Programs that Work
Healthy and Safe Children
Children Ready for School
Children not experiencing physical, psychological or emotional abuse
Fathers maintaining regular involvement with their children
Children ages 0 to 5 exhibiting age-appropriate mental and physical development
Children and youth not engaging in violent behavior or displaying serious conduct problems
Age of Child
Early Childhood (0-8)
Type of Setting
Community-Based Service Provider
Health Care Provider
Type of Service
Type of Outcome Addressed
Evidence Level (What does this mean?)
Proven / Promising
Family Foundations (FF) is composed of eight pre- and post-natal classes designed for expectant couples who are living together (cohabitating or married). FF classes are interactive and skills-based, focusing on enhancing the "coparenting" relationship. The coparenting relationship is defined as the ways parents organize their parenting, support or undermine each other, and manage conflict regarding parenting. Research shows that coparenting relationship quality has a strong influence on parenting and child outcomes for families regardless of marital status, residential status, and risk level.
Participants include expectant couples who are either cohabitating or married. The evaluation participants were heterosexual couples expecting their first child.
The effectiveness of FF was examined in a trial in which 169 heterosexual adult couples expecting their first child were recruited from hospitals in two small cities. Couples were assigned to either the intervention (89) or comparison (80) groups. Randomization was successful in that both groups were equivalent on all measured variables, including age, income, education, marital status, weeks of gestation, mental health, and relationship quality. Intervention and comparison group couples were assessed before the intervention (pretest) at an average of 22 weeks gestation, and again after the intervention was complete (posttest) when their children were an average of 6.5 months old. Ninety percent of couples who completed the pretest also completed the posttest, and this was not significantly different across groups (Feinberg and Kan, 2008).
Two additional follow-up studies were conducted: The 13-month follow-up was conducted when the children were an average of 13.7 months old, with 91 percent of couples completing the 13-month follow-up (Feinberg, Kan, and Goslin, 2009), and a final follow-up was conducted when the children were an average of 3 years old, with 81 percent of couples completing the 36-month follow-up (Feinberg et al., 2010). (Results from a further follow-up when children were an average of 6 years old are being prepared for publication.)
At pretest and/or posttest, the following measures were assessed:
- Parental mental health of both mothers and fathers was assessed at pretest and posttest and measured by the following scales:
- Center for Epidemiologic Studies Depression Scale (CES-D)
- Taylor Manifest anxiety scale.
- The Dysfunctional Interaction subscale from the Parental Stress Index was administered to both parents at pretest and posttest.
- Coparenting, a 37-point scale of self-reported coparenting behaviors, was completed by both mothers and fathers at posttest. This scale was developed by the program developers and includes the following three subscales:
- coparental support
- parenting-based closeness
- coparental undermining.
- Infant regulation subscales of the Infant Behavior Questionnaire were administered to both fathers and mothers at posttest only:
- infant soothability
- infant orienting (baby's attention to a single object for a specific length of time).
At the 13-month follow-up, family interactions were videotaped and coded. Parents and the infant engaged in 12 minutes of joint free play on the floor. Parents were then asked to teach their child to accomplish a set of tasks designed to be at the limit of most infants' developmental capacity (e.g., rolling a ball back and forth with a parent, building a tower of blocks). This interaction lasted 6 minutes. Blind coders were trained to rate the videotapes of tasks according to a coding system of 5- to 7-point scales. This coding system was developed for this project by program developers. Measures assessed through videotaped interactions included the following:
- Couple relationship behaviors, including:
- warmth to partner (physical or verbal affection)
- negative communication (contempt, hostility, demandingness)
- Parenting behaviors, including:
- positivity (positive affect, support for exploration)
- negativity (irritability, hostility toward child)
- Coparenting measures, including:
- competition (competition for child attention, love)
- triangulation (use of child as pawn in partner conflict)
- warmth (caring, affection toward partner)
- inclusion (active inclusion of partner in play)
- cooperation (overt cooperation with partner in play)
- Child behaviors, including:
- self-soothing (self-directed comforting: stroking, sucking)
- sustained attention (sustained involvement with objects/people).
At the 36-month follow-up, the following outcomes were assessed by researchers during a home visit:
- The Parenting Sense of Competence scale was administered to both parents, asking parents about their confidence in their parental role.
- The Parenting Stress Index was administered to both parents, asking parents to respond to their agreement with certain questions, such as, "I feel trapped by my responsibilities as a parent."
- Parental depression was assessed for both parents with the Center for Epidemiological Studies Depression Scale (CES-D).
- A Coparenting Scale was administered to both mothers and fathers and assessed items such as coparental agreement, support, undermining, and exposure of the child to conflict.
- The Quality of Marriage Index asked parents to rate their agreement with certain statements about their relationship, such as, "We have a good relationship."
- The Parenting Scale was administered to both parents, assessing discipline practices in parents of children from 18-48 months. Three subscales were used:
- physical punishment.
- Child outcomes were assessed using the Child Behavior Checklist (CBCL), which was reported by mothers only. Researchers assessed the following dimensions:
- total problems
- externalizing problems
- internalizing problems
- Emotional competence was assessed using the Head Start Competence scale, with mothers reporting on the child's interactions.
Key Evaluation Findings
At posttest, study authors found the following:
- Coparenting outcomes:
- Both mother and father report of coparental support was significantly higher for the FF group than for the comparison group.
- Father report of parental-based closeness was significantly higher among fathers in the FF group than those in the comparison group, and no significant difference was found for mothers.
- No significant differences were found in coparental undermining.
- Parental mental health:
- Maternal depression exhibited greater reductions in the FF group than the comparison group, and no significant difference was found for fathers.
- Maternal anxiety exhibited greater reductions in the FF group than in the comparison group, and no significant difference was found for fathers.
- Dysfunctional interaction was significantly improved for both fathers and mothers in the FF group versus parents in the comparison group.
- Infant regulation:
- Combined mother/father report of infant orienting was significantly improved for FF parents versus comparison group parents.
- Parental report of infant soothability was not significantly different across groups.
At the 13-month follow-up, in which family interactions were videotaped, study authors found the following:
- Coparenting outcomes:
- FF mothers and fathers performed significantly better (i.e., lower scores) on parental competition compared with the comparison group.
- FF mothers and fathers performed significantly better (i.e., lower scores) on parental triangulation compared with the comparison group.
- FF fathers performed significantly better on parental warmth than fathers in the comparison group, but there was no significant difference in parental warmth for FF mothers versus comparison group mothers.
- FF mothers performed significantly better than those in the comparison group on parental inclusion, but this was not true for FF fathers.
- There were no significant differences between FF and the comparison group in parental cooperation.
- Mothers and fathers were both significantly more positive in their parenting practices than those in the comparison group.
- Fathers were significantly less negative in their parenting practices than fathers in the comparison group, but the difference was not significant for mothers.
- Child behavior:
- Infants belonging to couples in the FF group were better at self-soothing than those in the control group.
- There were no differences across groups in sustained attention.
- Dyadic couple behaviors:
- Mothers in the FF group exhibited significantly less negative communication than mothers in the comparison group, but the difference was not significant for FF fathers versus fathers in the comparison group.
- Both mothers and fathers exhibited significantly more warmth to their partner than those in the comparison group.
At the 36-month follow-up, study authors found the following:
- Parenting stress and parenting efficacy were significantly improved for both mothers and fathers in the FF group versus the comparison group on average across all follow-up waves; however, results were not reported for the 36-month follow-up alone.
- Coparenting and Couple Relationship:
- FF parents scored significantly higher on the overall measure of coparenting than parents in the comparison group.
- FF parents were not significantly different than comparison parents on relationship quality; however, relationship quality among parents of boys was significantly improved in the FF versus the comparison group.
- Parenting Scale:
- Parents in the FF group exhibited significantly lower levels of over reactivity than parents in the comparison group.
- FF parents exhibited significantly lower levels of laxness than those in the comparison group.
- FF parents exhibited significantly lower levels of physical punishment than parents in the comparison group.
- Child outcomes Child Behavior Checklist (CBCL):
- There were significantly lower levels of behavior problems among children of couples in the FF group as measured by the Total Problems Scale. Analyses showed that this effect was driven by differences among boys, and, when analyzed separately, girls did not show significantly different levels of problem behaviors.
- Children of couples in the FF group showed significantly lower levels of externalizing behaviors and aggressive behaviors compared with the control group. Again, subgroup analyses revealed that these differences were driven by the boys in the FF group.
- There were no significant differences found for FF versus comparison group children on Internalizing Problems or the Attention/Hyperactivity scale. However, when examining the scores for boys alone, boys in the FF group were significantly improved on both of these measures compared with boys in the comparison group.
Many different organizations and individuals might implement Family Foundations, including health care organizations, social service agencies, childbirth educators, teen parenting programs, faith-based organizations, and employee assistance providers.
Grant writing support is available through the Family Foundations website: http://www.famfound.net/pages/for-professionals
The goal of FF is to support parents as they adjust to the stress that new parenthood can put on the parental relationship through increased conflict, changes in the division of labor, and reduced couple companionship and sex. FF does this by enhancing positive support and coordination in the coparenting relationship.
The program as evaluated was delivered by a trained facilitator over four prenatal and four post-natal in-person sessions, with accompanying worksheets and homework materials.
A facilitator is trained in the approach, and the facilitator does not need to be from a particular field.
Curricular materials are available online at http://www.famfound.net/collections/educators
Issues to Consider
This program is rated "proven" for the indicators Children ages 0 to 5 exhibiting age-appropriate mental and physical development and Children not experiencing physical, psychological, or emotional abuse. This program is rated "promising" for the indicators Fathers maintaining regular involvement with their children and Children and youth not engaging in violent behavior or displaying serious conduct problems.
The program evaluation utilized a rigorous research design. However for the two "promising" indicators, the outcomes measured are considered "intermediate" because while there is existing evidence that they impact the PPN indicators, specific PPN indicators were not directly measured.
The study authors implemented the FF program in two small cities in the United States.
For general questions about the FF program, email Info@FamFound.net.
For questions about training, consultation, or large-scale implementation of the classes, contact Jill Zeruth at Jill@FamFound.net, phone: 814-954-0262.
For questions about the research and/or program development, contact program developer Mark Feinberg at Mark@FamFound.net.
Materials and information can be found at http://www.famfound.net/.
Feinberg, Mark E., and Marni L. Kan, "Establishing Family Foundations: Intervention Effects on Coparenting, Parent/Infant Well-Being, and Parent-Child Relations,"
Journal of Family Psychology,
Vol. 22, No. 2, April 2008, pp. 253-263.
Feinberg, Mark E., Damon E. Jones, Marni L. Kan and Megan C. Goslin, "Effects of Family Foundations on Parents and Children: 3.5 Years After Baseline," Journal of Family Psychology, Vol. 24, No. 5, 2010, pp. 532-542.
Feinberg, Mark E., Marni L. Kan, and Megan C. Goslin, "Enhancing Coparenting, Parenting, and Child Self-Regulation: Effects of Family Foundations 1 Year After Birth," Prevention Science, Vol. 10, No. 3, September 2009, pp. 276-285.