Research roundup: Engaging fathers in treatment

With increased numbers of dual income families and stay-at-home dads, fathers are playing a larger role in parenting than in previous decades. Despite this increase in involvement, numerous reviews have demonstrated a lack of representation of fathers in both research and practice regarding mental health interventions for children and their families (Flippin & Crais, 2011; Panter-Brick, et al., 2014; Smith, et. Al., 2012).

There is evidence, however, that engaging fathers in parenting interventions is associated with improved parenting and reductions in children’s externalizing behavior (Lundahl et al., 2008) among other benefits.

The following research studies examine the relationship between father involvement in parenting and children’s academic and psychological outcomes, explore the buffering effects of sensitive fathering on children’s mental health, and describe the rates of father attendance, practitioner competence, organizational support, and barriers to engaging fathers in parenting interventions.

In addition to reviewing the following research summaries, psychologists are encouraged to explore the literature more completely to determine what may be useful to them in practice.

Jeynes, W. H. (2015). A meta-analysis: The relationship between father involvement and student academic achievement. Urban Education, 50(4), 387. https://doi.org/10.1177/0042085914525789

In this meta-analysis, Jeynes examined the relationship between father involvement—defined as paternal participation in the child’s life by the biological male parent of the child in a legally recognized relationship—and the educational and psychological outcomes of urban school children.

A search of articles through numerous social science research databases (PsycInfo, ERIC, Sociological Abstracts, etc.) resulted in the inclusion of 66 studies examining the relationship between father involvement and the academic achievement and/or the psychological welfare of children from grades pre-kindergarten through college. Effect sizes were calculated from the data in each study using a variety of indices (e.g. t tests, F tests, p levels). Study quality ratings were also coded, and supplementary analyses were conducted using only studies of certain quality levels (quality factors: random assignment; avoided mono-method bias, mono-operation bias, and selection bias; had specific definition of father involvement).

Evidence from the reviewed studies indicate that overall there is a positive relationship between father involvement and youth outcomes. Interestingly, father involvement appeared to produce stronger positive effects in U.S. samples than in international samples (Asia, Latin America, Europe). In the combined sample (international and U.S.), the effects for children of color were significantly larger than for White children. Looking at the U.S. sample alone, the effects for children of color were larger but varied in level of significance depending on the quality of the data.

While not statistically significant, a trend emerged with father engagement having more of an impact on younger children than on older children.

In breaking down the studies by category of outcomes that father involvement was designed to foster, those for behavioral outcomes (primarily externalizing behaviors) yielded the largest effect size. Positive psychological outcomes and other healthy outcomes also produced a statistically significant effect size. Father’s participation that was intended to enrich academic outcomes (e.g. GPA, scores on academic assessments) did not yield statistically significant results.

Vakrat, A., Apter-Levy, Y., & Feldman, R. (2018). Sensitive fathering buffers the effects of chronic maternal depression on child psychopathology. Child Psychiatry & Human Development, 49, 779. https://doi.org/10.1007/s10578-018-0795-7

While the above study examined father involvement in a broad sense, this study focused on a specific population of children at increased risk for mental health issues. These authors sought to explore the possible buffering effects of sensitive fathering on children’s mental health within the milieu of chronic maternal depression. Sensitive parenting refers to interactions in which parents are aware of their children’s emotional and physical needs and respond appropriately and consistently.

A cohort of 1,983 married/cohabitating women over 21 years of age, living above the poverty line, recruited from three maternity wards, completed measures of anxiety and depression postbirth. Those scoring in the highest and lowest quartiles on the Beck Depression Inventory then completed measures of anxiety and depression again at six months and nine months, and at six years follow-up. Also, at the six-year follow-up, a family home visit was conducted to establish psychiatric diagnosis of the mothers (using the Structured Clinical Interview for DSM-IV Axis 1 Disorders) and children (using the Development and Well-Being Assessment) and to video-tape father-child interactions.

Two matched cohorts were established: 46 mothers with chronic depression and 103 non-depressed controls. Ten minutes of video-taped father–child interactions using toys shown to elicit symbolic play were examined using the Coding Interactive Behavior system. The following constructs were used: “Parent Sensitivity” (acknowledging, elaboration, social gaze, praising, positive affect, affectionate touch, etc.), “Dyadic Reciprocity” (reciprocity, adaptation-regulation, fluency), and “Dyadic Tension” (negativity-anxiety, hyper-diligence, constriction of play).

Results indicated that the partners of mothers with depression displayed lower sensitivity, lower father–child reciprocity (responding to a positive action with another positive action), and higher levels of tension during their father–child interactions.

With respect to the children, chronic maternal depression was associated with significantly higher prevalence of child psychopathology. 61% of the children of depressed mothers received Axis-I diagnoses compared to 15% of children of the controls.

Additionally, an interaction effect was found between maternal depression and father sensitivity. Among children of mothers with depression, children who experienced sensitive fathering were significantly less likely to receive a clinical diagnosis at age 6 compared to those whose fathers were less sensitive.

The prevalence of child psychopathology was low among the control group children regardless of father sensitivity level.

Tully, L., Collins, D., Piotrowska, P., et al. (2018). Examining practitioner competencies, organizational support and barriers to engaging fathers in parenting interventions. Child Psychiatry & Human Development, 49, 109. https://doi.org/10.1007/s10578-017-0733-0

In this study, the authors sought to examine rates of father attendance, practitioners’ competencies in engaging fathers, the barriers to engaging fathers in parenting interventions, and organizational support for father-inclusive practice.

Following pilot testing, 210 practitioners working with families to provide parenting treatment for child externalizing behaviors completed a survey with questions regarding demographics, rates of father attendance, competencies, training experience, perceived barriers, and organizational policies or practices around engaging fathers in treatment. Psychologists (39%), family support or case workers (21%), and social workers (18%) were the most common respondents, and most participants worked for either a non-government organization (40%), government child and family mental health service (24%), or private practice (16%).

For families with a father residing in the home, 17% of practitioners reported that fathers often attended, 53% reported that fathers sometimes attended, and 29% said that fathers rarely attended services. While practitioners agreed that services were more effective if fathers were involved (93%), only 27% were rated high in father engagement competence (a combined measure of practitioner confidence and reported usage of father engagement strategies). A similar percentage of practitioners (27%) reported receiving specific training in working with or engaging fathers.

Regarding barriers to engagement, the most frequently reported obstacles from the practitioners’ perspective were fathers’ work commitments (81%), fathers not having time (55%), fathers’ discomfort asking for or receiving parenting assistance (54%), and fathers feeling that it is a mother’s role to parent children (47%). Cost of service was the least endorsed perceived barrier (4%).

Practitioners viewed their organizations as supportive of father-inclusive practice (23% “extremely” and 37% “very”) with only 5% reporting that their organization was not very supportive; however only 41% of practitioners reported that their organization regularly offered sessions outside regular working hours to accommodate the identified barriers to engagement.

Results of a logistic regression indicated that practitioners who had received training in father engagement were 2.25 times more likely to be in the high versus low competence category. Regarding practitioners reporting moderate levels of father attendance (“sometimes” attended versus “rarely”), for every additional year of experience, practitioners were 1.05 times more likely to report that fathers sometimes attended relative to rarely attended.

For father attendance ratings of “often” attended when compared to “rarely” attended, there were two additional predictors: high levels of organizational support (6.28 times more likely than those with low levels of support to report that fathers often attended) and practitioners with high competence levels (5.68 times more likely than those with low competence to report that fathers often attended).

While there is an underrepresentation of fathers in both research and practice regarding mental health interventions for children and their families (Flippin & Crais, 2011; Panter-Brick, et al., 2014; Smith, et. Al., 2012), studies like the first two above demonstrate that fathers’ involvement can play a critical role, perhaps especially in the United States.

Explored in the meta-analysis above, children from pre-kindergarten to college had more successful outcomes with father involvement. In the second study, while children of depressed mothers were four times more likely to have a psychiatric disorder by age six, sensitive fathering reduced this risk by half, highlighting the importance of assessing a father’s role in the context of early adversity.

Despite the positive benefits that father engagement can have, the authors of the third study found that only one in six practitioners reported that fathers often attended parenting interventions.

Psychologists looking to increase the number of fathers who participate in treatment may want to consider providing programs at times that are convenient for fathers, such as evenings and weekends. Additional potential strategies include advertising that intervention programs or family sessions are for fathers as well as mothers and highlighting the importance of fathers’ participation during intake.

Because attending training programs on working with fathers was predictive of higher competence in engaging fathers, psychologists may want to research active skills training that cover enhancing confidence and experience in engaging fathers indirectly through mothers as well as engaging them directly. Future training topics could also include important, easy-to-implement strategies, such as effective ways to invite fathers to participate and problem-solving barriers to attendance.