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III. The Supporting Healthy Marriage Program Model
The goals of SHM programs are to help interested married couples learn how to maintain and improve their marital relationships and to have healthy long-lasting marriages, ultimately with the aim of improving the well-being of their children. To accomplish this, every SHM program includes three components: a core marriage education curriculum; extended marriage education activities that continue after the core sessions; and individual support for couples to help them participate in the program, to provide “coaching” or reinforcement of skills learned in the curriculum, and to link them with additional services in the community if needed.
To guide sites’ program development, the SHM team provided program guidelines that communicated essential principles and requirements for each component, but also gave curriculum developers and program operators substantial local flexibility in designing their programs. Two aspects of these program guidelines, and the program model itself, set the SHM program apart from many previous marriage education models. First, given the voluntary nature of the program, the guidelines particularly emphasized strategies to maximize participation by creating engaging services and removing as many barriers to participation as possible. Second, the program model is relatively intensive and comprehensive, with particular emphasis on strengthening programs’ capacity to address the major external sources of marital distress for low-income couples that might limit couples’ ability to attend and to apply the skills they have learned. As a starting point for understanding how we sought to accomplish these goals, it is helpful to have an idea of the kinds of organizations and supports involved in operating SHM programs.
Program Structure and Supports
When the SHM project began, virtually no organizations were already providing marriage education services to low-income married couples at any scale. Thus, in the site selection process we were looking for organizations that were interested in adding this brand new program to their existing menu of services. Some of them had experience working with low-income families but not in providing marriage education, while others had expertise providing marriage education to more general or middle-class populations. Other than capacity and interest, there were no restrictions on the kinds of organizations that could be SHM sites — the sites could be new or existing organizations, public or private agencies, and run centrally in one area or by several agencies in multiple locations. The key requirements were the ability to develop and operate a program meeting SHM program guidelines, to recruit and sustain participation of a target number of eligible couples, and to support the random assignment and data collection requirements associated with the experimental evaluation.
As mentioned, because recruitment and retention of low-income couples posed special challenges — most notably that of engaging both spouses in the program over a period of months — SHM guidelines put special emphasis on measures sites should take to promote participation. Recommended programmatic measures included: locating the program in a pleasant environment; designing activities that are fun and motivating; making certain that the environment is welcoming to men; hiring warm, engaging staff; and making sure that couples leave each session with new skills that are immediately useful. The guidelines stressed the need for marketing materials to address likely attitudinal barriers arising from general unfamiliarity with a new kind of service, particularly the potential for confusion with marital therapy and the perception that participation would represent an admission of marriage problems. Programs also were to provide material supports to support attendance, such as child care, transportation, and participation incentives.
The Core Marriage Education Curriculum
The core of each SHM program is 24 to 30 hours of marriage education workshops provided in a group setting over several (typically two to four) months. While sites were allowed to choose from among different curricula, each curriculum was expected to cover six broad content areas, identified primarily because of evidence from prior research that they were potentially important influences on the quality of relationships for low-income couples. Program guidelines allow curriculum developers and sites substantial discretion in emphasis, organization, and pedagogic approaches to these topics. The first three areas represent traditional concerns of marriage education:
- Understanding marriage. This topic area addresses the assumptions, values, and levels of “relationship-mindedness” couples bring to their marriages. Material might explore expectations for responsibilities and roles, financial aspirations, time together, handling of anger and conflict, emotional intimacy, sexual exclusivity, or child-rearing. This area also covers the benefits of healthy, lasting relationships for children and adults, and the role of commitment, sacrifice, and effort in healthy relationships.
- Managing conflict. Communication is a central skill in strong marital relationships. Good communication has a technical aspect (learning to express oneself clearly and to listen to one’s spouse), as well as an emotional aspect (showing empathy and respect for other points of view). Material under this heading includes skills for identifying and controlling negative interaction styles (discussed in Section Two), for clear and empathetic communication, and for structured approaches to problem-solving.
- Promoting positive connections between spouses. The basis of a long-term healthy relationship often lies in developing deeper bonds of friendship and love. Under this topic area falls material on understanding and showing appreciation for each other’s perspectives and dreams, spending enjoyable time together, creating shared goals, strengthening emotional connections, enhancing physical intimacy, and building mutual trust and commitment.
At the time SHM began, all three of these topic areas were covered in a variety of existing marriage education curricula. For SHM, curriculum developers were encouraged to tailor these topics for low-income couples by tying illustrations, anecdotes, and exercises explicitly to the personal and environmental influences that might place greater stress on low-income couples’ relationships, to help make instruction more vivid, relevant, and effective. For example, a discussion of how participants’ own parents shared household responsibilities could be used to stimulate dialogue about expectations and desired changes in the division of labor in their current relationships. Or an exercise focused on helping couples plan for a night out together would ideally tackle financial, child care, and other obstacles.
Unlike the first three curriculum content areas, the remaining three topics have not been widely included in marriage education curricula for middle-class couples. Reflecting the conceptual model described earlier, these content areas are designed to provide insights and skills pertinent to several broad external challenges:
- Strengthening relationships beyond the couple. Strong relationships with other family members and support networks are good for marriage and personal well-being. Low-income couples are more likely than their higher-income counterparts to have children from previous relationships and to have weaker connections to community organizations. Relationships at work also may be more difficult, given the hierarchical and contingent nature of much low-wage employment. SHM curriculum guidelines encourage programs to explore how relationship skills might generalize to these relationships and to structure group sessions and related activities to promote such strengthening. For example, curricula might encourage couples to identify current and potential sources of support or opportunities for social involvement and steps to strengthen these connections.
- Enhancing couples’ ability to manage challenging external circumstances. When couples experience stressful living conditions, it is more difficult to find the time and the emotional energy to sustain positive relationships. Challenges range from strains created by one spouse’s mental health problems or substance abuse, to problems shared by both partners, such as financial stress or lack of safe, affordable housing. The guidelines emphasize the importance of this topic for helping couples become more sensitive to, and learn to respond to, the effects of stress on each others’ behaviors (as a complement to the programs’ supplemental services, which provide referrals to directly address some of these stressful conditions). Curricula may address coping skills, including providing emotional and instrumental support and solving problems together.
- Strengthening parenting. In addition to direct positive effects on child well-being of exposure to healthy relationships between parents, the SHM conceptual framework also reflects the possibility that the intervention could affect children through improved parenting skills. As a couples program, SHM is in a position to focus on skills that couples can use in parenting as a team, referred to by some as co-parenting; for example, by sharing responsibilities and supporting each other in parenting decisions. Some curricula might also emphasize parenting issues specific to fathers and to children of varying ages.
In addition to adapting the content of
marriage education, the SHM model embodies several key principles
for making instructional formats more
appropriate for economically disadvantaged couples. One key principle
is to keep lecturing at a minimum in favor of interactive activities
that are interesting and help participants build and practice their
skills. For example, some programs structure their sessions to begin
with a short presentation, followed by demonstration of a new skill
by the facilitator, followed by an interactive exercise for each couple
to practice. Other programs regularly use group discussions to generate
new insights for the couples. The model assumes that the most effective
curricula will maximize learning by using a mix of approaches, including
in-person demonstrations and role modeling, videos, direct practice
of new skills, coaching during this practice, and group discussion.
The model also stresses the importance of using simple, culturally
sensitive language; avoiding too much reading and writing; and repeating
key themes throughout.
At the time the study began, there were few existing curricula that spanned all of these topics, were well-documented in manuals, and used the range of recommended instructional formats. The team nonetheless felt that it was important to select and adapt well-established curricula, rather than create “model curricula” from scratch, since the former would be more readily disseminated if they were effective. Neither did we want to dictate that sites use a particular curriculum. The research team therefore reviewed numerous existing curricula to identify those that most comprehensively addressed the six topics of interest, with particular emphasis on curricula that had some evidence of effectiveness in prior research and a track record of being used with a variety of populations in different programmatic contexts. Based on this review, the SHM team worked with the developers of the PREP and Practical Application of Intimate Relationship Skills (PAIRS) curricula to produce adaptations that would meet the SHM curriculum guidelines and be available for SHM sites if they wished to use them. Sites were also invited to propose other curricula that would meet the SHM curriculum guidelines. Ultimately, sites proposed using two additional curricula — the Becoming Parents Program and Loving Couples, Loving Children, so that the eight SHM pilot sites are using four different curricula. The SHM team worked with the developers of these four curricula to guide what were in some cases extensive adaptations to meet the content and format guidelines described above.
Extended Marriage Education Activities
In the second SHM component, programs seek to engage participants in additional activities for a full year (about nine months beyond the core program). Providers are to design this component to be engaging, to provide varied activities that reinforce and integrate the skills and concepts learned in marriage education sessions, and to provide new information identified as needed by couples or facilitators. In addition to increasing program comprehensiveness, this component helps raise the probability that educational services will be available to couples as specific issues arise in their relationships.
SHM guidelines provide a series of examples of extended activities, but leave providers substantially free to design this component. Through one or more booster sessions, programs might provide opportunities to explore new issues or revisit material covered in the core curriculum. Or programs might provide opportunities for one-on-one coaching or mentoring by program staff or peers, perhaps during visits to couples’ homes. Group social events or community service activities can be used to maintain and deepen bonds between participants and help them get to know local community agencies. Help organizing date nights reinforces the idea that it is good for couples to spend time on their relationships together and expands their repertoire of mutually enjoyable activities. Finally, activities for the whole family can help parents develop ideas and habits for spending quality time with their children — and possibly other relatives — or provide additional educational modules focusing on specialized aspects of family life.
Supplemental Services
Although the central emphasis in SHM is teaching relationship skills — including skills that help couples to weather external stresses successfully — the model recognizes that low-income couples often will have urgent needs for direct assistance. In addition to negatively affecting couples’ relationships with each other and their children, these problems may also pre-vent them from attending marriage education sessions and distract them from practicing at home the skills they are learning. To respond to these needs, the SHM model thus also includes a supplemental services component.
Guidelines specify that programs should help couples gain access to a wide range of services and supports. Typically, access requires capacity to link couples to services in the community, such as physical or mental health services, substance abuse treatment, housing assistance, employment and training services, or child care. Programs are encouraged to designate specialized staff members to function as family support coordinators. These staff typically play three roles, providing the types of outside referrals described here, providing and tracking participation supports, such as child care or transportation vouchers, and providing one-on-one coaching with couples to help reinforce the lessons learned during the marriage education work-shops.
This chapter has described the research foundations and conceptualization of the SHM program model. Each site has used this model to develop a program that is consistent with its organizational culture and local needs. In addition, throughout the early program operations, the SHM team provided training and technical assistance to assist the sites in meeting these programmatic guidelines and developing their programs effectively. As described below, future SHM implementation reports will describe how each component of the program was developed and operated in each site.
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