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CHAPTER VI

PROGRAM DEVELOPMENT AND IMPLEMENTATION ISSUES

Developing programs that encourage and support healthy marriages among low-income unmarried parents raises several challenges for program designers. Trends in marriage and family formation must be understood. Program staff must be committed to tackling factors that impede healthy marriages and to promoting services that encourage them. The target population must be identified, its heterogeneous nature fully considered, and a range of family needs assessed so that services can be appropriately tailored to various subgroups and families. Creative ways to engage couples, especially fathers, in programs need to be developed. Finally, important implementation issues such as the mode and setting of service delivery, staffing requirements, and service intensity need to be addressed.

This chapter focuses on these and other program development and implementation issues. It starts with an overview of two program development options that would incorporate the three components of the conceptual framework—relationship skills and marriage education, services to improve marriageability, and policy changes. It then discusses several implementation issues related to service delivery and couple and family assessment.

A. PROGRAM DEVELOPMENT OPTIONS

The sweeping changes in family formation over the past 50 years suggest that efforts to reverse or redirect these trends would need to be ambitious in nature and comprehensive in scope. With high proportions of Americans either marrying late, not marrying at all, or marrying and then divorcing, interventions that would encourage and promote healthy, stable marriages should be well-grounded in what is known about the factors associated with strong marriages and the barriers to strong and healthy marriages. The most promising program model is likely to be one that blends elements from each of the three general approaches detailed in the previous chapters: (1) relationship skills and marriage education; (2) employment, education, and support services that improve marriageability; and (3) policy changes that remove disincentives to marriage among the low-income population.

How should these three approaches be combined to develop a new and innovative program that can promote strong, healthy marriages? Two program development options are possible: (1) modify existing relationship skills and marriage education programs to focus more on the needs and circumstances of low-income families and (2) add or strengthen a relationship component in a program that currently provides services to low-income families. Either option could incorporate changes to TANF or child support policies. The choice of one or the other may depend on the nature of the sponsoring organizations and on the foundation of existing program services on which a new program is built. Organizations that already run programs focusing on relationship skills could modify their couple and marriage services to address the broader human capital and service needs of low-income couples. In contrast, public or community agencies that already provide services to low-income families—with home visiting programs, fatherhood interventions, prenatal care initiatives, or early childhood development programs—could strengthen or add a relationship or marriage component to their services. The extent to which TANF and child support policy changes are integrated into either program model is likely to depend on the involvement of high-level officials in a state welfare agency or governor’s office who can “champion” the new program, rallying the will and support needed to change current welfare policy.

To be more specific, under the first option, any of the programs described in Chapter III might be modified to serve a different target population. For example, the Oklahoma Marriage Initiative (OMI) focuses on providing relationship and communication skills instruction statewide using PREP. The OMI trains counselors, mental health professionals, clergy, social workers, nurses, and others to provide PREP workshops in communities across the state. It also provides training to state agencies and community based organizations in how to refer clients to the workshops. Oklahoma is currently considering expanding and modifying its marriage initiative to pilot a new program that would focus more specifically on the needs and circumstances of low-income unmarried couples around the time of childbirth. This pilot program would supplement the relationship skills instruction under PREP with other support services and education for low-income couples expecting a baby.

If an existing marriage education program intends to offer other services to meet the needs of low-income unwed parents, program staff must decide whether to provide these services “in house” or to refer couples to available resources in the community. Providing these services “in house” may be costly and may duplicate services already available in the community. Program staff would have to weigh these costs against any expected benefit associated with in-house service delivery, such as the ability to tailor the services or schedule them in more convenient ways. However, the costs may outweigh such possible advantages, and suggest that referral and follow-up is preferable.

The second option—adding a relationship component to a program that currently serves low-income families—could build on both that program’s infrastructure and the program staff’s awareness of the needs of low-income families. Examples of existing programs that could be modified to include relationship skills and marriage education are:

• Prenatal Care Programs. Prenatal and infant care programs such as Healthy Start provide case management services that link low-income pregnant and postpartum women and their infants to community services. In addition, Healthy Start has a strong outreach component and delivers health and parenting education to clients. Many local programs have a men’s services component. These outreach efforts and the service delivery infrastructure could act as a springboard for a module or modules on couple relationships.
  
• Fatherhood Programs. This broad array of programs for low-income fathers—such as child support enforcement and paternity establishment programs, fatherhood initiatives, and team parenting programs—seeks to help men become better able to support and contribute to the emotional well-being of their children. The Men’s Services component of CFWD, for example, provides case management, life skills development, and parenting education services to encourage men to become more active in their children’s lives. This structure could support relationship or couples services. Indeed, CFWD is developing a module on the principles of marriage that will be added this fall.
  
• Home Visitation Programs. Healthy Start and David Olds’ Nurse-Family Partnership Program are intensive long-term home visitation programs in which the intervention starts with at-risk mothers during pregnancy or shortly after the birth of the child. The goals are to improve health-related outcomes for mothers and children and prevent child abuse and neglect. Efforts are under way (Children First program) to integrate elements of PREP into the Nurse-Family Partnership Program and to develop program elements to reduce domestic violence.
  


• Early Childhood Development Programs. In programs such as Early Head Start, which also intervene early in the child’s life, a strong effort is made to involve both parents in the child’s development. Some programs are based in centers; some use a home visitation approach; some use a combination. These programs do not currently focus explicitly on healthy marriage, but many promote positive father involvement (Raikes et al. 2000).
  
• Family Support Programs. Some programs are intended to promote family stability and reduce involvement in the child welfare system among at-risk low-income families. The Bienvenidos program, for example, is a culturally sensitive, holistic, comprehensive program serving a low-income Latino community at high risk for domestic violence and child abuse and neglect. Couple relationships are an important part of nearly every program component.

The key issues to consider in weighing the trade-offs between the two program options presented here revolve around a program’s ability to (1) recruit participants from the target population and conduct thorough outreach, (2) provide services and use curricula that are culturally competent, (3) deliver a message that encourages healthy couple relationships and marriages, and (4) assess participants’ needs and link them to employment, education, health, and supportive services.

One important advantage of the first option—modifying existing relationship and marriage education programs to serve low-income, unwed parents—is that there is no need to adapt the program mission, goals, or core service components in order to provide couples with the skills needed to encourage, develop, and sustain healthy relationships and marriages. However, most of these programs have been designed for and implemented with middle- and upper-income married or engaged couples, or with married couples making the transition to parenthood. In contrast, the target population for the programs to be developed under this conceptual framework is primarily low-income unmarried couples with children born out of wedlock.

Consequently, despite the advantages afforded by adapting existing relationship skills programs, this option may pose challenges with regard to fully reaching the “new” target population—not only geographically, but culturally and linguistically as well. For instance, program staff would have to be knowledgeable about the needs of different racial and ethnic groups and sensitive to any cultural variations in how “healthy” relationships and marriages are conceptualized. Finally, these programs will need to develop a systematic way of assessing client needs and linking clients to services, as the target population is more likely to face multiple personal and family challenges relative to couples who have traditionally participated in these programs.

The second option—adding a relationship component to a program that serves low-income families—is promising because these programs already conduct outreach with, recruit, and serve low-income families. In addition, an established service delivery infrastructure makes it even more feasible to add a new component as opposed to developing a new program. Such programs also tend to be responsive to the communities they serve and are thus able to provide services that are congruent with the needs, beliefs, attitudes, and values of their service populations. Moreover, these programs typically assess clients for a variety of risks, needs, and challenges and can refer and link clients to services, many of which are offered in house.

On the other hand, many existing programs are not oriented toward couples and, as a result, may struggle to incorporate a message about healthy relationships and marriages into the program’s mission, goals, and services. In particular, program administrators may be especially concerned about any unintended consequences of an intervention to encourage healthy marriages. More important, however, this option means that staff would have to be trained to provide relationship skills and marriage education or that new staff would have to be hired to provide this additional component. If existing staff are used, they may face competing demands on their time, and they will likely need to decide how to prioritize the various issues faced by families.

B. PROGRAM IMPLEMENTATION

Moving from a general program model to implementation is a complex, intensive, ongoing process that raises the following issues for program designers: how to build support and develop program messages, how to make services culturally sensitive, how to conduct outreach and recruit program participants, and how and when to assess couples and families. This section provides some guidance with respect to these key implementation issues.

1. Building Support for a Focus on Healthy Marriage

Addressing marriage poses a dilemma for some programs and program staff, at least as they first design and implement a new program approach. This is especially true for staff of existing programs that provide services to low-income families. They are sometimes hesitant to broach discussions of the relative advantages of marriage over cohabitation or single parenting because of the potential either to stigmatize couples or individuals who are not married or to encourage the continuation of an unhealthy relationship. In such programs, staff are accustomed to encouraging clients to make their own choices but generally try to avoid the appearance of judging, or advocating, one choice over another. Although some program staff believe that a healthy marriage is the ideal situation for raising children, they prefer to focus on strengthening the individual as the best preparation for making good choices about marriage.

Staff of faith-based programs examined as part of the Strengthening Families study are the most comfortable discussing the benefits of marriage and espousing specific values about relationships and marriage. Still, even in some of these programs—Christian Family Communication Mediation Services in St. Louis, for example—staff are hesitant about the appearance of advocating marriage.

Program staff in general do not think that a couple’s decision to break up or remain unmarried reflects a lack of values or an abandonment of marriage as an ideal. This is consistent with research showing that many unmarried parents view marriage as the ideal situation for children and aspire to marry the parent of their child (McLanahan et al. 2001; Thornton 1989). In the eyes of program staff, what keeps these plans from being realized is not the state of marriage itself but issues like domestic violence, substance abuse, and multiple partner fertility.

Part of the reluctance to address relationship issues in the context of programs serving low-income families likely stems from the fact that they tend to serve a broad range of low-income individuals, rather than couples at the time of their child’s birth when the parental relationship is often still good and hopes for marriage are high. Another reason is that the quality and status of parental relationships have not been defined as program goals in the past, and staff have not received adequate training or support to explore these issues. This is particularly true for programs that have traditionally provided services to women and their children, but to a lesser extent, or not at all, to fathers. For example, nurse home-visitors in Oklahoma’s Children First program voiced concerns about the ability to effectively integrate a focus on the parents’ relationship without disturbing the dynamics of the nurse-mother relationship, the foundation of the nurse home-visiting model. These nurses have been trained to view the mother as their client, and while they include fathers if the mothers request it, it would be an adjustment to view the couple as the client. They are unsure how they would proceed if the couple broke up, what services they might offer to males, and whether men would be open to receiving help from a female nurse. However, design work is underway to adapt this program to couples.

Even state policymakers and key community leaders are sometimes hesitant to support healthy marriage as a program goal, especially in the early stages of discussion about a marriage initiative. This reluctance reflects both an uneasiness about appearing to judge people on the basis of their marital status and the reality that many single people function well. More so than for most program areas, people bring to this policy discussion their personal experience with marriage—whether it is marriage itself, divorce, single parenthood, or cohabitation—and program models and policies that do not reflect this reality may exacerbate, rather than address, the discomfort or uncertainty related to addressing this issue in a program.

Despite some uneasiness about promoting marriage per se, relationship issues are commonly discussed in the course of providing many services to low-income families, such as parenting education and father involvement programs. Not surprisingly, the couple’s relationship is one of the issues that clients care most about. Program staff say they discuss topics like conflict, co-parenting, and communication with their clients, though not in a structured way and usually without the use of any formal research-tested curriculum. In Bienvenidos, for example, home visitors regularly counsel parents on their relationship. During one home visit observed by the Strengthening Families study team, program staff spent about one-third of their time discussing issues related to the couple’s relationship and advised the couple (who had six children) to try to set time aside for the two of them to be together without their children.

The natural interest in couple and family relationships opens up an opportunity for encouraging healthy marriage, and creative ways to overcome the reluctance about making healthy marriage a program goal need to be considered. Several possibilities include the following:

• Provide Information on Marriage Research and Marriage Education. Many program and policy leaders are unaware of the evidence showing that children fare best when raised by married parents. Others are unfamiliar with the array of promising approaches that could be used to help couples who are interested in strengthening their relationships. Information dissemination efforts could address these “why” and “how” questions by:
  • Providing an easy-to-read explanation of the evidence for the beneficial effects of healthy marriage on child well-being
    
  • Compiling, disseminating, and demonstrating some of the most promising curricula used in marriage education and relationship skills programs
    
  • Suggesting areas for adaptation to make programs more appropriate for low-income unmarried parent couples
    
• Avoid Overstating the Research Findings. Presentations involving long lists of the statistics on better outcomes for children and adults in married households can come across as simplistic and as slights to the successes of single parents. This might be avoided if the presenters acknowledge that marriage is not for everyone, that getting married is not a sure path to positive outcomes, that the real goal is to improve the chance of success, and that, other things being equal, a healthy marriage gives parents and children a better chance of success in many spheres of life.
  


• Engage in Strategic Planning Discussions. It takes time and open dialogue to overcome initial resistance to the idea of healthy marriage as a program goal. Reaching out to key state and local agencies and community leaders (especially those involved with domestic violence issues), convening community or statewide meetings or workshops to discuss the role of healthy marriage promotion in a public program, and contacting other states or community organizations that are running marriage initiatives are some ways to start and sustain the dialogue needed for buy-in, as well as to frame a shared agenda for the objectives and components of a healthy marriage initiative.


• Provide Staff Training. The resistance to promoting healthy marriage sometimes emanates from an inadequate understanding on the part of program staff about the nature of relationship-education services. Staff may be concerned about the risk of encouraging individuals to remain in unhealthy relationships, or they may fear that the new initiative will require that they push marriage for particular couples. Investing in staff training—as in the Oklahoma Marriage Initiative—may help to alleviate these and other staff concerns by presenting information on the content of the intervention and the circumstances under which couples would be eligible.
  
• Tailor the Intervention. Staff may be less resistant to marriage education and relationship skills instruction in programs that assess client needs and tailor services to them. In particular, unmarried parents in an abusive relationship and very young unmarried parents might need a different set of services to address their needs. However, for those unmarried parents who are romantically involved, an intervention that provides relationship and communication skills instruction may strengthen the relationship, increasing the chance that the couple will choose to marry and that the marriage will be healthy.

2. Providing Culturally Sensitive Services

Program participants are more interested and motivated to participate in services that are relevant, or sensitive, to their culture and community. Culture can be viewed broadly as being a function of race and ethnicity, but it is also rooted in neighborhood, socioeconomic status, and shared life experiences. Programs achieve cultural sensitivity in a variety of ways, including (1) incorporating traditions and cultural teachings in curricula, (2) hiring staff whose background is similar to that of the target population, and (3) using cultural themes in office décor and program materials.

Probably the most effective way to achieve cultural sensitivity is to infuse program curricula and activities with elements of the culture. For example, Bienvenidos includes aspects of Latino and indigenous culture in all aspects of service provision; CFWD has designed an Afro-centric curriculum for Men’s Services in which African and African American themes are used throughout its lessons. Holiday celebrations and other traditions are a common way for both of these programs to connect with participants. For example, CFWD begins all support groups with a “libation,” an African tradition for honoring ancestors by pouring a ceremonial liquid into a container and paying tribute in verse. Similarly, in its fatherhood services, Bienvenidos emphasizes becoming an Hombre de Honor or Hombre de Palabra—a Man of Honor or a Man of Word—which connotes a uniquely Latino value, or view, of personal responsibility.

Staff hiring and training also are important elements of culturally sensitive programs. Participants are more likely to express their needs and problems to staff if they feel comfortable and understood in the program setting. Staff who share a “community” with clients—whether that community is defined by race, ethnicity, geography, or common life experiences—are especially able to connect with participants and to design and provide services that are relevant to them. At both Bienvenidos and CFWD, most or all of the staff share race, ethnicity, and language with participants along with life experiences and a connection to local neighborhoods.

Cultural sensitivity also goes beyond curriculum design and staffing. For instance, the office décor at Bienvenidos and CFWD includes art, posters, cloth, and photographs that capture cultural themes. A tribal TANF agency in Riverside and Los Angeles counties, the Torres-Martinez Desert Cahuilla Indians Consortium, promotes the continuation of cultural traditions by helping couples pay for traditional Indian weddings. The mode of service delivery is also an indication of cultural sensitivity. For example, Dr. Lorraine Blackman chose to teach classes on relationships and marriage in her African American Family Life Education program instead of engaging couples one on one because her review of research suggested that African Americans prefer receiving information through lessons rather than in the context of personal disclosure.

3. Conducting Outreach and Recruitment

Enrolling individuals in programs can be a major challenge. Unless participation is mandatory, eligible individuals in the target population must understand both their need for and the benefits of program services. This task may be challenging in programs intended to strengthen families when the parents are not married, since the couple is the focus of the intervention and both the mother and father need to be reached and recruited. On the other hand, interventions that begin during the pregnancy or around the time of birth may capitalize on the motivation and receptiveness couples experience during this period.

Outreach and recruitment may be easier under the second option—adding relationship services to programs that already serve low-income families—because these programs have the infrastructure and a client base from which to recruit new participants. Examples of such programs include early childhood development programs or programs serving pregnant and postpartum women. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for example, may be a program from which to recruit couples. Data from the Fragile Families study show that 83 percent of unwed mothers in the Fragile Families sample received WIC benefits (McLanahan, personal communication).

These programs can also provide outreach models. Healthy Start, which offers case management and health education to low-income pregnant and postpartum women and their children, is a good example. Its outreach strategies fall into seven categories: (1) intensive door-to-door canvassing, (2) periodic targeting of housing units, (3) canvassing of community/public spaces, (4) community events, (5) telephone contacts, (6) mass media campaigns, and (7) hotlines (McCann et al. 1996). These strategies vary in intensity, in frequency of use, and in the types of staff who implement them. Essentially, outreach workers canvass all community locations frequented by pregnant women—grocery stores, malls, laundromats, nail and hair salons, and housing units. In addition, many Healthy Start programs host or participate in community health fairs, taking advantage of the opportunity to spread information about program services.

Broader public information/education efforts—such as radio spots, bus cards, hotlines, billboards, and flyers—are other vehicles for contacting potential program participants. Links to other programs are also a useful outreach strategy. For instance, clients enrolled in Medicaid managed care plans could be assessed and referred to a program to strengthen families.

4. Assessing Couples and Families

Providing low-income parents with relationship services that are appropriate begins with a solid understanding of their needs and circumstances. Therefore, assessing low-income couples and families for substance abuse problems, mental and physical disabilities, criminal backgrounds, family violence, and the other issues that typically act as barriers to employment can also provide clues to what is standing in the way of their ability to create and maintain stable and healthy marriages and relationships. Personal and family issues also have the potential to complicate service design and delivery. For instance, participants with physical or mental health disabilities may participate inconsistently or require special accommodations. Other considerations include safety concerns that may come into play when delivering services to young men involved in rival gangs—family and staff members could be at risk by interacting with fathers in public or at program events.

This section discusses some key factors for which families targeted for intervention should be assessed. In most cases, these assessments can be used to tailor services to client needs; in other cases, the assessments can be used to screen individuals from irrelevant services.

Abusive Relationships. Program staff confirm what research has consistently shown: abuse in relationships is a prevalent problem among low-income couples. As a result, programs must develop strategies specific to identifying and addressing abuse. Studies have found that 10 to 30 percent of female welfare recipients—compared with 3 percent of women nationally—report being in a relationship marked by domestic violence (U.S. General Accounting Office 2001; Danziger et al. 2000). The research also shows that abuse in couple relationships and child abuse often occur in the same families (Ooms 2001). Given the evidence, it is particularly important for programs developing relationship services to carefully consider how they will ensure that clients are not encouraged to remain with abusers or put themselves or their children at risk. In addition, screening for domestic violence also allows for the tailoring of services to both perpetrators and victims of abusive relationships.

Addressing this issue appropriately and consistently is a challenging task, given certain characteristics of abusive relationships. For one, the types and degrees of abuse vary from one client to the next. The traditional signs of domestic violence—controlling behavior, threats, physical and verbal abuse, and an inevitable escalation of violence—do not always apply to all couples. Moreover, couples are sometimes mutually violent, further exacerbating the conflict and complicating the resolution. While physical abuse can be life threatening, emotional abuse and control (e.g., not letting someone see friends or family or restricting their access to money) can be as damaging or more so. As a result, program staff must not only take all types of abuse seriously but also must differentiate between them in order to link families to appropriate and useful services. For example, some marriage experts who work with distressed couples make the case that while certain types of abusers are not treatable, many others can benefit from a marriage intervention program that focuses on conflict resolution.

Unfortunately and for a variety of reasons, it can be difficult to identify and gauge the severity of abuse. Shame, guilt, or denial on the part of both the abused and the abuser can keep them from admitting the problem. Along the same lines, victims of domestic violence, often convinced that they are at fault, have self-esteem issues that keep them from seeing the abuse as a problem. In fact, many young couples have grown up around violent relationships, therefore seeing abuse as normal, appropriate, or inevitable. Further complicating the issue is the fact that even formal tools for assessing domestic violence often rely on self-report. Consequently, the assessment results may be less than accurate if program staff and participants have not had time to develop the kind of trusting relationship that would encourage clients to “speak their mind.” Staff at many programs are not trained to identify domestic violence. Therefore, to effectively address the issue of abuse, programs need someone on staff, ideally a mental health professional, who is trained to identify abuse and to differentiate between its various forms.

Programs have also found that many people stay in abusive relationships for long periods of time or cycle in and out of them. Many women in the Bienvenidos Family Services domestic violence program, Latinas en Progreso, stay with their abusive partner throughout the series of classes and beyond. Bienvenidos staff approach each situation individually, help to secure the safety of the abused partner and children, and work to strengthen the abused partner’s skills and confidence while working with the abuser on both anger management and relationship and parenting issues. In more severe cases, staff refer abused participants to a local domestic violence shelter.

The “gray areas” of domestic violence have led some program staff to develop a flexible, case-by-case approach to the issue and to focus on providing families with the skills and information they need to make their own decisions. When CFWD identifies a man in its programs who is abusing his partner, staff approach the situation in different ways, depending on the severity of the problem and the willingness of the participant to admit to the problem. These approaches range from helping the client see his behavior as a problem to referring him to a batterer’s program at an organization that treats domestic violence. Jerry Tello’s curriculum, used by the National Latino Fatherhood and Family Institute at Bienvenidos, focuses on the root causes of violent behavior, including the pressures caused by racism, poverty, and violence in the client’s family of origin or neighborhood. The fathers in the program are asked to reflect on how they have internalized these pressures and directed them at others through violence, drug use, and other unhealthy behaviors.

Multiple Partner Fertility and the Influence of Extended Family. Couples should also be assessed for multiple partner fertility and extended family networks as part of developing and delivering appropriate relationship services because, regardless of income level, couple relationships are often influenced by other relationships with family, friends, and previous partners. However, among low-income families in particular, parenting and couple relationships can be especially complicated if one or both parents have had children with other partners. Moreover, these families may be strongly influenced either positively or negatively by the extended family.

Parenting and couple relationships can be particularly complicated if one or both parents have children with other partners. According to a recent analysis of the Fragile Families data, 36 percent of both mothers and fathers have children with other partners (Mincy 2001). Of those mothers who have two or more children, more than half have a child by someone other than the father in the study. Multiple partner fertility is found to be more common among blacks (46 percent) than whites or Hispanics (22 and 29 percent, respectively). It is more common among mothers 25 years and older (who are more likely than younger women to have had two or more children) (Mincy 2001). Some evidence suggests multiple partner fertility discourages marriage (Lichter and Graefe 2001; Mincy 2001). Mothers may be reluctant to marry fathers with financial and emotional responsibilities to other children, and fathers may be reluctant to take responsibility for nonbiological children.

Previous relationships and children with other partners can be both a challenge and a source of conflict for couples. A CFWD analysis of participants found that, on average, fathers in the program have two children, each with a different partner. Multiple partner fertility complicates both family structure and program efforts to provide services, especially relationship services, to the family. In these situations, program staff try to help the parents identify the best outcomes for all concerned. Some programs, including Constructing a Godly Home in Michigan, encourage participants to view parenting relationships as permanent and to work on improving communication among themselves, with their current partner, and with former partners with whom they have had children.

Unlike multiple partner fertility, connections to extended family can be both a strength and a challenge in couple relationships. Parents may receive support from extended family in various forms, financial and otherwise. Nonetheless, the involvement of extended family may also complicate family formation decisions. The primary strategy for dealing with this challenge is to acknowledge the importance of extended family and to include them, as much as possible, in program services and discussions with participants.

Young Age. Marriages between teenagers are significantly more likely to end in divorce than are marriages between older adults (Booth and Edwards 1985). For this reason, unmarried parents eligible for program services should be assessed for age and their relationship status in order to tailor services accordingly. It may be useful to provide younger parents with general relationship and marriage education classes of the type provided to high-school students (see Chapter III). Such classes do not seek to strengthen existing relationships and marriages but to prepare young people for healthy marriage in the future.

Low Education and Literacy. Program content must be appropriate for a variety of education levels and language skills. Education levels are lower, on average, among low-income families than among the general population. Many programs work with individuals who have limited education or learning disabilities, who are illiterate, or who are recent immigrants to the United States and do not speak English as their first language. These demographics affect program staffing, curriculum development, and the design of program materials like application forms.

Studies have shown that approximately one-third to one-half of welfare recipients do not have a high school diploma, and more than one-fifth have a learning disability (Pavetti 2002). Although program classes and materials need to be tailored to both these individuals and those who are illiterate, curriculum content can remain the same, although staff will need to identify the language level and mode of learning that will be most appropriate for participants. For example, the director of Christian Family Communication Mediation Services noted that participants in her program did not immediately understand the term “biological parent,” so she has learned to use different terms for the same concept and to provide more explanation for terminology she uses. Another illustration of this kind of adaptation is the Couples’ Relationship Enhancement Program, which not only developed curriculum materials that are appropriate for participants with limited education but also created audiotapes of program materials for illiterate participants.

English language skills are also an issue for many programs that serve low-income families. Some participants may be learning English as a second language but still need some program materials translated into their native language; other participants may not speak English at all. Depending on the English language skills of participants, some programs hire bilingual staff and offer classes in several languages. Bienvenidos Family Services offers weekly parenting classes in English and in Spanish, and all program materials are available in both languages. Boot Camp for New Dads in Denver, Colorado, developed a Spanish version of its curriculum and offers classes in Spanish regularly.

C. SERVICE DELIVERY

This section offers guidance with respect to the following service delivery issues: (1) context and setting, (2) mode or modes of service delivery, (3) service intensity (such as frequency and duration of services, and amount of staff interaction), and (4) staff characteristics, backgrounds, and training.

1. Context and Setting

The setting in which a program is implemented is an important factor in determining the following: the extent to which couple relationships and healthy marriage can be readily addressed, the type and scope of services, the population served, and the amount of staff training required. Programs in the Strengthening Families study operate in hospitals and health care clinics; as part of health care, welfare, and early childhood programs for low-income families; in faith-based programs; and in community-based organizations.

Health Care Setting. The health care setting is a promising environment for programs that seek to intervene with couples at or around the time of birth. Typical settings include prenatal care clinics, hospitals, or other facilities in which health-related services are delivered to pregnant and postpartum women. Healthy Start and Children First both begin working with women while they are pregnant and could seize upon this critical point in a couple’s relationship by including fathers in services and expanding the scope and content of their programs.

Other advantages of the health care setting include the availability of services and the fact that participants see these services in a positive light. For instance, programs that operate in health care settings typically provide thorough health and social risk assessments, linking clients to appropriate physical and mental health services as well as social and other support services. In addition, the involvement of clinical and highly trained staff in service delivery often fosters a sense of trust in program participants and, consequently, their acceptance of the accuracy of the advice they receive.

As discussed, however, staff in health care settings may sometimes be reluctant to formally address relationship issues. In particular, staff at prenatal care programs that focus primarily on health interventions may not view marriage and relationship issues as important to the program’s mission. Resistance from this and other sources might be overcome through training or by hiring new staff with the professional background and training to provide relationship skills services.

Welfare Setting. Despite the advantages of a welfare setting for reaching the target population, it poses several challenges with regard to acting as the foundation for programs designed to strengthen couple relationships or build healthy marriages. First, because benefit levels are tied to household structure, mothers on welfare face a disincentive to be involved, or at least to report their involvement, with the fathers of their children. Second, including a marriage-related message in the context of providing welfare benefits might inadvertently suggest to participants that the receipt of public assistance is somehow contingent upon their marital status or their relationship with the father of their child. In addition, TANF caseworkers are unlikely to be equipped with the training and skills required to talk to participants about their relationships and the benefits of healthy marriage. Moreover, the likely demands on staff time, such as linking clients to services and moving them into employment, would not allow them enough time to devote to clients’ relationships.

On the other hand, if implemented carefully, interventions developed within the welfare setting might provide TANF clients with the support they need to form healthy and stable marriages. The Torres Martinez Desert Cahuilla Indian Consortium is an example of a tribal TANF agency that has put services in place to support clients’ decisions to marry. Through its marriage promotion program, the agency offers premarital counseling through a Native American counselor; $2,000 in cash assistance that is not counted against their TANF grant; and $1,500 to offset the costs of a traditional Native American wedding. In addition, as part of the TANF-funded Oklahoma Marriage Initiative, TANF workers are trained both in how to talk with clients about relationships and to refer them to relationship education workshops provided by community organizations.

Early Childhood Education Setting. Programs that focus on early childhood education, such as Early Head Start, are more likely than programs in health care or welfare settings to work with the whole family—an advantage in itself. Because such programs often begin intervention services around the time the child is born or shortly thereafter, they may be particularly well positioned to implement services that focus on the couple as the unit of intervention. Moreover, Early Head Start staff are equipped to discuss sensitive issues and family challenges, including couple relationships, as they already work with parents to set goals as part of the family development component of the standard program model.

Nevertheless, even in this type of setting, the issue of initial resistance or reluctance concerning efforts to promote healthy marriage may present a challenge. This issue would need to be addressed by modifying the program’s mission and by training staff to incorporate this additional goal into their approach.

Faith-Based Setting. A faith-based setting is an especially good context in which to operate programs intended to strengthen relationships and build healthy marriages because this particular program orientation is likely to be congruent with the mission and philosophy of the institution in which the program is implemented. Because the vast majority of marriages begin with a religious ceremony, most religious leaders are comfortable discussing the benefits of marriage. In addition, faith-based settings, because they reach so many people on a regular basis, provide a natural forum for outreach. The Constructing a Godly Home program is a good example of this connection between the mission and philosophy of faith-based settings and the goals of marriage-oriented programs. The goal of Constructing a Godly Home is to provide couples with the tools to build a home together that provides the love, security, and nurturing needed for family development and a long-lasting marriage.

Although staff at programs implemented in faith-based settings would be likely to embrace efforts to strengthen couple relationships and promote healthy marriage, their ability to enroll nonreligious participants may be limited. Some faith-based settings may also lack the resources needed to assess clients’ needs and link them to services appropriate for low-income individuals facing multiple personal and family challenges.

Community-Based Setting. Community-based organizations tend to develop in response to identifiable community needs and often work with particularly disadvantaged populations facing an array of personal and family challenges. This strong community tie makes it likely that relationship-strengthening programs operated in a community-based setting will achieve the cultural and linguistic sensitivity that is so important to effective outreach and appropriate service design and delivery.

Staff at community-based organizations commonly discuss relationship issues with low-income families when providing services, such as parenting education, home-visiting services, and father involvement activities. Bienvenidos has found that the relationship issues are primary in the minds of the couples it serves, and that when participants raise this topic, staff take the opportunity to discuss conflict, co-parenting, and inter-personal communication. However, programs that operate in community-based settings rarely use a formal research-tested curriculum in addressing relationship skills. Moreover, staff at community-based organizations can often be particularly resistant to strategies designed explicitly to strengthen couple relationships or promote healthy marriage because participants often have a host of other needs that may require more immediate attention.

2. Mode of Service Delivery

The three primary modes of service delivery are (1) classes, lectures, seminars, or workshops; (2) home visits; and (3) support groups. The choice of one over the others will likely depend on the program approach, the available financial capital and human resources, and the characteristics of the target population.

Classes, Lectures, Seminars or Workshops. The use of traditional educational structures in service delivery is particularly common in relationship and marriage education programs and in programs that focus on parenting and co-parenting because this is probably the most direct way to impart the relationship skills that clients can begin to use immediately. In contrast to other modes of service delivery, this approach does not typically require staff to gain participants’ trust in order to effectively provide services because participants are not asked to express their emotions or discuss sensitive topics. This approach may be particularly useful in certain populations. As noted, Lorraine Blackman developed the African American Family Life Education Program on the basis of an extensive literature review suggesting that African American couples are more likely to prefer the classroom approach over activities involving the disclosure of personal information. In addition, PREP program developers have found that men in general are more likely to participate in programs that use a didactic approach.

Workshops, seminars, and retreats are typically designed for educated and middle-to high-income populations. Their effectiveness with low-income populations remains unknown. One possible drawback to the classroom approach is that it may require couples to take time off from work, a significant challenge not only because low-income workers cannot afford to lose earnings (assuming they have not accrued vacation time) but also because many low-income individuals work odd hours and weekends.

Home Visits. Home-based services allow staff to address multiple needs of families while teaching participants relationship skills in a one-on-one setting. Bienvenidos has found that because home visits can accommodate the schedule of individual families, they are a particularly effective way to address the needs of the most vulnerable and needy families on an ongoing basis.

The limitations to a home visiting model are related to cost-efficiency in terms of the resources required by the approach relative to the number of families that can be served. Home visits are typically more costly than classroom methods because services are delivered one on one rather than to groups. In addition, if families are not at home at the time of the scheduled visit, the program must still bear the cost of the staff time to travel to and from the residence. But no-shows have been few and far between in the Bienvenidos home visiting program component, and staff members attribute this to three aspects of their programs: (1) home visitors approach clients with respect, understanding, and in a nonintrusive way that focuses more on what families are doing right and less on what they are doing wrong, (2) female home visitors bring male staff along on visits as needed to help fathers feel more comfortable, and (3) families go through a process of assessments and referrals, and those with serious issues receive treatment before being placed into a home-based program. In the past, Bienvenidos found that participants who were difficult to engage or who dropped out of the program often had issues (such as substance abuse or domestic violence) that they were trying to hide from program staff.

Support Groups. Support groups are often used to provide a safe place for discussing sensitive topics and expressing emotions in a socially and psychologically supportive peer environment. Support groups may also be effective in combination with other strategies. The Men’s Services program at CFWD, for example, uses weekly support groups in conjunction with a weekly class, affording men the opportunity to connect emotionally with a supportive group of peers while gaining practical skills. Bienvenidos uses support groups in combination with classes, workshops, and individual counseling when participants are struggling with other serious issues, such as substance abuse and domestic violence, that require long-term and intensive treatment. Support groups in the Baby Makes Three program and in the Becoming a Family program are intended to help couples during the transition to parenthood.

Trade-Offs. For program designers, the choice of a mode of service delivery is closely related to the selected approach to improving relationships and the desired objectives of that approach. For example, programs may choose to only teach relationship skills, or they may also choose to help couples discuss specific relationship topics or address and resolve current relationship issues. An educational approach—such as classes, workshops, or lectures—is advantageous because it provides participants with a concrete set of skills that they can practice and use at home to resolve specific issues. Certain types of participants may be more comfortable with this approach because it does not require the sharing of personal information with strangers. Yet couples that are more stressed may require additional support to get beyond specific issues. A more personalized mode of service delivery, such as home visiting, can allow program staff to help couples resolve current relationship problems, as well as address an array of other issues that may be facing couples. Support groups, alone or in combination with other modes, offer some of the benefits of both of the other approaches in that participants can cover topics that are universally important for the health and stability of relationships but also offers a more personal setting for discussing problems and specific relationship topics.

Other Service Delivery Considerations. Choosing a service delivery mode is related not only to the three approaches to strengthening relationships but also to whether one mode or another is more effective in (1) removing barriers to family formation and (2) sustaining program participation. Those two goals could be accomplished by gaining participants’ trust, accommodating couples’ schedules, assessing and responding to individual and familial needs, and providing an environment conducive to positive peer influence and the sharing of experiences. Gaining participants’ trust may involve delivering services in an environment in which clients can meet other couples who are struggling with similar issues. This could help to sustain participation by putting couples at ease as they confront issues that are deeply personal. In addition, given that many low-paying jobs require employees to work nontraditional hours or in rotating shifts, sustaining participation may mean offering services at times that dovetail with couples’ schedules. For instance, services could be provided in the evening or on weekends, or at different times and on different days according to participants’ availability. Finally, program designers might ensure that a service mode responds to participants’ needs beyond relationship issues by adding a case management component to the core relationship-oriented service.

3. Program Intensity

Services can be characterized as low, moderate, or high in intensity, depending on frequency and duration, extent of participants’ exposure to the program, and extent of interaction between participants and program staff. For program designers, the decision about service intensity often involves a trade-off between providing less service to more people or more service to fewer people. The final choice will affect the opportunity for program staff to develop rapport and trust with program participants, the ability of the program to meet client needs, and the likelihood that participants will be able to process and put into practice the skills they have acquired through the intervention. One option to consider is a program that would provide a low-intensity intervention for a broad group of couples, and a more intensive set of services for couples who are interested in and might benefit most from a sustained and intensive set of services.

Low Intensity. One-time workshops, seminars, or brief video presentations are low-intensity services that provide very limited exposure to program materials and staff and that occur for a short time (from a ten-minute video presentation to a single day or weekend). Several traditional marriage and relationship skills education programs fall into this category. Although this approach may work well with middle- to high-income educated populations, it may be less effective in addressing the multiple needs of and challenges faced by low-income families.

Moderate Intensity. Moderately intensive services may consist of classes or support groups that occur weekly or bi-weekly over a period of several weeks or months. Because such services are often provided in a large group setting, there is typically little one-on-one interaction between staff and clients. However, relationships between the two may develop over time, so such services are likely to provide clients with more staff interaction and program exposure than are workshops, retreats, or seminars.

High Intensity. High-intensity services include home visits on an ongoing basis, treatment programs that provide an array of services over an extended period (typically one year or more), and services provided by some comprehensive programs that address multiple needs concurrently. High-intensity services are likely to be particularly effective in addressing the needs and circumstances of low-income families for a variety of reasons. For instance, services that occur frequently and over a long period allow staff and clients to get to know each other well, sowing the seed for a trusting relationship that allows staff to more readily monitor progress, assess client needs, and link them to appropriate services.

4. Staff, Background, and Training

Personal Characteristics. A key lesson learned from a broad range of programs, regardless of their overall mission, is that the most effective program staff are those who unambiguously believe in the program message and who are genuine and caring when they deliver services. In addition, program staff also report that one of the most important staff characteristics is the ability to understand and appreciate the needs and circumstances of their service population. Some programs that serve low-income minority families have found that it may be easier for staff to gain participants’ trust if they come from similar ethnic and racial backgrounds, and in some cases, of the same gender.

Professional Background. The educational background and experiences of the program staff in this study run the gamut, although most tend to be paraprofessionals or professionals. Programs that provide health education and services, such as the Nurse-Family Partnership Program, use registered nurses to provide core program services. Staff in early childhood programs are often certified early childhood educators. Home visitors work with families on a variety of issues, and while many have a master’s degree in social work, others have bachelor’s degrees in combination with a great deal of experience in the field. Individuals who implement relationship and marriage education programs are typically trained and certified in the use of the program’s curriculum.

Training. Regardless of whether an intervention is developed by adapting an existing relationship skills and marriage education program to low-income couples or by adding a relationship component to a program that provides services to low-income families, training staff members to implement the program will be key to its success. In the first model, staff must be trained in several areas, including building their understanding of the needs of low-income populations and the extent to which community resources are available to address their needs. They may also need to be trained in assessing participants for various needs and linking them to the appropriate services. In the model in which a relationship component is added to an existing program for low-income people, staff would need training in the benefits and use of a formal research-tested curriculum that emphasizes relationship skills. Regardless of the program model, the more complex the healthy marriage intervention, either because of tailoring services for different target populations or because of the curriculum content, the more important professional training and adequate supervision becomes.

 

 

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