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e-Family Foundations

Evidence rating
3
Cost rating
1
Review: January 2021

e-Family Foundations (e-FF) is an online co-parenting programme for couples expecting their first child. It is a universal programme, delivered to individual families from pregnancy up until the first year of the baby’s life. The programme is an online adaptation of the group-based face-to-face programme, Family Foundations (FF).

The programme is delivered in eight sessions of 1 hours’ duration each, over a period of 4-8 weeks, and involves online self-study covering prenatal and postnatal modules. 

Like FF, e-FF aims to support couples at the transition to parenthood, by helping them to build supportive and cohesive co-parenting relationships, and in so doing, improving both parent and child outcomes. 

e-FF seeks to improve children's outcomes by improving the quality of interparental relationships (IPR).

EIF Programme Assessment

Evidence rating
3

e-Family Foundations has evidence of a short-term positive impact on child outcomes from at least one rigorous evaluation.

What does the evidence rating mean?

Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.

This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants. 

Please note that whilst this programme is universal and not designed for any particular group, its best evidence to date exclusively investigates the impact of the programme with reference to a sample of military families (and not a broader population including civilians).

Cost rating
1

A rating of 1 indicates that a programme has a low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of less than £100.

Child outcomes

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Supporting children's mental health and wellbeing

based on
0.69-point improvement on the Infant Behavior Questionnaire (sadness subscale)
Improvement index: +24
This means we would expect the average participant in the comparison group who did not receive the intervention (ie, someone for whom 50% of their peers have better outcomes and 50% have worse outcomes), to improve to the point where they would have better outcomes than 74% and worse outcomes than 26% of their peers, if they had received the intervention.
Immediately after the intervention

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

e-Family Foundations

Key programme characteristics

Who is it for?

The best available evidence for this programme relates to the following age-groups:

  • Antenatal
  • Perinatal
  • Infants

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Online or app

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Home

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Universal

Where has it been implemented?

Australia, United Kingdom, United States

UK provision

This programme has been implemented in the UK.

UK evaluation

This programme’s best evidence does not include evaluation conducted in the UK.

Spotlight sets

EIF includes this programme in the following Spotlight sets:

  • Improving interparental relationships
e-Family Foundations

About the programme

What happens during delivery?

How is it delivered?
  • e-Family Foundations is an online self-study programme, delivered to individual families in eight sessions of 1 hours’ duration each, over a period of 4-8 weeks. 
What happens during the intervention?
  • Parents learn skills, tools and perspectives to better cope with the transition to parenthood, specifically around adjusting expectations, adopting a realistic vision and preparing for the strains of parenthood. Parents develop skills to reduce conflict, enhance problem solving and increase supportive and cohesive coparenting communication.  
  • During the online sessions, which are comprised of five prenatal and three postnatal modules, parents work through the online interactive content together and at their own pace. Parents use the online material to read, listen to narration, and watch videos to take in information, practice skills through partner exercises, engage in online and written exercises, and watch vignettes of other families.

What are the implementation requirements?

Who can deliver it?
  • This programme is an online self-study programme for parents to complete at home and therefore it does not involve any practitioners.  
What are the training requirements?
  • As above.
How are the practitioners supervised?
  • As above.
What are the systems for maintaining fidelity?
  • As above.
Is there a licensing requirement?

Yes, there is a licence required to run this programme.

How does it work? (Theory of Change)

How does it work?
  • Supportive coparenting relationships among parents and parenting figures promote enhanced parental adjustment and reduced parental stress. This leads to enhanced parenting quality and reduced family conflict, which in turn is associated with improved child outcomes – particularly in terms of behaviour, social and emotional learning, mental health and academic outcomes.
  • e-Family Foundations aims to provide parents with the skills, tools, and perspectives that reduce conflict, enhance problem solving and increase mutual coparenting support.
  • In the short-term, parents provide a more supportive, warmer, and less negative childrearing environment. 
  • In the long-term, children develop enhanced self-regulation capacity and emotional security, increased self-confidence and self-concept, better peer relationships, and enhanced capacity to focus on schoolwork and develop positive relationships with teachers. 
Intended outcomes

Supporting children's mental health and wellbeing
Enhancing school achievement & employment
Preventing crime, violence and antisocial behaviour

e-Family Foundations

About the evidence

e-Family Foundation’s most rigorous evidence comes from one RCT which was conducted in the United States. 

This study identified statistically significant positive impact on a number of child and parent outcomes.

This programme is underpinned by one study with a Level 3 rating, hence the programme receives a Level 3 rating overall.

Study 1

Citation: Feinberg et al., 2020
Design: RCT
Country: United States
Sample: 56 heterosexual couples who were living together and expecting their first child together. At least one member of all 56 couples was in the military, with some couples (20%) having both members in the military.
Timing: Post-test
Child outcomes: Reduced infant sadness
Other outcomes: Reduced parental depression
Study rating: 3

Feinberg, M. E., Boring, J., Le, Y., Hostetler, M. L., Karre, J., Irvin, J., & Jones, D. E. (2020). Supporting Military Family Resilience at the Transition to Parenthood: A Randomized Pilot Trial of an Online Version of Family Foundation. Family Relations, 69(1), 109-124. 

Available at
https://onlinelibrary.wiley.com/doi/abs/10.1111/fare.12415

Study design and sample

The first study is a rigorously conducted RCT.   

This study involved random assignment of couples to an e-Family Foundations treatment group and a no-treatment control group.  

This study was conducted in the United States, with a sample of 56 heterosexual couples (average age: expectant mothers = 29.7 years; expectant fathers = 31.0 years) who were living together (93% married) and expecting their first child together. At least one member of each couple was in the military and not assigned to deploy in the next 6 months. Most couples included a service member father and civilian mother (62%), but there were also some dual-military couples (20%) and couples with a service member mother (16%).

The majority of participants identified as non-Hispanic White (71%), but the sample was also represented by Hispanic (7%) and African American (10%) individuals, as well as those from “other” or multiple ethnicities (12%). The median annual household income was $72,500, with a wide range from $12,500 to $162,500. 

Measures

  • Parental depression was measured using the 14-item version of the Center for Epidemiological Studies Depression Scale (parent self-report).
  • Parental efficacy was measured using the abbreviated eight-item version of the Parenting Sense of Competence Scale (parent self-report).
  • Coparenting was measured in four key domains (including Coparental Agreement, Coparental Support, Coparental Undermining and Parenting-Based Closeness) using the Coparenting Scale (parent self-report).
  • Relationship Conflict was measured using the Conflict Subscale from the Relationship Questionnaire (parent self-report).
  • Couples' conflict resolution style was measured using the eight-item Ineffective Arguing Inventory (parent self-report).
  • Infant temperament (including distress to limitations, sadness and soothability) was measured using subscales from the Infant Behavior Questionnaire (parent report).

Findings

This study identified statistically significant positive impact on a number of child and parent outcomes.

This includes:

  • Decreased levels of infant sadness (parent report)
  • Reduced parental depression (parent self-report)
More Less about study 1

Published March 2021   |   Last updated April 2021