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

Abstract

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

The Father’s Part: A Pilot Evaluation of a Father-Centered Family Intervention Group in Child and Adolescent Psychiatry

“…Admitting the need for external help seems to be less pronounced among men [60]. Thus, it is important to validate caregiver-specific contributions in child mental health development and therapy [6]. The present study marks an important step toward father-inclusive therapeutic interventions in systemic child and adolescent psychiatry in Germany.…”

“…Family research is often lacking mother-father specification in developmental, educational, and mental health investigations, particularly as fathers are less involved in clinical mental health treatments of children and adolescents. Specifically within a clinic setting, fathers' engagement is poor [6]. High maternal child-care, fathers' working habits, and therapists' selection bias are among previously postulated reasons [34,55].…”

“…Formerly, hypotheses on conservative family models-when childcare was mainly a maternal task-focused on a deficit approach, with the aim of assimilating fathers and mothers [5,6]. Current family research examines the specific contributions of mothers, fathers, and other caregivers to child and adolescent development [7].…”

“…However, some gender-specific parent interventions exist, and also some specifically focusing on fathers; for example, the English manual 'Coaching Our Acting-out Children: Heightening Essential Skills' (COACHES) is specifically designed for fathers supporting the mental health treatments of children with ADHD. The eight-week training program combines the use of cognitive-behavioral strategies with recreational (mainly physical) activities (e.g., soccer drills and other games) for the development and training of fundamental positive parenting skills (e.g., homework support, reinforcement, timeouts) [6,42]. For young German patients and their families, there are no standardized and manualized father-centered intervention programs.…”

“…Study aims: Although family research is increasingly focusing on parent-specific influences on child development and mental health, fathers are still underrepresented in the psychological treatment processes of minors [34], and children and adolescents may significantly benefit from a paternal involvement [6,45]. There are only few structured father-centered interventions in child and adolescent psychiatry, and none in the German language.…”