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Practitioner Review: Engaging fathers recommendations for a game change in parenting interventions 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. Leckman 4 1 Department of Anthropology & Jackson Institute, Yale University, New Haven, CT, USA; 2 Fatherhood Institute, London, UK; 3 MacMillan Center for International and Area Studies, Yale University, New Haven, CT, USA; 4 Child 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 the least well-explored and articulated aspects of parenting interventions. It is therefore critical to evaluate implicit and explicit biases manifested in current approaches to research, intervention, and policy. Methods: We conducted a systematic database and a thematic hand search of the global literature on parenting interventions. Studies were selected 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 and undertook 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 father participation 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 motherchild dyad. We identified seven 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 to engaging men as parents work against father inclusion as well as father retention, and undervalue coparenting as contrasted with mothering. Robust evaluations of father participation and father impact on child or family outcomes are stymied by the ways in which parenting interventions are currently designed, delivered, and evaluated. Three key priorities are to engage fathers and coparenting couples successfully, to disaggregate process and impact data by fathers, mothers, and coparents, and to pay greater attention to issues of reach, sustainability, cost, equity, and scale-up. Clarity of purpose with respect to gender-differentiated and coparenting issues in the design, delivery, and evaluation of parenting programs will constitute a game change in this field. Keywords: Research design, coparent, father involvement, child development, violence, prevention, family. Introduction Parenting interventions hold great promise for the promotion of healthy children, healthy families, and healthy societies, in ways that comprehensively impact the social, physical, and mental dimensions of human wellbeing (Olds, Sadler, & Kitzman, 2007; Panter-Brick & Leckman, 2013). Why then are fathers so marginal to the bulk of parenting inter- ventions? Issues related to fathers were hardly discussed in a recent literature review of early child development programs, which assessed the effec- tiveness of 15 parenting interventions in low-income and middle-income countries and formulated research priorities and programmatic recommenda- tions (Engle, Fernald, Alderman, Behrman, & Al, 2011). Similarly, very few references to engaging fathers were made in policy documents that reviewed the clear economic, health, and education argu- ments for investing in early child development programs worldwide (Naudeau, Kataoka, Valerio, Neuman, & Elder, 2011). Programmatic approaches to early child development have recently called for a paradigm shift in global policy, to foster more effec- tive interventions and systemic approaches to rele- vant health, education, child protection, and financing agenda (Britto & Ulkuer, 2012). This demands a careful evaluation of how issues of father participation and impact are articulated in approaches to (a) research, (b) intervention, and (c) policy. This review aims to engage with academic researchers who involve themselves in program design and/or evaluation, and with stakeholders who define the parameters, fund programs, or direct the implementation of parenting interventions. Our purpose is to distill the ingredients that matter for including fathers in a range of settings, in order to best promote the social, physical, and mental health of children and caregivers. We respond to a need to disseminate evidence, flag problematic issues, and encourage best practice, regarding the effectiveness Conflict 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 and distribution 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

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Page 1: Practitioner Review: Engaging fathers recommendations for ... · Practitioner Review: Engaging fathers – recommendations for a game change in parenting interventions based on a

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

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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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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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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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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,

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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.

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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.

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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)

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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)

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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)

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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)

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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)

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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.

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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.

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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.

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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.

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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)

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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.

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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.

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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.

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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

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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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