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Chapter III: Recruiting Couples

Finding and recruiting the target population is the first challenge usually faced by social services programs. Even programs that recruit individual adults often find that projections of a large eligible population that might benefit from services do not translate into a correspondingly high flow of applicants in response to program outreach. A variety of factors can affect recruitment, chief among them that potential participants may not be fully aware of the program, or may face competing demands for their attention and time.

BSF programs face some special recruitment challenges. Surveys have shown that many low-income unmarried couples are in romantic relationships, interested in marriage, and open to the idea of marriage skills education. Nevertheless, during the planning stage, MPR and the BSF sites foresaw that recruitment could be a challenge, most obviously because programs have to recruit not one but two individuals who agree to participate. In addition, couples and men in particular, might have reservations about participating in open discussions about their relationships in group settings. Each potentially eligible couple has to be recruited in the relatively brief “time window” encompassing the period of pregnancy up to three months after delivery (the eligibility period defined for BSF). And while trying to attract couples to the program, sites must take precautions to screen out couples who might be placed at heightened risk of domestic violence by participating.

Success in recruitment is particularly important to the BSF program because its core is a series of group sessions. A steady, substantial flow of couples into the program is essential, so that programs can form and start new groups of adequate size and at frequent intervals. Although the ideal group size depends on the particular curriculum in use, and varies from 6 to 15 couples, all of the sites placed a high priority on filling scheduled groups to achieve the desired group dynamic and to keep program cost per couple within budget. Recruiting enough couples to start such groups also was important so that couples do not have to wait a long time before participating; this helps to avoid the possibility that they will lose interest while waiting.

Beyond the pilot stage, recruitment success also will be important for the BSF evaluation. It will determine the size of the sample of couples randomly assigned to the program or to a control group. Achieving a larger sample will allow more precise estimates of the impacts of BSF.

The pilot experience to date provides a basis for reporting on three topics related to recruitment: (1) the main elements of recruitment strategies as practiced in the sites, including the issues raised and tradeoffs presented by these strategies for BSF sites and potentially for other healthy marriage programs; (2) recruitment data during the early stages of the BSF pilot sites, including the number of enrolled couples and their background characteristics; and (3) preliminary lessons about recruitment for others who plan to offer services like those of BSF for similar populations.

A. BSF RECRUITMENT STEPS

Although their recruitment approaches varied, all BSF sites had to accomplish the same general outreach, recruitment, and enrollment steps with each potential participant:

• Identifying Potentially Eligible Couples. Sites identified potential participants—individuals with whom they could conduct the full intake process—by asking other agencies to provide referrals, or by using their own staff to pre-screen expectant or new mothers in hospitals, clinics, or within their own programs.
• Determining BSF Eligibility. Potential participants met individually with program staff to complete a simple checklist (separately for mother and father) to determine if they both met eligibility requirements. A private screening for domestic violence was also conducted at this point. Those who were ineligible proceeded no further with the intake process.
• Describing the Program and Obtaining Consent for Study Participation. For each parent that was found eligible for BSF, staff described the program and ascertained whether the parent was interested. If so, the parent was taken through a formal informed consent process, since BSF is being implemented as part of a research study.
• Administering Study Baseline Forms. For each consenting parent, program staff separately administered a brief baseline data form and a form requesting contact information for several friends or relatives. Although both forms were designed to serve research purposes, they correspond to what sites running similar programs outside of a research project might use to collect basic demographic information and emergency contacts.

B. RECRUITMENT SOURCES AND OUTREACH METHODS

All sites followed standard procedures for enrolling eligible couples, as in steps 3 and 4 above. They diverged, however, in the sources and methods they used for identifying potentially eligible participants and determining their eligibility. In addition, the sequence of recruitment steps varied somewhat across sites. In part, this variation derives from the organizational frameworks in which BSF is implemented, as well as from host organizations’ existing practices and preferences. The divergences may have implications in that they may be associated with achieving particular successes and encountering certain difficulties, although several sites used more than one method.

Stationing BSF Intake Staff at Birthing Hospitals. Building on their established procedures, the three Healthy Families sites (Florida, Indiana, and San Angelo, Texas) chose to station BSF intake staff in the maternity wards of local hospitals. Through agreements with the hospitals, the BSF staff approached potential BSF participants directly. Whenever possible, all steps of the recruitment process outlined above were completed in the hospital with mothers shortly after they gave birth. When fathers were present, their eligibility also was assessed. The assessments determined eligibility for both BSF and Healthy Families. If all steps could not be completed or if the father was not present but the mother was eligible and interested, staff followed up (usually in the home) to complete the assessment process. For the sake of efficiency, one site (San Angelo) used a prescreening procedure, in which staff asked the mother’s permission to briefly review her hospital chart to determine whether she was likely to be eligible on the basis of factors like age and marital status. Other sites chose to conduct assessments with every new mother willing to be assessed.

Stationing BSF Outreach Staff at Prenatal Clinics. Through agreements with a major prenatal clinic and doctor’s offices, one site (Oklahoma) approached expectant women waiting for prenatal appointments. BSF staff selected and approached women based on the clinic’s appointment schedule listing its patients and their characteristics. Staff explained the program and, for those who were interested, obtained contact information and scheduled appointments to meet with the staff elsewhere to conduct intake. The full recruitment process was conducted at various locations in the community, at the individual or couples’ home, or at the BSF office.

Implementing a Referral System at Clinics or Other Agencies.Several sites (Atlanta, Baltimore, and Houston) relied primarily or completely on a referral system they implemented especially for BSF. A few others used a similar approach, although to a lesser extent (Oklahoma, a county in Indiana). Atlanta worked with neighborhood public health clinics where low-income women often go to apply for Medicaid or other pregnancy-related services. Staff at these clinics were asked to provide a one-minute description of BSF and give interested women a four-item screener indicating whether they were likely to be eligible. Based on this brief introduction, those who were interested signed a “consent to be contacted” form, which then was forwarded to the BSF program by agency staff. Intake staff responded by making appointments with interested couples to conduct the full eligibility and recruitment process. Baltimore and Houston followed a similar recruitment process, sometimes collecting referrals from hospitals as well as clinics.

Approaching Expectant Women Participating in Group-Oriented Programs. One site (Baton Rouge) operated by a community-based organization specializing in serving the needs of new parents was in a unique position to approach large numbers of expectant mothers efficiently. Each week, newly pregnant Medicaid-eligible women, most of whom were unmarried, came to the center to be connected to a range of prenatal services by attending a one-time group meeting. At the end of this meeting, staff briefly described the BSF program and invited participants to fill out the BSF eligibility checklist, and to stay behind to meet individually with an intake worker. Those who were found eligible were given 48 hours to talk to their partners and determine whether the partners also would be open to being assessed by program staff. If so, program staff took steps to schedule an intake appointment and complete the eligibility process. Staff also followed up with women who expressed interest in the program but were unable to stay behind following the group session.

Sites attempted to recruit couples through a variety of other approaches, including placing ads or posters; distributing flyers; running public service announcements; and visiting churches, schools, and other community organizations. Although most sites continue to supplement general recruitment through these efforts, none have so far found these sources to be as fruitful as targeting the maternal health care system.

C. VARIATION IN THE RECRUITMENT PROCESS

The recruitment process appears to vary in five ways: : (1) how couples first hear about BSF; (2) when in the transition to parenthood they hear about it; (3) where they hear about it; (4) whether parents hear the program described together or separately; (4) in the full program presentation, what the overall focus is; and (5) how sites approach screening for domestic violence (see Table III.1). These five aspects of the recruitment process are related to one another in that the choices made in one area often imply a particular choice in another area.

1. Nature of the Initial Encounter with BSF

A major decision for BSF programs, and potentially for other programs as well, is the question of who first initiates contact with parents. As discussed below, the decision on who makes the initial contact has implications for efficiency and message control in the first stage of the recruitment process.

Efficient Use of Outreach Staff. The efficiency with which programs use their recruitment staff is one of the variables affected by the decision about who makes first contact. If individual parents or couples who are eligible for the program appear only infrequently where outreach staff are deployed, the outreach staff may be idle much of the time. Stationing BSF program staff at a prenatal clinic, for example, might be efficient if a high percentage of women using the clinic are unmarried and in couple relationships, but inefficient if such couples are exceptions. If the target population is rare at a particular recruitment site, reliance on the staff of the clinic or other entity, instead of BSF staff, might be more efficient if the clinic staff can easily integrate their brief introduction of BSF into their normal duties and do it well. In Healthy Families programs, where program staff sometimes must contact all women delivering a child, using program staff to introduce BSF may be efficient even if potential BSF participants are a small percentage of the population, because the staff have to be at the hospital anyway.

Table III.1. Primary BSF Outreach and Recruitment Strategies

Strategy		ATL		BALT	B-R	FL		IN			OK	TX
		GSU	LAA			Orange	Broward	Marion	Allen	Lake		San Angelo	Houston
Nature of First Encounter	Client hears BSF via a referral system
	Client hears about BSF from host program staff
	Prescreening prior to full intake procedure
Timing of First Encounter	During pregnancy
	After childbirth
Setting of First Encounter	Hospital maternity ward
	Home, community, host program center or office
	Prenatal or public health clinics
Attendance at Full Program Presentation	Both partners usually present
	Only one partner usually present
Focus of Recruitment Message	Primary emphasis on couple
	Primary emphasis on children
Approach to DV Screening	Structured/specific screening questions
	Conversational interview and staff assessment

This efficiency tradeoff, however, may also affect the burden on outreach staff to contact couples identified through referral agencies. Relying on hospitals or clinics to refer couples represents an efficient approach if most referred couples make their own way to the BSF program to complete the intake process, or if outreach staff have little difficulty in making and completing appointments in couples’ homes. If there are difficulties reaching parents, or with missed appointments, it may be more efficient for outreach staff to be stationed at the referral source agency and be able to complete part or all of the intake process, even if they are not busy all the time. Each program site must explore this issue, estimate the tradeoff, and be willing to revise its approach based on this decision process.

Another aspect of the initial encounter that is related to efficiency is the choice to prescreen or not to prescreen for likely eligibility before starting the usual full intake assessment process. Prescreening may make recruitment more efficient by reducing the need to interview numerous individuals who are not likely to meet the eligibility criteria. Generally speaking, prescreening involves checking a few basic eligibility requirements to determine whether a full intake might be fruitful, but it can take several forms. For instance, intake staff stationed at maternity wards can ask new mothers for their permission to briefly review their medical charts. However, only if the mother’s general information suggests that she is within the basic eligibility criteria (e.g., age and marital status) do the intake staff then proceed to explain the program and conduct a full eligibility assessment (San Angelo, Orlando). In another variation of prescreening, staff review forms filled out by interested parents who have heard about the program through a prenatal or public health clinic (Atlanta, Houston, Oklahoma, and Baltimore). The forms include four basic questions related to eligibility (age, marital status, primary language, and nature of relationship with other parent). Those who meet these requirements are contacted for a full intake interview, and those who do not are informed that they are not eligible for the program. In a third variation of prescreening, interested pregnant women attending a center-based group prenatal program self-administer the entire eligibility checklist (Baton Rouge); those who meet the criteria are invited to complete a full intake interview while those who do not are informed of their ineligibility. Regardless of how parents are prescreened, the process allows staff to use their resources more efficiently in that they conduct a full intake only with parents who are most likely to be eligible.

Control over Message Delivery. A second issue that the BSF sites have had to address in their recruitment procedures is how well the first message about the program is delivered to parents. To the extent that BSF staff themselves are the first to discuss the program with potential participants, the program maintains greater control over the process. Program leaders can select and train their own outreach staff; monitor the accuracy, enthusiasm, and reliability with which they convey information about the program; and, if necessary, retrain or replace them. For situations in which a program like BSF is integrated into a broader program, however, this advantage will be fully realized only if outreach staff are thoroughly trained and can avoid conveying messages based on the traditional purposes of the host program, which may not be fully in line with the focus of BSF on the couples’ relationship.

Relying on other agencies for this first encounter produces other challenges. Agreements must be negotiated with those agencies and their staff, who often are trained through the referral agencies’ supervisory structure. In addition, new staff must be trained as turnover occurs. Special attention must be paid to verifying the buy-in and enthusiasm of the front-line staff, and ensuring that the extra referral task they are given is defined, so as to pose a minimal amount of additional burden on them. The interest and support of the referring staff may have to be cultivated over time, bolstered with positive information about the program filtering back to them from couples they have referred.

At BSF pilot sites, staff who believed the program had the potential to help couples worked energetically to recruit them, describing the program in positive, animated ways, and taking time to explain and demystify it. Some outreach workers emphasized the exclusivity of the program, stressing to couples that they were among the lucky few for whom program slots were available. Enthusiastic staff communicated verbally and nonverbally that BSF was valuable and worthy of couples’ time.

2. The Timing of Recruitment Relative to the Course of Pregnancy

In programs serving unmarried new parents, methods for recruitment and their results are likely to depend on when recruitment is attempted, relative to the couple’s pregnancy and delivery. BSF sites typically have relied primarily on recruitment either during pregnancy or after the baby’s delivery, although a few sites have made substantial use of both timeframes. Their experience underscores the tradeoffs involved, including how the timing may affect later participation in group sessions.

Recruiting couples during pregnancy, particularly early in pregnancy, gave BSF sites certain advantages relative to post-delivery recruitment. During the prenatal period, couples are not yet dealing with the stresses, time demands, and fatigue of caring for a newborn (which can be compounded if they already are caring for older children). For this reason, it may be easier for them to participate in the group sessions prior to the new baby’s arrival. They also may be more open to the idea of devoting substantial time to a couples’ program during pregnancy than later. The happy anticipation of parenthood together may encourage their joint interest, as may the anxiety of one or both parents about the solidity of their relationship and how it might change. A disadvantage to this prenatal recruitment is that, unless the couple is enrolled early enough during the pregnancy, their attendance at the group sessions may be interrupted by the birth of the baby. In addition, pregnant women may find it difficult to sit during the group sessions, which can last two hours or more.

Recruiting for BSF after the couple’s child is born also has advantages and disadvantages. First, post-delivery mothers in hospitals are easy to identify and approach, and, if the father also is present and the intake can be completed with both, there is no need to follow up on referral forms or reach out to the parents in the home. However, recruiting after the child is born can delay the onset of group participation, since parents sometimes do not like to take their babies outside for several weeks or months after the birth. In addition, newborns may get sick, and parents may get little sleep until the baby adjusts, leading to fatigue that results in poor attendance. The later postnatal period can bring other adjustments that also can interfere with regular participation. For instance, mothers often must go back to work after a couple of months and may have to take on a schedule that is no longer compatible with the group sessions they started just after the birth.

3. Setting of the First Encounter

The different locations for the first BSF informational presentation have their own strengths and weaknesses, regardless of whether the setting is a hospital maternity ward, a public health clinic, or a meeting of expectant women. Maternity ward rooms in hospitals are rife with interruption; doctors, nurses, and relatives have their necessary duties and joyful roles to fulfill, and intake sessions can be prolonged far beyond their planned length. Despite such interruptions, if both parents are present and can focus on the BSF information, the intake process can be completed. Doctor’s offices offer a concentrated and scheduled flow of program candidates, but the experience in one BSF site, where staff were stationed at the clinics, was that many prenatal appointments were missed, resulting in fewer recruited couples than expected based on scheduled prenatal appointments. Visiting couples who have indicated interest by submitting a “consent to be contacted” form in their home offers a chance for relaxed conversation and gaining trust, but can involve additional staff time in the form of travel and missed appointments. Presenting information about BSF and conducting intake with interested individuals who already are attending a center-based activity is efficient if many potentially eligible people attend, but it is rare that couples attend such activities together. For this reason, following up with the eligible clients’ partner still is necessary in these situations, and may present challenges if the interested parent fails to present the program accurately or in a nonjudgmental way.

4. Meeting Parents Together or in Sequence

The BSF program and evaluation model calls for eliciting the interest and consent of both parents before they can be enrolled, but the sequence of meetings with couples has raised issues. The BSF pilot sites have had to consider the advantages of presenting information about the program and initiating intake when both parents are together, as opposed to allowing sequential presentations of the program with each parent. In the end, no BSF site used joint or sequential program introduction solely but they varied in the frequency in which the first full presentation of the program and the ensuing consent process occurred with either both parents present or just one. To some extent, this variation reflected conscious choices that sites made, and to some extent it reflected how couples responded.

Several sites found that presenting the program to both parents together had important advantages. With both parents hearing the same message, there was no risk that one would inaccurately describe BSF to the other, or be perceived by the other as exerting pressure to enroll. A presentation about the program to both parents underscores the fact that the program staff see both as equally important partners in their relationship, and potentially in the program. Meeting with both parents together, if both respond with interest, may relieve each of them of the hesitation associated with uncertainty about how the other will react. Most obviously, a meeting with both parents makes efficient use of outreach staff time. Given these advantages, all sites welcomed opportunities to describe the program when parents were together.

Sites varied, however, in how much they insisted on starting the intake process with both parents present. At some sites, other decisions about the recruitment process made it inevitable that intake would usually begin with one parent. For example, although some women attend the prenatal program in Baton Rouge with their partner, most come alone, and so receive their introduction to BSF before their partners. Similarly, some of the Healthy Families programs traditionally have conducted most of their initial assessments with women alone. However, some sites have made conscious decisions to increase the prevalence of two-parent intake sessions. In Orange County, Florida, for example, staff determine whether the father is present at the hospital and give highest priority to assessing couples with both partners present. In Atlanta and Oklahoma, staff strive to make intake appointments only if both partners indicate they are interested and when both will be present for enrollment together.

Allowing the intake session to proceed if only one parent is present seems appropriate for most of the BSF sites. Although later followup with the other parent is necessary if the first parent wishes to move forward, confirming one parent’s eligibility and interest is at least a good sign that the effort to locate and meet with the second parent may result in a recruited couple. In some cases, completing the process with one parent may make it easier to make an appointment with the other if the first parent conveys enthusiasm about BSF. However, at one site that only has recruited postnatally, the likelihood of completing sequential intake is not regarded as high unless there is a clear sign of the father’s interest: he visited the mother and baby in the hospital after delivery. Without that signal, the staff have found that since BSF expects parents to participate as a couple, it is generally not worthwhile to initiate intake with the mother in such cases.

Conducting separate intake meetings with each parent also offers one minor advantage with regard to screening for domestic violence (DV). To detect domestic violence that might exclude a couple from the BSF program, site staff must conduct a portion of the intake interview separately. For this reason, when both parents meet with the BSF outreach staff, they are asked to split up in separate rooms, to respond independently to the Baseline Information Form, but also to allow the mother to answer questions about domestic violence privately. Although this separation of the two parents can almost always be accomplished without awkwardness, the possibility of difficulty is reduced if only one parent is present.

5. Focus of the Message: Couples or Their Children?

The BSF program is designed to benefit couples and their children, and the emphasis placed on one goal or another can affect how potential participants respond to recruitment. During program planning, it was hypothesized that emphasizing “doing the best for your child” could help overcome any reluctance couples might feel about getting involved. Experience confirms the couples’ interest in how the program can benefit their children, but it also has revealed the considerable relief and satisfaction couples take in getting the opportunity to work on their relationships.

There are subtle differences in recruitment message emphasis across sites, mostly related to the organizational framework of the program. In Florida and Indiana, where BSF recruitment begins as part of the Healthy Families assessment, information about BSF and marriage education is conveyed in the context of the overall Healthy Families purpose: helping families to learn positive parenting practices so as to avoid child abuse and neglect. Given this larger purpose, the information conveyed to parents puts helping their child’s development front and center. At other sites, there is a somewhat greater emphasis on characterizing the program as “helping you as a couple,” in addition to providing benefits to children.

There is no clear answer as to which emphasis works better, but programs are well advised to pay attention to the uses that can be made of both messages. Recruitment staff should be well trained to talk about both potential benefits and to be responsive to what couples are most concerned about.

6. Approach to Screening for Domestic Violence

All BSF sites were required to establish protocols for detecting and addressing DV in collaboration with their local or state domestic violence coalitions. These protocols define how the program staff will screen or assess for domestic violence, particularly situations that might be aggravated by participation in BSF and so place a partner at increased risk, and how the staff will respond when domestic violence is detected. Such screening is intended, as part of the intake process, to identify couples who would better be excluded from the program and referred to more appropriate services. Sites’ protocols for domestic violence also were required to address how they will continue to assess participants once they are in the program, since no intake screening is perfectly reliable.

The aim of DV screening for BSF is to screen out and refer for appropriate services those individuals/couples who are involved in partner violence that is marked by repeated and severe instances of physical violence (e.g., hitting or kicking), or violence that involves controlling and dominating behavior, where there is a clearly identifiable perpetrator and a clear victim. Unfortunately, a high percentage of unmarried and married couples experience conflicts that escalate to the point of shoving, slapping, or pushing. The curricula used in BSF are designed to help couples who have poor conflict management skills learn to avoid harmful fights and conflict escalation. Therefore, couples who could be helped in this way are included in the program, when doing so is not expected to put either partner at risk.

BSF sites have chosen or developed different screening methods. Three sites have adopted a structured questionnaire for administration to women, which includes 22 specific questions about their partner’s actions and behavior, developed by prominent experts on domestic violence and marriage.2 The scoring of the questionnaire, which can be done as soon as it is completed, indicates whether there is DV, and whether the couple should be excluded from BSF. The other sites have developed more conversational protocols designed to elicit, particularly from women, descriptions of their relationship and any violence that may be occurring. This information is reviewed with supervisors to determine whether it warrants the couple’s exclusion from BSF. These sites favor the conversational approach because they see it as less intrusive and they believe it is more likely to elicit honest responses. Sites using the more structured approach, however, have not found that the explicit questions are offensive to women and also believe it elicits honest responses. They have found that most women seem to understand that this is a slightly uncomfortable but appropriate feature of assessing eligibility for this kind of program. Both approaches have resulted in a small number of couples being screened out of the BSF program at intake and referred for more appropriate services.

How sites choose to screen for DV inevitably will involve balancing their existing practices and program context with alternative approaches for reliable detection. The BSF experience to date provides no rigorous test of which method is more reliable. Sites using the conversational approach have later excluded some couples who turned out to be involved with DV. Sites using the structured questionnaire have not so far reported a need for subsequent exclusions. Continued experience, as well as continued input and guidance from DV experts, likely will lead to some further evolution of the screening methods used.

D. RECRUITMENT RESULTS

The BSF pilot sites have accumulated substantial experience with the recruitment process. Sites began BSF recruitment between February and September 2005, and by December 2005 647 couples (1,294 individuals) had completed the full intake process and had consented to participate in the study (see Table III.2). The experiences of sites in identifying and enrolling couples for the pilot provides the first information about the yield of enrolled couples from the intake process and the characteristics of the couples enrolled.

1. Recruitment Yield from the Intake Process

The recruitment results are the product of considerable effort by the pilot sites. Overall, the BSF sites initiated the intake process with 6,084 individuals by December 2005, but intake could not be always completed for three reasons: one or both partners did not meet BSF eligibility criteria, the second partner could not be reached to determine eligibility within the “time-out” deadline set by the site, or one or both partners refused consent (the latter was a relatively rare occurrence).

The enrollment yield from the recruitment efforts varied widely and was affected by a variety of factors. Most of the discrepancy between the number of initiated intakes and the number of completed enrollments can be explained by the recruitment process at two sites. The BSF recruitment process in both areas was combined with the recruitment process for the host program (Healthy Families), which targeted a more broadly defined population of pregnant or new mothers at risk for child abuse. One site (D) began the BSF recruitment process with 3,735 individuals as part of its regular eligibility assessment for Healthy Families. Out of this number, staff were able to identify only 117 couples meeting the BSF eligibility criteria and obtain their consent to participate in the BSF program. The other site also experienced a low enrollment yield, assessing a total of 1,559 individuals to obtain 143 BSF-eligible couples. The experiences of both of these sites reflect the anticipated fact that a considerable portion of the overall Healthy Families target population falls outside the BSF target population. For example, in one of the sub-sites, about 52 percent of mothers going through the Healthy Families assessment through December 2005 were found to be ineligible for BSF, and in more than three-quarters of those instances, the mother or father was under 18, the couple was married, the two parents were not in contact with each other or did not have a romantic relationship, or domestic violence was suspected.

Table III.2. BSF Pilot Site Recruitment as of December 5, 2005

Site	Number of Months Since Recruitment Initiated	Total Number of Couples Recruited	Average Number of Couples Recruited Per Month
Site A	5	51	10
Site B	3	26	9
Site C	8	63	8
Site D	10	143	14
Site E	10	117	12
Site F	4	48	12
Site G	10	199	20
Total		647

The remaining sites (excluding Sites D and E) initiated recruitment with 790 individuals, yielding 387 fully eligible and consenting couples, a rate of about 49 percent. It is likely that some combination of factors described earlier in this chapter could explain the variation in recruitment yield, including the timing, setting, and context of the recruitment effort and the characteristics of the local population.

Two particular enrollment practices could also have affected the recruitment yield: the use of prescreening and joint versus sequential presentation of the program to the two partners. As described earlier in this chapter, prescreening involves checking basic eligibility factors before conducting a full eligibility interview, enabling the program to focus its resources on couples most likely to be eligible. Explaining the program to, and conducting intake with, both members of a couple is also more efficient in terms of recruitment yield because it eliminates the possibility of losing a potentially eligible couple in the event of difficulty in obtaining an eligibility interview with the second partner. Although our findings on the issue of a joint versus a sequential approach to recruiting are not conclusive, observations made during the pilot period suggest that enrollment procedures in which eligible women explain the program to their male partners are not as effective a recruiting strategy as procedures in which staff explain the program to both members of the couple simultaneously.

Although prescreening and describing the program to both members of a couple at the same time appear to be promising recruitment practices, it is difficult to conclusively tie enrollment procedures to recruitment yield for the reason that other factors were also in play during the pilot. For example, during the early period, the sites did not enter recruitment data in the same way—some entered data for every person who expressed interest in the program, including those who completed a prescreening form but were ultimately found to be ineligible. Others often entered data only when both members of the couple were fully interviewed and had consented to participate. This practice makes the recruitment yield appear artificially high. However, data entry and tracking procedures were standardized by the end of the pilot period, and the majority of sites had begun to meet their monthly recruitment goals. Future observation and more detailed analysis, which will be conducted during the full implementation study, is expected to help us pinpoint the steps in the recruitment process at which couples are most often lost, thus providing a better sense of what might be done to prevent that from happening.

2. Characteristics of Enrolled Couples

Each individual who goes through the BSF intake process completes a baseline information form (BIF). Completion of this form by both partners is a mandatory step before a couple can be enrolled in the study (and randomly assigned to the program or a control group). The form collects information on the demographic, economic, and relationship characteristics of those who are were attracted to and voluntarily enrolled in the BSF programs. Table III.3 and Table III.4 show data from this form for 540 couples (representing all enrolled couples except for those whose baseline characteristics could not be included because of pending Institutional Review Board (IRB) approval for the release of such data).3 The data can be used in at least three ways. First, it can help determine whether the BSF implementation strategy resulted in identifying and reaching the intended population. Second, it can be used to form subgroups for analysis of program impacts, to identify whether the program affected various groups within the target population. Third, it may inform the targeting of future programs that seek to provide relationship skills and marriage education to unmarried parents.

Table III.3. Individual-Level Characteristics of BSF Enrollees at Intake*

		All Sites	Atlanta	Baltimore	Baton Rouge	Florida	Indiana	Texas
Number of Persons		1080	102	48	126	284	124	396
Age	Average	25	26	25	24	24	25	25
	Mother	24	25	24	22	23	23	24
	Father	26	28	26	25	26	26	26
Race/Ethnicity (%)	White, Non-Hispanic	15	3	0	20	10	54	11
	African American, Non-Hispanic	42	56	90	72	64	40	7
	Latino/Hispanic	39	40	8	4	17	2	81
	Other	3	0	2	3	6	0	1
	Multi-racial	1	1	0	1	3	4	0
Primary Language (%)	English	75	60	100	99	90	99	50
	Spanish	22	37	0	0	4	0	48
	Other	3	3	0	1	6	1	2
Enrollment During Pregnancy (%)		46	75	63	98	2	55	48
	1st trimester	45	32	33	13	67	91	55
	2nd trimester	46	49	40	75	33	9	40
	3rd trimester	9	19	27	12	0	0	4
Enrollment After Birth of Child (%)		54	26	38	2	98	45	52
	Less than 1 month	81	39	11	100	97	68	73
	1-2 months	11	15	44	0	2	20	18
	More than 2 months	9	46	44	0	2	12	10
Completed at least high school or equivalent (%)		68	78	58	70	70	69	64
	Mother	68	78	63	79	72	63	62
	Father	68	78	54	60	69	76	66
Currently Working for Pay (%)		50	59	42	57	43	35	56
	Mother	21	41	21	41	10	6	22
	Father	79	77	63	73	76	65	90
Mother’s Total Earnings in Past 12 Months (%)	No earnings	32	24	14	19	23	18	51
	Less than $15,000	57	56	59	68	66	71	44
	$15,000 - $24,999	9	14	27	9	10	9	5
	$25,000 - $34,999	1	4	0	2	0	0	0
	$35,000 or more	1	2	0	2	1	2	1
Father’s Total Earnings in Past 12 Months (%)	No earnings	6	6	22	3	5	7	6
	Less than $15,000	57	61	48	51	58	57	58
	$15,000 - $24,999	28	16	26	34	25	22	32
	$25,000 - $34,999	8	8	4	7	11	12	4
	$35,000 or more	2	8	0	5	1	2	0
Children by other partners (%)		33	37	44	32	35	36	30
	Mother	33	37	46	30	31	36	33
	Father	33	37	42	33	38	36	26
Mothers (Not Married to Current Partner) (%)	No chance of marriage	2	0	0	2	1	0	3
	Little chance of marriage	4	5	10	2	2	0	5
	A 50-50 chance of marriage	23	29	24	14	30	19	21
	A pretty good chance of marriage	26	33	33	21	27	32	24
	An almost certain chance of marriage	46	33	33	62	40	50	48
Fathers (Not Married to Current Partner) (%)	No chance of marriage	1	0	0	0	1	5	1
	Little chance of marriage	3	5	5	4	2	0	3
	A 50-50 chance of marriage	17	23	15	11	24	15	14
	A pretty good chance of marriage	27	42	40	29	32	22	21
	An almost certain chance of marriage	52	30	40	57	41	58	62

Source: Data from BSF Baseline Information Form, analysis of December 8, 2005 Extract file. * Note: Data for Oklahoma and for some Indiana couples could not be included in table due to pending IRB approval.

Prenatal and Postnatal Enrollment. The BIF data confirm that overall, sites succeeded in enrolling couples both during pregnancy (about 46 percent) and after delivery (54 percent). Atlanta, Baltimore, and Baton Rouge conducted most of their recruitment during pregnancy, while Florida conducted most recruitment after birth. Indiana and Texas were more evenly split in their recruitment timing, but their sub-sites tended to specialize in either pre- or postnatal recruitment.

III.4. Couple-Level Characteristics of BSF Enrollees at Intake*

			All Sites	Atlanta	Baltimore	Baton Rouge	Florida	Indiana	Texas
Number of Couples			540	51	24	63	142	62	198
Education	Completed High School or Equivalent (%)	Both completed	50	71	38	46	53	52	45
		Only mother completed	18	8	25	33	19	9	17
		Only father only completed	18	8	17	14	16	24	20
		Neither completed	14	14	21	6	12	16	18
Employment	Currently Working for Pay (%)	Both working	16	33	13	30	7	3	17
		Only mother working	5	8	8	11	3	3	4
		Only father working	63	43	50	43	68	61	73
		Neither working	16	16	29	16	22	32	6
Marital Status and Cohabitation (%)	Married to current partner*		6	12	8	6	4	10	4
	Unmarried, cohabiting all or most of the time		76	67	71	68	71	84	84
	Unmarried, cohabiting some of the time		10	8	17	19	12	5	7
	Unmarried, not cohabiting		8	14	4	6	13	2	5
Family Structure (%)	Couple has other children in common		28	23	22	18	30	13	38
	Either or both partner(s) has a child/ren by a different partner		50	49	58	46	54	55	47
Race/Ethnicity(%)	Both white, non-Hispanic		12	2	0	14	6	46	8
	Both African American, non-Hispanic		36	49	83	62	55	36	6
	Both Latino/Hispanic		34	35	4	0	11	0	77
	Both other race/ethnicity		1	0	0	0	3	0	1
	Partners are of different race/ethnicities		17	14	13	24	25	18	9

Source: Data from BSF Baseline Information Form, analysis of December 8, 2005 extract file. * Note: Oklahoma data and data for some Indiana couples could not be included in table due to pending IRB approval. a BSF eligibility criteria permit enrollment of married as well as unmarried couples if marriage occurred post-conception.

Income and Race/Ethnicity. One of ACF’s goals was to attract the participation of culturally diverse, lower-income unmarried parents, who rarely have access to marriage education. Instead of setting eligibility criteria for socioeconomic status, however, sites with experience serving this population were selected. The BIF data indicate that this strategy was effective in reaching the groups it was intended to reach.

• BSF attracted a culturally diverse population. Across sites, almost 42 percent of participants were non-Hispanic African Americans, 39 percent were Hispanic or Latino, and 15 percent of participants were non-Hispanic whites. There was great variation across sites in the breakdown, however, reflecting the composition of the communities served by them. For instance, the high overall number of Hispanic couples is driven largely by the Texas site.

• Employment was common, at least for men, but earnings were low. About half of participants were working at baseline, but there was a pronounced gender difference. About 21 percent of mothers were working, compared to almost 79 percent of fathers. This is not surprising, since many mothers were pregnant or had just given birth. Earnings were low. The majority of participants earned less than $15,000, and almost all earned less than $25,000.

Age and Education. BSF eligibility criteria specified that both men and women had to be age 18 or older, which meant that older adolescents could participate. However, most participants were not in their teens, and most had already completed high school.

• Participants were typically in their mid-twenties. Overall, the average age of participants was just under 25 years (approximately 24 for mothers and 26 for fathers). Seventeen percent of the total sample was 18 or 19 years old; the upper bound for women was 42 years, 54 years for men.

• About two-thirds of participants (both mothers and fathers) had completed at least high school. About 68 percent of all participants had attained a high school education or more. Atlanta had the highest proportion of high school graduates (78 percent) and Baltimore the lowest (58 percent). Across all sites, roughly 50 percent of couples were composed of two high school graduates.

Couples’ Relationships. To participate in BSF, both parents had to indicate that they were romantically involved, but the pregnancy that brought them into the program did not have to be their first, nor were their living arrangements or expectations for marriage a criterion for eligibility. Interestingly, most participants who enrolled were cohabiting and many had children from previous relationships. Although these findings might suggest ways to target future marriage programs, the actual impact results will determine which kinds of unmarried couples are likely to be affected by the program.

• More than three-quarters of couples were cohabiting at BSF intake and nearly six percent were already married. Approximately 76 percent of couples reported living together all or most of the time (see Table III.4, which shows couple-level characteristics). This was fairly consistent across sites; the percentage of unmarried couples cohabiting all or most of the time ranged from 67 percent (Atlanta) to 84 percent (Texas). Six percent met the criteria of having married after the date of conception of the pregnancy or birth that brought them into the program.

• In many cases, couples had previous children. In roughly half of all couples, at least one parent had a child or children by another partner (Table III.4). This ranged from 46 percent in Baton Rouge to 58 percent in Baltimore. In addition, more than one-quarter of couples (28 percent) had other children in common.

• Many participants, particularly fathers, anticipated marrying. Fathers oft