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 society’s 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/0309038308/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/about/mission.html#ms

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/about/mission.html#ms

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/about/mission.html#ms

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/about/mission.html#ms

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/about/mission.html#ms

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/about/mission.html#ms

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. Bourbon Clark Fayette Jessamine Madison Scott Woodford Franklin Target Counties Source: http://www.ca.uky.edu/healthymarriage

24. Target Populations Source: http://www.ca.uky.edu/healthymarriage

25. 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 Marriage Education Curriculums

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 (n=575) • 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 Public’s Health in the 21st Century. http://www.nap.edu/catalog/10548.html#toc

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 public’s health in the 21st Century. http://www.nap.edu/catalog/10548.html#toc • 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/about/mission.html#ms). 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.