The Impact of Behavioural Parent Training on Fathers' Parenting: A Meta-Analysis of the Triple P-Positive Parenting Program

The role of parenting- and employment-related variables on fathers' involvement in their children's education

BACKGROUND

Parent involvement strongly correlates with children's educational attainment. Sociocultural shifts in parenting roles and shared responsibilities have driven an increase in the need for involvement of fathers in activities to support their children's educational development. Several factors are thought to influence father involvement in children's education; however, the most salient factors remain unclear.

AIMS

To examine which variables correlate with father involvement in their children's education using a combination of demographic, parent-related and employment-related variance.

SAMPLE

A total of 166 fathers of at least one child aged 6-17 years and residing across five industrialized Western countries participated in an online survey.

METHOD

Hierarchical multiple regression analysis (HMRA) was performed to examine the total and incremental variance using regression models including demographic, parenting- and employment-related variables linked to educational involvement.

RESULTS AND CONCLUSIONS

The variables included in the current study could explain a large and statistically significant 34% of the variability in fathers' educational involvement. Of these variables, only four were statistically significant in the final model. Specifically, fathers were more likely to be engaged in their children's education when their children were younger, and when parent self-efficacy, positive work-to-family interface and financial anxiety were high. The study's findings indicate that a positive work environment can help fathers better support their children's education, offering a new focus for future interventions and policies. This includes those focused on targeting work-related constructs to optimize family functioning.

Barriers and Facilitators to Engaging Mothers and Fathers in Family-Based Interventions: A Qualitative Systematic Review

The current systematic review examined the similarities and differences between mothers' and fathers' reported barriers and facilitators to engaging in family-based interventions for child and adolescent behavioural problems (aged 2-17 years). Systematic searches of six electronic databases and grey literature alongside a two-way screening process identified twenty eligible qualitative studies from 2004 to 2019. A thematic meta-synthesis identified similarities in major themes of psychological, situational, knowledge/awareness, programme/intervention, co-parenting, practitioner, and beliefs/attitudes factors, alongside group experiences and stages of engagement. However, differences emerged in subthemes related to parental, treatment, and service delivery factors that included individual ideologies of parenting, parental roles, and treatment participation; the role of mothers in facilitating engagement; and individual preferences for treatment content and delivery. Overall, findings suggest that while mothers and fathers experience similar challenges to engagement, they can also experience distinct challenges which need to be addressed at the treatment outset to maximise engagement.

The developmental trends of parental self-efficacy and adolescents' rule-breaking behaviors in the Italian context: A 7-wave latent growth curve study

Parental self-efficacy (PSE) captures parents' beliefs in their ability to perform the parenting role successfully and to handle pivotal issues of specific developmental periods. Although previous studies have shown that, across the transition to adolescence, parents show decreasing levels of PSE while adolescents exhibit increasing engagement in rule-breaking (RB) behaviors, there is a paucity of studies investigating whether and how changes in PSE are related to late adolescents' RB behaviors across development. The present study examined the developmental trends of PSE among Italian mothers and fathers over seven waves (representing children's transition from late childhood to late adolescence; approximately from 9 to 18 years old) as well as the longitudinal associations between PSE and RB behaviors during late adolescence. Data were drawn from seven waves of the Parenting Across Cultures (PAC) project, a large-scale longitudinal, cross-cultural study, and included 200 Italian children (MAgeAtTime1 = 9.80, SD = 0.65; 50.5% girls) and their parents (200 mothers; 190 fathers). PSE was measured across all seven time-points (from T1 to T7), while adolescents' RB behaviors were measured at the first and last assessment (T1 and T7). Results of univariate latent growth models showed a cubic trend of mothers' PSE, which revealed a decreasing pattern characterized initially by a slight decline, followed by a rebound before continuously decreasing. By contrast, fathers' PSE followed a linear decrease over time. Finally, our findings evidenced that only the slope of mothers' PSE negatively predicted adolescents' RB behaviors at T7, implying that mothers who maintained higher levels of PSE over time had children who later engaged in lower RB behaviors. The study implications are discussed.

Reach and predictors of effects during nation-wide dissemination of the universal parenting program All Children in Focus

BACKGROUND

Parenting programs have the potential to improve population health, if widely disseminated. However, wide-scale dissemination is challenging. Also, more knowledge is needed of whether parenting programs are effective for the variability of families in the general population.

METHODS

This study aimed to investigate who the universal parenting program All Children in Focus (ABC) reaches when offered in routine care in Sweden. A second aim was to investigate if the outcomes were predicted by factors related to family background, group leader experience, and homework completion. Questionnaires were collected before and after ABC from 1420 parents. Hierarchical regression analyses were performed to examine predictors of disruptive child behavior, parenting practices, and satisfaction.

RESULTS

ABC was available in about 40% of Swedish municipalities and reached a fairly representative population sample, with the exception that fewer fathers than mothers participated. The examined predictors explained a small proportion of the variance in the outcomes (2.5, 3.5 and 14.7%, respectively). Still, the effect on disruptive child behavior was statistically significantly larger for parents born in Sweden, with higher education, and older children. The effect on parenting practices was also larger for parents born in Sweden, for mothers, and for those practicing homework more frequently. Most examined predictors showed no statistically significant association with child and parenting outcomes. Parents were generally satisfied with ABC and the significant predictors of satisfaction had little practical meaning.

CONCLUSIONS

A fairly representative group of parents across Sweden were reached by ABC. Background variables, homework completion, and group leaders' experience explained a small proportion of variance in the outcomes. Meanwhile, the slightly lower intervention effects found for preschool children and parents born abroad calls for further investigation, since even small differences in effects can have an impact at a population level. The study also points to the importance of stressing homework completion and to increase the reach of universal parenting interventions to some underrepresented groups.

"Connection, community and convenience": A case study of a Facebook group for fathers navigating parenthood

ISSUES ADDRESSED

Fathers remain less likely to participate in parenting interventions which can limit their ability to receive support and build their parenting capacity. The advent of social media has engendered novel opportunities for fathers to connect with, and support, one another in the form of online peer support. Growth of these online communities exemplifies the demand from fathers to relate to other fathers who are navigating parenthood. However, the benefits of membership to these communities remain unclear. This study evaluated the perceived benefits of members of an online father-to-father, community-created and moderated Facebook group designed for Australian fathers in both rural and metropolitan regions.

METHODS

One-hundred and forty-five Australian fathers (aged 23-72 years) who were members of the same online fathering community completed an online survey where they qualitatively described their experiences as members of this community.

RESULTS

Content analysis of open-ended survey questions revealed that fathers identified a series of unique and important personal and familial benefits, which were largely attributed to their ability to connect with fellow fathers. Specifically, the opportunity to have convenient access to a safe space for fathers to connect was highly valued, providing fathers with opportunities to support, discuss and normalise parenting experiences.

CONCLUSIONS

Online father-to-father connection is a highly valued resource for fathers who are navigating parenthood. SO WHAT?: Online, community-led groups for fathers contribute to perceptions of genuineness and ownership by its members and provide a unique opportunity to connect and seek support for parenting.

Online mental health screening for rural fathers over the perinatal period

OBJECTIVE

To determine the feasibility of identifying distressed fathers in rural areas of NSW via a 'light touch' support program (SMS4dads).

DESIGN

A retrospective observational study using self-reported distress and routinely captured help-seeking behaviour over a 14-month period (September 2020-December 2021) comparing rural and urban fathers.

SETTING

Rural and urban Local Health Districts in NSW.

PARTICIPANTS

A total of 3261 expectant and new fathers enrolled in a text-based information and support service (SMS4dads).

MAIN OUTCOME MEASURES

Registrations, K10 score, program engagement, attrition, escalation and referral to online mental health services.

RESULTS

Rural (13.3%) and urban (13.2%) enrolments were equivalent. Rural fathers had higher rates of distress than urban fathers (rural 19%; urban 16%) and were more likely to be smokers, consume alcohol at risky levels and report lower education levels. Rural fathers were more likely to exit the program early (HR = 1.32; 95% CI 1.08-1.62; p = 0.008); however, once adjusted for demographic factors aside from rurality, this increased likelihood was nonsignificant (HR = 1.10; 95% CI 0.88-1.38; p = 0.401). Although engagement with psychological support during the program was equivalent, a greater proportion of rural participants were escalated to online mental health support (7.7%) than urban participants (6.1%); however, this was nonsignificant (p = 0.222).

CONCLUSION

Digital platforms offering text-based parenting information in a 'light touch' format may be an effective way to screen rural fathers for mental distress and connect them to online support.

Using machine learning to identify early predictors of adolescent emotion regulation development

As 20% of adolescents develop emotion regulation difficulties, it is important to identify important early predictors thereof. Using the machine learning algorithm SEM-forests, we ranked the importance of (87) candidate variables assessed at age 13 in predicting quadratic latent trajectory models of emotion regulation development from age 14 to 18. Participants were 497 Dutch families. Results indicated that the most important predictors were individual differences (e.g., in personality), aspects of relationship quality and conflict behaviors with parents and peers, and internalizing and externalizing problems. Relatively less important were demographics, bullying, delinquency, substance use, and specific parenting practices-although negative parenting practices ranked higher than positive ones. We discuss implications for theory and interventions, and present an open source risk assessment tool, ERRATA.

Understanding Attrition in Text-Based Health Promotion for Fathers: Survival Analysis

BACKGROUND

Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back "STOP" to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions.

OBJECTIVE

This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers.

METHODS

Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021.

RESULTS

Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale [K10] category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included "other reasons" (83/202, 41.1%), followed by "not helpful" (47/202, 23.3%) and "too busy" (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked.

CONCLUSIONS

Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers' role may be an important consideration in reducing fathers' disengagement.

Comparative efficacy of the Triple P program on parenting practices and family violence against children

BACKGROUND

The Triple P - Positive Parenting Program was rolled-out in two communities in Quebec, Canada, in order to prevent child maltreatment.

OBJECTIVES

(1) Evaluate the effects of Triple P versus care as usual on positive parenting practices, dysfunctional disciplinary practices, and family violence towards the child; (2) verify whether the observed changes persisted over time.

PARTICIPANTS AND SETTING

A quasi-experimental protocol with an active comparison group was used. Participants were 384 parents or parental figures of at least one 0-12-year-old child, assigned to one of two groups: Triple P (n = 291) and Care as usual (n = 93). We conducted a follow-up study with 164 parents from the Triple P group.

METHODS

We administered questionnaires at pretest, post-test, and follow-up. Standardized instruments measured positive parenting practices, dysfunctional disciplinary practices (overreactivity, laxness, hostility), and family violence towards the child (repeated psychological aggression, minor physical violence). The intervention dose received by each parent was calculated from data provided by practitioners.

RESULTS

Belonging to the Triple P group was associated with increased positive practices and decreased overreactive and hostile discipline. A higher dose of intervention was associated with a decrease in laxness. All observed changes were maintained at follow-up, with medium (η²_p = 0.073, hostility₎ to large (η²_p = 0.271, overreactivity) effect sizes. Also, Triple P was more effective in reducing minor physical violence, this effect persisting over time (from 36 % to 21 %).

CONCLUSIONS

This study supports the sustainable efficacy of the Triple P parenting program, except for repeated psychological aggression towards children.

Non-violent resistance parental training versus treatment as usual for children and adolescents with severe tyrannical behavior: a randomized controlled trial

Objective

This single-blinded, randomized, parallel group superiority trial evaluates whether the Non-Violent Resistance (NVR) program, a 10-session parental-group intervention, was more effective in reducing stress in parents of children aged 6-20 years and displaying severe tyrannical behavior (STB) compared to a treatment as usual (TAU) intervention that provided supportive counseling and psychoeducation.

Methods

Eighty two parents of youth aged 6-20 years with STB were enrolled by the Child and Adolescent Psychiatry Department at the University Hospital of Montpellier (France). A random block and stratified by age (6-12 and 13-20 years) randomization, was performed. All participants were interviewed by independent, blinded to group assignments, research assistants, and completed their assessments at baseline and treatment completion (4 months from baseline). Since this program has not been previously evaluated in this population, the study primarily evaluated the efficacy, using the Parenting Stress Index/Short Form (PSI-SF). The primary outcome was the change from baseline to treatment completion of the PSI-SF total score.

Results

Seventy three participants completed the study and were available for analysis (36 NVR and 37 TAU). At completion, between-groups comparison of the change (completion minus baseline) in the total score of PSI-SF was not significant (NVR: -4.3 (± 13.9); TAU: -7.6 (± 19.6); two-sample t-test p = 0.43; effect size of -0.19 [-0.67, 0.28]).

Conclusion

Contrary to our expectation, NVR was not superior to TAU in reducing parental stress at completion for parents of children with STB. However, NVR showed positive outcomes in the follow-up, pointing to the importance to implement parental strategies and following this population over longer time periods in future projects.Clinical trial registration: Clinicaltrials.gov, identifier NCT05567276.

Intervention and Implementation Characteristics to Enhance Father Engagement: A Systematic Review of Parenting Interventions

In recent years, the prevalence rates of children's mental health disorders have increased with current estimates identifying that as many as 15-20% of children meet criteria for a mental health disorder. Unfortunately, the same robust parenting interventions which have long targeted some of the most common and the most treatable child concerns (e.g., externalizing, disruptive behavior, and aggression) have also shown consistently low rates of father engagement. This persistent issue of engagement comes in the wake of an increasingly large body of literature which highlights the unique positive contributions fathers make to children and families when they are engaged in parenting interventions. As the role fathers play in families shifts to become more inclusive of childcare responsibilities and less narrowly defined by financial contributions, it becomes increasingly important to understand how best to engage fathers in interventions that aim to enhance parenting efficacy and family outcomes such as coparenting. The current review examined intervention (e.g., format and setting) and implementation characteristics (e.g., training and agency-level changes) associated with father engagement. Particular attention is paid to studies which described father-specific engagement strategies (e.g., inviting fathers directly, father-only groups, and adapting intervention to incorporate father preferences). A total of 26 articles met inclusion criteria after screening and full-text review. Results indicate that father engagement (i.e., initiating treatment) remains low with 58% of studies either not reporting father engagement or having engagement rates below 50%. More than two-thirds of studies did not include specific father engagement strategies. Those that did focused on changes to treatment format (e.g., including recreational activities), physical treatment setting (e.g., in-home and school), and reducing the number of sessions required for father participation as the most common father-specific engagement strategies. Some studies reported efforts to target racially and ethnically diverse fathers, but review results indicated most participants identified as Non-Hispanic White. Interventions were largely standard behavioral parent training programs (e.g., PCIT and PMT) with few exceptions (e.g., COACHES and cultural adaptations), and very few agencies or programs are systematically making adjustments (e.g., extended clinic hours and changes to treatment format) to engage fathers. Recommendations for future directions of research are discussed including the impact of differential motivation on initial father engagement in treatment, the importance of continuing to support diverse groups of fathers, and the potential for telehealth to address barriers to father engagement.

Psychosocial Resources Predicting Maternal and Paternal Positive Parenting and Lower Child Abuse Risk

Young children have the highest victimization rates of physical abuse in their first year of life, making up nearly half of all child abuse-related fatalities. More effective prevention is needed to reduce child victimization, yet many risk reduction models rely on problematic inclusion criteria, only intervene after maltreatment has occurred, or focus only on mothers. More proactive prevention models that promote positive parenting practices early in the transition to parenthood could be key to reducing child maltreatment. The current study sought to assess how both mothers' and fathers' psychosocial resources (e.g., emotion regulation, coping, and social support) and empathy can predict positive parenting and predict lower child abuse risk across time in a cross-lagged model. Parenting and abuse risk were examined prenatally, through the transition into parenthood, until children were 4 years old. First time mothers and their partners were recruited in the third trimester of pregnancy and assessed again when children were 6 months, 18 months, and 4 years old. Separate path models for mothers and fathers analyzed whether psychosocial resources and empathy at earlier timepoints predicted their positive parenting and lower abuse risk by the time children were age 4. Findings demonstrated that mothers' earlier empathy predicted later positive parenting and earlier positive parenting predicted later empathy. Fathers' lower prenatal abuse risk predicted greater subsequent empathy. Both mothers' and fathers' psychosocial resources and empathy at earlier timepoints predicted later positive parenting. Parents' psychosocial resources can be integral assets in positive, effective parenting approaches both concurrently and longitudinally. Mothers' and fathers' resources are an important point of intervention prior to and during the transition into parenthood to support healthier families that would confer benefits to child functioning.

Impact of the Momentum pilot project on male involvement in maternal health and newborn care in Kinshasa, Democratic Republic of the Congo: a quasi-experimental study

Background

The World Health Organization recommends that programs that seek to improve maternal and newborn health outcomes actively involve men during pregnancy, childbirth, and postpartum. However, there is little evidence on what strategies work to increase male knowledge of and involvement in antenatal and postnatal care. This study assessed the impact of the Momentum project on male involvement in maternal health and newborn care. The project involved monthly home visits to a cohort of first-time mothers aged 15–24 recruited at six-months gestation and group education sessions for their male partners using the Program P toolkit. Participants were followed-up for 16 months.

Methods

The study used a quasi-experimental design with three intervention and three comparison health zones. Baseline data were collected in 2018 and endline data in 2020. Exploratory factor analysis was used to develop scales of male involvement. We measured the causal influence of Momentum using an intent-to-treat analysis at the health-zone level and a dose–response analysis at the individual level. We used random-effects probit and linear models for outcomes measured at baseline and endline, and treatment effects models with inverse-probability weighting for outcomes measured only at endline. The impact analysis involved 1,204 male partners of first-time mothers with live births.

Results

Intervention health zones were associated with an 18.1 percentage point (95% CI [(10.6, 25.6]) increase in knowledge of three or more obstetric danger signs and a 13.9 percentage point (95% CI [6.3, 21.6]) increase in knowledge of newborn danger signs. Significant increases in male involvement in antenatal care (average treatment effect (ATE) = 0.728, 95% CI [0.445, 1.010]), birth planning (ATE = 0.407, 95% CI [0.157, 0.657]), and newborn care (ATE = 0.690, 95% CI [0.359, 1.021]) were found. The magnitude of Momentum’s impact increased steadily with the number of prenatal home visits and was statistically significant for all behavioral outcomes except shared decision making. Exposure to both home visits and group education sessions during the prenatal period had a significant impact on all outcomes relative to no exposure.

Conclusions

The study demonstrated the effectiveness of Momentum on male involvement in maternal health and newborn care.

Group Triple P Intervention Effects on Children and Parents: A Systematic Review and Meta-Analysis

Supporting parents through the delivery of evidence-based parenting interventions (EBPI) is a way of promoting children’s rights, given the known benefits to child development and family wellbeing. Group Triple P (GTP) is an EBPI suitable for parents of children aged 2–12 years, who experience parenting difficulties, and/or child behavior problems. Even though GTP has been intensively studied, information lacks on the magnitude of its effects, considering the risk of bias within and across prior research. To address this, a systematic review and meta-analysis (PROSPERO registration CRD42019085360) to evaluate the effects of GTP on child and parent outcomes at short- and longer-term was performed. Through a systematic search of a set of databases, 737 research papers were identified, and 11 trials were selected. The risk of bias within and across studies was evaluated. Significant positive effects of GTP were found immediately after the intervention for child behavior problems, dysfunctional parenting practices, parenting sense of competence, psychological adjustment, parental stress levels, conflict, and relationship quality. Six months after the intervention, positive effects were found only for child behavior problems. Data suggest that GTP might be an effective EBPI leading to positive family outcomes. Substantial risk of bias was found, highlighting the importance of improving the quality of research.

Azhe'é Bidziil (Strong Fathers): Study Protocol for the Pilot Evaluation of an American Indian Fatherhood Program to Improve the Health and Wellbeing of Diné (Navajo) Fathers

INTRODUCTION

Considering the critical role that American Indian and Alaska Native (Native) men play in family and child health, there is an urgent need to collaborate with Native communities in developing interventions and policies to improve Native men's health status. This study aims to address a significant gap in research by designing and implementing a culturally grounded health promotion program to increase economic stability, promote positive parenting, and build healthy relationships among Native fathers. The Azhe'é Bidziil ("Strong Fathers") study protocol, developed in response to community advisory board feedback, illustrates a community-engaged approach to developing and implementing a fatherhood program in two Diné (Navajo) communities.

METHODS/ANALYSIS

Azhe'é Bidziil was adapted from three evidence-based interventions developed in collaboration with Native communities. Intervention lessons were iteratively reviewed by a tribal working group to ensure that the content is culturally appropriate and relevant. A pre-post study will assess feasibility, acceptability, and satisfaction with the Azhe'é Bidziil intervention, as well as short-term impacts on positive parenting, economic stability, and healthy relationship outcomes. The intervention is composed of 12 weekly group sessions conducted with fathers (n = 750) that focus on developing knowledge and skills for positive father involvement, economic stability, and healthy relationships. Lesson content includes: honoring our roles as fathers, building healthy relationships, understanding the impact of historical trauma, goal-setting, and budgeting basics. Each of the 12 group lessons, consisting of 8-12 participants per group, last approximately 2 h. Eligible fathers or father figures are age ≥18 years, live within 50 miles of the participating Diné communities, and must be caregivers of at least one child ≤ 24 years. The outcomes for this study are acceptability, feasibility, and satisfaction with the intervention, as well as father involvement, quality of (co-) parenting communication, healthy relationships, fathers' engagement and communication with their children, protective factors (e.g., cultural connectedness and educational/career aspirations), and economic empowerment and stability. Participants will complete an outcome assessment at pre- and post-intervention (12 weeks later).

DISCUSSION

This study protocol presents one of the few evaluations of a fatherhood intervention to increase economic stability, promote positive parenting, and build healthy relationships among Native fathers in rural tribal communities. Such a study is sorely needed to address the health disparities perpetuated by social and Indigenous determinants of health that Native men experience today. If proven efficacious, this pre- post-study will inform a large scale randomized controlled trial to evaluate intervention impact, and if proven efficacious may be disseminated widely in tribal nations. Study findings may also deepen our understanding of peer mentoring, Native men's health status, involvement with their children, co-parenting relationships, family relationships, cultural connectedness, and economic status. The data collected may also inform strategies to ensure acceptability, feasibility, and satisfaction of an intervention designed specifically for Native fathers.

The Parents under Pressure parenting programme for families with fathers receiving treatment for opioid dependence: the PuP4Dads feasibility study

Background

The impact of parental drug use on children is a major public health problem. However, opioid-dependent fathers have been largely ignored in parenting research.

Objective

To implement and test the feasibility and acceptability of the Parents under Pressure programme (PuP4Dads) for opioid-dependent fathers and their families, and to determine whether or not a full-scale evaluation could be conducted.

Design

A mixed-methods feasibility study.

Setting

Two non-NHS family support services for parents who use drugs in Scotland.

Participants

Fathers prescribed opioid substitution therapy (n = 25), their partners (n = 17) and children, as well as practitioners, supervisors, service managers and referrers.

Intervention

A home-visiting programme, including an integrated theoretical framework, case formulation, collaborative goal-setting and modules designed to improve parenting, the caregiving environment and child welfare. The programme was delivered flexibly over 6 months by accredited practitioners.

Main outcome measures

Feasibility progression criteria included the recruitment target (n = 24 fathers), acceptability of PuP4Dads, father engagement in the study (including a minimum of 66% of fathers completing PuP and a minimum of 10 fathers completing baseline and post-treatment research interviews), engagement in qualitative interviews (including a minimum of 10 fathers and 90% practitioner uptake and 80% manager uptake), focus groups (with a minimum of 80% referrer uptake), adequate fidelity and no adverse events.

Data sources

The following researcher-administered validated questionnaires were used: the Brief Child Abuse Potential Inventory, the Parenting Sense of Competence Scale, the Difficulties in Emotion Regulation Scale, the Paternal Antenatal Attachment Scale, the Maternal Antenatal Attachment Scale, the Emotional Availability Scale, the Brief Infant Toddler Social and Emotional Assessment, the Strengths and Difficulties Questionnaire, the Conflict Tactics Scale, Treatment Outcome Profile and the EuroQol-5 Dimensions, five-level version. Other sources included parent-completed service use (an economic measure), social work child protection data, NHS opioid substitution therapy prescription data and practitioner-reported attendance data. We also conducted interviews with fathers (n = 23), mothers (n = 14), practitioners (n = 8), supervisors (n = 2) and service managers (n = 7); conducted focus groups with referrers (n = 28); and held an ‘expert event’ with stakeholders (n = 39).

Results

The PuP4Dads was successfully delivered within non-NHS settings and was considered acceptable and suitable for the study population. Referrals (n = 44) resulted in 38 (86%) eligible fathers, of whom 25 (66%) fathers and 17 partners/mothers consented to participate. Most fathers reported no previous parenting support. A total of 248 sessions was delivered to the 20 fathers and 14 mothers who started the intervention. Fourteen fathers (and 10 mothers) completed ≥ 6 sessions and six fathers (and four mothers) completed ≤ 5 sessions. Father and mother attendance rates were equal (mean 71%). Median length of engagement for fathers was 26 weeks and for mothers it was 30 weeks. Twenty-three fathers completed interviews at baseline, 16 fathers completed interviews at follow-up 1 and 13 fathers completed interviews at follow-up 2. Outcome measures were well tolerated; however, the suitability of some measures was dependent on family circumstances. The researcher-administered questionnaires had few missing data. The perceived benefits of PuP4Dads reported by parents, practitioners and managers included the following: the therapeutic focus on fathers improved parental emotion regulation, there was improved understanding and responding to child’s needs, there was better multiagency working and the programme was a good fit with practice ‘ethos’ and policy agenda. Learning highlighted the importance of service-wide adoption and implementation support, strategies to improve recruitment and retention of fathers, managing complex needs of both parents concurrently, understanding contextual factors affecting programme delivery and variables affecting intervention engagement and outcomes.

Limitations

Lack of emotional availability and economic (service use) data.

Conclusions

A larger evaluation of PuP4Dads is feasible.

Future work

Further work is required to demonstrate the effectiveness of PuP4Dads and the cost implications. A better understanding is needed of how the intervention works, for whom, under what circumstances and why.

Trial registration

Current Controlled Trials ISRCTN43209618.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.

Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial

BACKGROUND

Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low.

OBJECTIVE

This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials.

METHODS

A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used.

RESULTS

Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%).

CONCLUSIONS

The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307.

Global Workforce Development in Father Engagement Competencies for Family-Based Interventions Using an Online Training Program: A Mixed-Method Feasibility Study

Global access to practitioner training in the clinical engagement of fathers in family-based interventions is limited. The current study evaluated the feasibility of training practitioners in Canada and UK using online training developed in Australia by examining improvements in practitioner confidence and competence in father engagement, training satisfaction, qualitative feedback, and benchmarking results to those from an Australian sample. Practitioners were recruited to participate in a 2-h online training program through health services and charity organisations. The online program required practitioners to watch a video and complete self-reflection exercises in a digital workbook. Pre- and post-training measures were collected immediately before and after the online training program. The results indicated significantly large improvements in self-reported confidence and competence in engaging fathers following training, with levels of improvement similar to those found in Australia. Training satisfaction was high and qualitative feedback suggested providing local resources and increasing representation of social diversity could improve training relevance in local contexts. The findings suggest online training in father engagement can contribute to global workforce development in improving practitioners' skills in engaging fathers in family-based interventions.

Improving Parenting Practices Among Fathers Who Misuse Opioids: Fathering Through Change Intervention

Fathers have been largely neglected in the parenting literature though there is a critical need to improve parenting practices among fathers who misuse opioids in the midst of the opioid epidemic. Urgency is critical to rapidly intervene in the lives of fathers and children to reduce misuse and interrupt intergenerational cycles of substance misuse. Thus, we provide an overview of solutions to adapt existing parenting interventions for fathers who misuse opioids to accelerate the pace of science for this population.

Educating dog owners: how owner–dog interactions can benefit from addressing the human caregiving system and dog-directed parenting styles

Dogs need to adapt to a human environment to enhance their welfare and to avoid risks of undesired dog behaviour and relinquishment. Crucial to this adaptation may be how an owner interacts with the dog. Owner–dog interactions may be influenced by the human caregiving system with regard to how care, protection and resources are provided. This narrative review discusses how a consideration of the human caregiving system can benefit owner–dog interactions. Literature suggests that the human caregiving system and parenting styles could influence owner–dog interactions. Owner–dog education may improve these interactions. However, studies on owner–dog education present mixed outcomes for the dog. Also, only a few studies address owner outcomes, indicating a gap that needs filling. It is concluded that, when intervening in owner–dog interactions, more attention should be directed to aspects of human psychology. Dog-directed parenting styles can form one strategy as to improve owner–dog interactions and dog welfare.

Parenting behaviors of mothers and fathers of young children with intellectual disability evaluated in a natural context

The aims of this study were to analyze the interactions of mothers and fathers with their children with intellectual disabilities, focusing on certain parental behaviors previously identified as promoting child development, and to explore the relations between parenting and some sociodemographic variables. A sample of 87 pairs of mothers and fathers of the same children were recruited from Early Intervention Centers. The children (58 male and 29 female) were aged 20–47 months. Most of the families (92%) were from the province of Barcelona (Spain), and the remaining 8% were from the other provinces of Catalonia (Spain). Parenting behaviors, divided into four domains (Affection, Responsiveness, Encouragement, and Teaching) were assessed from self-recorded videotapes, in accordance with the validated Spanish version of the PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes). Parents were administered a sociodemographic questionnaire. The results revealed strong similarities between mothers’ and fathers’ parental behaviors. Mothers and fathers were more likely to engage in affectionate behavior than in teaching behavior. Only maternal teaching presented a significant positive relation to the child’s age. With respect to the child’s gender, no differences were observed in mothers’ parenting. Conversely, fathers scored significantly higher in Responsiveness, Encouragement and Teaching (and had higher total parenting scores) when interacting with boys. The severity of the child’s ID had a statistically significant effect only on fathers’ Teaching, which showed lower mean scores in the severe ID group than in the moderate and mild ID groups. Teaching also presented a significant positive relation to mother’s age, but father’s age was not related to any parenting domain. Mothers with a higher educational level scored significantly higher in Encouragement and Teaching, and the fathers’ educational level was not significantly related to any parenting domain. Mothers’ and fathers’ Teaching, and fathers’ Responsiveness, Encouragement and total parenting scores, presented a significant positive relation to family income. Finally, mothers spent more time in childcare activities than fathers, particularly on workdays. Our main conclusion is that mothers and fathers show very similar strengths and weaknesses when interacting with their children with intellectual disabilities during play.

"We're in the background": Facilitators and barriers to fathers' engagement and participation in a health intervention during the early parenting period

ISSUES ADDRESSED

Little is known about the barriers and facilitators associated with engaging fathers in interventions targeting their physical and mental health. The current research therefore aimed to explore fathers' perceived barriers and facilitators to engagement and participation in a health intervention delivered during the early parenting period.

METHODS

Eleven fathers of young children (0-4 years) were interviewed about their perceptions and experiences of facilitators and barriers to engaging and participating in an intervention (Working Out Dads) to target their mental and physical health. Interviews were recorded and transcribed. Transcripts were analysed using thematic analysis.

RESULTS

Fathers identified a number of program-related and father-related facilitators and barriers which impacted their engagement and participation. Program-related facilitators included: accessibility of the program; father advocacy of the program; group fitness/exercise component; and having a father-specific program. Facilitating factors related to fathers included: making social connections; learning how to be a better dad/partner; and partner support and encouragement to attend. Program-related barriers included: travel; lack of awareness; and gender roles. While father-related barriers included: being time poor; sacrifices to family; and apprehension.

CONCLUSIONS

The current findings identified many areas that facilitate, encourage and motivate men to participate in interventions which support their mental and physical health during the early parenting period.

RELEVANCE

Generating evidence on barriers and facilitators to health interventions is important to improving the current intervention along with informing the development of engaging and targeted health interventions for fathers in early parenthood.

ParentWorks: Evaluation of an Online, Father-Inclusive, Universal Parenting Intervention to Reduce Child Conduct Problems

Evidence-based parenting interventions are effective in reducing conduct problems, yet these interventions have limited reach, and few involve the participation of fathers. This paper describes the outcomes of an open trial of ParentWorks, a universal, online, father-inclusive parenting intervention aiming to decrease childhood behavioural problems and promote positive parenting in mothers and fathers. A total of 388 families (456 individual parents; 36.6% fathers) were included in the study. Mixed model analyses showed significant decreases in child emotional/behavioural problems, dysfunctional parenting, interparental conflict, and parental mental health problems. The baseline severity of child behavioural problems significantly moderated the effects on child outcomes so that children with higher levels of problems benefitted more from the program. Participation of both caregivers in two-parent families, as well as parent sex, did not significantly affect the program outcomes. Results provide initial empirical support for the universal, self-directed, online parenting intervention, in addressing both child behavioural problems and parenting outcomes. Trial registration: ACTRN12616001223426, registered 05/09/2016.

Are parental changes related to improvements in preschool children's disruptive behaviours?

OBJECTIVE

To investigate whether changes in parenting after behavioural parent training in routine clinical care are associated with improvements in preschool children's disruptive behaviours.

METHOD

We evaluated changes after parent training in maternal and paternal self-reports of parental discipline practices parenting sense of competence, and parents' ratings of child disruptive behaviours in parents of 63 children, with a one group pretest-posttest design. We also compared parenting parameters in this clinical sample with a nonclinical sample (n = 121).

RESULTS

Mothers' self-reports of parental discipline practices and parenting sense of competence significantly improved after behavioural parent training. Less over-reactivity in both mothers and fathers was associated with fewer disruptive behaviours in children. After parent training, mothers' ratings of their discipline techniques did not differ anymore from those in the nonclinical sample.

CONCLUSION

Positive changes in parental discipline practices, particularly less over-reactive parental behaviours, were related to a decrease of disruptive child behaviours.

Evaluation of 'The Father Effect' Media Campaign to Increase Awareness of, and Participation in, an Online Father-Inclusive Parenting Program

There is substantial evidence that parenting programs are effective in improving parenting and child mental health outcomes. While there is increasing focus on delivering parenting interventions online to increase their reach and dissemination, fathers are underrepresented in all formats of parenting programs. However, research suggests that father participation is important for intervention effectiveness. This study evaluated the effectiveness of a media campaign for increasing awareness of, and participation in, an online father-inclusive parenting program called 'ParentWorks'. An 8-week campaign was conducted in Australia via social media channels, digital display advertising, digital television, and radio. To assess the impact of the campaign, data were obtained from caregivers registering for ParentWorks during the campaign period (n = 848) and an 8-week comparison period that occurred 3 months later (n = 254). Additionally, a nationally representative sample of 2021 caregivers of children aged 2-16 years completed an online survey. Survey questions asked about exposure to the campaign, registration for participation in ParentWorks, and knowledge of the importance of father participation in parenting programs. Three times as many caregivers registered during the 8-week media campaign compared to the comparison period, and a significantly greater proportion of male caregivers registered in the campaign versus the comparison period. The online survey found that 11% of caregivers reported exposure to the campaign, and significantly more fathers than mothers reported exposure. Results showed that those who were exposed to the campaign were significantly more likely to endorse the importance of father participation in parenting programs, than those not exposed to the campaign. The findings indicate that media campaigns appear to be an effective method of increasing awareness of online parenting programs and enhancing rates of father involvement.

Treatment of child externalizing behavior problems: a comprehensive review and meta-meta-analysis on effects of parent-based interventions on parental characteristics

This is the first meta-meta-analysis examining the effects of parent-based interventions for children with externalizing behavior problems on parental characteristics (parenting, parental perceptions, parental mental health, parental relationship quality). Parent training interventions are recognized as evidence-based interventions for the treatment of externalizing behavior problems, although meta-analytic effects are heterogeneous. The objective of the present study was to comprehensively combine meta-analytic results on parent training interventions to arrive at valid effect predictions. Electronic databases were searched (PsycINFO, Medline, PubMed). In total, 11 meta-analyses were included that mainly comprised parents of children under the age of 13 years. Analyses were based on random effects models. Effect estimates were transformed to standardized mean differences (SMD) and corrected for primary study overlap. Results revealed a significant moderate overall effect for parenting (SMD 0.53) as well as for parents' report of parenting (SMD 0.60) and parental perceptions (SMD 0.52). Effects remained stable to follow-up. Results for observational data, parental mental health and parental relationship quality were small and only partially significant. Considerable heterogeneity within results was revealed. Overall, parent training interventions proved to be effective in improving parental characteristics for parents of children with externalizing behavior problems. Effectiveness was stronger regarding characteristics explicitly targeted by interventions. The findings should encourage health-care providers to apply evidence-based parent training interventions.

Evaluating Practitioner Training to Improve Competencies and Organizational Practices for Engaging Fathers in Parenting Interventions

Fathers are consistently underrepresented in parenting interventions and practitioners are an important target for change in interventions to enhance father engagement. This research examined the effects of two practitioner training programs in improving practitioner rated competencies and organizational father-inclusive practices. Two studies were conducted, each with a single group, repeated measures (pre, post and 2-month follow-up) design. Study 1 (N = 233) examined the outcomes of face-to-face training in improving practitioner ratings of competencies in engaging fathers, perceived effectiveness and use of father engagement strategies, organizational practices and rates of father engagement. Study 2 (N = 356) examined online training using the same outcome measures. Practitioners in both training formats improved in their competencies, organizational practices and rates of father engagement over time, yet those in the online format deteriorated in three competencies from post-training to follow-up. The implications for delivering practitioner training programs to enhance competencies and rates of father engagement are discussed.

Perspectives on ParentWorks: Learnings from the development and national roll-out of a self-directed online parenting intervention

Online parenting interventions are an increasingly viable alternative to face-to-face programs, as they can potentially overcome barriers to participation and increase program reach. The current paper describes learnings from the design, development and dissemination of ParentWorks, a self-directed online parenting intervention designed to be inclusive of both mothers and fathers. ParentWorks was promoted via a national media campaign and was accessible to all Australian parents through a dedicated website. Participants created a user account, engaged in a series of video modules, and completed assessment measures at pre-, post-program and 3-month follow-up. For two-caregiver families, parents were encouraged to participate together using a shared account. There was no direct practitioner support, although a range of innovative automated features were included to enhance participant motivation and encourage program completion. Several key lessons emerged from program development and implementation. These relate primarily to design and content of the program website, user account functionality, program structure and features, and data collection. Further research is needed particularly with regard to methods for increasing participant retention in self-directed online programs. The learnings described here will be relevant to those researching and developing online parenting interventions as well as other online mental health interventions aiming to reach a large population sample.

A benchmarking study of father involvement in Australian child mental health services

Fathers are underrepresented in interventions focussing on child well-being, yet research suggests their involvement may be critical to enhancing intervention effectiveness. This study aimed to provide the first Australian benchmark of rates of father attendance across several child mental health services. Retrospective casefile reviews were conducted to obtain data on father and mother attendance at 10 Australian child mental health services. A total of 2128 casefile records were retrospectively examined to extract family-level data. The main outcome measures were rates of father and mother attendance at sessions involving parents, and rates of father- and mother-instigated referral to services. Across services, fathers attended on average 48.2% (range 39.7% to 72.0%) of total parent sessions, with an average of 68.4% (range 53.1% to 88.1%) of fathers attending at least one session. Mothers attended sessions at significantly higher rates; an average of 92.8% of total parent sessions and 96.9% attendance for at least one session. For self-referred families, on average 12.6% of referrals were from fathers, and 87.4% were from mothers. These results indicate that rates of father attendance at Australian child mental health services vary, but are significantly lower than attendance rates for mothers. This may compromise the quality and outcomes of child mental health services in Australia. Routine monitoring of rates of father attendance is needed, as are strategies to enhance father engagement.

"Home Practice Is the Program": Parents' Practice of Program Skills as Predictors of Outcomes in the New Beginnings Program Effectiveness Trial

An examination of the content and processes of evidence-based programs is critical for empirically evaluating theories about how programs work, the "action theory" of the program (West et al. in American Journal of Community Psychology, 21, 571-605, 1993). The New Beginnings Program (NBP; Wolchik et al., 2007), a parenting-after-divorce preventive intervention, theorizes that program-induced improvements in parenting across three domains: positive relationship quality, effective discipline, and protecting children from interparental conflict, will reduce the negative outcomes that are common among children from divorced families. The process theory is that home practice of program skills related to these parenting domains is the primary mechanism leading to positive change in parenting. This theory was tested using multi-rater data from 477 parents in the intervention condition of an effectiveness trial of the NBP (Sandler et al. 2016a, 2016b). Four research questions were addressed: Does home practice of skills predict change in the associated parenting outcomes targeted by the program? Is the effect above and beyond the influence of attendance at program sessions? What indicators of home practice (i.e., attempts, fidelity, efficacy, and competence) are most predictive of improvements in parenting? Do these indicators predict parenting improvements in underserved subpopulations (i.e., fathers and Latinos)? Structural Equation Modeling analyses indicated that parent-reported efficacy and provider-rated parent competence of home practice predicted improvements in the targeted parenting domains according to both parent and child reports. Moreover, indicators of home practice predicted improvements in parenting for fathers and Latinos, although patterns of effects varied by parenting outcome.

A pilot evaluation of 'Working Out Dads': promoting father mental health and parental self-efficacy

AIM

Approximately one in 10 fathers experience mental health difficulties in the early years of parenting, yet there is a dearth of evidence-based interventions to promote fathers' mental health at this time. Therefore, the aims of this study were: (1) to obtain preliminary data on the short-term changes in mental health symptoms and parenting self-efficacy for fathers of young children (aged 0-4 years) participating in Working Out Dads (WOD) and (2) to explore fathers' experiences of participation in WOD.

METHOD

The sample consisted of 57 fathers who had at least one child aged between 0 and 4 years. Participants completed pre- and post- measures to assess the severity of depressive, anxiety and stress symptoms and parenting self-efficacy. A brief survey of fathers' experiences in WOD was also completed.

RESULTS

There was a significant reduction in fathers' reports of depressive and stress symptoms from pre- to post-intervention, and no significant change in anxiety symptoms. Parenting self-efficacy significantly increased from pre- to post-intervention. All changes were associated with moderate to large effect sizes. Fathers indicated that they were satisfied with the programme and that they were more confident in managing the stress of parenting and in their overall role as a father.

CONCLUSIONS

This is the first study to evaluate WOD and provides promising preliminary evidence for its short-term effects on fathers' mental health and parenting self-efficacy. Pilot results are positive and are a critical first step, informing the design of a more robust evaluation in the future.

Barriers to first time parent groups: A qualitative descriptive study

First-time parents' groups are offered to new parents in Australia to support their transition to parenthood. Not all parents avail of the service, some cease attendance, and fathers are under-represented. In the present descriptive, qualitative study, we examined first-time mothers' perspectives on the barriers to parental participation in the groups. Semi-structured interviews were conducted with a sample of eight first-time mothers in a regional city in Victoria, Australia. Interviews revealed groups were perceived as sites strongly reinforcing traditional social norms of parenting. From this central theme, six gendered subthemes emerged as barriers to attendance. Barriers to mothers included non-normative mothering narratives, such as experiencing stillbirth or having a disabled child, perceived dissonance in parenting ethos, and group size. Barriers to fathers, as perceived by mothers, included groups as female spaces, dads as a minority, and female gatekeeping. A multi-faceted approach is required to change the common perception that groups are for mothers only. Groups need to be more inclusive of different parenting experiences and philosophies. Segregated groups might better address the needs of both parents. Further research is required to capture fathers' perspectives.

Toward Father-friendly Parenting Interventions: A Qualitative Study

Levels of father participation in parenting interventions are often very low, yet little is known about the factors which influence father engagement. We aimed to qualitatively explore perceived barriers to, and preferences for, parenting interventions in a community sample of fathers. Forty-one fathers across nine focus groups were interviewed using a semi-structured interview. Data were analysed using inductive thematic analysis. Key barriers to father participation identified included: the perception that interventions are mother-focused; beliefs about gender roles regarding parenting and help-seeking; mothers' role as 'gatekeeper'; lack of knowledge and awareness of parenting interventions; and lack of relevance of interventions. Fathers reported preferences for specific content and intervention features, facilitator characteristics, practical factors, and highlighted the need for father-targeted recruitment and advertising. Many of the barriers and preferences identified are consistent with previous research; however, fathers' beliefs and attitudes around gender roles and help-seeking, as well as the perception that interventions are predominantly mother-focused, may be key barriers for community fathers. Strategies to overcome these barriers and better meet the needs of fathers in promoting and delivering parenting interventions are discussed.

Fathers' Perceptions of Change Following Parenting Intervention: Randomized Controlled Trial of Triple P for Parents of Children With Asthma or Eczema

Objective

To test whether families' participation in an evidence-based parenting program can improve health-related outcomes reported by fathers of 2- to 10-year-old children with asthma and/or eczema.

Methods

A 2 (Triple P-Positive Parenting Program vs. care as usual) by 3 (baseline, postintervention, 6-month follow-up) design was used, with random group assignment. Of 107 families, 51.4% (N = 55) had a father participate alongside the child's mother, who was the primary intervention target. Fathers completed questionnaires assessing illness-related child behavior problems; self-efficacy with illness management and illness-related child behavior problems; and health-related quality of life.

Results

Secondary intent-to-treat analyses indicated improved child behavior and self-efficacy for managing eczema, but not asthma. Health-related quality of life improved for children, but not parents/families. There were no other significant intervention effects.

Conclusions

Intervention outcomes were positive for eczema but not asthma, and did not depend on the extent of father participation in the intervention.

Examining Practitioner Competencies, Organizational Support and Barriers to Engaging Fathers in Parenting Interventions

Evidence-based parenting interventions have been developed and evaluated largely with mothers. This study examined practitioner reports of rates of father attendance, barriers to engagement, organizational support for father-inclusive practice, participation in training in father engagement, and competencies in working with fathers. It also explored predictors of practitioner competence and rates of father attendance. Practitioners (N = 210) who delivered parenting interventions completed an online survey. Participants reported high levels of confidence in engaging fathers, but only one in three had participated in training and levels of father attendance in parenting interventions were low. Logistic regressions showed that high levels of practitioner competence were predicted by participation in training. Moderate levels of father attendance (vs. low levels) were predicted by greater number of years of experience while high levels of attendance (vs. low levels) were predicted by greater experience, higher levels of competence and higher levels of organizational support. The implications of the findings to informing policy and practice for enhancing father engagement are discussed.

Promoting father involvement in early home visiting services for vulnerable families: Findings from a pilot study of "Dads matter"

Despite mounting evidence on the importance of fathers in children's development, evidence-based perinatal home visitation programs have largely overlooked fathers in the design and delivery of services. This paper describes the design, development, and pilot testing of the "Dads Matter" enhancement to standard home visiting services. Dads Matter is a manualized intervention package designed to fully incorporate fathers into perinatal home visiting services. Twenty-four families were enrolled in a pilot study to assess the feasibility, acceptability, and preliminary outcomes of the intervention. Using a quasi-experimental time-lagged design, 12 families received standard home visiting services and completed baseline and four-month post-tests. Home visitor staff were then trained and supervised to implement the Dads Matter enhancement in addition to standard services. Twelve additional families were then enrolled and completed baseline and four-month post-tests. Implementation data indicated that Dads Matter was implemented as planned. Cohen's d scores on outcome measures indicate positive trends associated with Dads Matter in the quality of the mother-father relationship, perceived stress reported by both parents, fathers' involvement with the child, maltreatment indicators, and fathers' verbalizations toward the infant. Effect sizes generally ranged from moderate to large in magnitude and were larger than overall effect sizes of home visitation services alone reported in prior meta-analyses. Dads Matter appears to be a feasible, acceptable, and promising approach to improving fathers' engagement in home visiting services and promoting family and child well-being.

Initial Findings from a Feasibility Trial Examining the SafeCare Dad to Kids Program with Marginalized Fathers

Few studies have explored the direct impact of behavioral parent training programs on child maltreatment behaviors among marginalized, at-risk fathers. This feasibility study examined SafeCare® Dad to Kids (Dad2K), an augmented version of the evidence-based child maltreatment prevention program SafeCare, to determine the acceptability and initial efficacy of the program for improving father parenting skills and reducing maltreatment risk. Ninety-nine fathers were enrolled in the study and randomized to the SafeCare Dad2K Intervention (n=51) or comparison (n=48). Intervention fathers participated in 6 home visiting sessions and comparison fathers received parenting materials via mail. All fathers participating in the study completed a baseline and 8-week assessment (post-intervention) of maltreatment behaviors. In addition, intervention fathers completed feasibility and parenting skill measures. A significant main effect emerged indicating decreases for both groups in psychologically aggressive behaviors. No significant group by time findings emerged for child maltreatment behaviors. Father intervention completers endorsed high satisfaction ratings for the program and demonstrated significant improvements in targeted father-child interaction skills. Based on the high rates of acceptability and initial improvement in positive parenting skills, findings demonstrate the feasibility for involving at-risk fathers in behavioral parent training programs targeting child maltreatment prevention.

Exploration of Factors Predictive of At-risk Fathers' Participation in a Pilot Study of an Augmented Evidence-Based Parent Training Program: A Mixed Methods Approach

There has been burgeoning parenting intervention research specifically addressing fathers in recent decades. Corresponding research examining their participation and engagement in evidence-based parent training programs, which have almost exclusively targeted mothers, is just emerging. The current study used mixed methods to examine factors that influenced completion of an augmented version of an evidence-based child maltreatment prevention program developed for male caregivers called SafeCare Dad to Kids (Dad2K) in a pilot study. The current sample comprised 50 male caregivers (Mage = 29.42 years, SD = 8.18) of a child between the ages of 2 and 5 years. Fathers participated in a baseline assessment and were considered program completers (n = 27) if they participated in the program's six home visiting sessions. A subsample of completers (n = 11) was recruited to participate in qualitative interviews that provided in-depth information about fathers' experiences in Dad2K. Logistic regression indicated that, in the context of other demographic predictors, fathers with an education beyond high school were over 5 times more likely to complete Dad2K program compared to fathers with a high school education or less. Qualitative analyses revealed that interviewed father completers were motivated to enroll and participate in a fathering program because of an interest to learn and obtain skills to make them a better parent. Fathers with a high school education or less may require additional engagement strategies to help proactively encourage their enrollment and completion of parent training programs.

Study protocol: evaluation of an online, father-inclusive, universal parenting intervention to reduce child externalising behaviours and improve parenting practices

Background

Parenting interventions that focus on enhancing the quality and consistency of parenting are effective for preventing and reducing externalising problems in children. There has been a recent shift towards online delivery of parenting interventions in order to increase their reach and impact on the population prevalence of child externalising problems. Parenting interventions have low rates of father participation yet research suggests that father involvement may be critical to the success of the intervention. Despite this, no online parenting interventions have been specifically developed to meet the needs and preferences of fathers, as well as mothers. This paper describes the protocol of a study examining the effectiveness of an online, father-inclusive parenting intervention called ‘ParentWorks’, which will be delivered as a universal intervention to Australian families.

Methods/design

A single group clinical trial will be conducted to examine the effectiveness of ParentWorks for reducing child externalising problems and improving parenting, as well as to explore the impact of father engagement (in two-parent families) on child outcomes. Australian parents/caregivers with a child aged 2–16 years will be recruited. Participants will provide informed consent, complete pre-intervention measures and will then complete the intervention, which consists of five compulsory video modules and three optional modules. The primary outcomes for this study are changes in child externalising behaviour, positive and dysfunctional parenting practices and parental conflict, and the secondary outcome is changes in parental mental health. Demographic information, satisfaction with the intervention, and measures of parental engagement will also be collected. Questionnaire data will be collected at pre-intervention, post-intervention and three-month follow-up, as well as throughout the program.

Discussion

This paper describes the study protocol of a single group clinical trial of a national, online, father-inclusive parenting intervention. The results from this study could be used to inform public policy about providing support to parents of children with behaviour problems, and enhancing the engagement of fathers in parenting interventions.

Trial registration

ACTRN12616001223426, registered 05/09/2016

Optimising child outcomes from parenting interventions: fathers' experiences, preferences and barriers to participation

Background

Early childhood interventions can have both immediate and long-term positive effects on cognitive, behavioural, health and education outcomes. Fathers are underrepresented in interventions focusing on the well-being of children. However, father participation may be critical for intervention effectiveness, especially for parenting interventions for child externalising problems. To date, there has been very little research conducted to understand the low rates of father participation and to facilitate the development of interventions to meet the needs of fathers. This study examined fathers’ experiences of, and preferences for, parenting interventions as well as perceptions of barriers to participation. It also examined how these factors were associated with child externalising behaviour problems, and explored the predictors of participation in parenting interventions.

Methods

A community sample of 1001 fathers of children aged 2–16 years completed an online survey about experiences with parenting interventions, perceived barriers to participation, the importance of different factors in their decision to attend, and preferred content and delivery methods. They also completed ratings of their child’s behaviour using the Strengths and Difficulties Questionnaire.

Results

Overall, 15% of fathers had participated in a parenting intervention or treatment for child behaviour, with significantly higher rates of participation for fathers of children with high versus low levels of externalising problems. Fathers rated understanding what is involved in the program and knowing that the facilitator is trained as the two most important factors in their decision to participate. There were several barriers to participation that fathers of children with high-level externalising problems were more likely to endorse, across practical barriers and help-seeking attitudes, compared to fathers of children with low-level externalising problems. Almost two-thirds of fathers of children with high-level externalising behaviour had not participated in a parenting intervention or treatment. The only significant predictors of intervention participation were severity of child externalising behaviour problems and child age.

Conclusions

The findings have important implications for services seeking to increase father engagement and highlight a number of strategies to enhance the promotion and delivery of parenting interventions to fathers. These strategies include more public health messaging about parenting programs and the importance of father participation.

Mothers, Fathers, and Parental Systems: A Conceptual Model of Parental Engagement in Programmes for Child Mental Health-Connect, Attend, Participate, Enact (CAPE)

Parenting programmes are one of the best researched and most effective interventions for reducing child mental health problems. The success of such programmes, however, is largely dependent on their reach and parental engagement. Rates of parental enrolment and attendance are highly variable, and in many cases very low; this is especially true of father involvement in parenting programmes. This paper proposes a conceptual model of parental engagement in parenting programmes-the CAPE model (Connect, Attend, Participate, Enact) that builds on recent models by elaborating on the interdependent stages of engagement, and its interparental or systemic context. That is, we argue that a comprehensive model of parental engagement will best entail a process from connection to enactment of learned strategies in the child's environment, and involve consideration of individual parents (both mothers and fathers) as well as the dynamics of the parenting team. The model provides a framework for considering parent engagement as well as associated facilitators and mechanisms of parenting change such as parenting skills, self-efficacy, attributions, and the implementation context. Empirical investigation of the CAPE model could be used to further our understanding of parental engagement, its importance for programme outcomes, and mechanisms of change. This will guide future intervention refinement and developments as well as change in clinical practice.

A randomized controlled trial of a brief versus standard group parenting program for toddler aggression

Physical aggression (PA) in the toddler years is common and developmentally normal, however, longitudinal research shows that frequent PA is highly stable and associated with long-term negative outcomes. Significant research has demonstrated the efficacy of parenting interventions for reducing externalizing behavior in children yet their typical length may overburden families, leading to low participation rates and high attrition rates. To increase the reach of parenting interventions and impact on the prevalence of externalizing behavior problems, brief interventions are needed. This RCT compared a standard (8 session) group Triple P to a brief (3 session) discussion group and a waitlist control for reducing toddler PA, dysfunctional parenting and related aspects of parent functioning. Sixty-nine self-referred families of toddlers with PA were randomized to the respective conditions. At post-assessment, families in the standard intervention had significantly lower levels of observed child aversive behavior, mother reports of PA and dysfunctional parenting, and higher levels of mother- and partner-rated behavioral self-efficacy than the waitlist control. Families in the standard intervention also had significantly lower levels mother-rated dysfunctional parenting than the brief intervention, and the brief intervention had significantly lower levels of mother-rated dysfunctional parenting than waitlist. There were no significant group differences at post-assessment for measures of parental negative affect or satisfaction with the partner relationship. By 6 month follow-up, families in the brief and standard intervention did not differ significantly on any measure. The implications of the findings to delivery of brief parenting interventions are discussed. Aggr. Behav. 43:291-303, 2017. © 2016 Wiley Periodicals, Inc.

Integrating Parents' Views on Sibling Relationships to Tailor an Evidence-based Parenting Intervention for Sibling Conflict

Parents play a crucial role in the development of their children's relationships with their siblings. Despite this, relatively few evidence-based parenting programs exist that specifically offer parents the strategies and techniques they desire and require for managing their children's sibling relationships. One way of bridging this gap is to design a tailored parenting intervention for sibling relationships that incorporates the parent voice in various aspects of program design. The current study recruited a convenience sample of 409 Australian parents to complete an online survey relating to their views on difficult sibling behaviors and what, if any, help they desire in dealing with the issue. The majority of respondents were Caucasian, middle- to upper-class mothers. Respondents predominantly attributed the causes of sibling conflict to their child's internal traits, but expressed strong desire for assistance with managing behavioral problems, especially when sibling relationships were marked by physical aggression. Respondents reported high levels of acceptability for positive, rather than punitive, parenting strategies and showed a clear preference for parenting interventions delivered in easy-to-access formats. The findings are interpreted in the context of guiding the development of a tailored parenting intervention for enhancing sibling relationships and reducing conflict.

Engaging Fathers in Effective Parenting for Preschool Children Using Shared Book Reading: A Randomized Controlled Trial

Engaging fathers and improving their parenting and, in turn, outcomes for their children in preventive/promotion-focused parenting interventions has been a notable, but understudied, challenge in the field. This study evaluated the effects of a novel intervention, Fathers Supporting Success in Preschoolers: A Community Parent Education Program, which focuses on integrating behavioral parent training with shared book reading (i.e., Dialogic Reading) using key conceptual models (i.e., common elements, deployment model, task shifting) to engage and improve father (i.e., male guardians) and child outcomes. One hundred twenty-six low-income, Spanish-speaking fathers and their children were recruited across three Head Start centers in urban communities and were randomized to the intervention or to a waitlist control condition. Outcomes were obtained before and immediately postintervention and included observed and father-reported parenting and child behaviors, standardized assessments of language, and father self-reported parental stress and depressive symptoms. Attendance data were also collected as a proxy measure of engagement to the intervention. Parenting behaviors (observed and father-reported), child behaviors (father-reported), and language development of the children in the intervention group improved significantly relative to those in the waitlist control condition. Effect sizes (ESs) were in the small to large range across outcomes. Fathers can be engaged in parenting interventions, resulting in improved parent and child outcomes. Greater attention must be given to methods for maximizing parenting within a family and toward developing effective, engaging, and sustainable intervention models for fathers.

Reducing Child Maltreatment by Making Parenting Programs Available to All Parents: A Case Example Using the Triple P-Positive Parenting Program

Preventing the maltreatment of children is a major public health challenge. Using the Triple P-Positive Parenting program as an example, this article makes the case that strengthening parenting and family relationships at a population level is a potentially powerful means of taking on this challenge. We focus on the value of making parenting programs available to all parents in the community. We conclude by examining the key ingredients required to make a population-level parenting approach to reducing child maltreatment work.