Study design

This project was conducted in 3 key stages:

1. a quick scoping review and stakeholder consultations to identify key relationship issues experienced by current and ex-serving members and to identify the existing services available to support their relationships
2. a Rapid Evidence Assessment (REA) to identify existing relationship education interventions available in Australia and internationally and assess evidence of their effectiveness
3. focus groups with stakeholders, current and ex-serving ADF members and/or their partners, and obtaining their views on existing programs and ideas on how they could be adapted to suit their specific needs.

Findings

Key relationship issues experienced by military and veteran couples

The following common relationship issues faced by current and ex-serving members and their partners were identified in the scoping review and stakeholder consultations:

• frequent separation of members and their partners due to members’ absence on military deployments and training, and relationship readjustment issues when they return
• frequent relocation of members to new postings, which can require partners to disrupt their lives to accompany the member or choose to live separately for extended periods
• feelings of isolation and lack of intimacy and support due to time apart and/or relocation to areas where couples have few extended support networks
• fears and concerns around trust and relationship commitment
• impacts of member absence and relocation on partners’ employment and domestic load, especially where couples share care of dependent children
• a belief that civilian partners are not sufficiently consulted in posting and deployment decisions and that members and partners do not sufficiently understand each other’s experiences, which can cause resentment in relationships
• physical and mental health impacts of service on members, and associated issues such as substance abuse
• stress around transition and adjustment to civilian life, including financial stress, loss of identity and community (for members and partners), and role adjustment.

Existing services

• The military and veteran specific services currently provided to support couple relationships in Australia include one relationship education program (Building Better Relationships) and a larger range of therapeutic interventions including couples counselling.
• While preventative support for couples is a component of some military and veteran specific services (such as webinars for members and families on the challenges of military service life and the FamilySMART resilience programs) ‘couple relationships’ are generally not the focus.
• Stakeholders consulted for this study believed that existing services were more focused on assisting those in crisis, rather than providing preventative supports.

Existing relationship education programs

• Through the REA, desktop review and stakeholder consultations undertaken for this study, we identified 33 relationship education programs in Australia or internationally. These include two additional programs previously delivered to military and veteran couples in Australia and other programs available for all Australian couples via Relationships Australia.  
• Existing relationship education programs use two different evidence-based approaches to improving couple relationship quality.
• Curriculum-based programs focus on training couples in key relationship skills such as positive communication, conflict management and positive expression of affection. These are generally targeted at well-functioning couples and are considered universal primary prevention.
• In programs that have an assessment and feedback approach, couples are assessed on their relationship strengths and concerns and receive feedback from a therapist to address these. They are generally targeted at couples experiencing minor issues and who do not require extensive couples therapy (secondary prevention).
• While relationship education is not typically targeted at couples in crisis, one of the assessment and feedback programs identified in this review (Marriage Check-Up in Integrated Care) was described in the literature as being suitable for couples on a broad spectrum from ‘relationally satisfied to severely distressed’ and therefore situated between primary prevention and tertiary therapy.
• Curriculum-based programs usually involve between 8 and 12 hours of content delivered once a week or intensively over 2 days. They can be delivered face-to-face in a group setting, online in a group setting, or privately in one’s own time via self-directed learning (online or book/manual).
• Programs using assessment and feedback approaches are usually shorter and can be delivered face-to-face or online and over the phone (e.g. online assessment with feedback and coaching over the phone).
• Assessment and feedback-based programs, such as Marriage Check-up, could be offered as an alternative for military and veteran couples who don’t have the time for curriculum-based programs regardless of whether they present with issues, given evidence they can improve outcomes for couples on a broad spectrum (from relationally satisfied to severely distressed).

Effectiveness of relationship education

• The REA assessed evidence on the effectiveness of 22 relationship education programs that had published evaluations during the review period. The REA examined whether: the program improved couple relationship quality; the findings were generalisable to Australian current and ex-serving members and their partners; and the applicability of the findings to the Australian context.
• There was sufficient evidence to determine effectiveness in improving couple outcomes and applicability to the Australian context for 8 programs. Among these, 4 were deemed promising for delivery to current and ex-serving ADF members and their partners:
  • Elevate
  • ePREP
  • Marriage Checkup in Integrated Primary Care
  • OurRelationship.
• All 4 programs were US programs that have been adapted for and/or tested with a US military population. While there are several programs already adapted for or delivered to Australian military and veteran couples, there was insufficient evidence on any of these programs to assess their effectiveness.
• The 4 promising programs varied in their approach, curricula/topics covered and delivery characteristics. Two were curriculum-based, one was a short ‘assessment and feedback’ program and the fourth program combined elements of both these approaches.
• All 4 programs have been found to lead to significant improvements in one or more couple outcomes. Given differences in research design, target populations and outcomes measured, it was difficult to compare outcomes from these programs to draw conclusions about their relative effectiveness.
• The findings from the REA and broader evidence suggest that relationship education programs generally lead to moderate short-term improvements in couple communication and small to moderate improvements in relationship satisfaction – the 2 most commonly assessed outcomes of relationship education.
• Of the 4 promising programs identified, evaluations of the curriculum-based programs generally reported larger improvements in communication skills. All programs reported significant improvements in relationship satisfaction. On balance, hybrid programs, which combined elements of both approaches, reported the largest improvements across measures.

Programs preferred by focus group participants 

• Few participants in this study identified a preference for any specific relationship education program deemed promising in the REA.
• Participants identified advantages and disadvantages with the different programs and felt that the most suitable program would depend on a couple’s circumstances and specific needs.
• In terms of content that was important to military and veteran couples, participants agreed that relationship education programs provided to this cohort should cover communication skills/training and expectations management. They also felt that the content should be adapted to cover ADF-specific information and examples (e.g. expectations and communication surrounding deployment).

Targeting relationship education

• The intervention points identified by participants as requiring targeted relationship education included:
  • early in a member or partner's experience with military life to provide them with skills to navigate military challenges
  • prior to postings and deployments
  • prior to or shortly after military to civilian transition.
• Other life course stress points identified for current and/or ex-serving members and their partners were:
  • when couples first have children
  • when children transition into the teenage years
  • the transition to the empty-nester years.
• The study also identified specific socio-demographic subgroups with additional support needs who may benefit from relationship education while serving or following transition, these included:
  • young couples, dual-serving couples
  • step and blended families
  • couples with children or a child with special needs
  • couples where a member was transitioning out of service for medical reasons.
• Stakeholders felt there would be benefit in offering some form of relationship education to young ADF members who are still single, as well current and ex-serving members who are in a relationship, to ensure members commence relationships on a strong footing.
• Participants suggested it would be valuable to include some form of relationship education in the routine training regime of all military personnel (with specific training points suggested such as ab-initio and pre-deployment training).
• While much participant discussion focused on the value of relationship education being offered early in a relationship or military career, consistent with an early intervention focus, participants also emphasised the value and importance of offering relationship education to veterans and at the point (or shortly after) service transition, as this can be a challenging time for members and their partners, and may interact with other life transitions (such as having children).
• Evidence suggests that couples who have previously completed relationship education are likely to benefit from repeat interventions to refresh and reinforce learnings, and service transition would be a timely point to offer and reinforce this.

Delivery characteristics

• Most participants believed that programs with different lengths and delivery formats were needed for different couples, depending on their circumstances and needs. This is consistent with previous research suggesting that decisions regarding the delivery format and dose of relationship education should be based on who is being served, viability of methods in a specific setting and resources.
• Participants in this study noted that some military and veteran couples would be unlikely to volunteer for lengthy curriculum-based training and that shorter programs or those with a modular approach (where they only complete specific modules of interest) would be more appealing to them.
• Most said that providing some option to participate online was important as many military couples would have difficulty attending face-to-face. However, stakeholders preferred a face-to-face approach for high-risk couples so they could monitor their responses and dynamics.
• Participants noted that group programs provided peer-to-peer interaction and the benefit of learning from others’ experiences. However, they suggested that some couples would be reluctant to participate in group programs and believed that programs that couples are able to complete privately with a therapist/educator and/or via self-directed learning were also needed.
• Focus group participants believed that the person or organisation that delivers the program must have a good understanding of family life in the military but must also be seen as separate and independent from Defence/DVA. Some suggested that people with lived experience such as veterans could be trained to deliver these programs.

Barriers to attendance

• A range of barriers were identified that may prevent current and ex-serving ADF members and their partners attending relationship education programs including:
• lack of awareness about program availability or eligibility
• lack of perceived value/need
• lack of time due to work or child care responsibilities
• belief that relationship education is only for couples experiencing difficulties
• reluctance to seek support and/or fear that it would impact the member’s career.
• A range of solutions were provided to these challenges including:
• promoting these programs direct to the partners as well as members and veterans
• provision of free child care during program participation
• support to complete the program during or after work hours
• promotion and endorsement from chain of command
• ability to self-refer (rather than having to go through one of the Defence or veteran organisations, their chain of command or any other group).