Emancipatory approaches in couples' intervention research.

A lack of diversity exists in couples research with an overrepresentation of white, middle to upper income couples. Additionally, researchers often do not reflect the study sample, particularly when studying underrepresented minority and historically marginalized (URM-HM) populations. Emancipatory research practices focus on language, processes, and practices to ensure that researchers and the research they conduct honor and contribute to the empowerment of the URM-HM research participants. Therefore, in this paper, we discuss five critical considerations with recommendations for emancipatory research practices for including couples from URM-HM populations. The aim is to provide a framework for researchers to critically reflect on their work with URM-HM populations. The research practices include: (a) research positionality and reflexivity; (b) understanding of the population being served; (c) power and empowerment; (d) accountability, voice, and participant engagement; and (e) research that benefits URM-HM populations and challenges the systems that perpetuate inequities. Additionally, we present practical strategies to implement these five considerations based on our own experiences conducting community-effectiveness studies with low-income and diverse couples.

Examining intervention hours attended for couples randomly assigned to receive relationship education.

Relationship education (RE) has shown promise as an effective intervention for couples. Yet, challenges exist with retaining low-income couples and federal funding required that grantees provide at least 12 h of core content. We conducted a follow-up analysis to a randomized trial of RE with low-income couples. We focused on couples randomly assigned to the treatment (N = 579) and examined the influence of intervention hours on emotion regulation, dyadic coping, and individual distress at 1 and 6-month follow-up. Results of longitudinal actor-partner interdependence models indicated that women who completed the program reported fewer difficulties in emotion regulation at 6-month follow-up than women who attended fewer intervention hours. Additionally, men who completed reported more individual distress at 1-month follow-up than men who attended fewer hours. Given that most couples were Hispanic, we conducted an exploratory analysis to examine language as a covariate with mixed results.

A Comparison Between the Rates of Radiation Oncologist and Urologist Consultations in Men Diagnosed With Prostate Cancer in Northern Ontario, Canada.

Purpose: Recommendations from Cancer Care Ontario stress the importance of multidisciplinary care from radiologists and urologists for prostate cancer treatment. The present study sought to examine what percentage of patients had a consultation with a radiation oncologist before undergoing a radical prostatectomy in Ontario, Canada, between 2010 and 2019. Methods and Materials: Administrative health care databases were used to analyze the number of consultations billed to the Ontario Health Insurance Plan from radiologists and urologists who treated men with a first prostate cancer diagnosis (n = 22,169). Results: In Ontario, 94.70% of Ontario Health Insurance Plan billings for patients with prostate cancer who had a prostatectomy within 1 year of a prostate cancer diagnosis were from urology, and 37.66% and 1.77% of billings were received from radiation oncology and medical oncology specialties, respectively. When sociodemographic variables were examined, having a lower neighborhood income (adjusted odds ratio [aOR], 0.69; confidence interval [CI], 0.62-0.76) and a rural residence (aOR, 0.72; CI, 0.65-0.79) were associated with lower odds of receiving a consultation from a radiation oncologist. When billings for consultations were examined geographically by region, Northeast Ontario (Local Health Integrated Network 13) had the lowest odds of receiving a radiation consultation compared with the rest of Ontario (aOR, 0.50; CI, 0.42-0.59). Conclusions: The results of this study show that differences in equitable access to multidisciplinary health care exist for men with a first prostate cancer diagnosis who reside in more northern and rural regions within Ontario, relative to the rest of the province. The reasons for these findings are likely multifactorial and may include factors such as patient treatment preference and distance/travel to receive treatment. However, as diagnosis year increased, so did the chances of receiving a radiation oncologist consultation, and this upward trend may reflect the implementation of Cancer Care Ontario guidelines.

Introduction to special section: Federally funded, community-based healthy marriage and responsible fatherhood program impact studies.

The focus of this special section is impact studies that were conducted as part of the Administration for Children and Families' Healthy Marriage and Responsible Fatherhood initiative. This initiative has led to more than 2 million people receiving relationship education and fatherhood programs across the United States over the last two decades. Community organizations develop these programs, select their curricula and content, and run these programs in their local communities. Many programs funded in the 2015-2020 cohort of grantees included randomized controlled trials of program effectiveness; some of these studies are presented in this issue, with the goal of marrying the field of program evaluation and family science.

A randomized trial of relationship education using Within Our Reach for economically vulnerable couples.

Couples relationship education is grounded in teaching couples' skills and strategies to form and sustain healthy relationships. The purpose of this investigation was to examine the impact of a relationship education intervention on emotion regulation, individual distress, dyadic coping, and relationship adjustment utilizing a randomized control trial for economically vulnerable couples. The analysis sample included 1418 couples (2836 individuals) who were randomly assigned to receive the 12-h Within Our Reach curriculum immediately, or to a wait-list control group. We estimated multilevel growth curve models over time among outcomes between treatment and wait-list control conditions. Treatment group couples demonstrated statistically significant improvements over the 6-month study period on emotional regulation and dyadic coping when compared to their wait-list group counterparts. Although models showed improvements in individual distress and relationship adjustments, these improvements did not amount to statistically significant group differences. Implications and limitations are also noted.

Using Intent-to-Attend to Predict Attendance in Community-Based Relationship Education.

Government-supported relationship education has provided resources for inclusion of economically vulnerable and ethnically diverse participants; however, many grantees and programs struggled to retain couples in longitudinal studies, which has likely influenced study effects and threatened internal validity. In the present study, we assessed 1,056 couples' baseline relationship satisfaction and intent-to-attend their next scheduled visit while participating in a randomized controlled trial of relationship education and evaluated the predictive ability of their responses to remain in the six-month study. We conducted actor-partner interdependence models for couples, using a probit cross-lagged regression with a structural equation modeling framework, to test the dyadic influence of intent-to-attend on future couple attendance. We also examined the influence of higher or lower baseline relationship satisfaction between partners and group assignment (treatment or wait-list control) on attendance. Intent-to-attend scores were associated with attendance for couples at the one-month follow-up, and early attendance was the biggest predictor of later attendance. Additionally, baseline intent-to-attend scores predicted later intent-to-attend scores for all follow-up time points. However, we found no partner effects, and no effects for the influence of baseline relationship satisfaction or group assignment. We discuss practical suggestions for including intent-to-attend in future studies, relationship education programming, and general therapy practice.

La capacitación en relaciones financiada por el gobierno ha facilitado recursos para la inclusión de participantes económicamente vulnerables y de distintas etnias; sin embargo, a muchos beneficiarios y programas les costó mantener a las parejas en los estudios longitudinales, lo cual probablemente haya influido en los efectos de los estudios y amenazado su validez interna. En el presente estudio, evaluamos la satisfacción con la relación en el momento basal de 1056 parejas y la intención de asistir a su próxima visita programada mientras participaban en un ensayo controlado aleatorizado de capacitación en relaciones, y evaluamos la capacidad predictiva de sus respuestas para permanecer en el estudio de seis meses. Implementamos modelos de interdependencia actor-pareja para las parejas usando un modelo Probit de regresión y retardo cruzado con un marco de modelos de ecuaciones estructurales con el fin de evaluar la influencia diádica de la intención de asistir en la asistencia futura de la pareja. También analizamos la influencia del nivel más bajo o más alto de satisfacción con la relación en el momento basal entre los integrantes de la pareja y la distribución a un grupo (de tratamiento o de control en lista de espera) en la asistencia. Los puntajes de la intención de asistir estuvieron asociados con la asistencia de las parejas en el seguimiento de un mes, y la asistencia inicial fue la mayor predictora de la asistencia posterior. Además, los puntajes de la intención de asistir en el momento basal predijeron los puntajes posteriores de la intención de asistir de todos los momentos de seguimiento. Sin embargo, no hallamos efectos de la pareja ni efectos de la influencia de la satisfacción con la relación o la distribución a un grupo en el momento basal. Comentamos sugerencias prácticas para incluir la intención de asistir en estudios futuros, en programas de capacitación en relaciones y en la práctica de la terapia general.

Examining quality time as a mediator of dyadic change in a randomized controlled trial of relationship education for low-income couples.

Research identifying specific mechanisms of positive change for couples participating in relationship education is scant. Recent studies have identified the potential of communication skills as a likely mechanism, yet more information is needed about the contribution of process factors. Thus, we examined the influence that quality time spent together had on positive post-intervention outcomes based on couples' reports of dyadic coping and dyadic adjustment for 1,367 low-income couples randomly assigned to receive relationship education. Results indicated that treatment couples reported significant gains in quality time spent together, and that those gains fully mediated positive changes in dyadic coping and adjustment. Additionally, actor and partner effects existed such that men's and women's reports of improved quality time influenced their own and their partners dyadic coping and dyadic adjustment. We discuss study implications for practice and future research.

The Dyadic Association among Technoference and Relationship and Sexual Satisfaction of Young Adult Couples.

Technology use within relationships has been shown to produce potential rewards and costs that influence relationship development and/or sustainment; however, the negative influence of modern technology (i.e., smartphone, computer, tablet, and/or television) use in romantic relationships during quality time spent together (i.e., technoference) remains an understudied area. Even less is known about the effects of technoference on young adult couples' relationship satisfaction and sexual satisfaction. The current study utilized a descriptive correlational survey design with 158 young adult couples. We used actor-partner interdependence modeling to test the dyadic associations between technoference and relationship and sexual satisfaction among the young adult couple sample. Results indicated statistically significant negative actor effects between technoference and relationship and sexual satisfaction and statistically significant negative partner effects between technoference and relationship satisfaction.

Effects of individual-oriented relationship education for parents: A randomized controlled trial.

Individual-oriented relationship education aims to support healthy relationship development for singles, and provides flexibility for couples when only one member is available or willing to attend. While quasi-experimental studies have shown some benefits for those who attended relationship education individually, no randomized controlled trials have been conducted for individual-oriented RE. Moreover, it is not clear how relationship education benefits the co-parenting relationship when only one parent attends. Thus, this paper presents the results of a randomized controlled trial, with a wait-list control group, for a sub-sample of parents (N = 322) who participated in a 6-month trial of individual-oriented relationship education utilizing Prevention and Relationship Education Program's (PREP) Within My Reach (WMR) curriculum. Results indicated statistically significant, small, positive intervention effects on parent-child relationships 3 months after random assignment. However, no other treatment effects were detected for parents. We also found no statistically significant differences in the rate of change over the 6-month study period between treatment and wait-list control parents. There was a statistically significant effect for time, indicating that all enrolled parents in the study reported significant positive growth on emotion regulation, positive encouragement, parent-child relationships, and parental adjustment. We discuss implications for relationship education programming, as well as evaluating outcomes in future studies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Relationship Between Social Support and Family Relationships Among Low-Income Couples Attending Relationship Education.

Results are mixed for relationship education (RE) interventions with low-income couples. For couples who experienced positive changes, it is not clear what aspects of program models contributed to change. Many low-income couples attend government-funded RE with limited access to social and community resources. Program models often provide related resources complimentary to RE skill-building. We examined the relationship between income, social support, and family functioning for low-income, ethnically diverse couples (N = 856) who attended RE, as well as the mediating effects of social support on family functioning outcomes. Analyses included three separate dyadic models that examined associations among constructs at baseline and immediately following the RE intervention. Results demonstrated relationships between participants' reported social support and family functioning such that (a) social support was associated with baseline family functioning for both men and women; (b) men's baseline social support was influenced by women's baseline family functioning; and (c) men's and women's social support change score had a positive influence on their own family functioning change score. However, social support was not a significant mediator of change in family functioning. Implications for RE practice and research are also discussed.

Los resultados de las intervenciones sobre educación para las relaciones (ER) con parejas de bajos recursos son variados. En el caso de las parejas que tuvieron cambios positivos, no está claro qué aspectos de los modelos del programa contribuyeron al cambio. Muchas parejas de bajos recursos asisten a ER financiadas por el gobierno con acceso limitado a recursos sociales y comunitarios. Los modelos del programa generalmente proporcionan recursos relacionados complementarios al desarrollo de habilidades para la ER. Analizamos la relación entre los ingresos, el apoyo social y el funcionamiento familiar en las parejas de bajos recursos y étnicamente diversas (N = 856) que asistieron a la ER, así como los efectos mediadores del apoyo social en los resultados del funcionamiento familiar. Los análisis incluyeron tres modelos diádicos independientes que examinaron las asociaciones entre los constructos al inicio del estudio e inmediatamente después de la intervención sobre ER. Los resultados demostraron las relaciones entre el apoyo social informado por los participantes y el funcionamiento familiar, por lo que (a) el apoyo social estuvo asociado con el funcionamiento familiar al inicio del estudio tanto en los hombres como en las mujeres; (b) el apoyo social de los hombres al inicio del estudio estuvo influenciado por el funcionamiento familiar de las mujeres al inicio del estudio; y (c) el puntaje de cambio del apoyo social de los hombres y las mujeres tuvo una influencia positiva en su propio puntaje de cambio del funcionamiento familiar. Sin embargo, el apoyo social no fue un mediador de cambio significativo en el funcionamiento familiar. También se debaten las implicancias para la investigación y la práctica en RE.

School and Teacher Factors That Promote Adolescents' Bystander Responses to Social Exclusion.

Schools may be one important context where adolescents learn and shape the behaviors necessary for promoting global inclusivity in adulthood. Given the importance of bystanders in halting bullying and peer aggression, the focus of this study is on both moral judgments regarding one type of bullying, social exclusion, and factors that are associated with bystander intervention. The study includes 896 adolescents, who were 6th (N = 450, M age = 11.73), and 9th (N = 446, M age = 14.82) graders, approximately evenly divided by gender. Participants were primarily European-American (63.3%). Results revealed that girls and participants who perceived better relationships between students and teachers were more likely to judge exclusion to be wrong. Further, ethnic minority participants, those who were more anxious about being rejected by their teachers and reported more teacher discrimination were less likely to judge exclusion as wrong. Participants who reported more positive student-teacher relationships, perceptions of a more positive school social environment and more prior experiences of teacher discrimination were more likely to report that they would seek help for the victim. On the other hand, participants who reported being more angry about teacher rejection, experiencing either peer or teacher discrimination, and perceiving they are excluded from opportunities at school were less likely to intervene to come to the aid of a peer who is being excluded. The results document the complex interplay of school and teacher factors in shaping adolescents' bystander responses to social exclusion. Our findings suggest that positive school climate can promote intentions to intervene. However, findings indicate that adolescents who are marginalized in their school environments, and who report experiences of rejection, exclusion or discrimination are not willing or likely to intervene to prevent others from experiencing exclusion.

Relationship Distress as a Mediator of Adverse Childhood Experiences and Health: Implications for Clinical Practice with Economically Vulnerable Racial and Ethnic Minorities.

Adverse childhood experiences (ACE) are interpersonal sources of distress negatively correlated with physical and mental health, as well as maladaptive intimate partner conflict strategies in adulthood. Economically vulnerable racial and ethnic minorities report the greatest disparities in exposure to ACE, as well as relationship distress and health. Yet, little is known about the connections between ACE, relationship distress, and health. We therefore tested a theoretical model for the mediating role of relationship distress to explain the ACE-health connection with a sample (N = 96) predominantly racial/ethnic minorities (87%) with low income. We applied partial least squares structural equation modeling with bootstrapping (N = 500). Relationship distress strengthened the predictive relationship between ACE and health, and accounted for 42% of the variance in health. The results provide preliminary support for relationship distress as a social determinant of health disparities with implications for interdisciplinary health intervention.

Las experiencias adversas de la infancia son fuentes interpersonales de distrés correlacionadas negativamente con la salud mental y física así como con estrategias desadaptativas de conflicto con la pareja íntima en la adultez. Las minorías étnicas y raciales económicamente vulnerables informan las mayores divergencias en la exposición a experiencias adversas de la infancia, así como en el distrés en la relación y en la salud. Sin embargo, se sabe poco acerca de las conexiones entre las experiencias adversas de la infancia, el distrés relacional y la salud. Por lo tanto, evaluamos un modelo teórico para el rol mediador del distrés relacional a fin de explicar la conexión entre la salud y las experiencias adversas de la infancia con una muestra (N = 96) de minorías raciales o étnicas (87%) predominantemente de bajos recursos. Aplicamos un modelo de ecuaciones estructurales utilizando regresión parcial por mínimos cuadrados con análisis de remuestreo (N = 500). El distrés relacional fortaleció la relación predictiva entre las experiencias adversas de la infancia y la salud, y justificó el 42% de la varianza en la salud. Los resultados ofrecen un respaldo preliminar del distrés de la relación como determinante social de divergencias en la salud con implicancias para una intervención interdisciplinaria en la salud.

The Effectiveness of Couple and Individual Relationship Education: Distress as a Moderator.

Current literature yields mixed results about the effectiveness of relationship education (RE) with low-income participants and those who experience a high level of individual or relational distress. Scholars have called for research that examines whether initial levels of distress act as a moderator of RE outcomes. To test whether initial levels of relationship and/or individual distress moderate the effectiveness of RE, this study used two samples, one of couples who received couple-oriented relationship education with their partner (n = 192 couples) and one of individuals in a relationship who received individual-oriented RE by themselves (n = 60 individuals). We delivered RE in a community-based setting serving primarily low-income participants. For those attending with a partner, there was a significant interaction between gender, initial distress, and time. Findings indicate that women who were relationally distressed before RE reported the largest pre-postgains. Those who attended an individual-oriented RE program reported significant decreases in individual distress from pre to post, but no significant relationship gains. Findings also suggest that initial levels of distress did not moderate the effectiveness of individual-oriented RE.

Use of an anecdotal client feedback note in family therapy.

To attain information about divergent agendas in family therapy, as well as incorporate client feedback, we present the Client Feedback Note (CFN). The CFN elicits information about each family member's feelings, learning, dislikes, and wishes for each session. Anecdotal feedback after each session may help the therapist have better insight into the clients' perceptions and experience of the therapy and the therapist. Sensitivity to information generated by the CFN can help both therapist and client work to coconstruct a therapeutic process that is relevant to the diverse needs of the client system. This manuscript will (a) discuss literature supporting the use of client feedback in therapy; (b) present the CFN and rationale for its development; (c) discuss our experiences utilizing the CFN along with case examples that illustrate its use; and (d) identify practical applications, limitations, and potential research with using the CFN in systemic therapy.

Emotional stocks and bonds: a metaphorical model for conceptualizing and treating codependency and other forms of emotional overinvesting.

Codependent behaviors are associated with an unhealthy reliance on others for meeting emotional needs. This over-reliance on others often leads to dysfunctional interpersonal relationships. This article presents emotional stocks and bonds (ESB), a metaphorical model for use with clients who display codependent behaviors. Emotional stocks and bonds incorporates theoretical tenets from Bowen family systems and attachment theory and aids clients in understanding and changing unhealthy relationship behavior patterns. In addition to an overview of the model's key concepts and its use in clinical practice, we provide a case illustration and a discussion of practice implications and limitations.