Gordon Couples Research Lab

Shayla Wieser, BA (2021)

Marital and family instability is a growing public health issue, but accessible relationship assistance is lacking in most communities. Most religious organizations recognize marriages as a central force for transmitting values to children (Root, 2010). Typically, couples go to clergy for help, yet the majority of clergy are not trained in delivering effective, science-based relationship interventions nor do they see the utility of science in advancing spiritual development. Developing a strong connection between research/academia and the clergy/church is a key interest for the Templeton Foundation.

Healthy Connections Knoxville (HCK) is an innovative collaboration between the University of Tennessee (UT), local churches, and community agencies to train clergy, volunteers, and practitioners to provide empirically-supported relationship education in their churches and in the wider community through agency partnerships. This collaboration is ideally suited to forge this partnership between science and religion. Furthermore, by using relationship science on interpersonally relevant character virtues to create loving families, we can also address the question of “what does it mean to live a life of love and virtue?”

HCK currently has a network of around 25 church and community partners, but it must be scaled up in order to have a larger community impact and transform the community culture around marriage and increase family stability at all income and education levels.

Thus, our goals are to (a) help HCK be strategically placed to grow to include 100 church partners, (b) develop sustainable collaborations between UT, churches, and agencies that will facilitate an exchange of information between science and religion, and (c) quantitatively and qualitatively assess the program’s impact on key community outcomes relevant to this partnership. Lessons learned from this project will also help other researchers better understand how to develop these kinds of university-church partnerships. We also expect that by creating a sustainable and scalable partnership that we can positively impact community couples and teach other communities how to develop similar programs.

Family instability significantly contributes to ongoing income and health disparities and is a source of many adverse childhood events. In Knoxville, a recent United Way needs assessment indicated that single-parent households are six times more likely to be in poverty than married households. Nationwide data indicates middle to low-income couples struggle to develop and maintain stable relationships, due to both financial stressors and the intergenerational transmission of poor relationship models. This relationship between poverty and unhealthy relationships is considered by experts to be bi-directional and thus needs to be addressed on multiple levels. In our proposed model to solve this problem, we will encourage couples to improve their relationship health using the following strategies:

1. Messaging. We will develop a public health campaign to prioritize relationship health and increase awareness of what a healthy marriage is and how to have one.
2. Equipping. We will create a centralized location to train professionals, clergy, and high-impact volunteers/interns in empirically-based couples and family programs and provide ongoing support as they deliver these programs in the community.
3. Delivering. We will provide high-quality, effective, relationship services to all couples regardless of ability to pay; couples would access these programs on a regular basis to keep their relationships healthy.  The programs can be targeted to specific issues (co-parenting, blended families,  transition to an empty nest, etc.).  We would deliver these services using a stepped-care format, including:
   1. Relationship Checkups – these would be delivered via home visits (or at the clinic on request) to couples by trained staff and high-impact volunteers;
   2. Marriage and relationship education workshops – these would be delivered in churches, community agencies, community schools, and the center via trained staff and high-impact volunteers;
   3. Couple therapy – this service would be provided via an in-house clinic for couples who need a higher level of care than the Checkup or Workshops can provide. This service could be self-sustaining after a few years by operating on a sliding scale with local therapists; services also could be provided via partnerships with UT mental health training programs;
   4. Wrap-around supportive services in the clinic – We will partner with local agencies to provide wrap-around support for under-resourced couples to connect them with needed services; we would also provide child care and transportation to the center for couples as needed.
4. Developing/Evaluating. We would engage in continuous rigorous evaluation of our services to improve our programs, develop new programs, and disseminate information learned to other professionals nationally. To improve our services and create significant community impacts, UT faculty and students would work with church and community partners to:

a. Target resources to develop culturally adapted programs in particularly vulnerable neighborhoods and track effects

b. Test these strategies again in other vulnerable neighborhoods to determine what generalizes and what is needs to be adapted to that community.

Over 80% of persons with Alzheimer’s disease or a related dementia (ADRD) are cared for in their home environments by family members. In 2015, an estimated 15.9 million family and friends supported someone with ADRD by providing 18.1 billion hours of unpaid care at an estimated economic value of over $221 billion. Family caregivers report increased anxiety, depressive symptoms, and many forego their own physical and psychological health needs as the demands of being a family caregiver are sustained over many years. Throughout the caregiving experience, many families struggle to maintain healthy relationships with each other, as the demands of caregiving for a person with a progressive neurodegenerative disease such as ADRD escalate. As ADRD progresses and the need for additional personal and healthcare needs ensue in order to keep their loved one safe in their home environment, family members oftentimes seek to employ home-based services, if this scant resource is available and if they have the financial means to pay for it. However, for many families, seeking institutionalization of their loved one with ADRD is their only option as their out of pocket costs soar and they enroll their loved one in Medicaid in order to pay for the costs of care. By delaying institutionalization, a savings of $2029/month per person could be realized in direct healthcare costs. Recently, in-home monitoring systems have been developed to facilitate in-home dementia patient care. It alleviates the heavy dependence on experienced personnel for in-home care and enables real-time monitoring with low cost. This project develops a monitoring, modeling, and interactive recommendation solution for caregivers for in-home dementia patient care that focuses on caregiver-patient relationships. This includes monitoring for mood and stress and analyzing the significance of monitoring those attributes to dementia patient care and subsequent behavior dynamics between the patient and caregiver. In addition, novel and adaptive behavioral suggestions at the right moments aims at helping improve familial interactions related to caregiving, which over time should ameliorate the stressful effects of the patient’s illness and reduce strain on caregivers.