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Family Foundations

Blueprints Program Rating: Promising

A universal prevention program to improve mother, child, and birth outcomes through promoting coparenting quality among couples who are expecting their first child.

Program Outcomes

  • Antisocial-aggressive Behavior
  • Anxiety
  • Conduct Problems
  • Depression
  • Externalizing
  • Internalizing
  • Prosocial with Peers

Program Type

  • Parent Training
  • Skills Training

Program Setting

  • Community (e.g., religious, recreation)
  • Hospital/Medical Center

Continuum of Intervention

  • Universal Prevention (Entire Population)

Age

  • Infant (0-2)
  • Adult

Gender

  • Male and Female

Race/Ethnicity

  • All Race/Ethnicity

Endorsements

  • Blueprints: Promising
  • SAMHSA: 3.6-3.7

Program Information Contact

Mark E. Feinberg
Prevention Research Center
Pennsylvania State University
S-109 Henderson Building
University Park, 16802
Email: mef11@psu.edu
www.famfound.net

Program Developer/Owner

  • Mark E. Feinberg, Ph.D.
  • Pennsylvania State University

Brief Description of the Program

Family Foundations is a universal prevention program developed in collaboration with childbirth educators to enhance coparenting quality among couples who are expecting their first child. The program consists of four prenatal and four postnatal sessions, run once a week, with each two-hour session administered to groups of 6–10 couples. Sessions are led by a trained male-female team and follow the Family Foundations curriculum. The female leader is a childbirth educator and the male leaders are from various backgrounds, but experienced in working with families and leading groups. Ongoing observation of sessions facilitates regular supervision discussions.

This program focuses on coparenting and the coparenting relationship, rather than other romantic relationship or parenting qualities. In assisting parents to work together supportively, the program content covers emotional self-management, conflict management, problem solving, communication, and mutual support strategies. Parenting strategies include an understanding of temperament, fostering children’s self-regulation, and promoting attachment security. The four prenatal classes introduce the couple to themes and skills, and the four postnatal classes revisit the themes once the couple has experienced life as parents and coparents. The delivery is psychoeducational and skills-based, with didactic presentations, couple communication exercises, written worksheets, videotaped vignettes of other families, and group discussion.

See: Full Description

Outcomes

At wave 2 (posttest, when children were about six months), the study (Feinberg & Kan, 2008) reported a significant intervention effect for:

  • Fathers’ coparental support, parenting-based closeness, and parent-child dysfunctional interaction
  • Mothers’ coparental support, depressive symptoms, and anxiety
  • Father-reported infant soothability
  • Child duration of orienting

At wave 3 (six-month follow-up, when children were about one year old), intervention participants showed improved (Feinberg et al., 2009):

  • Mothers’ coparenting competition, coparenting triangulation, warmth to partner, parenting positivity, coparenting inclusion, and negative communication
  • Fathers’ coparenting competition, coparenting triangulation, warmth to partner, parenting positivity, coparenting warmth, and parenting negativity
  • Observed child self-soothing

At wave 4 (2.5-year follow-up, when children were three years old), intervention participants showed program effects for (Feinberg et al., 2010):

  • Parent-reported parental stress, parental efficacy, coparenting quality, parenting overreactivity, parenting laxness, and physical punishment
  • Mother-reported child total behavior problems, externalizing problems, aggression, and social competence
  • Mother-reported child internalizing problems and attention/hyperactivity (boys only)

At wave 5 (six year follow-up, when children were 6-7.5 years old), intervention participants showed improvements in the following child outcomes (Feinberg, Jones et al., 2014)

  • Teacher-reported anxious/depressed and internalizing problems
  • Teacher-reported attention problems, aggressive behavior, and externalizing problems (boys only)

Pregnancy-related outcomes from mid-program showed a significant intervention effect (Feinberg, Roettger et al., 2014):

  • Reduced levels of Caesarian birth

In Feinberg et al. (2015), the program had no main effects on birth weight, maternal length of hospital stay, or neonatal length of hospital stay, but it did help some subgroups by improving

  • birth weight at low gestational age among parents with high economic strain or maternal depression
  • newborn length of stay among parents with high economic strain, depression, or anxiety
  • maternal length of stay among parents with high economic strain

Race/Ethnicity/Gender Details

Some child outcomes showed an intervention effect only for boys. These included internalizing, attention/hyperactivity, and relationship satisfaction collected at wave 4 and attention problems, aggressive behavior, and externalizing at wave 5. Supplemental analysis, gathered during the Blueprints review, also showed that anxious/depressed and Internalizing was only significant for the boys at wave 5. Some child outcomes showed intervention effects across gender, but stronger effects for boys. These included total behavior problems, externalizing, and aggression from wave 4.

Risk and Protective Factors

Risk Factors
  • Family: Family conflict/violence, Parent aggravation*, Parent stress*, Poor family management, Psychological aggression/discipline, Violent discipline
Protective Factors
  • Individual: Skills for social interaction*
  • Family: Attachment to parents, Non-violent discipline*

*Risk/Protective Factor was significantly impacted by the program.

See also: Family Foundations Logic Model (PDF)

Training and Technical Assistance

Implementation training is available from Community Strategies/Family Gold trainers. This interactive training prepares trainees to deliver Family Foundations with competence and confidence. Generally, implementation training is offered on-site for agencies and communities as requested, but occasionally we will offer open-enrollment workshops for multiple organizations. The cost of an on-site workshop is $3,000, plus travel and lodging expenses for the trainer(s). Open-enrollment workshops are $375.00 per person for the full training. An on-site training is accompanied by one hour of post-training technical assistance on a complimentary basis, with additional technical assistance available.

Training Process: The training is held in two phases:

  • 1.5 day first phase to introduce the program and review the prenatal material,
  • 1 day second phase to review prenatal group leading experiences and review the postnatal material.

Training Certification Process

Videotape Review: Trainees videotape themselves practicing sessions in front of an audience (expectant parents or a mock audience), and we review, code, and offer feedback. Cost is $100/class reviewed. Certification as a Family Foundations facilitator requires adequate performance in review of two classes.

Brief Evaluation Methodology

A randomized controlled design was used to evaluate Family Foundations. Couples were randomly assigned to an intervention (n=89) or to a no-treatment control condition (n=80), with the control condition consisting of receiving mailed literature on selecting quality childcare and developmental stages. Participants were primarily (81%) recruited from childbirth education programs at two hospitals located in small cities. Presumably, all couples responding to recruitment were enrolled, though no further details on recruitment procedures were provided.

Data were collected on participants five times. Data from 4-5 couples were not utilized in analyses because of developmental difficulties, death of one of the parents, or congenital medical problems for the baby, resulting in a sample size of 164-165. The study gathered pretest data (Wave 1) on all 164-165 couples when mothers were pregnant. Posttest data collection (Wave 2) occurred after the intervention couples had completed the program, when babies were about 6 months old. Of the eligible enrolled couples, 147 mothers completed the posttest (Wave 2) and were included in the analytical sample for posttest results. The study administered a six-month follow-up (Wave 3), when babies were about one year old. For this wave, 93% of mothers and 88% of fathers participated. A two and a half year follow-up (Wave 4) was conducted when children were about three years old (N=137). Wave 5 took place when children were ages 6 to 7.5, or six to seven years after program conclusion. Ninety-eight families provided parent and/or teacher data on child development. Additional analysis was conducted on a subsample (N=123) of mothers consenting to baseline cortisol measurement and completing posttest data collection (Feinberg, Roettger et al., 2014).

Key outcome measures included pregnancy-related indicators, attitudes and behaviors of mothers and fathers, coparenting and parenting behaviors, and child developmental outcomes.

References

Feinberg, M. E., Jones, D. E., Kan, M. L., & Goslin, M. C. (2010). Effects of Family Foundations on parents and children: 3.5 years after baseline. Journal of Family Psychology, 24(5), 532-542.

Feinberg, M. E., Jones, D. E., Roettger, M. E., Hostetler, M. L., Sakuma, K.-L., Paul, I. M., & Ehrenthal, D. B. (2015). Preventive effects on birth outcomes: Buffering impact of maternal stress, depression, and anxiety. Maternal Child Health Journal,  published online 21 July 2015.

Feinberg, M. E., Jones, D. E., Roettger, M., Solmeyer, A., & Hostetler, M. L. (2014). Long-term follow-up of a randomized trial of Family Foundations: Effects on children’s emotional, behavioral, and school adjustment. Journal of Family Psychology, 28(6), 821-831.

Feinberg, M. E., & Kan, M. L. (2008). Establishing Family Foundations: Intervention effects on coparenting, parent/infant well-being, and parent-child relations. Journal of Family Psychology, 22(2), 253-263.

Feinberg, M. E., Kan, M. L., & Goslin, M. (2009). Enhancing coparenting, parenting and child self-regulation: Effects of Family Foundations one year after birth. Prevention Science, 10, 276-285.

Feinberg, M. E., Roettger, M. E., Jones, D. E., Paul, I. M., & Kan, M. L. (2014). Effects of a psychosocial couple-based prevention program on adverse birth outcomes. Maternal Child Health Journal,  published online 27 June 2014.

Kan, M. L., & Feinberg, M. E. (2013a). Links between pre-birth intimate partner violence and observed parenting among first-time parents? Unpublished manuscript.

Kan, M. L., & Feinberg, M. E. (2013b). Can strong family foundations prevent parent and partner aggression among couples with young children. Unpublished manuscript.

Solmeyer, A. R., Feinberg, M. E., Coffman, D. L., & Jones, D. E. (2014). The effects of the Family Foundations prevention program on coparenting and child adjustment: A mediation analysis. Prevention Science, 15, 213-223.