Practitioner Review: Engaging fathers –recommendations for a game change in parentinginterventions based on a systematic review of the
global evidence
Catherine Panter-Brick,1 Adrienne Burgess,2 Mark Eggerman,3 Fiona McAllister,2
Kyle Pruett,4 and James F. Leckman4
1Department of Anthropology & Jackson Institute, Yale University, New Haven, CT, USA; 2Fatherhood Institute,London, UK; 3MacMillan Center for International and Area Studies, Yale University, New Haven, CT, USA;
4Child Study Center, Yale University, New Haven, CT, USA
Background: Despite robust evidence of fathers’ impact on children and mothers, engaging with fathers is one of theleast well-explored and articulated aspects of parenting interventions. It is therefore critical to evaluate implicit andexplicit biases manifested in current approaches to research, intervention, and policy. Methods: We conducted asystematic database and a thematic hand search of the global literature on parenting interventions. Studies wereselected from Medline, Psychinfo, SSCI, and Cochrane databases, and from gray literature on parenting programs,using multiple search terms for parent, father, intervention, and evaluation. We tabulated single programs andundertook systematic quality coding to review the evidence base in terms of the scope and nature of data reporting.Results: After screening 786 nonduplicate records, we identified 199 publications that presented evidence on fatherparticipation and impact in parenting interventions. With some notable exceptions, few interventions disaggregate‘father’ or ‘couple’ effects in their evaluation, being mostly driven by a focus on the mother–child dyad. We identifiedseven key barriers to engaging fathers in parenting programs, pertaining to cultural, institutional, professional,operational, content, resource, and policy considerations in their design and delivery. Conclusions: Barriers toengaging men as parents work against father inclusion as well as father retention, and undervalue coparenting ascontrasted with mothering. Robust evaluations of father participation and father impact on child or family outcomesare stymied by the ways in which parenting interventions are currently designed, delivered, and evaluated. Three keypriorities are to engage fathers and coparenting couples successfully, to disaggregate process and impact data byfathers, mothers, and coparents, and to pay greater attention to issues of reach, sustainability, cost, equity, andscale-up. Clarity of purpose with respect to gender-differentiated and coparenting issues in the design, delivery, andevaluation of parenting programs will constitute a game change in this field. Keywords: Research design, coparent,father involvement, child development, violence, prevention, family.
IntroductionParenting interventions hold great promise for thepromotion of healthy children, healthy families, andhealthy societies, in ways that comprehensivelyimpact the social, physical, and mental dimensionsof human wellbeing (Olds, Sadler, & Kitzman, 2007;Panter-Brick & Leckman, 2013). Why then arefathers so marginal to the bulk of parenting inter-ventions? Issues related to fathers were hardlydiscussed in a recent literature review of early childdevelopment programs, which assessed the effec-tiveness of 15 parenting interventions in low-incomeand middle-income countries and formulatedresearch priorities and programmatic recommenda-tions (Engle, Fernald, Alderman, Behrman, & Al,2011). Similarly, very few references to engagingfathers were made in policy documents that reviewedthe clear economic, health, and education argu-ments for investing in early child development
programs worldwide (Naudeau, Kataoka, Valerio,Neuman, & Elder, 2011). Programmatic approachesto early child development have recently called for aparadigm shift in global policy, to foster more effec-tive interventions and systemic approaches to rele-vant health, education, child protection, andfinancing agenda (Britto & Ulkuer, 2012). Thisdemands a careful evaluation of how issues of fatherparticipation and impact are articulated inapproaches to (a) research, (b) intervention, and (c)policy.
This review aims to engage with academicresearchers who involve themselves in programdesign and/or evaluation, and with stakeholderswho define the parameters, fund programs, or directthe implementation of parenting interventions. Ourpurpose is to distill the ingredients that matter forincluding fathers in a range of settings, in order tobest promote the social, physical, and mental healthof children and caregivers. We respond to a need todisseminate evidence, flag problematic issues, andencourage best practice, regarding the effectivenessConflict of interest statement: No conflicts declared.
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use anddistribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Journal of Child Psychology and Psychiatry **:* (2014), pp **–** doi:10.1111/jcpp.12280
of parenting interventions on family dynamics andchild wellbeing. Globally, we know that father–childrelations vary across time and cultures, and havedifferential impact on families and children (Cabrera& Tamis-Lemomda, 2013; Gray & Anderson, 2010;Hewlett, 2011; Shwalb, Shwalb, & Lamb, 2013). Wealso know that men’s parenting styles (e.g.,authoritarian, authoritative, permissive, indifferent,protective, negligent) are more variable and nuancedthan commonly thought (Selin, 2014), and thattraditional values pertaining to motherhood andfatherhood can exist alongside counter-culturalvalues that engage men in supporting mothers andchildren (Solis-Camara, Fung, & Fox, 2014). Anempirical, theoretical, and programmatic lenson gender equity is here needed to move beyondthe ‘one-size-fits-all’ parenting programs that essen-tially work to reproduce the social constructs ofmother-based childrearing practices.
Research on why fathers matter
Like mothers, fathers have roles and impacts thatprove both positive and negative for child wellbeingand family functioning: fatherhood is an importantaspect of child development (Lamb, 2010; Lamb &Lewis, 2013; Pleck, 2010). Cohort studies haverevealed the overall protective and positive effect offather involvement on offspring social, educational,behavioral, and psychological outcomes – through-out infancy, childhood, adolescence and adulthood.Short- and long-termpositive outcomes include thosepertaining to psychological health, externalizing andinternalizingbehavioralproblems, substancemisuse,criminality or delinquency, economic disadvantage,capacity for empathy, peer relationships, nontradi-tional attitudes to earning and child care, satisfactionwith adult sexual partnerships, and self-esteem andlife-satisfaction (Fatherhood Institute, 2013b; Feld-man, Bamberger, & Kanat-Maymon, 2013; Flouri,2005; Flouri & Buchanan, 2004; Kim, Mayes, Feld-man, Leckman, & Swain, 2013; Martin, Ryan, &Brooks-Gunn, 2007; Pattnaik & Sriram, 2010; Pleck& Masciadrelli, 2004; Sarkadi, Kristiansson, Oberk-laid, & Bremberg, 2008).
Disengaged and remote father–child interactions,as early as the third month of life, have been found topredict externalizing problems in children longitudi-nally (Ramchandani et al., 2013). Fathers’ sensitiv-ity in free play with their 2 year-olds was found to bepivotal to child adjustment at age ten, and morepredictive than early mother–child attachment at age16 (Grossman et al., 2002). In one prospectivelongitudinal study of 100 families, early-life mater-nal and paternal reciprocity were shown to eachuniquely predict children’s social competence andaggression in preschool, while father–adolescent andmother–adolescent reciprocity each predicted differ-ent aspects of dialogical negotiation (Feldman et al.,2013). A select body of literature has now evidenced
the neuroendocrine and neurobiological changesassociated with specific male and female parentalbehaviors (Atzil, Hendler, Zagoory-Sharon, Wine-traub, & Feldman, 2012; Kim et al., in press).Paternal psychopathology, evidenced in antisocialbehavior, substance misuse, and depression, hasdemonstrable impacts on child and adolescent func-tioning (Phares, Rojas, Thurston, & Hankinson,2010). Moreover, fathers are key to coparentinginteractions that impact family dynamics in waysrelated to, but distinct from, parent–child ormarital relationships (Fivaz-Depeursinge & Corboz-Warnery, 1999; McHale & Lindahl, 2011). In sum,an emergent but substantial body of research high-lights how critical fathers can be to child wellbeing,and why it seems good science and good practice toinvolve fathers in preventive interventions to fosterhealthy child development.
Interventions with fathers
The evidence base on parenting interventions thatexploit these benefits of paternal engagement, how-ever, is quite limited. Specifically, one systematicreview of early childhood programs identified only 14intervention studies that included fathers, 11 ofthem conducted in the United States (Magill-Evans,Harrison, Rempel, & Slater, 2006). In a metaanalysisof interventions for parents of children with devel-opmental disabilities, Singer, Ethridge, and Aldana(2007) identified 17 interventions (again mainlyUS-based), only three of which included impact datain relation to fathers. A systematic review of Behav-ioral Parent Training for attention-deficit/hyperac-tivity disorder (ADHD) studies found only 13%included information on father-related outcomes(Fabiano, 2007). And in a systematic review offathers’ involvement in programs for the primaryprevention of child maltreatment (most of which werealso US-based), only two of the 16 interventions thatmet eligibility criteria reported father-specific data(Smith, Duggan, Bair-Merritt, & Cox, 2012). Over-views that take a global perspective are currentlyconfined to the gray literature (i.e., published mate-rial that has not undergone formal peer review),namely conference proceedings, databases, pro-grams implemented by non-governmental organiza-tions and diverse charities worldwide (Burgess,2009; McAllister, Burgess, Kato, & Barker, 2012).For example, McAllister et al. (2012) reviewed cur-rent issues, discussed best practice, and listed atotal of 43 international ‘father-focused’ or ‘father--friendly’ programs, detailing case studies with thebest evidence base for interventions from the prena-tal period through the first 8 years of children’s lives.Their report made three crucial observations regard-ing the nature and scope of the evidence base. First,the evidence base is methodologically weak, in thesense that very few interventions dealing with fatherengagement have undergone robust evaluation any-
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2 Catherine Panter-Brick et al.
where in the world. Second, in evaluation, very few‘parenting’ interventions disaggregate findings bygender, and most are limited to short-term impactson family lives and self-reported beliefs and behav-iors. Taking this step would allow sound conclusionsto be drawn regarding the relative effectiveness ofmothering, fathering, or coparenting interventions.Third, on a global scale, the evidence base onparenting roles and parenting interventions is heav-ily tilted toward fathers, mothers, and children livingin the global north. In the global south, there existssome evidence regarding interventions with men topromote reproductive health and prevent gen-der-based violence or HIV transmission, but littleevaluation conducted with fathers in their role as
caregivers for promoting child health and develop-ment.
Father-focused interventions encompass programscommonly set to increase the quantity and improvethe quality of fathers’ involvement with their children.In this respect, parenting is considered a core medi-ator in the design of many interventions, given itsputative influence on a wide range of child outcomes(Olds et al., 2007; p. 357). An increased quantity ofthe time men spend interacting with their childrenthus serves as an important proxy for positive childoutcomes. Exemplars of interventions which payattention to fathers’ time commitments include, inthe United States, a range of Early Years father–childactivity programs, such as in Head Start (Fagan &Iglesias, 1999) and Early Head Start (Vogel et al.,2011) and, in Peru, Proyecto Papa in Acci�on (McAllisteret al., 2012). Of course, the time that fathers spend inparenting activities varies considerably worldwide –both in absolute terms, and relative to mothers(Miranda, 2011). Based onOECDdata, Scandinaviancountries emerge as the most gender-equal in timespent on child care (Fatherhood Institute, 2010). Inmiddle- and low-income countries, father-inclusiveprograms have often explicitly or implicitly encour-aged increased male involvement in child care anddomestic labor as part of a wider promotion of genderequality (Bhandari & Karkara, 2006; Barker,Dogruoz, & Rogow, 2009; McAllister et al., 2012).The quality of father–child interaction is commonlyaddressed in programs by focusing on fathers’ under-standing of child development and/or their skills inchild-behavior management. For example in Turkey,the community-based Father Support Program aimsto enhance awareness in fathers regarding theirimportance in child care and child development, andto reduce harsh parenting (Barker et al., 2009). Suchtypes of father-focused interventions are promoted ina wide range of settings, including jails, centersfostering early child development, and centers forchild and adolescent mental health, where fathers, astarget participants, are often not well acquaintedwithparenting literature, receive little social support, orhave little experience as primary caregivers. Interest-ingly, in cultures that favor a gender division of
reproductive and productive tasks, such as Turkeyand Pakistan, impetus for involving men in bothparenting programs and violence prevention pro-grams has come from women themselves (AC�EV,2009; Bhandari & Karkara, 2006), as well as frominternational organizations. Some UNICEF programshave begun with the premise that men have limitedknowledge of child health and development, whilefathers, beingprimedecision-makers in thehomeandcommunity, are crucial to improved maternal-childhealth outcomes. While engaging fathers in suchcontexts presents challenges, the demand by womenfor father engagement is apparent.
Moreholisticparenting interventions have addressedwider aspects of coparenting and family life known toimpact child health and development (Feinberg,Kan, & Goslin, 2009; Hawkins, Lovejoy, Holmes,Blanchard, & Fawcett, 2008). Thus Cowan, Cowan,Pruett, Pruett, and Wong (2009) identified fiveaspects of family life relevant to father engagement:caregiver mental health, the quality of relationshipsbetween parents, the quality of father–child ormother–child relationships, the pattern of care-giver–child relationships transmitted across genera-tions, and the balance of stressors and socialsupports outside the immediate family. Becauseparental mental health and the social architectureof family life can be important predictors of childhealth, the design and evaluation of some parentinginterventions have sought to address those widerdimensions. Indeed, a US program such as Family
Foundations has strategically focused on the copar-enting relationship of couples expecting their firstchild, in order to prevent the kind of stresses andearly parenting difficulties that may lead to a nega-tive developmental cascade in children (Brown,Feinberg, & Kan, 2011; Feinberg, Jones, Kan andGoslin, 2010; Feinberg & Kan, 2008). This approachis in stark contrast to the Nurse-Family Partnership(NFP) program, in place for more than three decades,but targeted at first-time mothers (Donelan-McCall,Eckenrode, & Olds, 2009). In the United Kingdom,where this program is known as the Family NursePartnership (FNP), relatively more attention hasbeen paid to engaging with fathers alongside vulner-able teenage mothers, providing early professionalhelp at a time when new parents redefine themselvesas caregivers and as a couple (Ferguson & Gates,2013).
There are substantial weaknesses in programevaluation related to coparents, namely programengagement with two parents rather than one. Fewstudies have sought to examine whether fathers areeffective ‘change agents’ (Elder et al., 2011), or aseffective as mothers in implementing change (Adesso& Lipson, 1981; Cia, Barham, & Fontaine, 2010).Some studies indicate that, even where only oneparent participates in the intervention, gains infamily functioning are greater or better maintainedwhen there is another parent in the home (Bagner &
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Engaging fathers 3
Eyberg, 2003; Hahlweg, Heinrichs, Kuschel,Bertram, & Naumann, 2010; Webster-Stratton,1985). Another-parent-in-the-home also seems tobe protective against program drop-out (Bagner,2013). But is delivery more effective when bothparents participate? May et al. (2013) found this tobe the case, as did Lundahl, Tollefson, Risser, andLovejoy (2008) and Bakermans-Kranenburg, vanIjzendoorn, and Juffer (2003) in metaanalyses. Thequality of evidence to-date, however, is highly vari-able: thus while Bakermans-Kranenburg et al.(2003) found three interventions with fathers to be‘significantly more effective’ than interventions withmothers alone, the studies involved only 81 fathers,and were not randomized. Without randomization,we cannot be sure whether positive effects have moreto do with the nature of families in which bothparents participate, than with fathers’ participationper se. The very few studies that have randomizedparticipants to test this important proposition havefound that engaging with both parents, rather thanone, may indeed deliver benefits (Besnard, Capuano,Verlaan, Poulin, & Vitaro, 2009; Cia et al., 2010;Cowan et al., 2009; May et al., 2013; Rienks, Wads-worth, Markman, Einhorn, & Etter, 2011).
In sum, most parenting evaluations have not beengender-disaggregated, nor has the impact of deliver-ing a program to both parents vs. one individualparent been measured. Most global overviews havefocused attention on identifying ‘strategic entrypoints’ for early child development investments, toinclude center-based programs, home-based pro-grams, and media campaigns (Naudeau et al.,2011). Moreover, concern is rarely expressed regard-ing the potential for couple participation to ‘skew’findings. For instance, if a significant percentage ofthe parents attending are couples, and if coupleparticipation enhances outcomes, does a positiveevaluation stem from program design and delivery,or from the fact that many parents attended �a deux?Similarly, given that fathers do not seem to benefit asmuch as mothers from program participation (argu-ably due to program design, rather than fatherdeficits), are findings skewed by participant gender,even when parents attend solo? In their review ofparenting interventions targeting competencies rele-vant to child health and development, Olds et al.(2007) emphasized that the evidence base on par-enting interventions will only be improved if researchprojects adhere to the highest standards of random-ization in controlled trials, and in particular, to theCONSORT standards for reporting evidence. Withoutrobust evidence, the considerable promise of par-enting programs for improving the life course ofchildren will remain undocumented.
Policy frameworks on parenting
Policies relevant to men as fathers are often focusedon specific social or health outcomes, rather than
holistically and synergistically geared to improvingfamily level caregiving environments. In the globalnorth, such policies are most often found in thedesign of paternity and parental leave systems andin the allocation of parenting time after divorce orseparation. In the global south, most of the fundingto engage men in programmatic interventions hasbeen in the areas of intimate partner violence, sexualand reproductive health, and HIV prevention,including Prevention of Mother to Child Transmis-sion. Even there, engagement with men may belimited or even counter-productive (Sherr & Croome,2012).
Policies on parenting tend to reflect and perpet-uate, implicitly or explicitly, the gender biases thatprevail in cultural stereotypes and mainstreamparenting practices. In the realm of social welfarepolicies, conditional cash transfers or other incomesupport programs for low-income families haveoften excluded men, on the grounds that womendevolve more of their income to the household thando men. Recent critiques of income support pro-grams are instructive: to focus exclusively onwomen may inadvertently contribute to a genderdivide, in which women are viewed as caregiversand responsible, while men are seen as inherentlyderelict in their capacity for family support.Similarly, strong gendering biases in parentingpolicies tend to reproduce a mothering ratherthan fathering cultural model of childrearing: thesetilt programmatic interventions toward mothers,rather than toward both fathers and mothers ascoparents.
Indeed, policy frameworks underpinning fam-ily-based interventions are often predicated on afather deficit model, one that sees fathers as inef-fective or neglectful in the arena of child health anddevelopment (Hawkins & Dollahite, 1997; Maxwell,Scourfield, Featherstone, Holland, & Tolman, 2012).Such a deficit model of father involvement is wide-spread in the social construction of parenting inter-ventions in countries such as the United Kingdomand the United States, but also in the global south.A more productive framework would espouse asocioecological model that focuses attention on thesocial, economic, and political environments thatshape the quality or quantity of father engagementwith their children and their commitment to copar-enting (Cowan et al., 2009; Sunar et al., 2013).
Gaps in the global evidence base
In sum, there is little evidence of a virtuous cycle inthe evidence base, given the gender biases that areoften manifested in policy frameworks, parentinginterventions, and even basic research. We knowthat gaps in the evidence base are best addressed bygrounding parenting interventions in theory, as wellas in epidemiology and developmental research.As highlighted by Olds et al. (2007; p. 357), this
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4 Catherine Panter-Brick et al.
includes a theory of program engagement, with aclear understanding of what drives beliefs andbehavior, including the fundamental question of‘why would parents want to spend their time partic-ipating in [a given] program.’ Olds et al. (2007) didnot highlight issues pertaining to father or coupleinvolvement. However, such issues lie at the heart ofbiases implicitly or explicitly embedded in mostparenting interventions.
Program engagement is certainly a critical elementof successful implementation. Yet there is scantresearch relating how participant engagementrelates to program outcomes (Daniel et al., 2011;Scourfield, Cheung, & Macdonald 2014). A growingnumber of studies are adopting more proactiveapproaches to engaging fathers, spurring a deeperreflection on how best to engage with men inprogrammatic interventions (Holmes, Galovan,Yoshida, & Hawkins, 2010; Maxwell, Scourfield,Holland, Featherstone, & Lee, 2012; Palm & Fagan,2008). In sum, when it comes to fathers, ourknowledge on the empirical associations betweenfathers’ involvement in raising children and thehealth or educational outcomes of children is quiteconsistent – fathers have a substantial impact onchild development and wellbeing. What is missing isa systematic evaluation of the global evidence baseregarding fathers’ impact on child wellbeing out-comes via the interventions which involve or couldinvolve them.
Objectives of this review
This paper offers a systematic review of father-inclu-sive parenting and coparenting interventions under-taken across the world. It asked two specificresearch questions. First, how are fathers currentlyinvolved in parenting interventions worldwide? Thisstep identifies the main obstacles to their inclusionand engagement, in terms of existing programs aswell as everyday parenting activities. Second, whatimprovements can be made in the design, imple-mentation, and evaluation of parenting programs toeffectively engage with fathers and assess relatedimpacts? This step identifies improvements thatwould constitute a game change in this field. Weconsidered preventive programs related to prenatalhealth and sexual health; harm-reduction programsthat addressed child maltreatment, domestic vio-lence, or alcohol abuse; behavioral training pro-grams, such as those for teenage parents, first-timeparents, and parents of children with developmentalor medical conditions; programs that engaged menin settings such as jails or early years’ centers; andprograms that involved men in child care andpromoting gender equality. Father/men-onlyprograms are not necessarily the best programmaticstrategy, but they are often the only place in whichto find evidence on father participation or effective-ness.
MethodsWe conducted a systematic search of standard literaturedatabases and a thematic hand search of the global literatureon parenting interventions, to include studies that offered dataon father participation and impact. This search strategyenabled us to identify the most widely used and best-documented parenting programs world-wide, and to includestudies of programs in the global south that would not havebeen captured by systematic searches of peer-reviewed jour-nals. We identified both single studies and reviews thatindicated successful strategies in father engagement and thatevidenced links between fathers’ program participation andchild outcomes. The term ‘father’ designated all men who aresocially significant to children or assume actual fatherly rolesin taking care of children, whether or not the birth father,married to the mother, or coresident with the child.
For the systematic database search, we targeted articlesfrom Medline, PsychInfo, SSCI, and the Cochrane Library.Using the appropriate proximity operators and (un)limitedtruncation characters for each respective database, our searchstrategy was as follows. In step 1, our search terms were:parent* with (program or intervention or engage or evaluation),father* with (program or intervention or engage or inclusion),men* with intervention, gender, partner, or coparent. In step 2,we narrowed the pool of results to necessarily include onesearch term designated by steps (a–c), as follows: we combinedstep 1 and (2a) father and (2b) (intervention or program) and(2c) (parent or coparent) and (2d) (evaluation or review). Thusresults from step 1 were narrowed such that the final set ofresults necessarily included at least one search term from Step2a, one search term from Step 2b, and so on. We imposed nodate or language limits on our database searches, which werefinalized in October 2013.
We supplemented the above searches with a thematic handsearch of the gray literature on parenting programs, such asthose conducted by UNICEF worldwide and available databas-es on the topic of fatherhood and child neglect. We alsoexamined books on fatherhood or parenting, conference pro-ceedings from voluntary organizations, research networkssuch as Childwatch, and the websites of OECD, the GlobalChild Development Network, the African Child Policy Forum,WHO, the World Bank, Fatherhood.gov, and ACF/OPRE.Finally, we contacted authors of sourced articles, and fathers’and men’s organizations worldwide.
Two authors removed duplicate records obtained fromsystematic database and thematic searches, then screenedall papers on the basis of their abstracts and/or full-lengthtext. Three coauthors independently assessed all papers withrespect to three exclusion criteria, to exclude material that (a)provided insufficient gender-disaggregation in program evalu-ation, (b) duplicated information presented elsewhere, or (c)did not include process evaluation or impact evaluation offamily dynamics or child wellbeing. Two coauthors reviewed asubsample of publications to ensure inter-rater reliability. Theremaining papers constituted the final set of full-text docu-ments selected for this review.
To evaluate quality and scope within this literature, we thenidentified a small number of studies on the basis of theirempirical and/or thematic contribution to father-inclusiveparenting interventions. We searched for exemplars of diversesettings, target group, mode of program delivery, and outcomeindicators, in order to characterize, on a global scale, currentefforts to engage with fathers and evaluate their impact onchild and family wellbeing. Four authors, working in pairs,independently assessed all papers selected for review, withrespect to three inclusion criteria, to capture studies (a)situated in the global south as well as the global north, (b)including both process data on father participation andoutcome data on father or child impact, and (c) exemplifyingdiverse modes of program delivery and target populations.Where several potential exemplars existed of a given program,
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Engaging fathers 5
we selected the parenting intervention that had benefited fromthe most comprehensive and high-quality evaluation.
Our review thus focused attention on research design andevaluation, rather than findings per se. On a global scale, thelack of gender-differentiated data essentially precluded auseful metaanalysis based on actual findings. Metaanalyses,however, are not the sole form of systematic reviews (Gough,Oliver, & Thomas, 2012; Petticrew & Roberts, 2006; Uman,2011). We systematically assessed the scope and quality ofextant literature. First, we comprehensively identified all thestudies relevant to answering two specific research questions(on engaging fathers in parenting interventions worldwide, andevaluating the soundness of program design and implementa-tion). Second, we tabulated single programs and created acoding scheme to explicitly assess the evidence base withrespect to caregiver demographics, sample size, group com-parison, and measures on family and child outcomes.
ResultsThe evidence base
Figure 1 shows the steps of our literature searches.From a total 31,586 articles that mentioned fathers,we identified 868 articles that engaged with fathersin parenting or coparenting interventions and men-tioned program evaluation or review, and an addi-tional 153 publications from hand searches of thegray literature, many of which concerned the globalsouth. In total, we screened 786 nonduplicaterecords. We then excluded 472 records on the basisof abstracts and 115 papers on the basis of full-textarticles, following our three exclusion criteria. To the
best of our knowledge, we identified the best-knownparenting interventions or studies that includedsome evidence of father inclusion or father impacton child or family outcomes (n = 199 publications).We categorized the results of our final searchaccording to whether this material consisted of(a) publications (n = 113) assessing a givenfather-inclusive parenting program, or (b) reviews,commentaries, book chapters, and working papers(n = 86) potentially useful for thematic discussion.
We present a global overview of the evidence basein Table 1 and online supplementary Table S1.Table 1 focuses on 34 exemplars (n = 52 publica-tions) to capture the diverse range of father-inclusive parenting interventions, in order to drawthematic conclusions on the nature of the evidencebase regarding gender-disaggregated parentinginterventions. It includes 14 exemplars from theUnited States, and 20 from other countries. TableS1 reviews an additional 58 programs (n = 61evaluations), including 36 US-based programs (39publications) and 22 programs from other countries.Upon examination, these were programs with smal-ler sample sizes, less rigorous evaluation of fatherparticipation or father impact, and/or interventionshighly similar to chosen exemplars. In selecting ourexemplars, we sought to achieve global representa-tion as well provide comparative perspective. Giventhe state of the evidence base, programs from theglobal south were often less rigorously evaluated
Figure 1 Literature search PRISMA diagram
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6 Catherine Panter-Brick et al.
than those from the global north; nonetheless, theywere included to provide geographical spread. In all,we list 92 programs (n = 113 publications) from 20different countries – Australia (n = 9), Brazil (n = 1),Canada (n = 5), China (n = 1), Finland (n = 1),Germany (n = 1), Iran (n = 1), Israel (n = 1), Jordan(n = 1), Mexico (n = 2), Niger (n = 1), the Netherlands(n = 1), New Zealand (n = 1), Pakistan (n = 1),Peru (n = 1), Sweden (n = 2), Turkey (n = 2), Ukraine(n = 1), United Kingdom (n = 7), and USA (n = 52).While Table S1 details, by country, the types ofprogram, their settings, target group, father samplesize, and data availability on father participation andimpact, Table 1 provides detailed information onprocess and impact data, in addition to informationon program type, mode of delivery, and target group.
Most program evaluations are situated in theglobal north – parenting interventions in the globalsouth are rarely captured by systematic databasesearches, while parenting interventions captured bythematic hand searches rarely involve fathers. Mostinterventions are designed with a view to harm-reduction or primary prevention. These includeprograms targeting vulnerable families ‘at risk’ ofvarious negative outcomes (e.g., programs such asHead Start in the USA, directed at low-incomeparents to mitigate the effects of poverty on parent-ing and child outcomes). They also include programsspecifically targeting men with a history of violentbehavior, or fathers of vulnerable children (e.g., bornprematurely, with disabilities or conduct disorders),for prevention of future harm and/or improvement ofparenting skills and child and family outcomes. Fewprograms aim to strengthen family-level resilience toenhance better-quality parenting.
How are fathers currently engaged?
Regarding our first question (how fathers are cur-rently involved in parenting interventions), posed toevaluate the extent to which fathers are targeted forinclusion, the cases in Table 1 and Table S1demonstrate a wide range of program design –and relatively low coherence overall. Some inter-ventions target just one parent, most often themother by default, as does, for example the Positive
Parenting Program (Triple P) developed in Australia(Fletcher, Freeman, & Matthey, 2011). Others aredesigned to engage with mothers and fathers inseparate groups, such as the Proyecto Papa in
Acci�on in Peru, aiming to increase the quantity offather–child engagement and fathers’ sensitivity tounderstanding child health and development issues(McAllister et al., 2012). Still others, such as theFatherhood Relationship and Marriage Educationintervention (FRAME) work only with couples(Rienks et al., 2011; Wadsworth et al., 2011). Someprogrammatic interventions are designed forhigh-risk families – such as the Australian Dads
on Board intervention with fathers who have under-
taken behavior-change programs due to their use ofviolence, while others are universal programs suchas the Leksand Models in Sweden, a maternityservices-based intervention (Hoskings & Walsh,2010; Johansson, 2012).
We found noteworthy exemplars of parenting inter-ventions offering relatively good designs as well aspromising outcomes from addressing or includingfathers (Table 1). Thus the Supporting Father Involve-
ment program in the United States focuses explicitlyon fathers’ roles and coparenting: remarkably, thisintervention tested whether men-only or coparentgroups were the most effective means of supportingfathers’ participation in the lives of their children(Cowan, Cowan, Kline Pruett, Pruett, & Gillette, 2014;Knox, Cowan, Cowan, & Bildner, 2011). Otherinitiatives have been developed to support positivecoparenting, taking this as a leverage point for theenhancement of family functioning and child out-comes (Feinberg & Kan, 2008). Also from the UnitedStates,Head Start exemplifies the type of interventionthat focuses explicitly on the father-preschooler dyad,looking to improve child behavior, social skills, andschool readiness by increasing fathers’ engagementwith their children and enhancing their support andchildrearing skills (Fagan & Iglesias, 1999). In Niger,Ecole des Maris characterizes a community-basedprogram that encourages men to advocate for andhelp develop health services to be accessed by moth-ers and children. This program, funded by the UnitedNations Population Fund (UNFPA), is based on thetheoretical premise that traditional male social powercan act as a brake on rates of improvement inmaternal and child health. Because men in Nigerdominate household and community decision-making, the program explicitly involved men totransform attitudes and behaviors of whole commu-nities, training ‘model husbands’ to enhance women’saccess to local health services, especially assistedchildbirth. Similarly in Turkey, the Father Support
Program (FSP) run by the Anne C�ocuk Egitim Vakfi(AC�EV) or Mother Child Education Foundation, wasestablished when the Foundation realized that fatherswould benefit from the kind of support that hadhitherto focused on the mothers of preschool chil-dren; indeed, the mothers enrolled in AC�EV’s Mother
Support Program had reported that their husbandswere ‘obstacles’ in supporting what women werelearning to foster positive child development (Barker,Do�gru€oz, & Rogow, 2009, p.8). The sessions targetedat fathers were thus designed to foster family-levelcommunication and move beyond authoritarian mod-els of fatherhood.
Of what quality are the evaluations?
Unsurprisingly, there exist few randomized-controltrials and quasi-experimental evaluations of parentingprograms that have included fathers. Among the 34programs in Table 1, eleven (eight of them in the
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Engaging fathers 7
Table
1Globaloverview
ofparentingprogra
msth
atevaluatedfath
erim
pactandparticipation(34exemplars)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
Australia
Burleigh
Relaxation
BabyBath
andMassage
19
1-h
rhomevisit
session,
showingavideoandgiving
both
parents
hands-on
experienceofth
etechniques
Moth
erandfath
ers
(couples)
andth
eir
4-w
eek-old
infants
RCT(n
=15intervention,
n=15controls).
Measures:self-completiontime
diaries;observationsoffath
er
–childintera
ctionandfamily
dynamics;KansasMarital
SatisfactionScale,CES-D
scale,Rosenberg
Self-esteem
scale
Process:timeandactivities
sheets
forparents
tofillout;
collected8weekslater,
at
whichtimeobservations
carriedoutbytw
oobservers.
Impact:
(a)parents:fath
er/
moth
erinfantbath
ing
frequency,massage
frequency,infantcaretaking,
intera
ctionquality,
self-esteem,depression,
maritalsatisfaction,and(b)
infants:responses/overtures
tomoth
er/
fath
er
Scholz
andSamuels
(1992),
andSamuels,Scholz,&
Edmundson(1992)
DadsonBoard
Weekly
2-h
rth
era
peutic
groupwork
sessionsover
8weeksplus‘thera
peutic
newsletter’(reportingoneach
session)forparents
betw
een
sessions.
Twofacilitators
(male
&female),
closely
supervised
Fath
ers
whohadalready
participatedin
behavior-changeprogra
msas
aresultofth
eiruseofviolence
–plusth
eir
babies/toddlers.
Moth
ers
canattendbutfocus
isonfath
er–childdyad
Progressofseven
fath
er-participants
andth
eir
partners
(ifattending),
monitoredandreported.
Measure:Matern
al/Patern
al
PostnatalAttach
mentSca
le
Process:pre/posttest(parent
report)plusfacilitator
observationandreport.
Impact:
fath
er/
infantand
moth
er/
infantattachment;
fath
ers’behaviorand
understanding(readinfant
cues;developcuriosity/
respectforinfant;understand
conceptof‘holding’;
understandim
pactofown
behavioroninfant)
Bunston(2013)
HealthyDads,
HealthyKids
Progra
m
89
1.5
hrweekly
face-to-face
sessionsfor3month
s:5
sessionsforfath
ers
only,3
physicalactivitysessionsfor
fath
ers
andchildren
Overw
eightandobesefath
ers
andth
eirprimary
school-aged
children
RCT(n
=27intervention,
n=26wait-listcontrol)
Process:data
collectedat
baseline,andat3-and
6-m
onth
follow-u
p:
observationandself-report.
Impact:
(a)fath
ers:weight
statu
s;waistcircumference;
systolicbloodpressure;
physicalactivity;dietary
intake,physicalactivity,and
(b)children:dietary
intake;
weightstatu
s
Burrowsetal.(2012),and
Morganetal.(2011)
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
8 Catherine Panter-Brick et al.
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
Positive
Parenting
Progra
m(Triple
P)
Exemplarofawidely-endorsed
behaviora
lparenttraining
(BPT)progra
m,deliveredin
variousform
ats
–th
emost
effectivewithfath
ers
being
SteppingStones(10sessions,
forparents
ofachildwitha
disability)andPathways(14
sessions,including4onanger
management)
Focusondyadic
parent–child
intera
ction:26%
ofattendees
are
single
moth
ers
and21%
fath
ers
[likely
tobeth
epartners
ofparticipating
moth
ers]
Metaanalysis
of28stu
dies
reportingfath
erengagement
inTriple
P(a
tinyproportionof
progra
mdelivery,sincedata
are
rarely
gender-disaggregatedand
neverdisaggregatedby
individualv.couple
participation).
Measure:TheParentingSca
le
Process:(m
ainly)pre-and
post-
self-report
(moth
ers
and
fath
ers);attendance&
homework
completion
(facilitatorreport);upto
2yearfollow-u
p.
Impact:(a)fath
ers:compliance
withprogra
m;im
pacton
fath
ers
relativeto
moth
ers,
and(b)children:behavior
Fletcheretal.(2011),and
Fabiano(2007)
Canada
CaringDads
17-w
eekgroupparenting
intervention;systematic
outreachto
moth
ers
toensure
safety
andfreedom
from
coercion;ongoing,
collabora
tive
case-m
anagementoffath
ers
withreferrers
andoth
er
professionals
involvedwith
their
families
Menwhohavemaltreated
(includingneglected)th
eir
childrenand/orexposed
them
tointimate
partner
violence
Assessmentof98menwho
completedth
ecourseandhad
pre
andpostassessments.
Measures:Buss-Perry
AggressionQuestionnaire;The
ParentingSca
le;TheParenting
Alliance
Measure
Process:Pre-andpost(fath
ers’
self-report).
Impact–fath
ers:aggression/
hostility/laxness;parenting;
coparenting
Scott
andLishak(2012)
Home-visiting
intervention
(noform
al
namegivento
this
intervention)
Parenteducationin
thehome
duringtw
ovisitsbyahome
visitor
First-timefath
ers
of
5-m
onth
-olds
RCT(n
=81intervention,
n=81control).
Measures:NursingChild
AssessmentTeach
ingSca
le;
ParentingSenseof
Competence
Sca
le
Process:Data
collectedat
baselineand3month
spostintervention(child
8month
old):observation;
fath
erself-report.
Impact–fath
ers:skills
infosteringcognitivegrowth
,sensitivityto
infantcues
Benziesetal.(2008),and
Magill-Evans,Harrison,
Benzies,Gierl,andKim
ak
(2007)
Chin
aEarly
intervention
forfath
ers
of
prematu
reinfants
Parenteducationandsupport
inaneo-n
atalintensivecare
unit:bookletplus5sessions
of1:1
guidancebynurses
Fath
ers
ofneonateslessth
an
37weeksgestationin
aneo-n
atalintensivecare
unit
Quasi-experimentaldesign–
historicalcomparisonstu
dy:
n=35interventionfath
ers,
n=34controls)
Measures:Parentalstressor
sca
le(NIC
U);Fatheringability
sca
le(NIC
U);Nurse-parent
support
tool(NIC
U);
demogra
phic
andcontrol
variables;bookletevaluation
Process:pre/postintervention
(fath
ers’reports).
Impact:
parentingstress;
fath
eringability;perceived
support
bynurse
Lee,Wang,Lin,andKao(2013)
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Engaging fathers 9
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
Iran Anger
management
training
79
weekly
groupwork
shops
Moth
ers
andfath
ers
13fath
ers
and8moth
ers
Measures:State-Tra
itAnger
ExpressionInventory;Parental
AngerEvaluation
Questionnaire
Process:Pre/postintervention
survey(parentself-report).
Impact:
angerintensity;anger
expression;angercontrol
Yekta,Zamani,Para
nd,and
Zard
khaneh(2011)
Isra
el
Nonviolent
resistance
(NVR)Parent
Tra
ining
50min
once-w
eekly
sessions
withboth
parents
for4–
10weeksplus29
intersessionphonesupport
calls
Moth
ers
andfath
ers
(couples)
ofchildren(ageunder18)
withacute
behaviorproblems
Quasi-experimental:46
moth
ers
and43fath
ers,with
wait-listcontrol.
Measures:TheParental
HelplessnessQuestionnaire;
anEsca
lationQuestionnaire;
Demogra
phic
Questionnaire
Process:Pre/post(6
weeks
afterintervention)
questionnaires(parent
self-report).
Impact:
parentalhelplessness,
powerstruggles,negative
feelings,parentalsubmission,
fath
er’sfamily-p
articipation
Lavi-Levavi,Shachar,
and
Omer(2013)
Jord
an
UNIC
EFBetter
Parenting
Progra
m(B
PP)
16hrdeliveredvia
different
schedules–e.g.,consecutive
days,weekly,month
ly
Moth
ers,fath
ers
(wheth
er
togeth
erasacouple
orin
single-sexgroupsis
not
known)
InJord
anonly
–quasi-experimentaldesign:
intervention(n
=336
participants,only
18ofth
em,
i.e.,6%,fath
ers),anda
controlgroup
Process:Data
collectedat
baselineandim
mediately
postintervention(parent
self-report).
Impact:
knowledgeofchild
development;
parentingskills
(reductionofharshdiscipline,
useofexplanationduring
discipline,perceptionof
behaviors
thatconstitu
techildneglect;
timewith
childrenplayingandreading)
Al-Hassan(2009),and
Al-HassanandLansford
(2011)
Niger
Ecolesdes
Maris
UNFPA-fundedschools
for
‘modelhusbands,’in
Zinder
region,tw
ice-m
onth
lymeetings
Menin
thecommunityvia
marriedhusbandsofgood
chara
cterasadvocates/early
adopters
Observation/report
data
monitoring
Process:Postintervention
reportingandself-report;pre–
postdata
comparison.
Impact:
ratesofprenatalcare,
assistedandsafe
deliveries,
infantmortality;community
actions(e.g.,new
facilitiesfor
womenandmidwives);men’s
attitudesandbehavior
UNFPA
(2011)
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
10 Catherine Panter-Brick et al.
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
Pakista
nAangan,Roza
nRegionalcapacitybuilding
work
shopsonmen,caring
andfath
erh
ood,to
address
childsexualabuse
Whole
community,including
fath
ers
andmen,religious
leaders,police,teachers
and
healthprofessionals
Reporting
Process:postintervention
reporting
Impact:
establishingoflocal
committee;attendanceby
menatcouples’andfath
ers’
groups;participationby
religiousleaders
inchild
sexualabusetrainingand
referral
Bhandari
andKark
ara
(2006)
Peru Proyecto
Papa
inAccion
Fivework
shopscoveringth
ebasicsofpositiveparenting
andth
eim
portanceofvisual/
verb
alstimulation/readingto
youngchildren;support
sessionforfath
ers
facing
particulardifficulties
Moth
ers
andfath
ers
(single
parents
andpartnered
parents)
Participants:n=500,
including125men
Process:Postintervention
survey:fath
erself-report
and
somepartnerreport.
Impact–fath
ers:family
involvement;
respectfor
familymembers;connection
withchildren;useofviolence;
participationin
domesticand
caregivingwork
McAllisteretal.(2012)
Sweden
Intern
et-based
Parent
Management
Tra
ining
(PMT)
79
1.5
hrsessionsdelivered
over10weeksvia
theintern
et
(text,
illustrations,videosof
parent/childintera
ctions,
parentingdiscussionforu
ms)
Homework
.Onlinefeedback
Moth
ers
andfath
ers
of104
childrenaged3–1
2exhibiting
conductdisord
ers
Quasi-experimentaldesign:
interventionparents
comparedwithwait-list
controls.
Sixty-n
inepercentof
participants
were
couples.
Couple
andindividualparent
participationmeasured,also
impactbychildgenderand
dose–responsera
tes.
Measuresincluded:Early
AssessmentRiskList-20B/
21G;Eyberg
ChildBehavior
Inventory;Strengthsand
Difficu
ltiesQuestionnaire;
ParentingPra
cticesInterview
Process:Baselineface-to-face
evaluationofchildrenfor
psychiatric
disord
ers.Pre/
post(and6month
follow-u
p)
parentreports.Attendance
record
s.
Impact:
childbehavior;
parentingstrategies;cost
Enebrink,Hogstrom,Forster,
andGhaderi
(2012)
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Engaging fathers 11
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
LeksandModel
16–1
8groupsessionsprenatal
to12month
spostp
artum.
Topicsincludechild
development,
bonding,couple
relationship,new
roles,
parentalleave
Expectantmoth
ers
andfath
ers
recru
itedvia
matern
ity
services,withfath
ers
specificallyinvitedto
thefirst
antenatalappointm
entand
there
personallyinvitedto
participate
inLeksand
Quasi-experimentaldesign:
familiesofbabiesborn
in2000,followedto
2006.
Leksandgroupscomparedwith
controls
whoreceived
traditionalparent-prepara
tion
andfewersessions
Process:surveys(self-report),
interviews,attendance
record
sIm
pact:
(a)moth
ers
&fath
ers:
satisfactionwithstaffand
progra
m;moth
er/
fath
er
attendance;fath
ers’parental
leaveuptake;progra
mcost,
and(b)children:collected,
butnotreportedin
English
languagepublications
Johansson(2012),and
HoskingsandWalsh(2010)
Turk
ey
Fath
erSupport
Progra
m(FSP),ACEV
13-sessionweekly
progra
mFath
ers
only
Surveys
Process:Pre/postsurveys
(fath
ers’self-report).
Impact:
parentingskills
and
behavior;
communication;
genderrelations
Bark
eretal.(2009)
UnitedKin
gdom
Celebra
ting
Fath
erh
ood:a
yearlong
campaign
2012–1
3
Activitiesincluded:trainingfor
professionals;aphotogra
phic
exhibition,afilm
,awebsite,a
celebra
tionevent,
and
‘Fath
ers’Fridays’
Fath
ers
andmale
carers;local
serviceproviders;policy
makers
Report
Process:Pre/postdata
comparison(2011–1
2vs.
2012–1
3).
Impact:
numbers
offath
ers
usingChildren’s
Centres,
attending‘Fath
ers’Fridays’,
SEN
(SpecialEducational
Needs)meetings,etc.;local
media
covera
geaboutfath
ers
Bath
&NorthEastSomerset
Council(2013)
FamilyNurse
Partnership
(FNP)
30-m
onth
intensive
home-visitingsupport
for
moth
ers
(progra
monLicence
anddevelopedfrom
theUS
NurseFamily-P
artnership
Progra
m)
Highly
vulnera
ble
teenage
moth
ers,fath
ers
frequently
engagedalso
(a)Surveyof54fath
ers
currentlyin
theprogra
m,(b)
interviewswith24fath
ers
and
professionals:(c)Data
and
inform
ationin
National
Evaluations
Process:fath
erself-report;
professionals’reports;
nationaldata
analysis
Impact:
fath
ers’progra
mparticipation;couple
communicationand
relationship;coparenting;
parenting
FergusonandGates(2013),
Barn
esetal.(2011),and
Fath
erh
oodInstitu
te(2013)
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
12 Catherine Panter-Brick et al.
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
Strength
toChange
Assessmentfollowedbyc.10
individualsessionsfollowed
bya1yeargroupprogra
m
Fath
ers
whohaveperp
etrated
domesticviolence
Mainly
processevaluation:(a)
projectth
roughputdata
(32
men,11women)over
18month
s,(b)47interviews
(21men,13partners),and(c)
10interviewswithproject
staff&
steeringgroup
members.
Measure:Bespokedata
collectiontoolrecord
ing
individual’sandpartner’s
history,serviceuse,socialand
familycontext,
pattern
sof
abuseandrisks
Process:interviewsduring/
postintervention(no
baseline);data
analysis.
Impact:
fath
ers’motivationto
complete
progra
mandchange
behavior;
actu
albehavior
change;awarenessofim
pact
ofviolenceonchildren
Stanley,Gra
ham-K
evan,and
Borthwick(2012)
Ukra
ine
UNIC
EFPapa
Schools
Betw
een7and92-h
rmen-only
peermentoringsessions
acrossth
etransitionto
fath
erh
ood.Oneelementin
amultifacetedprogra
mto
improveearlychildhood
healthanddevelopment
Expectantfath
ers
Regionaldata
(nocomparison
regions)andUNIC
EF
evaluationofth
ewhole
progra
m
Process:Baselineand
postinterventionsurveys;
data
analysis
Impact:
fath
ers’birth
attendanceandknowledge
andunderstandingofinfant/
childdevelopment;
breastfeedingra
tes,infant
mortality,childtrauma
McAllisteretal.(2012)
UnitedSta
tes
Creating
Opportunities
forParent
Empowermen
t(C
OPE)
A4-p
hase
educational-behaviora
linterventionprogra
mrelating
toth
ecare
ofprematu
reinfants
(audio-taped/written
inform
ationplusactivity
sheets)
Familiesofpreterm
infants
inintensivecare
units
RCT:258moth
ers
(147in
the
COPE
group,113in
the
comparisongroup)and154
fath
ers
(81in
theCOPE
group
and73in
thecomparison
group).
Measures:State-Tra
itAnxiety
Inventory;Beck
Depression
Inventory;ParentalStressor
Sca
le-N
eonatalIntensiveCare
Unit;IndexofParental
Behaviorin
theNIC
U;Parental
BeliefSca
le-N
ICU;Clinical
RiskIndexforBabies(CRIB
);InfantNIC
ULOS(length
of
hospitalstay);demogra
phic
inform
ation;infant
gestationalage
Process:analysis
ofhospital
data
anddemogra
phic
inform
ation;parent
self-report
andparent-infant
intera
ctionobservation.Data
collectedatbaselineandat5
oth
ertimepoints,includingat
2month
s’correctedinfant
age
Impact:
(i)moth
ers
and
fath
ers:parentalstressand
mood;parentalbeliefs;
parentingbehavior;
parental
sensitivity;involvementin
infantcare,and(ii)infant:
length
ofhospitalstayand
associatedcosts
Melnyketal.(2006)
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Engaging fathers 13
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
EarlyHead
Start
(EHS)
Fath
ers’participationin
EHS
activities
Low-incomefath
ers
of
preschoolers
inaru
ralarea
RCT:74fath
ers,47%
randomly
assignedto
EHSsupport
Measures:Coded
ObservationalMeasures;
BayleySca
lesofInfant
Development;Centerfor
EpidemiologicalStudies
DepressionSca
le;Parenting
StressIndex;Dyadic
Adjustm
entSca
le
Process:data
collectionat10,
14,24,and36month
s.
Observationat24month
s.
Impact:
(a)fath
ers:
fath
er-toddlersocialtoyplay,
(b)toddlers:developmentat
24and36month
s
Roggmanetal.(2004)
Family
Foundations
(FF)
Psycho-educationalsessions,8
classesover6month
sdeliveredth
roughexisting
childbirth
education
departments
Expectantfirst-timeparent
couples
RCT:5-w
avesoffollow-u
p;
secondwaveinvolvedn=147
moth
ers
(71control,76
interventiongroup).Follow-u
pto
7years
insomeinstances
Process:pre–p
ostsurveys
(parentself-report);
observation.
Impact:
(a)moth
ers
and
fath
ers:includesindividual
andfamilyfunctioning
(stress,depression,quality
of
couple
andcoparenting
relationship),and(b)
children:childadjustm
ent
Feinberg,Roettger,
Jones,
Paul,andKan(inPress),
Brown,Feinberg,andKan
(2011),Feinberg,Jones,Kan,
andGoslin(2010),Feinberg,
Kan,andGoslin(2009),
Feinberg
andKan(2008)
FlintFath
ers
andSons
Progra
m
Fifteen2-to-3
hrsessions
(fath
ers
withsons)conducted
twice-w
eekly
over2month
s
NonresidentAfricanAmerican
fath
ers
andth
eir
preadolescentsons
Quasi-experimentaldesign–
158interventionand129
comparisongroupfamilies.
Measures;:ParentalMonitoring
Index;questionsfrom
some
validatedscalescoalescedinto
new
scales;demogra
phic
and
controlvariables
Process:pre/posttestsurveys
(self-report)
Impact:
(a)fath
ers:patern
al
monitoring;fath
er–child
communications;
communicationaboutsex
andriskybehaviorextent;
intentionsto
communicate;
race-relatedsocializa
tion;
parentingskills;satisfaction,
and(b)sons:patern
al
monitoring;fath
er–child
communications;
communicationaboutsex
andriskybehaviorextent/
efficacy;ra
ce-related
socializa
tion;intentionsto
avoid
violence;physical
fighting;intentionsto
exercise
Ellis,Caldwell,Assari,andDe
Loney(2014),andCaldwell
etal.(2008,2010,2011,
2014)
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
14 Catherine Panter-Brick et al.
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
Fath
erh
ood
Relationship
andMarriage
Education
(FRAME)
14work
shophours
overfive
groupsessions,addressing
issuesknownto
affectth
equality
ofcouple
relationships:
communication,coping,
problem
solving;parenting
skills
Low-income,high-riskcouples
withchildren
RCT:data
collectedfrom
112
fath
ers
outof137couples
randomly
assignedto
couple,
male-only,orfemale-only
control.
Measures:Demogra
phic
and
controlvariablesincluding
relationship
withchild(birth
.v.socialfath
er);Brief
Symptom
Inventory-18
(anxiety
&depression);8-item
DangerSignssca
le(communication);Coping
Effica
cySca
le(m
odified);
Inventory
ofFather
Involvement;
Communication
Skills
Test;
ParentingAlliance
Inventory;Dyadic
Adjustm
ent
Sca
le(Relationship
Adjustm
ent
Process:pre–p
ostsurveys
(parentself-report);analysis
ofdemogra
phic
andcontrol
variables.
Impact:
amountoffath
er
involvement
Rienksetal.(2011),and
Wadsworthetal.(2011)
HeadStart
Class-room
volunteering;
Fath
ers’Dayactivities;
fath
ers’support
groups;
fath
er–childactivitysessions.
Fath
er-sensitivitytrainingfor
staff
Fath
ers
&fath
er-figuresof
3-to-5
yearolds
Quasi-experimentalresearch
design(146intervention
fath
ers/fath
er-figuresvs.55
comparisongroup)in
four
HeadStart
sitesvs.four
controlsites.
Measures:Parenting
Dim
ensionsInventory
Parent/CaregiverInvolvement
Sca
leWoodco
ck-JohnsonTests
of
Ach
ievement(revised)Social
Skills
RatingSystem
Process:Pre/postfath
ers’
self-report;interviews;
teacherreport;observation
Impact:
(a)fath
er:
accessibility
&engagementwithchild;
support
forlearn
ing;
child-rearingbehaviors;
dose-effect;
fath
er’s
residentialstatu
s;child
gender,
and(b)child:
behavior;
socialskills;
academic
readinessskills
FaganandIglesias(1999)
In-h
ome
trainingof
fath
ers
of
childrenwith
autism
A12-w
eektw
ice-w
eekly
in-h
ometrainingforfath
ers
infollowingth
echild’s
lead,
imitationwithanim
ation,
commentingonth
echild,and
expectantwaitingFath
ers
also
trainedto
train
moth
ers
Fath
ers
andmoth
ers
of19
childrenwithautism,
3-to-8
yearold
Surveysandobservation.
Measures:ADI–R,ADOS,and
theVinelandAdaptive
BehaviorSca
les;Parenting
StressIndex–S
hort
Form
;FamilyAdaptabilityand
CohesionEvaluationSca
lesII
Process:pre/postsurveys
(parentself-report);video
observation.
Impact:
(a)fath
ers
and
moth
ers:parentingstress;
parentingbehavior;
parent-to-p
arentknowledge/
skills
transmission,and(b)
child:behavior
Bendixenetal.(2011),Elder
etal.(2011),Elderetal.
(2005)
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Engaging fathers 15
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
InsideOut
Dads
12weekly
groupsessionsin
asmallgroupform
atwithat
leastonepeerleaderper
group
Incarcera
tedfath
ers
Quasi-experimental(n
=307)
andcontrol(n
=104)groups
inth
reecorrectionfacilities;
semistructu
redinterviews
withprogra
mparticipants
(n=27)andstakeholders
(n=6);within-facility
comparisonofinfractiondata
collectedfor90daysbefore
progra
mentry,during
progra
mparticipationandfor
90daysafterprogra
mexit.
Measures:InsideOutDad
Survey,plusCoping
Self-Effica
cySca
le,Fathers’
ParentalAttitudeResearch
Instrument
Process:Pre/postsurveys
(fath
erself-report);
postinterventioninterviews;
data
analysis.
Impact:
infractions;coping;
confidencein
receiving
support
from
staff;parenting
knowledge;parenting
behavior;
parentingattitudes;
familyrelationships;viewson
fath
erh
ood;progra
mcontent
anddelivery
Rutgers
University-N
ewark
Economic
Development
ResearchGroup(2011)
KeepA
Clear
Mind(K
ACM)
dru
guse
prevention
progra
m
49
weekly
in-schoollessonsfor
stu
dents,eachfollowedbyfive
parent/childhomework
activities
Teenagers
andth
eir
moth
ers
andfath
ers
RCT:1022parents
and511
teenagers
assignedto
interventionandwait-list
control.
Measures:(a)forstu
dents,
standard
izedandvalidated
developedbyauth
ors
for
previousstu
dies,and(b)for
fath
ers
andmoth
ers,new
but
pretested
Process:pre/postteststu
dent
andparentsurveys
(self-report);teachersurvey.
Impact:
(a)fath
ers:
dru
g-relatedparent–child
communication;parental
beliefs;progra
mcompliance,
satisfactionandperceived
effectiveness;dru
g-related
knowledge;motivationto
help
childrenavoid
dru
gs,and(b)
children:alcohol,tobacco,
andmarijuanause,
intentions,beliefs,and
knowledge;progra
mcomplianceandsatisfaction
Werchetal.(1991)
16 Catherine Panter-Brick et al.
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
Minnesota
Early
Learn
ing
Design
Coparenting
and
Childbirth
curricula
59
90-m
ingroupsessions
held
onceaweekfor5
consecutiveweeks
ExpectantyoungAfrican
AmericanandHispanic
fath
ers
andth
eir
adolescent
partners
RCT:coparentingintervention
(n=44,experimentalgroup)
andchildbirth
/babycare
intervention(n
=46,
comparisongroup)plus
‘strong’quasi-experimental
design(n
=64,controlgroup)
Measures:Fathers’prenatal
communicationand
involvement;
Parenting
Alliance
;Fathers’support
of
mother;
Fathers’engagement
withinfant;Parentingsenseof
competence
;Demogra
phic
measures;Measure
offathers’
subjectiveexperience
swith
theIntervention
Process:pre/postintervention
questionnaires(m
oth
ers
and
fath
ers);weekly
questionnaires(fath
ers).
Impact:coparenting;parenting
competence
Fagan(2008)
Oregonmodel
ofParent
Management
Tra
ining
(PMTO)
Manualprovidesmaterialfor
13sessions
Stepfath
ers;stepchildren
RCT:110recentlymarried
familieswithan
early-elementary-school-aged
focalchild:experimental
condition(61%)andcontrol
(39%)assessedover2years.
Themeannumberofsessions
attendedbyth
eintervention
groupwas11.71overan
avera
geof27.42weeks
Process:Extensive
multiple-m
eth
oddata
obtainedfrom
questionnaires,
interviews,anddirect
observationduringfour
centervisits,plus
preinterventionbaselineand
threepostintervention
follow-u
ps.
Impact:
(a)stepfath
ers:
involvement;
engagement;
parentingbehavior,
and(b)
stepchildren:compliance;
mood
DeGarm
oandForgatch(2007)
ShakenBaby
Syndrome
Prevention
Progra
m
Leaflets,posters,avideoand
signedparentalundertakings
inan8-county
regionof
western
New
York
State
Expectantandnew
moth
ers
andfath
ers
Quasi-experimentaldesign
comparingabusivehead
traumara
tesin
1–3
yearolds
over5years
with
preinterventionra
tesin
the
sameregionandstate-w
ide
ratesduringth
eintervention
period
Process:Postintervention
survey;data
collection;data
comparison;
Impact:
ratesofabusivehead
trauma;parents’recallof
videoandleafletcontentat
7month
follow-u
p,extentof
commitmentcontract
signatu
re
Diasetal.(2005)
Engaging fathers 17
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Table
1(continued)
Parenting
progra
mDelivery
Targetgroupandextentof
fath
erinvolvement
Natu
reandrigorofth
eevaluation
Processandim
pactoutcomes
Reference
Siempre
Papa
(the24/7Dad
Curriculum;
Spanish
edition,
delivered
acrossth
eUnitedStates)
Twelve2-h
rsessions
implementedin
groupsorwith
individuals
plusmental
health&
case-m
anagement
support
Latinofath
ers,includingin
acorrectionalfacility
211fath
ers
participatingin
the
intervention2006–2
011in
Maryland;plusheadline
findingsfrom
oth
er
evaluations
Process:Pre–p
ostfath
er
self-report.
Impact:
fath
ers’parenting
skills
andknowledge;time
spentwithchildren;attitudes
toward
partners
andgender
roles;communicationwith
partners
andchildren
McAllisteretal.(2012)
Supporting
Fath
er
Involvement
32-h
rcurriculum
over14–
16weeksbymale/female
coleaders
includingcouple
communication,parenting,
familybehaviorpattern
s.Case
managementandsupport
provided
Mainly
low-incomeMexican
AmericanandAfrican
Americanfamilies
3-arm
RCTwith900+couples.
Men-p
rimarily
groups
comparedwith
couples-groupsandcontrols.
Measuresinclude:video
observation;‘ThePie’;‘W
ho
doesWhat’Questionnaire;
Father–ch
ildRelationship
Sca
le;ParentingStressIndex;
Parentingstyle
attitudes
questionnaire;Quality
of
MarriageIndex;Couple
Communication
Questionnaire;ChildAdaptive
BehaviorInventory
Process:baselineand
postinterventionself-report
andindependentra
ting,with
videoobservationand
follow-u
pat18month
s.
Impact:
(a)fath
ers:
involvementandengagement,
parentingstressand
behavior,
couple
satisfaction,
(b)couples:relationship
satisfaction,decreasedstress,
couple
violence,harsh
parentingandfamilyincome,
(c)children:behavior
(hypera
ctivity)and
adjustm
ent,
and(d)
institu
tions:increased
fath
er-friendliness
Knoxetal.(2011),Cowan
etal.(2014),Cowanetal.
(2009),andCowanetal.
(2007)
Globalprogra
msare
designated
toaspecificcountrywhere
impactevaluation
took
place.RCT,ra
ndomized
controlled
trial.
Processdata
describeth
eextentto
which
fath
ers
were
includedin
thedelivera
blesofth
eintervention;im
pactdata
describeoutcomesrelatedto
effectiveness.
18 Catherine Panter-Brick et al.
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
United States) benefited from a randomized con-trolled trial evaluation, and nine (four of them in theUnited States) from quasi-experimental evaluation.Even among these robustly evidenced programs,sample sizes can be tiny: for example just 27 inter-vention and 26 control fathers were included in theAustralian child obesity program (Healthy Dads,
Healthy Kids), while others (e.g., Supporting Father
Involvement and Family Foundations, both UnitedStates) were couple interventions. Among 14 of ourtabulated programs, evaluations took the form ofsimple pre/post surveys, based on interviews withmixed groups of participants, while in some cases(e.g., Proyecto Papa in Acci�on, Peru), the evaluationwas a cross-sectional survey, postintervention.
Evaluations of programs from the global southtend to be among the least rigorous. For example, inJordan, while 93% of participants reported that theUNICEF-led Better Parenting Program was highlyuseful in conveying the role of fathers in children’slives, the evaluation survey data contained only 18fathers out of a total 336 participants – so fathers’views are essentially missing (Al-Hassan & Lansford,2011). And while the Turkish Mother Support Pro-
gram (AC�EV) is internationally renowned because ofits long-term evaluation (yielding key evidence oflifetime effects and multilevel benefits), the associ-ated Turkish Fathers Support Program has receivedlimited evaluation, namely a pre- and postcourseattitude survey to parenting roles, behavior, andcommunication (Barker et al., 2009).
In looking at the evidence from Table 1, whichincludes some of the best-known and best-evaluatedprograms for ‘parents’ in which fathers are known tohave participated, it is striking to find that (a) theevidence relating to fathers, where presented, iscommonly secondary to the evidence pertaining tomothers, and that (b) the evidence relating to couplev. individual participants is, with one exception,missing altogether. Indeed, the CONSORT standardsdesigned to provide a systematic and explicit frame-work for reporting quasi-experimental or experimen-tal data are far from attentively adhered to.
What outcomes are reported?
We indicate in Table 1 and Table S1 a range ofprocess and impact outcomes. The ‘process data’describe the activities, schedules, and deliverables ofthe intervention, while the ‘impact data’ describeoutcomes related to effectiveness per se. In mostcases, the lack of robust evaluation makes it difficultto evaluate ‘findings’ and substantiate the claimsthat programs have made for positive outcomes offather engagement; for this reason, we do not tabu-late empirical findings.
The evidence base on fathers is both patchy andlimited, reflecting the fragmented nature of datacollection and program design. While relevant out-comes of parenting interventions include both par-
ent-focused and child-focused variables, many of theinterventions in Table 1 include only parent-focusedvariables, rather than comprehensive measures offamily functioning and child developmental out-comes. As for research methods, only eight of theinterventions (e.g., the Home Visiting Program inCanada) include observation, rather than just paren-tal reports, to capture the quality of parent–childinteractions. Few assessment periods extend to6 months postintervention, although exemplarcohort studies with several-wave data such as Family
Foundations, the Leksand model and the Oregonmodel of Parent Management Training (Stepfathers)are able to shed light on longer-term birth outcomesand school or family functioning. Few studies haveincluded measures of mental health in their evalu-ation; the Family Foundations program is one exam-ple of couple-based prevention program thatexplicitly examined the protective or buffering effectson stress and maternal depression (Feinberg, Jones,Kan, and Goslin, 2010). Some interventions havefocused specifically on violence prevention, includingreduced harsh parenting by fathers (examplesinclude Triple P and Dads on Board in Australia,and UNICEF’s Better Parenting Program in Jordan).And while outcomes in Table 1 encompass bothfather impact and father participation, some parent-ing interventions (e.g., Celebrating Fatherhood in theUnited Kingdom and Aangan in Pakistan) weredesigned principally to increase fathers’ engagementwith local services, rather than to assess the impactof this on family or child wellbeing. Well-evaluatedparenting interventions (e.g., Incredible Years, Tri-ple-P, Family Nurse Partnership) typically reportmoderate effects on parent and child outcomes,including parents’ knowledge acquisition, healthbehaviors and children’s externalizing behavior.However, ‘father effects’ may remain elusive wherereporting is not gender-disaggregated, where samplesizes of mothers or fathers are not equivalent, orwhen different procedures are used for fathers andmothers in data collection.
Discussion and recommendationsOur evidence base shows that systematic evaluationof ‘father engagement’ and ‘father effectiveness’ isstymied by the way parenting interventions aredesigned and delivered. We turn to the secondquestion guiding this review: what improvementscan be made? Thus far, our results show that anoverhaul of program design and delivery is requiredto obtain the necessary good-quality data on fatherand couple participation and impact. In bothresearch and community-based practice, a gamechange in this field would consist in engagingunequivocally with coparents – rather than includejust mothers and explicitly or implicitly marginalizefathers and other coparents, as in the bulk ofparenting interventions implemented to-date.
Engaging fathers 19
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
Table 2offersaguide tobestpractice tohelp rethinkissues of (a) design, (b) delivery, and (c) evaluationonaglobal or local scale.We identified, fromour reading ofthe literature, key issues at each of these three stagesof parenting interventions; specifically, our researchand clinical experience led us to highlight issues thatpresent themselves as programmatically related toengaging coparents. First, with respect to design, weidentified seven major issues in terms of cultural,institutional, professional, operational, content,resources, and policy biases that work to marginalizefathers from the outset. We have already raised someof the gender biases in cultural, institutional, andprofessional practices predicated on a deficit modelthat sees fathers as ineffective or neglectful as par-ents. Because the impact of fathers on child wellbeing
and family functioning, either positive or negative, isincontrovertible, it is short-sighted to sideline fathers,or indeed other coparents, and to ignore their contri-butions by focusing only on mothers. Asking thequestion ‘how to make parenting interventions cul-turally compelling to both fathers and mothers ascoparents?’ is a good starting point. The next funda-mental requirement for a game change in parentinginterventions would be to pay attention to the neces-sity of gender-disaggregated data collection and datareporting – namely, exactly how many fathers, moth-ers, andcoparentsparticipated inagivenprogram – torender analyses by subgroup possible.
Second, with respect to delivery, we highlight keyprogrammatic and logistic issues that can work tosystematically disengage fathers from parenting
Table 2 A guide to best practice for building the evidence base of coparenting interventions
Design Delivery Evaluation
Cultural biases: Howculturally-compelling are parentinginterventions, in terms of makingthemselves relevant and attractive tocoparents?
When, where, and how: Does the timing,the place, and the medium of programdelivery work to include fathers as well asmothers? Are sufficient resourcescommitted to ensure reaching themboth? What are the advantages anddisadvantages of individual home visitsvs. group-based programs, and those ofprograms that engage with single parentsvs. coparents?
Reach: Inclusion and engagement ofsignificant caregivers, including fathersand other individuals in addition tomothers.
Institutional biases: How father-friendlyis the organization in terms of policies,recruitment, support, and monitoring?How responsive are parentinginterventions to gender-relateddifferences in parenting goals?
Training: Are facilitators ready andskilled to work with coparents, fathers aswell as mothers or other caregivers? Aretheir approaches sensitive togender-specific concerns?
Process: Data on recruitment ofparticipants, delivery of program,monitoring of attendance, participation,and referrals, pre/post institutionalpractices, and participant attitudinalchanges; observation and monitoringbeyond self-reports.
Professional biases: Do staff capabilitiesand attitudes toward parents excludefathers?
Communication: Are both mothers andfathers explicitly informed andindividually reminded about theimportance of program participation, andbenefits to children? Are both parentsfollowed up in cases of nonattendance?Are nonparticipating partners explicitlycontacted?
Impact: Prevention and reduction ofproblematic outcomes related to qualityof parenting and family functioning; childoutcomes in health, education,psychosocial development, andmaltreatment.
Operational biases: Is data collection onparents disaggregated by sex? Does itidentify coparents among mixed groupsof participants?
Activities: Are homework expected of allcoparents? Is participation monitored forone or both parents?
Sustainability: Commitment to policies,resources, and activities; outcomeslasting beyond a program’s timeframe.
Content biases: Is the content of theintervention relevant to fathers, as wellas mothers?
Holistic support: Are the needs of fathersas well as mothers recognized? Wheresupport is needed, are male as well asfemale caregivers directed to relevanthealth, education, and other socialservices?
Cost: Demonstrable cost-benefit forchildren, families, and societies;estimated cost of failing to engage withcoparents.
Resource biases: Are sufficient resourcescommitted to enable an organization toaudit current practices and implementchange?
Equity: Better outcomes for those mostdisadvantaged.
Policy biases: Are vision, needsassessment, partnerships, action plans,and strategies endorsed and integrated,with clear attention given to gender andcoparenting issues?
Scale-up: Provision for replication in othersettings; dissemination of findings tostrengthen the evidence base; advocacyfor a policy agenda on child wellbeing.
20 Catherine Panter-Brick et al.
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
interventions. For example the timing and the loca-tion of program delivery can be obvious deterrents tofathers, and to working parents generally. The case ofFamily Foundations presents a good example of amethodof delivering aprogram tofirst-timeparents ina nonstigmatizing way, with 8-week sessions pro-vided through an existing institutional niche, namelya hospital’s childbirth education department (Brown,Feinberg & Kan, 2011). Involving fathers early on,offering flexible hours or visiting at home, beingpersistent in communicating the positive gains tochildren of father involvement, being explicit in wel-coming them personally to participate (not simplythrough the mothers), are all essential steps thatremove barriers to father engagement (Maxwell,Scourfield, Featherstone, et al., 2012). Some keyquestions – with respect to ‘how’ programs are bestimplemented – still remain unanswered: dependingon cultural norms, risk profiles, financing and flexi-bility, programs might work best when targetingmothers and fathers during home visits or whendelivering group-based parenting programs inhealth,community or employment settings, and might bemost effective when reaching out to an individualparent or to two or more family members involved incoparenting.
Finally, with respect to evaluation, key issuesinclude moving beyond the evaluation of process
data (for example how many fathers or mothersparticipated in program activities and how and whenimpacts were measured). What is needed is morerobust and longer-term evaluation of outcome data,to include parenting quality, coparenting quality,family functioning, parental stress/depression, aswell as child outcomes in relation to health, educa-tion, psycho-social development and maltreatment.At best, this evidence is provided through random-ized controlled trials, cohort studies, observations,or third-party reports. We highlight here issues ofreach and sustainability, rather than just effective-ness or impact. These are important components ofprogrammatic ‘success’ that raise issues regardingpossible tradeoffs between effectiveness, efficiency,and equity. For example they raise questions as towhether the needs of harder-to-reach fathers areserved in parenting interventions, and whether psy-cho-education programs targeting behavior change,in the absence of structural interventions to benefitvulnerable families, benefit mostly those who arealready advantaged.
One of the most neglected aspects of evaluationrelates to economic arguments, in terms of compar-ing the benefits of targeted versus holistic interven-tions or engaging with one parent versus coparents.A comprehensive framework would includecost-effectiveness analyses, evaluating alternativeyet comparable programs, and cost-benefit analyses,weighing tradeoffs of alternative investments for‘maximum social gain’ (Naudeau et al., 2011; pp.160–2), to allow better financing allocation mecha-
nisms and scale-up of initiatives with demonstrableshort- and long-term benefits. For example in theirreview, Olds et al. (2007; p. 372 and p. 381) citedestimates from The Washington State Institute forPublic Policy showing that two programs – Parentsas Teachers (home visits and 3-year parent-groupmeetings) and the Nurse-Family Partnership program(tested in three separate randomized controlledtrials, RCTs) – respectively produced a$800-per-family and a $17,000-per-family returnon investment. Importantly, Heckman and col-leagues have argued that traditional ‘equity-effi-ciency tradeoffs’ are not pertinent to interventionsdelivered to disadvantaged children in the earlyyears of life: early child development programs offerboth a cost-efficient way to produce a capableworkforce and an equity-gain in helping those atgreatest disadvantage (Heckman, 2009; Heckman &Masterov, 2007; Campbell et al., 2014). From apolicy point of view, ‘it is not enough to know thatearly-life conditions matter. It is important to knowthe costs and benefits of remediating early-life def-icits at different stages of the life cycle’ (Conti &Heckman, 2013), as well as the longer-term benefitsof enhancing the capabilities of children.
ConclusionsThis review has fore-grounded discussion of parent-ing interventions that include fathers as significantactors in the lives of children. It makes a threefoldcontribution to the extant literature: we provide aglobal and comparative overview of the evidencebase, highlight why there are weaknesses in thisfield, and offer recommendations on father inclusionand engagement.
First of all, our review demonstrates a current lackof synthesis and coherence in the global evidencebase. To-date the literature on father engagement ishighly fragmented across education, gender, socialwork, and health-related fields, with patchy synthe-sis therein. It lacks a comparative perspective as wellas global representation, which makes it difficult toextrapolate relevant data from the experience ofpractitioners and participants in the high-incomenorth, and from the initiatives emerging from theglobal south.
Second, our review highlights a number of reasonswhy the evidence base on parenting interventionsthat have included fathers is often of poor quality.There are few exemplars using an overarching the-oretical model or an integrated operational strategyfrom design through to evaluation. Most reviewsto-date have included studies in which the smallnumbers of participating fathers were excluded fromanalysis, in which ‘parents’ were undifferentiated bygender, and in which the participation of couplesversus individual parents was not accounted for.Our understanding of fathers’ participation andimpact in parenting interventions is therefore still
Engaging fathers 21
© 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.
in its infancy, and the generalizability of findings farweaker for fathers than for mothers.
Third, we make recommendations on father inclu-sion and engagement in parenting programs, butcaution that these must be respectful of culturalvalues and consonant with structural constraintsthat shape everyday behavior. Some of the evidencepresented in this review comes from father-onlyprograms, with only a few focused more comprehen-sively on coparenting relationships. While this evi-dence is important, one must not be drawn intothinking that father-only programs are the best wayforward – some noteworthy research suggests thatthey are not (Cowan et al., 2009; Spaulding, Gross-man, & Wallace, 2009; Wadsworth et al., 2011).Indeed, many men are extremely unwilling to attendmen/father-only groups (Russell et al., 1999), whilefrom a programmatic point of view, men-only servicesare often an add-on to other programs, deemedunsustainable when resources are short. Further-more, behavioral change within families seems unli-kely to be sustained when only one parent, whetherthe mother or father, is the sole target of a parentingintervention. We need to comprehensively under-stand the community of care provided to children,and the sensitivity of children to a range of caregivingcontexts. A body of cross-cultural research thusreminds us of the significance of alloparents (includ-ing grandparents, other blood relatives, and commu-nity neighbors) as alternative caregivers with a stakein the everyday responsibilities of parenting, beyondsole consideration of the mother or biological parent(Bentley, 2009). In fact, children may be raised byseveral generations of female relatives, as in Mexico(Solis-Camara et al., 2014), or placed under the careof different relatives in response to changing socio-economic demands, as in Afghanistan (Panter-Brick,Goodman, Tol, & Eggerman, 2011). This raises ques-tions regarding which program modalities are themost compelling in which contexts, focusing atten-tion on the means of program delivery (group-basedvs. home visits, universal v. targeted, mother-only,father-only, or coparents), above and beyond atten-tion to program content. Recent advances in the fieldof child health and development have also remindedus that we need to rethink interventions in terms ofthe best leverage points to build family-level resil-ience, not justminimize risk to children (Panter-Brick& Leckman, 2013). They also challenge us to rethinkthe kind of evidence needed to detect ‘differentialsusceptibility to context,’ regarding both adverse andbeneficial effects of parenting (Pluess & Belsky,2010).
Understanding the fundamental dimension ofgender in parenting programs is as significant ascurrent efforts to target the different subgroups ofmothers (lone parent, teenage mothers, low-incomemothers,minority-groupmothers, substance-abusingmothers, and/or incarcerated mothers) in the globalnorth, or indeed to recognize the caregiving impor-
tance of grandmothers, mothers-in-law, and otherrelatives in the global south. The gendered and socialnature of parentingmeans that fathers, mothers, andother caregivers arrive with distinct expectations,assets, constraints, and experiences: these cannotbehomogenized or overlooked. In lower-income coun-tries, women (e.g., in the AC�EV-led initiatives inTurkey, Aangan in Pakistan) and professionals (e.g.,healthcare and development workers in Niger,Jordan, Ukraine) have actively sought methods ofengaging men in family issues. They work to mobilizemen’s interestand toengagemen inprivateandpublicspaces, in order to enhance interpersonal communi-cation, family-level care, community action, and childoutcomes.
Parenting interventions thus need to be compellingto all stakeholders and decision-makers, namelyfathers and other significant caregivers as well asmothers, program directors, and funders. More spe-cifically, resources can be unnecessarily wastedwhere there is no effective engagement with fathersin their roles as caregivers, because this mayundermine a range of existing parenting activitiesand negate additive or synergistic impacts in thelives of children. Whether absent or present, fathershave an impact on children, mothers, and familydynamics, for better and for worse. Marginalizingsuch important players amounts to poor profes-sional practice and poor evaluation. It may alsoundermine practitioners’ and policy makers’ duty ofcare, in failing to assess risk, enhance resilience, andoptimize the positive impacts on family and childwellbeing that are aspired to in parenting interven-tions. Key priorities are to engage fathers andcoparenting couples successfully, to disaggregateprocess and impact data by fathers, mothers, andcoparents, and to pay greater attention to issues ofreach, sustainability, cost, equity, and scale-up.
Supporting informationAdditional Supporting Information may be found in theonline version of this article:
Table S1 Global overview of parenting programs thatevaluated father impact and participation.
AcknowledgementsThe authors received no specific funding to undertakethis systematic review. They thank the Yale-AC�EVpartnership, The Fatherhood Institute, and the Bernardvan Leer Foundation for their collaboration, andWilliam Hodges for generating the initial set of refer-ences to be reviewed.
CorrespondenceCatherine Panter-Brick, Department of Anthropology &Jackson Institute, Yale University, 10 Sachem Street,New Haven, CT 06511, USA; Email: [email protected]
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Key points
• Fathers have substantial impact on child development, wellbeing, and family functioning, yet parentinginterventions rarely target men, or make a dedicated effort to include them.
• Our review of the global evidence on parenting interventions that have included men as parents or coparentsshows that insufficient attention is given to reporting father participation and impact.
• A fundamental change in the design and delivery of parenting interventions is required to overcome pervasivegender biases and to generate robust evidence on outcomes, differentiated by gender and by couple effects inevaluation.
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Accepted for publication: 28 March 2014
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