A Randomized, Controlled Trial of the Impact of the Couple CARE for Parents of Newborns Program on the Prevention of Intimate Partner Violence and Relationship Problems

Effectiveness of Father-Focused Interventions to Prevent or Reduce Intimate Partner Violence During Pregnancy and Early Parenthood: A Systematic Review

During pregnancy and the early parenting period, women are especially vulnerable to intimate partner violence (IPV), with devastating impacts on women, children, and families. The aim of this systematic review was to determine the effectiveness of father-focused interventions to prevent or reduce IPV during pregnancy and early parenthood. Six databases were searched, using a combination of the concepts "fathers," "pregnancy/early parenthood," "IPV" and "intervention." Articles were double screened by title and abstract, and then full-text. Methodological and reporting quality was assessed using the Quality Assessment with Diverse Studies tool. Fifteen papers were eligible for inclusion; these articles were mostly of poor-to-moderate quality. Only three of the articles reported on interventions in lower- and middle-income countries. The most common forms of IPV addressed in these interventions were physical (10), psychological (8), sexual (4), and economic/financial (3). Of 12 articles reporting on data from both intervention and control groups, only six indicated statistically significant results; among these, only three reported robust analyses showing significantly greater reduction in IPV in intervention than in control groups. All three took place in lower- or middle-income countries. Two were underpinned by theoretical frameworks, which considered transforming traditional perceived gender norms. Therefore, interventions based on principles that address transformation of gender norms show promise but the success of such underlying principles needs to be confirmed, and better-quality evidence and reporting are needed for interventions targeting fathers to prevent or reduce IPV.

Which battering interventions work? An updated Meta-analytic review of intimate partner violence treatment outcome research

This meta-analytic review is an update to the first meta-analysis of battering interventions (Babcock et al., 2004) and includes 59 studies that evaluated treatment efficacy for domestically violent men and women. The outcome literature of controlled quasi-experimental and experimental studies was reviewed to test the relative impact of Duluth, cognitive-behavioral therapy (CBT), and novel types of treatment on subsequent recidivism of violence. The first model examines studies comparing interventions to no treatment control conditions. The second model compares novel interventions to treatment as usual (i.e., the Duluth curriculum). Study design and type of treatment were tested as moderators in both models. Consistent with previous meta-analyses, effect sizes were in the small range, smaller in true experiments as compared to quasi-experimental designs when recidivism was based on partner or police reports. However, new experiments comparing novel treatments to the Duluth curriculum reveal effect sizes comparable to when comparing novel interventions to an untreated comparison group. Novel interventions, including Acceptance and Commitment Therapy and Circles of Peace had the largest effect sizes when put head-to-head with Duluth control groups. Future research directions include testing moderators and mechanisms of change of the battering interventions that work. Implications for evidence-based practice in criminal justice include broader implementation and continued testing of these novel interventions with demonstrated efficacy in stopping intimate partner violence.

Exploring the complex links between childhood exposure to intimate partner violence, maltreatment, and self-regulation: A three-wave cross-lagged study

BACKGROUND

Intimate partner violence (IPV) often co-occurs with childhood maltreatment and negatively impacts children's development. While previous research has shown a direct link between these experiences and children's self-regulation, less is known about the potential unique effect and bidirectional associations between them.

OBJECTIVE

The present study aims to investigate the bidirectional effects among maternal IPV experiences, child maltreatment, and children's behavioral self-regulation.

PARTICIPANTS AND SETTING

4,402 participants from three waves of the longitudinal study of the Future of Families and Child Wellbeing Study (FFCWS) were included in the study.

METHODS

Cross-lagged path analyses were conducted to examine the longitudinal reciprocal relationships among IPV, child maltreatment, and children's behavioral regulation when children were 3, 5, and 9 years old.

RESULTS

IPV exposure at ages 3 and 5 was negatively associated with levels of behavioral self-regulation at ages 5 and 9, even after accounting for physical maltreatment, psychological maltreatment, or neglect. Neglect at ages 3 and 5 was found to be associated with lower levels of behavioral self-regulation at later ages, when IPV exposure was considered in the models. Lower levels of behavioral self-regulation at age 3 were found to be linked with higher levels of psychological maltreatment, physical maltreatment, neglect, and IPV exposure at age 5.

CONCLUSION

This study revealed bidirectional effects between maternal IPV experiences, child maltreatment, and children's behavioral self-regulation. Furthermore, the study demonstrated that exposure to IPV during early childhood significantly predicts long-term behavioral self-regulation difficulties, even after controlling for the effects of child maltreatment.

A test of the dyadic associations between ineffective arguing, emotional distress, and violence perpetration and victimization among couples seeking therapy

Researchers have tested associations between ineffective arguing and emotional distress among couples without relationship violence. Moreover, studies have demonstrated associations between physical violence perpetration and victimization in the aftermath of emotional distress. However, there is a paucity of research examining linkages between ineffective arguing, emotional distress, and physical violence perpetration or victimization. Dyadic data from 231 married, heterosexual couples seeking therapy were used to test a model examining pathways between ineffective arguing and physical violence perpetration and victimization through emotional distress. The hypothesized model was compared to two plausible alternative models. Results revealed higher levels of men's ineffective arguing were positively associated with men's physical violence perpetration, both directly and indirectly, through higher levels of emotional distress. Higher levels of men's ineffective arguing were associated with lower men's physical violence perpetration through higher levels of women's emotional distress. Results can inform the clinical treatment of interpersonal violence by targeting ineffective arguing and emotional distress.

Do relationship education programs reduce relationship aggression? A meta-analytic study

There is an increasing focus on evaluating the effectiveness of Relationship Education (RE) programs on reducing relationship aggression. Nevertheless, there has been little by way of a systematic quantitative synthesis of research to date. The primary aim of this research was to conduct a meta-analysis into the effects of RE programs on relationship aggression and provide a comprehensive assessment as to the moderating effects of various methodological characteristics of studies. A secondary aim was to determine whether RE programs reduce negative aspects of relationship functioning that are known to exacerbate relationship aggression. Thirty-one studies (n = 25,527) were included comprising of pre-post comparison studies and control trials. Overall, RE programs were significantly associated with reductions in relationship aggression (d = 0.11, p = .001). Pre-post studies yielded a significantly larger effect size (d = 0.28, p < .001) than RCT studies (d = 0.05, p = .10). Subgroup analysis revealed that participants who reported moderate to severe relationship aggression upon RE program entry demonstrated large reductions in physical (d = 0.66, p = .01) and psychological (d = 0.85, p < .001) aggression compared to those who reported minimal to low relationship aggression on entry (physical aggression d = 0.07, p = .009; psychological aggression d = -0.04; p = .17). Amongst participants who reported moderate to severe relationship aggression, RE programs were also found to reduce controlling behavior (d = 0.20, p < .01) and conflict behavior (d = 0.40, p < .001). Findings demonstrate the emerging efficacy of RE programs for reducing relationship aggression and conflict behavior, particularly in those with a history of moderate to severe levels of relationship aggression.

Interventions for intimate partner violence during the perinatal period: a scoping review protocol

INTRODUCTION

Globally, the prevalence and incidence of perinatal intimate partner violence (IPV) are well documented and substantiated; however, there is an urgent need to identify interventions to prevent recurrence or revictimisation, and decrease the harms of perinatal IPV. This scoping review is designed to broadly capture all potential interventions for the secondary prevention of IPV, review them in detail, and assess what can reduce revictimisation and foster improvements in both maternal and neonatal outcomes.

METHODS AND ANALYSIS

With the structure of the Joanna Briggs Institute and Arksey and O'Malley methodology for scoping reviews, the search will be conducted in: MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), APA PsycInfo (OvidSP), Cochrane Central Register of Controlled Trials (OvidSP), Web of Science, and Applied Social Sciences Index & Abstracts (ProQuest). A manual search of the reference lists of the retrieved articles will be conducted to capture all relevant studies for potential inclusion. A year limit of January 2000-June 2022 will be applied to retrieve most current peer-reviewed articles. No search filters or language limits will be used, but only publications in English and French will be eligible for inclusion. Interventions include but are not limited to: psychotherapy, educational sessions, home visitation, etc. Outcomes include but are not limited to: (1) harms of IPV among survivors (eg, revictimisation) and (2) adverse perinatal outcomes (eg, preterm birth). Interventions will be excluded if they target the perpetrator or child(ren) alone. Titles and abstracts of included studies will be screened in duplicate. Full-text documents will be extracted and reviewed by two independent reviewers. Conflicts between reviewers will be resolved by a third independent reviewer. Findings will be presented with descriptive statistics and narrative synthesis.

ETHICS AND DISSEMINATION

Ethics approval is not required for this scoping review. The results will be disseminated through peer-reviewed publication and conference presentations.

STUDY REGISTRATION

Open Science Framework (OSF) registry (https://osf.io/e294r) in Centre for Open Science (OSF) on 27 May 2022.

Dynamics of oral microbiome acquisition in healthy infants: A pilot study

Objectives

The human oral microbiota is one of the most complex bacterial communities in the human body. However, how newborns initially acquire these bacteria remains largely unknown. In this study, we examined the dynamics of oral microbial communities in healthy infants and investigated the influence of the maternal oral microbiota on the acquisition of the infant's oral microbiota. We hypothesized that the infant oral microbial diversity increases with age.

Methods

One hundred and sixteen whole-salivary samples were collected from 32 healthy infants and their biological mothers during postpartum and 9- and 15-month well-infant visits. Bacterial genomic DNA was extracted and sequenced by Human Oral Microbe Identification using Next Generation Sequencing (HOMINGS) methods. The Shannon index was used to measure the microbial diversity of the infant-mother dyads (alpha diversity). The microbial diversity between the mother-infant dyads (beta-diversity) was calculated using the weighted non-phylogenetic Bray-Curtis distance in QIIME 1.9.1. Core microbiome analysis was performed using MicrobiomeAnalyst software. Linear discriminant analysis coupled with effect size analysis was used to identify differentially abundant features between mother and infant dyads.

Results

A total of 6,870,571 16S rRNA reads were generated from paired mother-infant saliva samples. Overall, oral microbial profiles significantly differed between the mother and infant groups (p < 0.001). The diversity of the salivary microbiomes in the infants increased in an age-dependent manner, whereas the core microbiome of the mothers remained relatively stable during the study period. Breastfeeding and gender did not affect the microbial diversity in infants. Moreover, infants had a greater relative abundance of Firmicutes and a lower abundance of Actinobacteria, Bacteroidetes, Fusobacteria, and Proteobacteria than their mothers. The SparCC correlation analysis demonstrated constant changes in infants' oral microbial community network (p < 0.05).

Conclusions

This study provides new evidence that the oral cavities of infants are colonized by a distinct group of bacterial species at birth. The acquisition and diversity of changes in oral microbial composition are dynamic during the first year of an infant's life. Before reaching the second birthday, the composition of the oral microbial community could be more similar to that of their biological mothers.

Three tests of the Vulnerability-Stress-Adaptation Model: Independent prediction, mediation, and generalizability

Objective

Efforts to understand why some marriages thrive while others falter are (a) not well integrated conceptually and (b) rely heavily on data collected from White middle-class samples. The Vulnerability-Stress-Adaptation Model (VSA; Karney and Bradbury, 1995) is used here to integrate prior efforts and is tested using data collected from couples living with low incomes.

Background

The VSA Model assumes (a) that enduring vulnerabilities, stress, and couple communication account for unique variance in relationship satisfaction, (b) that communication mediates the effects of vulnerabilities and stress on satisfaction, and (c) that the predictors of satisfaction generalize across socioeconomic levels. To date, these assumptions remain untested.

Materials and methods

With 388 couples from diverse backgrounds (88% Black or Hispanic), we used latent variable structural equation models to examine enduring vulnerabilities, chronic stress, and observed communication as predictors of 4-wave, 27-month satisfaction trajectories, first as main effects and then interacting with a validated 10-item index of sociodemographic risk.

Results

(a) The three variable sets independently predict satisfaction trajectories; (b) couple communication does not mediate the effects of enduring vulnerabilities or stress on satisfaction; and (c) in 19% of tests, effects were stronger among couples with higher sociodemographic risk.

Conclusion

Effects of established predictor domains on satisfaction replicate in a diverse sample of newlywed couples, and most findings generalize across levels of sociodemographic risk. The failure of couple communication to mediate effects of enduring personal vulnerabilities and stress raises new questions about how these two domains undermine committed partnerships.

A culturally grounded prenatal coparenting intervention: Results of a randomized controlled trial with unmarried Black parents

This study examines the efficacy of a prenatal intervention designed to promote healthy coparenting relationships in families where low-income, unmarried mothers and fathers were expecting a first baby together. One hundred thirty-eight Black and mixed-race mother-father dyads participated. Coparent dyads were randomly assigned to either a treatment as usual (TAU) group, receiving referrals and navigation support to existing community services (control), or to TAU plus invitation to a series of six dyadic Focused Coparenting Consultation (FCC) sessions led by a male-female mentor team (intervention). Seventy-one percent of those prenatally assessed were later reassessed at 3 months postpartum. Both mothers and fathers contributed reports of coparenting, father engagement, physical and psychological intimate partner violence (IPV), and depressive symptoms. Intent-to-treat analyses indicated: (a) some evidence that mothers in the intervention group reported more positive coparenting communication at 3 months postpartum than did control group mothers; (b) mothers in the intervention group reported significantly more time spent by fathers with the child than did control group mothers; (c) parents in the intervention group had significant reductions in psychological IPV compared to parents in the control group; and (d) both mothers and fathers showed reductions in self-reported depression over time, with no differential impact of group. Findings suggest that the FCC intervention may produce modest but important benefits for unmarried, low-income Black coparents in the transition to parenthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using systemic interventions to reduce intimate partner violence or child maltreatment: A systematic review of publications between 2010 and 2019

This systematic review seeks to understand the effectiveness of systemic interventions to reduce Intimate Partner Violence (IPV) or child maltreatment published between January 2010 and December 2019. We found nine studies reviewing systemic interventions for IPV and 12 studies reviewing systemic interventions for child maltreatment. In our discussion, we added relevant articles published before 2010 to determine the overall state of the evidence for these interventions. We determined that parent training programs with in vivo coaching components for child maltreatment meet the criteria for well-established interventions. Relationship education approaches are probably efficacious. Parent education and family therapy programs to reduce child maltreatment, and cognitive behavioral couples treatment to reduce IPV are possibly efficacious interventions. Programs based on "naturalistic" couples therapy for IPV are experimental interventions. This review also highlights limitations in this research in addressing the needs of marginalized couples and families.

Using phenome-wide association studies and the SF-12 quality of life metric to identify profound consequences of adverse childhood experiences on adult mental and physical health in a Northern Nevadan population

In this research, we examine and identify the implications of Adverse Childhood Experiences (ACEs) on a range of health outcomes, with particular focus on a number of mental health disorders. Many previous studies observed that traumatic childhood events are linked to long-term adult diseases using the standard Adverse Childhood Experience Questionnaire. The study cohort was derived from the Healthy Nevada Project, a volunteer-based population health study in which each adult participant is invited to take a retrospective questionnaire that includes the Adverse Childhood Experience Questionnaire, the 12-item Short Form Survey measuring quality of life, and self-reported incidence of nine mental disorders. Using participant's cross-referenced electronic health records, a phenome-wide association analysis of 1,703 phenotypes and the incidence of ACEs examined links between traumatic events in childhood and adult disease. These analyses showed that many mental disorders were significantly associated with ACEs in a dose-response manner. Similarly, a dose response between ACEs and obesity, chronic pain, migraine, and other physical phenotypes was identified. An examination of the prevalence of self-reported mental disorders and incidence of ACEs showed a positive relationship. Furthermore, participants with less adverse childhood events experienced a higher quality of life, both physically and mentally. The whole-phenotype approach confirms that ACEs are linked with many negative adult physical and mental health outcomes. With the nationwide prevalence of ACEs as high as 67%, these findings suggest a need for new public health resources: ACE-specific interventions and early childhood screenings.

Prevention of Mental Health Difficulties for Children Aged 0-3 Years: A Review

The period of infancy and early childhood is a critical time for interventions to prevent future mental health problems. The first signs of mental health difficulties can be manifest in infancy, emphasizing the importance of understanding and identifying both protective and risk factors in pregnancy and the early postnatal period. Parents are at a higher risk of developing mental health problems during the perinatal period. An understanding of the evidence around prevention and intervention for parental anxiety and depression is vital to the process of prevention of early mental health disorders in infants and young children. Here we review the existing prevention and treatment interventions in the early years focusing on the period from conception to 3 years - the majority targeting parents in order to improve their mental health, and that of their infants. Elements of successful programs for parents include psychoeducation and practical skills training, as well as work on the co-parenting relationship, developing secure attachment, and enhancing parental reflective functioning. While both targeted and universal programs have produced strong effect sizes, universal programs have the added benefit of reaching people who may otherwise not have sought treatment. In synthesizing this information, our goal is to inform the development of integrated models for prevention and novel early intervention programs as early in life as possible.

An Uncontrolled Trial of Flexibly Delivered Relationship Education with Low-Income, Unmarried Perinatal Couples

OBJECTIVE

To examine couple and parenting outcomes from an American version of Couple CARE for Parents (CCP) in low-income, unmarried couples.

BACKGROUND

We adapted an evidence-based, flexibly delivered program for use with low-income, unmarried couples, for whom the outcome literature is scarce.

METHOD

Couples (n = 443) were recruited from maternity units and began CCP. They completed measures before, during, and immediately after the intervention, and 6 months later.

RESULTS

Moderate psychological intimate partner violence (IPV) declined and perceived parenting efficacy increased over time; there was no change in severe psychological or physical IPV. Individuals with lower levels of relationship commitment than their partners showed improvement in relationship satisfaction, whereas those with similar or higher levels of commitment maintained their baseline levels despite being in a period of expected satisfaction decline.

CONCLUSION

CCP showed some signs of helping low-income couples during a stressful period and its flexible service delivery model allowed these couples to participate by reducing the impediments of transportation challenges, conflicting work schedules, and overall time poverty.

IMPLICATIONS

Practitioners interested in using CCP with low-income couples would likely maximize the impact by (a) focusing on pregnant, first-time parents; (b) integrating CCP within post-natal healthcare; and/or (c) assuming that a considerable minority of couples will avail themselves of only up to two sessions, and thus practitioners should front-load content, making other content optional or just-in-time. In addition, non-psychoeducational elements (e.g., gamification, easy computerized tasks to reduce angry responses, watching couple-themed movies) could enliven preventative offerings for perinatal couples.

Interventions for Couples

Because relationship discord and dissolution are common and costly, interventions are needed to treat distressed couples and to prevent distress among vulnerable couples. We review meta-analytic evidence showing that 60-80% of distressed couples benefit from behavioral and emotion-focused approaches to couple therapy, but we also note that treatment effects are weaker in actual clinical practice than in controlled studies, dissipate following treatment for about half of all couples, and may be explained by factors that are common across models. Meta-analyses of prevention programs reveal reliable but smaller effects, reflecting a need to know more about whether and how communication mediates effects, about how risk and diversity moderate effects, and about how technology-enabled interventions can reduce attrition in vulnerable populations. Interventions for couples are improving and expanding, but critical questions remain about how and for whom they work.

Research on Marital Satisfaction and Stability in the 2010s: Challenging Conventional Wisdom

Although getting married is no longer a requirement for social acceptance, most people do marry in their lifetimes, and couples across the socioeconomic spectrum wish their marriages to be satisfying and long-lasting. This review evaluates the past decade of research on the determinants of satisfaction and stability in marriage, concluding that the scholarship of the past ten years has undermined three assumptions that were formerly accepted as conventional wisdom. First, research exploiting methods like latent class growth analyses reveal that, for most couples, marital satisfaction does not decline over time but in fact remains relatively stable for long periods. Second, contrary to predictions of behavioral models of marriage, negative communication between spouses can be difficult to change, does not necessarily lead to more satisfying relationships when it is changed, and does not always predict distress in the first place. Third, dyadic processes that are reliably adaptive for middle-class and more affluent couples may operate differently in lower-income couples, suggesting that influential models of marriage may not generalize to couples living in diverse environments. Thus, the accumulated research of the last ten years indicates that the tasks of understanding and promoting marital satisfaction and stability are more complex than we appreciated at the start of the decade, raising important questions that beg to be answered in the years ahead.

Predicting Program Retention in a Flexibly-Delivered Relationship Education Program for Low-Income, Unmarried Parents

Participation rates in couple relationship education (CRE) programs for low-income couples are typically low. We examined predictors of session attendance and early dropout (i.e., dropout after 1 session) among a sample of low-income, unmarried parents of a newborn (N = 467 couples) enrolled in an evidence-based CRE program. Predictors included demographics and socioeconomic status, as well as baseline indicators of relationship commitment, family and individual functioning, infant health, preventive health care utilization, and CRE coach perceptions of participant engagement and alliance in the first session of the program. Couples attended an average of 4.4 (SD = 2.5) of the 7 sessions, with nearly a quarter of couples dropping out after the first session. Attendance at fewer sessions was predicted by younger age. Early dropout was predicted by lower ratings of females' engagement and both partners' therapeutic alliance and, unexpectedly, by commitment. We discuss considerations for engaging low-income couples in CRE.

The prevalence of intimate partner violence among couples signing up for universally offered parent preparation

BACKGROUND

Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and the unborn child. Nevertheless, IPV is seldom addressed in the context of parent preparation.

AIM

This study aimed to map the prevalence, direction, and severity of IPV in a sample of expectant couples signing up for universally-offered parent preparation.

METHOD

A total of 1726 Danish couples expecting their first child provided data on physical and psychological IPV by completing the Family Maltreatment measure during the second trimester of pregnancy.

RESULTS

In 18.5% of the couples, at least one partner reported psychological or physical IPV acts during the past year. In more than 8% of couples, one or both partners reported acts and impacts above the ICD-11 threshold for clinically-significant IPV (CS-IPV) during the past year (3.6% physical CS-IPV, 5.3% psychological CS-IPV, and 0.8% both physical and psychological CS-IPV). Among couples with physical IPV below the clinical threshold, pregnant-woman-to-partner (50%) and bidirectional (38.2%) IPV were more common than partner-to-pregnant-woman IPV (11.8%). Among couples with physical CS-IPV, pregnant-woman-to-partner (36.1%), partner-to-pregnant-women (29.1%) and bidirectional (34.4%) forms were equally common. Among couples with psychological IPV, pregnant-woman-to-partner (54.9%) and partner-to-pregnant-woman (39.6%) IPV were more common than bidirectional IPV (5.5%).

DISCUSSION

The prevalence of violence was markedly higher in this study compared with previous reports from the Nordic region and highlights a previous oversight of a substantial and clinically significant level of pregnant-woman-to-partner IPV-as well as the reverse. Data from this study call for IPV to be addressed in universally offered parent preparation programs.

A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent-child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low-income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low-income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at-risk new parents. These results have implications for public policies that aim to benefit children and families.