Relationship Education through Local Departments of Health

1
Relationship Education through Local Departments
of Health

• Erik L. Carlton
• University of Kentucky

2
Abstract

• DHHS currently funds hundreds of millions of
  dollars worth of healthy marriage and responsible
  fatherhood initiatives targeted at informing the
  public about the importance of marriage and
  fatherhood and designed to provide valuable
  skill-based education to those who need and
  desire it. Numerous studies have shown the health
  and financial impacts of failed relationships not
  only on those involved therein, but on
  communities as well. While interest is high for
  these services (over 75 of those polled would
  take classes to strengthen their relationships if
  offered), there exist several barriers to
  providing these services to populations. Local
  public health departments offer a unique and
  compelling partner in the educational and
  awareness efforts of healthy relationship
  initiatives. This presentation details the
  rationale for working with local public health
  departments and recommends a process, including
  local resources, to accomplish that end.

3
Understanding Public Health

• WHO Definition of Health
• A complete state of physical, mental, and social
  well-being and not merely the absence of
  disease.
• Mission of Public Health
• Fulfilling societys interest in assuring
  conditions in which people can be healthy.

Source (1) World Health Organization. (1946).
Preamble to the Constitution of the World Health
Organization as adopted by the International
Health Conference, New York, 19-22 June 1946, and
entered into force on 7 April 1948.
Source (2) Institute of Medicine. (1988). The
Future of Public Health Summary and
Recommendations. http//books.nap.edu/books/030903
8308/html/1.html
4
Addressing Essential Functions of Public Health

• Monitor health status to identify community
  health problems
• Inform, educate, and empower people about health
  issues
• Mobilize community partnerships to identify and
  solve health problems
• Develop policies and plans that support
  individual and community health efforts
• Link people to needed personal health services
  and assure the provision of health care when
  otherwise unavailable

5
Marriage Health Current Findings
6
Physical Health Longevity

• Children who live with their own two married
  parents enjoy better physical health, on average,
  than do children in other family forms
• Parental marriage is associated with a sharply
  lower risk of infant mortality
• Marriage is associated with reduced rates of
  alcohol and substance abuse for both adults and
  teens

Source Institute for American Values. (2005).
Why marriage matters (2nd ed.) Twenty-six
conclusions from the social sciences.
7
Physical Health Longevity

• Married people, especially married men, have
  longer life expectancies than do otherwise
  similar singles
• Marriage is associated with better health and
  lower rates of injury, illness, and disability
  for both men and women
• Marriage seems to be associated with better
  health among minorities and the poor

Source Institute for American Values. (2005).
Why marriage matters (2nd ed.) Twenty-six
conclusions from the social sciences.
8
Mental Health Emotional Well-Being

• Children whose parents divorce have higher rates
  of psychological distress and mental illness
• Divorce appears significantly to increase the
  risk of suicide
• Married mothers have lower rates of depression
  than do single or cohabiting mothers
• Boys raised in single-parent families are more
  likely to engage in delinquent and criminal
  behavior

Source Institute for American Values. (2005).
Why marriage matters (2nd ed.) Twenty-six
conclusions from the social sciences.
9
Mental Health Emotional Well-Being

• Marriage appears to reduce the risk that adults
  will be either perpetrators of victims of crime
• Married women appear to have a lower risk of
  experiencing domestic violence than do cohabiting
  or dating women
• A child who is not living with his or her own two
  married parents is at greater risk of child abuse

Source Institute for American Values. (2005).
Why marriage matters (2nd ed.) Twenty-six
conclusions from the social sciences.
10
Why Healthy Marriages?

• A 2003 multi-state analysis conducted at Utah
  State University estimated the cost of divorce to
  the Commonwealth of Kentucky at 650 million
  annually (Schramm, 2003)
• Year 2000 figures. Cost in 2007 dollars is
  roughly 750-800 million
• Government has a reasoned interest in marriage
  because government bears the burden of its
  failure.
• DHHS Secretary Mike Leavitt

11
Background to the Healthy Marriage Initiative
12
Administrative Background

• To encourage marriage and promote the well-being
  of children, I have proposed a healthy marriage
  initiative to help couples develop the skills and
  knowledge to form and sustain healthy marriages.
  Research has shown that, on average, children
  raised in households headed by married parents
  fare better than children who grow up in other
  family structures. Through education and
  counseling programs, faith-based, community, and
  government organizations promote healthy
  marriages and a better quality of life for
  children. By supporting responsible
  child-rearing and strong families, we are
  seeking to ensure that every child can grow up in
  a safe and loving home.
  President George W. Bush

Source http//www.acf.dhhs.gov/healthymarriage/ab
out/mission.htmlms
13
ACF HMI Mission

• To help couples, who have chosen marriage for
  themselves, gain greater access to marriage
  education services, on a voluntary basis, where
  they can acquire the skills and knowledge
  necessary to form and sustain a healthy marriage.

Source http//www.acf.dhhs.gov/healthymarriage/ab
out/mission.htmlms
14
What is a Healthy Marriage?

• Mutually enriching
• Beneficial to husband, wife, and children (if
  present)
• Characterized by deep respect
• Committed to ongoing growth
• Use of effective communication skills
• Use of successful conflict management skills

Source http//www.acf.dhhs.gov/healthymarriage/ab
out/mission.htmlms
15
Goals

• Increase of children raised by two parents in a
  healthy marriage
• Increase of couples in a healthy marriage
• Increase of premarital couples equipped with
  skills and knowledge necessary for a healthy
  marriage
• Increase of youth and young adults who have
  skills and knowledge about healthy relationships
• Increase public awareness of value of healthy
  marriages
• Encourage support research
• Increase of homes free of domestic violence

Source http//www.acf.dhhs.gov/healthymarriage/ab
out/mission.htmlms
16
Activities

• Public advertising campaigns
• Marriage and relationship education programs
• High schools
• Pre-marital Marital couples Expectant parents
• Includes parenting skills, financial management,
  job training
• Marriage enhancement programs
• Divorce reduction programs
• Marriage mentoring programs
• Reduce marriage disincentives
• Research

Source http//www.acf.dhhs.gov/healthymarriage/ab
out/mission.htmlms
17
The HMI is NOT About

• Coercing anyone to marry or remain in unhealthy
  relationships
• Withdrawing supports from or diminishing the
  important work of single parents
• Stigmatizing those who choose to divorce or
  limiting access to divorce
• Promoting the initiative as a panacea for child
  and family well-being
• An immediate solution for lifting families out of
  poverty

Source http//www.acf.dhhs.gov/healthymarriage/ab
out/mission.htmlms
18
BHMI A Local Healthy Marriage Effort
19
Bluegrass Healthy Marriage Initiative

• Collaborative effort
• UK Department of Family Studies
• Bluegrass Healthy Marriages Partnership, Inc.
• Purpose
• To increase child well-being by affirming
  enabling healthy marriage co-parenting
  relationships through research, education, and
  awareness
• Funding
• KY Cabinet for Health Family Services
• U.S. Administration for Children Families

Source http//www.ca.uky.edu/healthymarriage
20
Bluegrass Healthy Marriage Initiative
Bluegrass Healthy Marriages Partnership
UK Department of Family Studies
Research Expertise Fiduciary Management Technical
Support Project Staff
Community Volunteers Coalition of Partner
Organizations
BHMI Initiative
21
Purpose Goal

• Increase child well-being and family stability
• Affirm enable healthy marriages
• Affirm enable healthy co-parenting
  relationships
• Launch and maintain an Initiative that unites
  like-minded organizations into a vigorous
  Partnership that works to achieve that purpose

Source http//www.ca.uky.edu/healthymarriage
22
Objectives

• Increase access to marriage education activities
  relationship resources
• Increase quantity and quality of activities
  resources
• Increase individual and couple predisposition to
  participate in and take advantage of resources
• Enable the advancement of the coalition of
  organizations in perpetuity
• Amass and publicize scholarly research

Source http//www.ca.uky.edu/healthymarriage
23
Target Counties

• Bourbon
• Clark
• Fayette
• Jessamine

• Madison
• Scott
• Woodford
• Franklin

Source http//www.ca.uky.edu/healthymarriage
24
Target Populations
Source http//www.ca.uky.edu/healthymarriage
25
Marriage Education Curriculums

• Over 20 programs in our in-house reference
  library
• Primarily out of the box
• Range in cost from 80 - 500
• Workshop Leaders Regional Directory

• BHMI recommended ME program criteria
• Marriage content
• Skill building
• Evaluation
• Written curriculum
• Replication
• Sensitivity
• Safety
• Review

26
Domestic Violence Protocol

• Community Partners
• Bluegrass Domestic Violence Program
• Fayette County Domestic Violence Prevention Board
• Brenda Cowan Coalition
• Participating Partner Coordinators
• Trained on the protocol
• Facilitate classes, but may not teach
• Show DVD hand out DV awareness info

27
How does BHMI Work?

• Partner with community organizations
• Research organizations constituencies
• Individual relational functioning and
  well-being
• Communication, conflict, power/control, marital
  virtues
• Demographics
• Provide research-based recommendations of
  programs, activities, or intervention
• Work to provide education services as available
• Cross-promote activities resources

28
Operational Diagram
Source The Lewin Group
29
Cross-Sector Collaborative Model
30
Community Saturation

• Working through communities partners allows BHMI
  to reach a much greater population, creating a
  form of community saturation

constituents each organization services or
represents
31
Elements of Partnership

• Research
• Help facilitate research using our Constituency
  Questionnaire (CQ)
• Marriage Education Programming
• Provide one Marriage Education-specific program
  or extended event during the course of a year

32
Benefits to Partners

• Research-based constituency profile
• Initiative-sponsored educational activities
• Quarterly in-service training events
• Cross-promotion of partner events
• Initiative website recognition and links
• Access to extensive Marriage Education resource
  library

33
BHMI Research Findings (n575)

• Clinically dissatisfied with relationship 41
• Consensus (agreement) 32
• Satisfaction 27
• Cohesion (closeness) 42
• Would use relationship education 79
• At severe risk for abuse 14
• At mild risk for abuse 28
• Clinically distressed (individual) 21

Data from BHMI Constituent Questionnaire accurate
as of April 20, 2007.
34
Implications for LDPH
35
LDPH Operational Objectives

• Future of PH in the 21st Century (IOM, 2002)
• Adopting a population health approach that
  considers the multiple determinants of health
• Building a new generation of intersectoral
  partnerships that also draw on the perspectives
  and resources of diverse communities and actively
  engage them in health action
• Making evidence the foundation of decision making
  and the measure of success

Source Institute of Medicine. (2002). The Future
of Publics Health in the 21st Century.
http//www.nap.edu/catalog/10548.htmltoc
36
Role of the LDPH

• Local health departments are an integral part of
  the health care delivery system

37
Role of the LDPH, cont.

• Access to broad and at-risk populations
• Facilitate research to understand specific needs
• Host educational activities for constituents

38
Advantages to LDPH of BHMI

• Evidence-based practice No-cost, research-based
  constituent profile
• Educational activities sponsored by outside
  entity limited cost
• Centralized, concurrent delivery to multiple
  parties
• Opportunity for staff training to build capacity
  and sustainability
• Breadth of services increased through partnership

39
Other Considerations

• Local Health Departments should also consider
  applying for the breadth of Federal grant money
  available through the Healthy Marriage and
  Responsible Fatherhood Initiatives, including
• HMI, African-American HMI, Hispanic-American HMI
• Refugee work
• Youth relationship and abstinence education
• Public advertising (health behavior) campaigns
• Divorce reduction, co-parenting, and pre-marital
  programs

40
References

• Bluegrass Healthy Marriage Initiative website
  (www.ca.uky.edu/healthymarriage). Accessed April
  20, 2007.
• Institute for American Values. (2005). Why
  marriage matters (2nd ed.) Twenty-six
  conclusions from the social sciences.
• Institute of Medicine. (2002). The future of the
  publics health in the 21st Century.
  http//www.nap.edu/catalog/10548.htmltoc
• Institute of Medicine. (1988). The future of
  public health Summary and recommendations.
  http//books.nap.edu/books/0309038308/html/1.html
• Lewin Group (www.lewingroup.com)
• Schramm, D. (2003). What could divorce be costing
  your state?
• U.S.Administration for Children Families
  website (http//www.acf.dhhs.gov/healthymarriage/a
  bout/mission.htmlms). Accessed April 20, 2007.
• World Health Organization. (1946). Preamble to
  the Constitution of the World Health Organization
  as adopted by the International Health
  Conference, New York, 19-22 June 1946, and
  entered into force on 7 April 1948.