MotherWise: Implementation of a Healthy Marriage and Relationship Education Program for Pregnant and New Mothers

The process study examines (1) preparations for program implementation; (2) procedures for hiring, training, and supervising frontline staff; (3) the extent to which Within My Reach was implemented with fidelity; and (4) participants’ engagement with and responsiveness to the program.

Findings from this process study will provide context and help interpret impact evaluation findings. Key findings are:

• Program leaders’ expertise informed MotherWise. MotherWise program leaders applied their expertise as Within My Reach authors, research professors, and clinical psychologists to identify areas of Within My Reach to bolster and reinforce for the target population. One Within My Reach author was the program director. She supported facilitators and case managers in high-quality delivery of Within My Reach content. The other author led fidelity monitoring, and regularly reviewed audiotapes of relationship skills workshop sessions. Together with the program director, he met with the facilitators every other week to go over the audiotapes and discuss facilitation successes and challenges. nFORM data entered by facilitators suggested that the staff achieved high fidelity to the curriculum.
• MotherWise engaged women by creating a safe and welcoming environment, delivering highly relevant content, and helping them apply it to their lives. MotherWise staff sought to create a program environment that helped women feel safe and comfortable. They set up the program office to feel safe and comforting, and offered materials in English and Spanish so that women who spoke either language felt welcome. Case managers helped women process the Within My Reach lessons and apply them to their own circumstances. In these one-on-one meetings, women could continue a conversation they had begun in the workshop and discuss personal matters, such as a history of trauma or medical issues with their pregnancy. Additionally, MotherWise provided free transportation and child care to address two primary barriers to participation. Program engagement and participation were high, and feedback from focus groups and staff suggests that this was related to the availability of holistic and complementary services and a supportive program environment.
• A cohesive team of well-qualified staff were committed to MotherWise and its mission. MotherWise sought to hire staff who were flexible, willing to use their skills in multiple roles, and passionate about serving low-income women. Almost all of the frontline staff filled more than one role, including facilitation and case management. All were qualified for their roles, with experience providing case management and/or relationship skills education and relevant educational backgrounds. All of the staff were women, which was important for creating an environment in which the female participants felt comfortable, and many frontline staff spoke Spanish. All staff—even those who did not provide direct services—participated in Within My Reach training to ground themselves in the goals of the curriculum. The program director structured group meetings and team-building events to build group cohesion among the staff. Staff survey responses indicated high job satisfaction and turnover was minimal.

This report is based on analysis of data from the following four sources, collected to document MotherWise’s first year of operation (September 2016 — September 2017).

1. Semi-structured interviews, focus groups, and observations. We conducted a three-day site visit in October 2017 to collect qualitative data. We interviewed 14 MotherWise and partner staff. We observed one relationship skills workshop session and held two focus groups with 11 total participants who had attended workshop sessions.
2. Staff survey. All full-time program staff who recruited participants, facilitated Within My Reach, or reinforced it during case management sessions and three supervisors completed a web-based survey in April 2017. The survey asked about their work roles and experiences; feelings toward the program; and impressions of the quality of their supervision, training opportunities, and organizational climate.
3. nFORM data. nFORM was the client management system that OFA provided to MotherWise and other 2015 grantees. MotherWise staff entered workshop and case management attendance records in the system. After each relationship skills workshop session, MotherWise facilitators completed a short self-assessment about their ability to deliver that day’s planned content and engage participants. We analyzed nFORM data on 326 participants who enrolled between September 2016 and September 2017.
4. STREAMS baseline survey. Participants completed a baseline survey administered during their intake appointment. We analyzed survey responses from 326 participants who enrolled and completed the survey between September 2016 and September 2017.

Baumgartner, Scott and Diane Paulsell (2019). MotherWise: Implementation of a Healthy Marriage and Relationship Education Program for Pregnant and New Mothers, OPRE Report # 2019-42, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.