job placement, and retention. This project was funded in its entirety until May 10, 2018 by the Department of Health and Human Services (HHS), Administration for Children and Families (ACF), Office of Family Assistance (OFA) under the Healthy Marriage and Responsible Fatherhood (HMRF) program. After that date, the OFA continued to fund the intervention but not the local evaluation. Data collection and analysis from couples that had signed the consent form for participation in the project and had been randomized before May 10, 2018 The evaluation plan that included a randomized control trial and was approved of by OFA for years 2016, 2017, and 2018 until the local evaluation was discontinued by OFA included the enrollment of 720 couples, out of which 360 couples would be randomly assigned to the intervention group and 360 couples to a control group.However, due to the unexpected termination of funding for the local evaluation, the program was evaluated with 292 couples (145 intervention group couples and 147 control group couples). This project was developed and conducted by Project Director, Mariana Falconier, Ph.D. at Virginia Tech and Associate Director, Jinhee Kim, Ph.D. at University of Maryland. Both universities collaborated for this project and University of Maryland was a subawardee of Virginia Tech. In addition, Virginia Tech subcontracted with SkillSource Group, Inc. for delivery of the intervention and University of Maryland contracted with Family Services, Inc. for delivery of Services. Services were delivered at Virginia Tech, Family Service Inc, University of Maryland, and in agencies in which we have agreements to use their space (City of Bowie in Bowie, MD and Ebenezer Baptist Church, Alexandria, VA) The funding agency required the grantee to have an independent local evaluator and for that purpose Virginia Tech contracted with AVAR Consulting, which was involved in the implementation and outcome evaluations until August 31, 2018.. Avar Consulting as well as Dr. Falconier and Dr. Kim will only used the database without participants' identifying information to conduct their outcome evaluations Our approach integrated two components (1) a 20-hour evidence-informed couple group program called TOGETHER workshop that integrates relationship education and financial literacy skills and (2) case management (assessment of participant needs, development of Individual and Couple Development Plan, referrals for social and mental health services, and referrals and coordination with job and career enhancement services, linking and coordination of all services as needed). The main goals of this project were to promote healthy couple relationships and economic stability and mobility for low-income couples in Northern Virginia, Prince George's County, MD, and Montgomery County, MD. The main objectives were: 1) improve personal well-being; 2) improve couple's relationship skills; 3) improve parenting and co-parenting; 4) improve financial literacy and capability; and 5) improve employability, job placement, and retention skills. Short-term outcomes of this project's core intervention were expected immediately after completion of the last session of the 20-hour relationship/financial education program (TOGETHER) whereas medium-term outcomes were anticipated six months after that last session. Expected measurable outcomes among program participants for objective 1 (improved personal well-being) included increased frequency of positive stress management, reduced psychological distress, decreased financial stress. Expected measurable outcomes for objective 2 (improved couple's relationship skills) included increased frequency of positive communication behaviors, increased frequency of positive conflict management behaviors, increased frequency of positive dyadic stress management, increased frequency of conjoint problem solving behaviors, increased satisfaction with couple's relationship, and increased comfort with financial styles and roles. Expected measurable outcomes for objective 3 (improved parenting and co-parenting) included increased frequency of positive parenting behaviors, increased closeness to children, and increased satisfaction with co-parenting. Expected measurable outcomes for objective 4 (improved financial literacy and capability) include increased financial literacy skills, increased financial self-efficacy, decreased use of alternative financial services, and increased financial management behaviors. Finally, expected measurable outcomes for objective 5 (improved employability, job placement, and retention) include decreased perceived barriers to employability, increased intentions and motivations for work, increased confidence in job skills, and increased employability, employment status, and retention. These outcomes were expected by comparing the intervention and control group outcomes in the RCT. TARGET POPULATION Low income couples in Northern Virginia (VA) and Prince George's County and Montgomery County, Maryland (MD). Even though the target population for this project was low-income couples, any couple that wanted to participate in the program was accepted as long as they met the eligibility criteria: residing in Northern Virginia and Prince George's County and Montgomery County in Maryland, married or cohabiting for at least a year, 18 years of age or older, and English-speaking. Exclusion criteria included both partners being retired, physical domestic violence (defined as behaviors that frighten, terrorize, manipulate, hurt, humiliate, blame, often injure, and sometime kill, a current or former intimate partner) or feeling unsafe with partner in the last six months, current diagnosis of a severe psychiatric disorder that required hospitalization in the last 12 months, cognitive impairment, or/and severe untreated substance abuse disorder. Couples could participate as long as both partners consent to be part of the program. RECRUITMENT Recruitment activities began on June 1, 2016. Activities included producing and distributing flyers, brochures, and posters and/or giving presentation in schools, churches, faith-based community centers, child support agencies, TANF offices, WIC agencies, Head Start programs, Healthy Start program, child welfare agencies, community centers, libraries, stores, barber shops, employment centers, Virginia Tech and University of Maryland clinics and cooperative extension centers, and community events. The Women's Center and Family Services Inc. concentrated on marketing and recruitment efforts from the network of providers and partner organization they were part of. In addition, the program was advertised through social media outlets that would be used for marketing and recruitment purposes and posting calendars with program activities. The program was also advertised through its own website (www.togetherprogram.org) and online ads. PROCEDURES DATABASES The funding agency OFA requires all HMRF grantees to enter information into a secure system called the Information, Family Outcomes, Reporting, and Management system (nFORM). The information requested to enter was about (a) program operations (e.g., aggregated data without personally identifiable information on outreach and recruitment activities, enrollment numbers, staff qualifications and training, staff supervision and observation, and implementation challenges); (b) services (e.g., case management activities, workshop attendance, and referrals); (c) participants' contact information, demographics, and outcome measures. The funding agency also required the use of tablets for collecting data from participants. This tablet was also used to collect additional participants' outcome measures through Qualtrics (Please see section on measures) Besides nFORM and Qualtrics, two additional databases were used to collect information about participants and about program operations. One of them was called the Initial Contact and Screening (ICS) database and was used to collect contact information about potential participants and screen them to see if they met inclusion criteria before enrollment in the program. The section with identifying information such as participants' name, phone number or email address were stored separately from the answers to the screening questions. This ICS database was cleaned once a month so that all contact information was erased and only the number of participants that qualified or didn't qualify for the program could be counted. This system had proper encryption at log in and data collection pages. The second database was called Participant Tracking System (PTS). PTS was a secure system that was developed for the purposes of automated randomization, entering needs assessments and individual and couple development plans.. INITIAL CONTACT AND SCREENING Individuals interested in participating in the program dialed a 1-800-number or could visit the program at any of the program locations (Virginia Tech, University of Maryland, The Women's Center, and Family Services, Inc.). Program staff (a) collected contact information from the individual interested in participating, (b) described the program and the potential compensation, (c) asked for verbal consent to proceed with screening questions, and (d) performed a 10-minute inclusion screening process of the potential participant and his/her partner. The program staff spoke with each partner during the call or visit if both partners are available. Otherwise, the program staff collected information and screening information about both partners with the only partner that was present. All potential participants who were eligible after the initial screening and agreed to participate were scheduled for an Intake and Enrollment meeting with the case managers. The study procedures were described and additional information was sent upon request. Potential participants were offered the consent form for them to review prior to the Intake and Enrollment meeting, given either in person or mailed to them upon request. Potential participants who were interested enrolling in the Together Program had the option of completing the screening with an ICS staff member online as well. If potential participants chose to complete an online screening. INTAKE AND ENROLLMENT MEETING: Part I The first part of the Intake and Enrollment meeting lasted 60 minutes. During the meeting, the case manager (a) presented a detailed program description and obtain voluntary, informed written consent for program participation from both partners; (b) conducted a formal assessment of domestic violence with each partner individually for 10 minutes (see Domestic Violence Protocol section); (c) enrolled participants and collected contact information in nFORM; (d) assigned couples to intervention or control group through an automated system of randomization that uses only state of residence (Maryland or Virginia) (PTS); (f) provides orientation about program procedures (one orientation for intervention couples and one orientation for control couples, participants were given the Welcome Letter and Instructions for Intervention Couples or the Welcome Letter and Instructions for Control Couples and the Control Group Flowchart for Participants or Intervention Group Flowchart for Participants; (g) described participants with detailed explanation about payment procedures and VA and MD Tax requirements (providing VA and MD Tax requirements letters); and (h) directed and assisted intervention and control couples to complete applicant characteristics survey nFORM and demographic information survey in a tablet Part II The second part of the Intake and Enrollment meeting was different for intervention and control couples. For intervention couples (90 minutes) , the case manager (a) provided an in-depth description of the study procedure (this will be supported by presenting couples with The Intervention Group Flowchart for Participants to enhance understanding; (b) conducted a Needs Assessment in areas such as health care, employment, housing, childcare, education, legal barrier, income and financial, transportation, food, relationships, mental health, alcohol abuse, and substance abuse in order to determine which areas the couple needs support; (c) scheduled the individual and couple development plan (ICDP) meeting, progress meetings, and exit meeting as part of case management; (d) enrolled couple in the eight-week TOGETHER workshop (20 hours; at Virginia Tech, University of Maryland, The Women's Center Family Services, Inc. or designated agencies/schools/churches) and a booster session which occurred three months after the completion of the TOGETHER workshop (3 hours); and (e) described child care support and provided participants with the Child Care Support Letter. The Schedule for Intervention Couples did not only indicate when and where the scheduled meetings and workshops took place, but also included the incentives that couples could receive and the content of the meetings. All of these materials were included in the attachments. For intervention couples that did not wish to stay for the 90 minutes of the second part of the Intake and Enrollment meeting, the case manager offered to conduct the Needs Assessment by phone with both partners at a later time that was agreed upon this meeting. At the end of the meeting the couples were compensated gift cards for participating in the Needs Assessment. During part II for control couples, (90 minutes), the case manager (a) provided a detailed description of the procedure for control group (this was supported by presenting couples with The Control Group Flowchart for Participants to enhance understanding); (b) oversaw and assisted couples complete pre-test surveys including the Pre-Program Survey (nFORM) and Pre-test Assessment (Qualtrics) (both surveys combined took about 90 minutes; (d) scheduled the couple for their post-test assessment meeting (in 8 weeks) and financial workshop/follow-up assessment (six months from the date of the post-test assessment meeting months). In the event that control couples could not stay for this second part of the Intake and Enrollment meeting, they were be offered the possibility of completing the pre-program survey nForm and pre-test assessment in paper format. If the couple chose to complete the survey and assessment in paper, they were provided the questionnaires, the instructions to complete the questionnaire, and a self-addressed envelope to mail the questionnaires. CONTROL COUPLES: Control Couples: Post-Test Assessment Meeting Eight weeks after the Intake and Enrollment meeting, control couples would return to one of the program locations to meet with the case manager, and complete the Post Program Survey in nFORM and the Post-test Assessment in Qualtrics (both surveys combined would take about 90 minutes). Couples were reminded about Financial Literacy Workshop (FLW) and follow-up assessment date. For couples that could attend the meeting in person, the questionnaires were mailed to them with instructions on how to complete them and return them to the program in a self-addressed envelope included in the package. CONTROL COUPLES: FOLLOW-UP SURVEY/FINANCIAL LITERACY WORKSHOP Six months after control couples were invited to come 90 minutes before the Financial Literacy Workshop that would offered for them. Trained program staff would provide tablets for these couples to complete the follow-up survey in Qualtrics before the beginning of the workshop. Completion of follow-up survey would take about 90 minutes. The trained program staff would provide the couple their compensation in gift cards for assessments and will ask partners to sign the Gift Card Receipt Form. After the participants completed the follow-up survey, they were invited to attend a three-hour Financial Literacy Workshop (FLW), led by workshop facilitators. FLW was a three-hour financial management class to improve financial management knowledge and skills based on Money Smart curriculum by the Federal Deposit Insurance Corporation. For couples that could attend the meeting in person, the questionnaires were mailed to them with instructions on how to complete them and return them to the program in a self-addressed envelope included in the package. Couples could also choose to complete the follow-up survey online in which case program staff emailed to each partner the link and their individual passcode. INTERVENTION COUPLES TOGETHER WORKSHOP TOGETHER workshop is a 20-hour psycho-educational program for couples that supports the personal well-being, couple relationship, parenting, and financial literacy and management. TOGETHER was developed by Dr. Mariana Falconier (PI) and the late Dr. Hayhoe as part of the emerging interdisciplinary field that integrates relationship education with financial education (Falconier, 2015). TOGETHER adapted the Couples' Coping Enhancement Training (CCET) program developed by Dr. Guy Bodenmann (Bodenmann, 1997) and whose effectiveness in improving stress management, communication, and relationship satisfaction has been supported in various studies (e.g., Bodenmann & Shantinath, 2004) to financially distressed couples by applying CCET content to financial issues and incorporating financial education. The workshop aims at reducing financial stress and improving relationship functioning by providing couples with knowledge and skills on stress management, communication, conflict resolution and management, problem-solving, and financial management. The TOGETHER workshop has 9 modules and is designed to be delivered in groups of four to eight couples for 20 hours: 8 weekly sessions of 2.5 hours each. Each session is co-led by two facilitators: a financial counselor and a couples therapist. Each session includes a warm-up activity, brief review of past session content and homework, presentation and practice of new content, summary of all contents covered in the session, and assignment of new homework. After each session, couples are assigned homework so that the skills learned in the session can be practiced between sessions. The TOGETHER curriculum has been pilot tested and results have been published in 2015 in the Journal of Marital and Family Therapy. Below is a list of the introduction and the 9 modules. Introduction to program Module 1: Understanding Stress and Money Stress Module 2: Managing* Stress and Money Stress by Yourself Module 3: Communicating Stress and Money Stress to Your Partner Module 4: Managing Stress and Money Stress with Your Partner Module 5: Communicating Effectively and Learning to Talk about Money Raise awareness about the Module 6: Clarifying Financial Roles and Expectations Module 7: Improving Money Management Skills Module 8: Credit and Risk Management Module 9: Improving Financial Problem-Solving Skills A total of 30 workshops were offered between July 1, 2016 and May 10, 2018. Out of the 145 couples assigned to the intervention group, 106 couples started the workshop. The rest of the couples could not attend any of the available workshops due to schedule conflicts. As noted earlier, the workshop was offered in eight sessions (2 hours and 30 minutes each) scheduled on the same day of the week and at the same time. At the end of each session participants completed a 2 minute-session evaluation and a 2-minute homework evaluation. In the last session they completed a 5 minute session evaluation+overall workshop evaluation within the session. At the first TOGETHER session, couples will completed the Pre Program Survey (nFORM) and the Pre-test Assessment (Qualtrics) before the session began. Completion of the Pre Program Survey and Pre-test Assessment took about 90 minutes. For participants both surveys was collectively referred to as Pre-Test Survey. Partners were instructed to complete these surveys in tablets provided by the group facilitators. TOGETHER session facilitators oversaw the completion of the Pre-Test Survey. Participants that failed to attend the first session of the TOGETHER workshop were mailed the Pre-Test Survey for their completion. After the last (eighth) TOGETHER session, couples completed on site the Post Program Survey (nFORM) and the Post-test Assessment (Qualtrics). Surveys took about 90 minutes. Participants knew these surveys as Post-Test Surveys and completed them in the tables. TOGETHER session facilitators oversaw the completion of the Post-Test survey. Participants that failed to attend the eight session of the TOGETHER workshop were mailed the questionnaires with instructions on how to complete them and return them. CASE MANAGEMENT 2. 1. Individual and Couple Development Plan (ICDP) Meeting: One week after the first workshop session, intervention couples partook in an ICDP meeting with the assigned case manager at VT, FSI, UMD, or designated locations for 90 minutes. Based on the information collected in the Needs Assessment during the IE meeting, the case manager created an ICDP with the couple that included (a) setting individual and couple goals; (b) agreeing on action steps and establishing a realistic timeline to meet those goals; (c) discussing possible barriers participants might encounter; (d) providing referrals as part of the action steps to meet their goals (i.e., housing, TANF, health care, child welfare, child support services, mental health services, and job and career enhancement services).. At the end of this meeting participants were reminded of all of their scheduled appointments. If the ICDP included a goal within the area of employment/career a first meeting would be scheduled for the partner in need of those services with an employment case manager to receive services at either the SkillSource Group, Inc. or a federally funded employment agency in Maryland. In addition, the participant was invited to sign a release to exchange information between the employment agency and our program so that information could be exchanged with the employment agency regarding information collected by our program (Couple's Needs Assessment and the ICDP) and the employment agency (employment/career services recommended and received, the participant's eligibility for those services, and the Employment Individual Plan). The present study provided funding for (a) employment services for those participants that did not meet eligibility criteria to receive services funded through the Workforce Innovation and Opportunity Act (WIOA) or other state and local funding in those agencies and (b) for reporting all the employment/career services that participants referred from our program were recommended (Individual Employment Plan) and actually received (Employment Services and Trainings Tracking Form) in such agencies. Since this study targeted the low-income population, it was expected that most participants would meet eligibility criteria to receive services in those agencies funded through WIOA or state or local programs and not through this study. 2. 2. Progress Meetings and Exit Meeting Five weeks after the ICDP meeting, intervention couples met with the case manager for their first of five progress meetings (approximately five weeks between each progress meeting). At each meeting, the case manager (a) checked progress towards goals established in the ICDP, (b) updated the ICDP if necessary, (c) addressed barriers towards meeting ICDP goals, (d) checked safety (e.g., presence of domestic violence), and (e) addressed any program issues (e.g., attendance to employment trainings, Two of these meetings were in person and three over the phone and each of them lasted around 30 minutes and will require the presence of both partners. However, the two in-person meetings were conducted over the phone as well if the couple was unable to attend the meetings in person. Couples had a final meeting with the case manager 6 months after the last TOGETHER session, which was approximately five weeks after the fifth case management progress meeting. At this exit meeting, the case manager (a) made with the couple a final progress assessment toward the goals established by the ICDP, (b) discussed with the couple their plan for continue working towards the ICDP goals, (c) invited the couple to complete the follow-up survey in the tablets, (d) provided information about the TOGETHER program's Facebook group, and (e) presented the couple with a termination/graduation letter. If one or both partners could not attend the meeting in person, the six-month follow-up survey was mailed to them If the couple chose to complete this survey online, 3. INCENTIVES FOR WORKSHOP ATTENDANCE At the third progress meeting, case managers provided the attendance incentives for the TOGETHER workshop. 4. BOOSTER SESSION Intervention couples were invited to an optional 3- hour booster session three months after completing the last session of TOGETHER workshop. These booster session included up to 16 couples and was be co-led by a UMD or VT marriage and family therapy intern and a UMD or VT extension specialist. It offered an abbreviated version of the contents covered in the 20-hour TOGETHER workshop. 5. DOMESTIC VIOLENCE All the program staff that interacted with program participants received a three-hour training to learn to identify, assess, and response to situations of domestic violence. A pre-screening for domestic violence took place in the ICS stage before participants were enrolled in the program. Then, later, after enrollment but before randomization and entering participants' information into the nFORM a structured screening for domestic violence took place so that cases of domestic violence could be referred to appropriate services and participation in the program was discontinued. This structured screening involved an individual 10-minute meeting with each partner, during which each were asked questions about any incidents of physical, sexual and/or psychological violence that had occurred in their relationship. Each partner was asked about whether or not they felt threatened by their partner, and whether or not they feel safe in participating in the program with their partner. Additionally, each partner was asked about his/her willingness to commit to safety and no violence, and his/her willingness to learn strategies to de-escalate conflict between them in a safe way. Based on the participants' responses, a determination was made regarding the couples' participation in the program. If both partners provided responses that indicated a lower risk for domestic violence, then the decision was made that they could continue participating in the program with no referral for additional services to directly address domestic violence. However, if either partner provided responses indicating the presence of domestic violence in the current relationship, describing minor domestic violence, including pushing, shoving, infrequent domestic violence, and/or incidents which occurred more than one year ago and no weapons in the home, the decision was made that the couple may participate in the program, and they would be referred to services that directly address domestic violence. This decision was made if both partners also indicated a commitment to no violence and both felt safe participating in the program with each other. Request to discontinue participation in the program and referral to domestic violence services could also occur at any point in the participation in the TOGETHER program beyond the initial structured screening at the Intake and Enrollment meeting in the presence of domestic violence. 6. PROGRAM TERMINATION Individuals terminated their participation in the program six months after the second assessment, which took place at the exit meeting (intervention couples) or before the financial workshop (control group). They could also drop out of the program or be asked not to participate in the presence of domestic violence or untreated substance abuse or serious psychiatric disorder. 7. FIDELITY Fidelity to Curriculum: Facilitators received a 25 hour training in the program, out of which 17 hours focused on the curriculum. In addition they were required to attend a biweekly one-hour group supervision with the developers of the curriculum, were observed at least once by the developers of the curriculum, and on the third session by the local evaluators staff. In addition facilitators completed jointly a checklist to report on the extent to which they completed the scheduled activities, met all session objectives, used all materials as outlined in the manual, and spent the time as planned. Fidelity to case management procedures: A checklist was developed to assess the extent to which case managers were implementing the case management protocol.

Official Title
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TOGETHER: A Couple's Model to Enhance Relationships and Economic Stability

Conditions
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No Condition

Intervention / Treatment
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* Behavioral: Connection to community services through case management
* Behavioral: TOGETHER Workshop
* Behavioral: Employment Support Services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Lliving together for at least a year Being at least 18 years English speaking. Exclusion criteria: Current physical domestic violence and/ or feeling unsafe to participate with your partner in a psycho-educational group in the last twelve months Current diagnosis of a severe psychiatric disorder that required hospitalization in the last 12 months Cognitive impairment that prevent comprehension of materials and participation in a psycho-educational group Severe untreated substance abuse disorder Both partners fully retired.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized controlled trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control group<br>Control group of couples will receive no intervention | |
| Experimental: Intervention<br>Intervention group of couples received the intervention: case management (connection to community services), 20 hour pscycho-educational workshop on communication, conflict resolution, problem-solving, stress management, and financial management, booster session, and employment support services if needed | Behavioral: Connection to community services through case management<br>* Case managers met with couple and conduct a needs assessment for the couple and their family. Then they developed an Individual and Couple Development Plan to take care of those needs, usually by accessing community services. Case managers met every 5 weeks with the couple to check on progress toward meeting the goals of the plan and assess for the present of any new needs.<br>Behavioral: TOGETHER Workshop<br>* Couples were required to participate in a 20 hour workshop (8 sessions of 2 1/2 hours each)in groups of 3 to 8 couples. These groups were facilitated by a financial expert and a couples' expert. The workshop is interdisciplinary and psycho-educational. Couples learn about skills to improve their communication about stress and money problems, conflict resolution, individual and couple stress management in general and about money stress in particular, and financial management<br>Behavioral: Employment Support Services<br>* Only for those participants that were in need of employment support services. If the needs assessment conducted by the case manager indicated an employment or career need. After completion of the TOGETHER workshop, an employment case manager met with the participant, conducted an employment needs assessment and connected the participant with a workforce agency or one-stop employment centers. After doing so, the employment case manager followed through the various steps that the participant had to complete as part of the employment services for a period of 6 months<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Information, Family Outcomes, Reporting, and Management (nFORM)- Pretest (Time1) | nFORM survey was developed by Mathematica. It includes Psychological distress (6 items; Scale range: 6-30); Positive conflict management (7 items; Scale range: 7-28); Negative conflict management (5 items; Scale range: 5-20); Emotional abuse (2 items; Scale range: 2-8); Conflict management Satisfaction (1 item; Scale range: 1-3); Relationship quality (5 items; Scale range:5-20); Time with partner (3 items; Scale range: 3-12); Relationship Satisfaction (1 item; Scale range: 1-3); Nurturance (4 items, Scale range: 4-16); Harsh discipline (3 items; Scale range: 3-12); Co-parenting (1 item; Scale range: 1-4); Parenting stress (1 item; Scale range: 1-4); Banking (3 items; Scale range: 0-3); Difficulty to pay bills (1 item; Scale range: 1 - 4); Confidence in job skills (5 items; Scale range: 5-20); Work motivation (3 items; Scale range 3-12); Work ethics (2 items; Scale range: 2-8); updated resume (1 item, 0 = NO; 1= Yes). Higher scores = higher levels in the variable | Pre-test (Time 1) | 
| Information, Family Outcomes, Reporting, and Management (nFORM)- Post-test at 8 weeks after Pre-test (Time2) | nFORM survey was developed by Mathematica. It includes Psychological distress (6 items; Scale range: 6-30); Positive conflict management (7 items; Scale range: 7-28); Negative conflict management (5 items; Scale range: 5-20); Emotional abuse (2 items; Scale range: 2-8); Conflict management Satisfaction (1 item; Scale range: 1-3); Relationship quality (5 items; Scale range:5-20); Time with partner (3 items; Scale range: 3-12); Relationship Satisfaction (1 item; Scale range: 1-3); Nurturance (4 items, Scale range: 4-16); Harsh discipline (3 items; Scale range: 3-12); Co-parenting (1 item; Scale range: 1-4); Parenting stress (1 item; Scale range: 1-4); Banking (3 items; Scale range: 0-3); Difficulty to pay bills (1 item; Scale range: 1 - 4); Confidence in job skills (5 items; Scale range: 5-20); Work motivation (3 items; Scale range 3-12); Work ethics (2 items; Scale range: 2-8); updated resume (1 item, 0 = NO; 1= Yes). Higher scores = higher levels in the variable | Post-test (8weeks after pre-test/Time1) | 
| Information, Family Outcomes, Reporting, and Management (nFORM)- Six-month Follow-up (Time3) | nFORM survey was developed by Mathematica. It includes Psychological distress (6 items; Scale range: 6-30); Positive conflict management (7 items; Scale range: 7-28); Negative conflict management (5 items; Scale range: 5-20); Emotional abuse (2 items; Scale range: 2-8); Conflict management Satisfaction (1 item; Scale range: 1-3); Relationship quality (5 items; Scale range:5-20); Time with partner (3 items; Scale range: 3-12); Relationship Satisfaction (1 item; Scale range: 1-3); Nurturance (4 items, Scale range: 4-16); Harsh discipline (3 items; Scale range: 3-12); Co-parenting (1 item; Scale range: 1-4); Parenting stress (1 item; Scale range: 1-4); Banking (3 items; Scale range: 0-3); Difficulty to pay bills (1 item; Scale range: 1 - 4); Confidence in job skills (5 items; Scale range: 5-20); Work motivation (3 items; Scale range 3-12); Work ethics (2 items; Scale range: 2-8); updated resume (1 item, 0 = NO; 1= Yes). Higher scores = higher levels in the variable | Six-month follow up (six months after post-test/Time2) | 
| Brief COPE - In general and in relation to financial problems - Pre-test (Time1) | Developed by Carver (1997). This is a 28 item self-report instrument that measures the respondent's individual coping strategies. We have repeated the same 28 items but respondents had to answer about coping strategies in relationship to coping with financial issues in particular. Fourteen subscales. Scale range: 0-6 for each subscale. Higher scores represent more use of the particular coping strategy. We also asked respondents to answer the same items about coping strategies again but in relation to financial problems. | Pre-tset (Time 1) | 
| Brief COPE In general and in relation to financial problems - Post- test (Time2) | Developed by Carver (1997). This is a 28 item self-report instrument that measures the respondent's individual coping strategies. We have repeated the same 28 items but respondents had to answer about coping strategies in relationship to coping with financial issues in particular. Fourteen subscales. Scale range: 0-6 for each subscale. Higher scores represent more use of the particular coping strategy. We also asked respondents to answer the same items about coping strategies again but in relation to financial problems. | Post-test (8weeks after pre-test/Time1) | 
| Brief COPE In general and in relation to financial problems - Six-month follow-up (Time 3) | Developed by Carver (1997). This is a 28 item self-report instrument that measures the respondent's individual coping strategies. We have repeated the same 28 items but respondents had to answer about coping strategies in relationship to coping with financial issues in particular. Fourteen subscales. Scale range: 0-6 for each subscale. Higher scores represent more use of the particular coping strategy. We also asked respondents to answer the same items about coping strategies again but in relation to financial problems. | Six-month follow up (six months after post-test/Time2) | 
| Family Economic Strain Scale - Pre-test (Time 1) | Developed by Hilton and Devall (1997). This is a 15-item self-report instrument that measures the respondent's level of economic strain. Scale range: 13-65. Higher scores represent higher economic strain | Pre-test (Time1) | 
| Family Economic Strain Scale - Post-test (Time 2) | Developed by Hilton and Devall (1997). This is a 15-item self-report instrument that measures the respondent's level of economic strain. Scale range: 13-65. Higher scores represent higher economic strain | Post-test (8weeks after pre-test/Time1) | 
| Family Economic Strain Scale - Six-month follow-up (Time 3) | Developed by Hilton and Devall (1997). This is a 15-item self-report instrument that measures the respondent's level of economic strain. Scale range: 13-65. Higher scores represent higher economic strain | Six-month follow up (six months after post-test/Time2) | 
| Difficulties in Emotion Regulation - Pre-test (Time 1) | Developed by Gratz and Roemer (2004). This is a 36-item self-report instrument that measures the respondent difficulties in emotion regulation. Scale range: 36-180. Higher scores represent more difficulties in emotion regulation | Pre-test (Time1) | 
| Difficulties in Emotion Regulation - Post-test (Time 2) | Developed by Gratz and Roemer (2004). This is a 36-item self-report instrument that measures the respondent difficulties in emotion regulation. Scale range: 36-180. Higher scores represent more difficulties in emotion regulation | Post-test (8weeks after pre-test/Time1) | 
| Difficulties in Emotion Regulation - Six-month Follow-up (Time 3) | Developed by Gratz and Roemer (2004). This is a 36-item self-report instrument that measures the respondent difficulties in emotion regulation. Scale range: 36-180. Higher scores represent more difficulties in emotion regulation | Six-month follow up (six months after post-test/Time2) | 
| Experiences in close relationships - Pre-test (Time 1) | Developed by Brennan, Clark, & Shaver (1998). This 36- item self report instrument measures avoidant and anxious attachment. Anxious scale has 18 items (scale range: 18-126) and avoidant scale has 18 items (scale range 18-126). Higher scores represent more on that attachment dimension | Pre-test (Time1) | 
| Experiences in close relationships - Post-test (Time 2) | Developed by Brennan, Clark, & Shaver (1998). This 36- item self report instrument measures avoidant and anxious attachment. Anxious scale has 18 items (scale range: 18-126) and avoidant scale has 18 items (scale range 18-126). Higher scores represent more on that attachment dimension | Post-test (8weeks after pre-test/Time1) | 
| Experiences in close relationships - Six-month follow-up (Time 3) | Developed by Brennan, Clark, & Shaver (1998). This 36- item self report instrument measures avoidant and anxious attachment. Anxious scale has 18 items (scale range: 18-126) and avoidant scale has 18 items (scale range 18-126). Higher scores represent more on that attachment dimension | Six-month follow up (six months after post-test/Time2) | 
| Conflict Tactics Scales-R - Pre-test (Time 1) | Developed by Straus, Comby, Boney-McCoy, & Sugarman (1996). This 78 item self report instrument measures physical assault, physical injury, psychological aggression, sexual coercion and negotiation by the respondent and by the partner. Prevalence or frequency scores can be computed for each of the subscales. Higher scores represent more prevalence or frequency of the specific behavior. | Pre-test (Time1) | 
| Conflict Tactics Scales-R Post-test (Time 2) | Developed by Straus, Comby, Boney-McCoy, & Sugarman (1996). This 78 item self report instrument measures physical assault, physical injury, psychological aggression, sexual coercion and negotiation by the respondent and by the partner. Prevalence or frequency scores can be computed for each of the subscales. Higher scores represent more prevalence or frequency of the specific behavior. | Post-test (8weeks after pre-test/Time1) | 
| Conflict Tactics Scales-R - Sxi month follow-up (Time 3) | Developed by Straus, Comby, Boney-McCoy, & Sugarman (1996). This 78 item self report instrument measures physical assault, physical injury, psychological aggression, sexual coercion and negotiation by the respondent and by the partner. Prevalence or frequency scores can be computed for each of the subscales. Higher scores represent more prevalence or frequency of the specific behavior. | Six-month follow up (six months after post-test/Time2) | 
| Depression, Anxiety, and Stress Scale - Stress Subscale Pre-test (Time 1) | Developed by Lovibond & Lovibond (1995). The stress subscale has 7 items and scale range is 0-21. Higher scores represent more symptoms of stress | Pre-test (Time1) | 
| Depression, Anxiety, and Stress Scale - Stress Subscale Post-test (Time 2) | Developed by Lovibond & Lovibond (1995). The stress subscale has 7 items and scale range is 0-21. Higher scores represent more symptoms of stress | Post-test (8weeks after pre-test/Time1) | 
| Depression, Anxiety, and Stress Scale - Stress Subscale Six-month follow up (Time 3) | Developed by Lovibond & Lovibond (1995). The stress subscale has 7 items and scale range is 0-21. Higher scores represent more symptoms of stress | Six-month follow up (six months after post-test/Time2) | 
| Dyadic Coping Inventory - Pre-test (Time 1) | Developed by Guy Bodenmann (2008). This 37-item self-report instrument measures how couples cope with stress in general. It includes stress communication, supportive dyadic coping, delegated dyadic coping, common dyadic coping, and negative dyadic coping. The two items evaluating the respondents's evaluation of their dyadic coping were excluded. Each subscale score ranges from 1 to 5 with higher scores representing more use of the dyadic coping strategy. | Pre-test (Time1) | 
| Dyadic Coping Inventory - Post-est (Time 2) | Developed by Guy Bodenmann (2008). This 37-item self-report instrument measures how couples cope with stress in general. It includes stress communication, supportive dyadic coping, delegated dyadic coping, common dyadic coping, and negative dyadic coping. The two items evaluating the respondents's evaluation of their dyadic coping were excluded. Each subscale score ranges from 1 to 5 with higher scores representing more use of the dyadic coping strategy. | Post-test: 8 weeks after Pre-Test ; Follow-up: 6 months after Post-Test | 
| Dyadic Coping Inventory - Follow-up (Time 3) | Developed by Guy Bodenmann (2008). This 37-item self-report instrument measures how couples cope with stress in general. It includes stress communication, supportive dyadic coping, delegated dyadic coping, common dyadic coping, and negative dyadic coping. The two items evaluating the respondents's evaluation of their dyadic coping were excluded. Each subscale score ranges from 1 to 5 with higher scores representing more use of the dyadic coping strategy. | Six-month follow up (six months after post-test/Time2) | 
| Dyadic Coping with Economic Stress Inventory - Pre-Test (Time 1) | Adapted by Falconier, Rusu, & Bodenmann (2019). This 34-item self-report instrument is an adaptation of the Dyadic Coping Inventory to economic stress and measures how couples cope with economic stress. It includes stress communication, supportive dyadic coping, negative dyadic coping, and negative dyadic coping. Each subscale score ranges from 1 to 5 with higher scores representing more use of the dyadic coping strategy. | Pre-test (Time1) | 
| Dyadic Coping with Economic Stress Inventory - Post-Test (Time 2) | Adapted by Falconier, Rusu, & Bodenmann (2019). This 34-item self-report instrument is an adaptation of the Dyadic Coping Inventory to economic stress and measures how couples cope with economic stress. It includes stress communication, supportive dyadic coping, negative dyadic coping, and negative dyadic coping. Each subscale score ranges from 1 to 5 with higher scores representing more use of the dyadic coping strategy. | Post-test (8weeks after pre-test/Time1) | 
| Dyadic Coping with Economic Stress Inventory - Six-month Follow-up (Time 3) | Adapted by Falconier, Rusu, & Bodenmann (2019). This 34-item self-report instrument is an adaptation of the Dyadic Coping Inventory to economic stress and measures how couples cope with economic stress. It includes stress communication, supportive dyadic coping, negative dyadic coping, and negative dyadic coping. Each subscale score ranges from 1 to 5 with higher scores representing more use of the dyadic coping strategy. | Six-month follow up (six months after post-test/Time2) | 
| The Brief Communication Patterns Questionnaire - General and In relation to Money Problems - Pre-test (Time 1) | Developed by Futris, Campbell, Nielsen, & Burwell (2010). This is an 11-item self-report questionnaire that assesses the couple's demand/withdraw communication patterns as well as their level of constructive communication when there is a problem. Eleven items were added to assess the same communication behaviors in relation to money problems. The same questions were asked in relation to financial problems as well. Higher scores represent more occurrence of the communication pattern | Pre-test (Time1) | 
| The Brief Communication Patterns Questionnaire - General and In relation to Money Problems - Post-test (Time 2) | Developed by Futris, Campbell, Nielsen, & Burwell (2010). This is an 11-item self-report questionnaire that assesses the couple's demand/withdraw communication patterns as well as their level of constructive communication when there is a problem. Eleven items were added to assess the same communication behaviors in relation to money problems. The same questions were asked in relation to financial problems as well. Higher scores represent more occurrence of the communication pattern | Post-test (8weeks after pre-test/Time1) | 
| The Brief Communication Patterns Questionnaire - General and In relation to Money Problems - Six-month follow-up (Time 3) | Developed by Futris, Campbell, Nielsen, & Burwell (2010). This is an 11-item self-report questionnaire that assesses the couple's demand/withdraw communication patterns as well as their level of constructive communication when there is a problem. Eleven items were added to assess the same communication behaviors in relation to money problems. The same questions were asked in relation to financial problems as well. Higher scores represent more occurrence of the communication pattern | Six-month follow up (six months after post-test/Time2) | 
| Financial Self-Efficacy Scale - Pre-test (Time 1) | Developed by Dietz, Carrozza & Ritchey (2011). This is a 3-item self-report questionnaire that assesses the respondent's financial self-efficacy. Scale range 4-12. Higher scores represent higher financial self-efficacy | Pre-test (Time1) | 
| Financial Self-Efficacy Scale - Post-test (Time 2) | Developed by Dietz, Carrozza & Ritchey (2011). This is a 3-item self-report questionnaire that assesses the respondent's financial self-efficacy. Scale range 4-12. Higher scores represent higher financial self-efficacy | Post-test (8weeks after pre-test/Time1) | 
| Financial Self-Efficacy Scale - Six-month follow-up (Time 3) | Developed by Dietz, Carrozza & Ritchey (2011). This is a 3-item self-report questionnaire that assesses the respondent's financial self-efficacy. Scale range 4-12. Higher scores represent higher financial self-efficacy | Six-month follow up (six months after post-test/Time2) | 
| Revised Financial Management Behavior Scale - Pre-test (Time 1) | Developed by Dew and Xiao (2011). This is a 15-item self-report questionnaires that assesses the respondent's financial management Behavior. It includes four subscales: Insurance (not used in this study), Credit management (3 items; scale range: 3-15), Savings (3 items; scale range: 3-15), Cash management (4 items . Scale range: 4-20) range | Pre-test (Time1) | 
| Revised Financial Management Behavior Scale - Post-test (Time 2) | Developed by Dew and Xiao (2011). This is a 15-item self-report questionnaires that assesses the respondent's financial management Behavior. It includes four subscales: Insurance (not used in this study), Credit management (3 items; scale range: 3-15), Savings (3 items; scale range: 3-15), Cash management (4 items . Scale range: 4-20) range | Post-test (8weeks after pre-test/Time1) | 
| Revised Financial Management Behavior Scale - Six-month follow-up(Time 3) | Developed by Dew and Xiao (2011). This is a 15-item self-report questionnaires that assesses the respondent's financial management Behavior. It includes four subscales: Insurance (not used in this study), Credit management (3 items; scale range: 3-15), Savings (3 items; scale range: 3-15), Cash management (4 items . Scale range: 4-20) range | Six-month follow up (six months after post-test/Time2) | 
| Financial Services Survey from FINRA - Pre-test (Time 1) | Developed by Finra This is a 5-item self-report questionnaire that assesses the respondent's use of financial services. Higher sores represent higher use of services | Pre-test (Time1) | 
| Financial Services Survey from FINRA - Post-test (Time 2) | Developed by Finra This is a 5-item self-report questionnaire that assesses the respondent's use of financial services. Higher sores represent higher use of services | Post-test (8weeks after pre-test/Time1) | 
| Financial Services Survey from FINRA - Six-month follow-up (Time 3) | Developed by Finra This is a 5-item self-report questionnaire that assesses the respondent's use of financial services. Higher sores represent higher use of services | Six-month follow up (six months after post-test/Time2) | 
| Shared Goals and Values Higher scores represent more sharing - Pre-test (Time 1) | Developed by Archuleta, Grable, & Britt (2010) . This is a 4-item self-report questionnaire that assesses the respondent's perception of the extent to which he or she share financial goals and values with his/her partner. Scale range: 4-28. | Pre-test (Time1) | 
| Shared Goals and Values Higher scores represent more sharing - Post-test (Time 2) | Developed by Archuleta, Grable, & Britt (2010) .This is a 4-item self-report questionnaire that assesses the respondent's perception of the extent to which he or she share financial goals and values with his/her partner. Scale range: 4-28. | Post-test (8weeks after pre-test/Time1) | 
| Shared Goals and Values Higher scores represent more sharing - Six-month follow-up (Time 3) | Developed by Archuleta, Grable, & Britt (2010) .This is a 4-item self-report questionnaire that assesses the respondent's perception of the extent to which he or she share financial goals and values with his/her partner. Scale range: 4-28. | Six-month follow up (six months after post-test/Time2) | 
| Couple Financial Management Roles and Satisfaction - Pre-Test (Time 1) | Developed by Archuleta (2008). This is a 13-item self-report questionnaire that assesses the respondent's perception of financial management roles and satisfaction in the couple's relationship. Higher scores represent more participation or more satisfaction. | Pre-test (Time 1 | 
| Couple Financial Management Roles and Satisfaction - Post-Test (Time 2) | Developed by Archuleta (2008). This is a 13-item self-report questionnaire that assesses the respondent's perception of financial management roles and satisfaction in the couple's relationship. Higher scores represent more participation or more satisfaction. | Post-test (8weeks after pre-test/Time1 | 
| Couple Financial Management Roles and Satisfaction - Six-month follow-up (Time 3) | Developed by Archuleta (2008). This is a 13-item self-report questionnaire that assesses the respondent's perception of financial management roles and satisfaction in the couple's relationship. Higher scores represent more participation or more satisfaction. | Six-month follow up (six months after post-test/Time2) | 
| Perceived Employment Barriers - Pre-test (Time 1) | Developed by Hong (2013). This is a 27-item self-report questionnaire that assesses the respondent's perception of employment barriers. It has the following subscales: Physical and mental halth (6 items, scale range: 6-30), Labor Market Exclusion (3 items: scale range: 3 -15), Child Care (3 items: scale range: 3 -15)Higher scores represent higher barriers; Human Capital (5 items, scale range: 5-25), and soft skills (5 items, scale range: 5-25). Higher scores represent more barriers in that area. | Pre-test (Time1) | 
| Perceived Employment Barriers - Post--test (Time 2) | Developed by Hong (2013). This is a 27-item self-report questionnaire that assesses the respondent's perception of employment barriers. It has the following subscales: Physical and mental halth (6 items, scale range: 6-30), Labor Market Exclusion (3 items: scale range: 3 -15), Child Care (3 items: scale range: 3 -15)Higher scores represent higher barriers; Human Capital (5 items, scale range: 5-25), and soft skills (5 items, scale range: 5-25). Higher scores represent more barriers in that area. | Post-test (8weeks after pre-test/Time1) | 
| Perceived Employment Barriers - Six-month follow-up (Time 3) | Developed by Hong (2013). This is a 27-item self-report questionnaire that assesses the respondent's perception of employment barriers. It has the following subscales: Physical and mental halth (6 items, scale range: 6-30), Labor Market Exclusion (3 items: scale range: 3 -15), Child Care (3 items: scale range: 3 -15)Higher scores represent higher barriers; Human Capital (5 items, scale range: 5-25), and soft skills (5 items, scale range: 5-25). Higher scores represent more barriers in that area. | Six-month follow up (six months after post-test/Time2) | 
| Short Employment Hope Scale - Pre-test (Time 1) | Developed by Hong, Sheriff & Naeger, (2009) This is a 24-item self-report questionnaire that assesses the respondent's psychological readiness and hope for employment. Subscales are: Psychological Empowerment (4 items, scale range: 0 -40), Futuristic Self-Motivation (2 items, scale range: 0-20), Utilization of skills and resources (4 items; scale range: 0-40); Goal Orientation (4 items, scale range: 0-40). Higher scores represent higher readiness or hope | Pre-test (Time1) | 
| Short Employment Hope Scale - Post-test (Time 2) | Developed by Hong, Sheriff & Naeger, (2009) This is a 24-item self-report questionnaire that assesses the respondent's psychological readiness and hope for employment. Subscales are: Psychological Empowerment (4 items, scale range: 0 -40), Futuristic Self-Motivation (2 items, scale range: 0-20), Utilization of skills and resources (4 items; scale range: 0-40); Goal Orientation (4 items, scale range: 0-40). Higher scores represent higher readiness or hope | Post-test (8weeks after pre-test/Time1) | 
| Short Employment Hope Scale - Six-month follow-up (Time 3) | Developed by Hong, Sheriff & Naeger, (2009) This is a 24-item self-report questionnaire that assesses the respondent's psychological readiness and hope for employment. Subscales are: Psychological Empowerment (4 items, scale range: 0 -40), Futuristic Self-Motivation (2 items, scale range: 0-20), Utilization of skills and resources (4 items; scale range: 0-40); Goal Orientation (4 items, scale range: 0-40). Higher scores represent higher readiness or hope | Six-month follow up (six months after post-test/Time2) |