Association for Public Policy Analysis & Management

Despite growing evidence on the importance of fathers in children’s development, home visitation programs have largely overlooked fathers in the design and delivery of services. This study describes the development, pilot testing, and early phases of a multisite randomized clinical trial (RCT) testing the efficacy of the “Dads Matter” enhancement, a manualized intervention designed to incorporate full consideration of fathers in the context of standard home visiting services. The enhancement guides home visitors to optimally engage fathers, to improve their knowledge, skill, and commitment to the fathering role, and to foster co-parenting strategies among mothers and fathers. This paper presents findings from a highly promising pilot study and preliminary trends from the ongoing RCT.  

Methods

For the pilot study, two program sites delivering home visiting services across well studied models were engaged in the greater metropolitan Chicago area and 24 families were recruited. Using a time-lagged design, families were enrolled sequentially in two study phases. In the baseline comparison group phase, twelve families received standard home visiting services and completed pre- and post-tests.  Following this phase, staff at the home visiting programs were trained and supervised to implement the Dads Matter enhancement. Twelve more families were then enrolled and completed identical pre- and post-tests. For the ongoing multisite clustered RCT, twenty-one home visiting program supervisors across five large organizations were randomized to deliver Dads Matter or deliver home visiting services as usual. In both studies, mothers and fathers completed baseline, 4-month, and (for the RCT only) 1- year follow-up interviews, along with audio-recorded sessions assessing parent-child verbalizations. Feasibility, acceptability, and fidelity of implementation of the intervention, and its components were also examined. Outcomes measured include father engagement, the mother-father relationship, father-child interactions, child maltreatment risk, parent-to-child verbal interactions, and (during the RCT phase only) child developmental outcomes.

Results

The pilot study included predominantly low-income African American and Latino families. A high percentage of fathers were retained in the study, and both parents were engaged in the enhanced services at rates exceeding clinical trials of most standard home visiting services. Pilot outcomes indicated positive trends in the quality of the mother-father relationship, both mothers’ and fathers’ reported stress, fathers’ involvement with the child, maltreatment indicators and fathers’ total verbalizations toward the infant. Pilot phase effect sizes were moderate to large in magnitude, and larger than effect sizes of home visitation services reported in prior meta-analyses.  Though the RCT is ongoing, similar trends are emerging. Trends on enrollment and outcomes, as well as fidelity of implementation in the RCT will be presented.  Cost analyses indicate the enhancement is highly cost efficient relative to the overall cost of home visitation services.

Conclusions and Implications

The Dads Matter enhancement to standard home visiting services is a potentially feasible, acceptable, and effective approach to increasing fathers’ engagement and promoting family and child wellbeing.  The enhancement will benefit from the completion of the RCT and feedback to continue to establish its efficacy and potential for large-scale dissemination to benefit vulnerable families nationally.