Examining Practitioner Competencies, Organizational Support and Barriers to Engaging Fathers in Parenting Interventions

This study reports on a survey of practitioners to examine their competencies in engaging fathers, barriers to engagement of fathers in parenting interventions, and organizational support for father-inclusive practice. While there have been several previous studies with practitioners to examine fathers’ engagement in services and programs, only one study to date has specifically been conducted with practitioners who deliver parenting interventions [22]. The present study involved a survey of practitioners from a broad range of professions and organizations who deliver parenting interventions or treatment for child externalizing problems. Overall, only one in six practitioners reported that fathers often attended parenting interventions, with just over half indicating that fathers sometimes attended and just under one-third reporting fathers rarely attended, where there was a father available in the home. This finding is consistent with previous studies and confirms that fathers have low rates of engagement in child-focussed services and interventions [25‐27].

Examination of practitioners’ reports of barriers provides insights into their perceptions regarding the key reasons for the low rates of father engagement. The most frequently endorsed barriers were fathers’ work commitments and lack of time, which have been identified as barriers in previous studies with practitioners [22] and fathers [21, 24, 29]. This finding points to the need to provide programs at times that are convenient for fathers, such as evenings and weekends. Despite this, only 40% of practitioners in this study indicated that their organizations frequently provided sessions outside working hours. Providing services outside working hours is unlikely to be feasible for all organizations due to staffing challenges [22], so greater overall flexibility in service provision may also be needed. For example, delivering parenting interventions in the workplace may increase access to services among fathers [30], although this may not achieve the goal of involving both parents in the intervention. Workplaces also need to provide greater flexibility by allowing fathers (and mothers) to attend services for their children during working hours, and research suggests that involvement in parenting interventions may improve both work and family life [31], and therefore may benefit employers as well. Another option for overcoming such barriers is to harness new technologies. For example, evidence from a meta-analytic review (k = 12) supports the efficacy of internet-delivered parent training [32]. Importantly, a recent survey of 1000 fathers in the community found that they would be most likely to participate in internet-based interventions [24]. Thus, these programs provide another mode of intervention for families who are unable to attend a face-to-face program.

Around half of practitioners also endorsed barriers such as ‘fathers don’t feel comfortable asking for/receiving parenting assistance’ and ‘fathers feel that it’s a mother’s role to parent the children’, which suggests that help-seeking attitudes and perceptions of masculinity may also be key barriers to participation for some fathers, and this has been identified in qualitative studies with fathers as well [29, 33]. These specific barriers were included in a recent survey of fathers, but were endorsed as a barrier by very few fathers; not feeling comfortable asking for assistance and feeling it was a mother’s role to parent the children were only endorsed by 7% and 3% of fathers respectively [24]. While it is difficult to compare a community sample of fathers with practitioners who largely work in clinical contexts, these differences are striking, and may reflect practitioner overestimation of the extent to which these factors are barriers to father engagement. While in the current study practitioners were asked to indicate whether fathers or families report these barriers, it may be that their responses reflect their personal beliefs about these barriers. Alternatively, fathers who attend services delivered by these practitioners may in fact experience these barriers to a greater extent than community-based fathers. In any case, further research with both practitioners and fathers is needed to determine the extent to which help-seeking attitudes and gender-role stereotypes act as barriers to father engagement.

Cost of service was the barrier least endorsed by practitioners. In contrast, a recent survey of fathers found that one in five rated cost of service as a barrier to participation, and it was the most frequently endorsed barrier (along with work commitments) from more than twenty barriers listed [24]. It is possible that practitioners may not be aware of cost as a barrier to participation, perhaps because families who attend are in general able to afford treatment. Alternatively, it is possible that the practitioners in this study largely provided interventions free of charge or at low cost which would explain the differences in perceptions between these practitioners and fathers. Although this study did not ask practitioners if their program incurred a cost, given that almost two-thirds of practitioners worked for a non-government organization or a government family mental health service, it could be assumed that most would not charge a fee for service.

Just under one in three practitioners endorsed the barrier that mothers attended services alone and did not encourage fathers to participate. This suggests that for some families, mothers may play a key role in either facilitating or preventing fathers from engaging in treatments or services. The term ‘maternal gatekeeping’, which was originally used to describe whether mothers encourage or discourage father involvement in domestic or child care responsibilities [34‐36], has also been used to describe the extent to which mothers facilitate the participation of fathers in parenting interventions [22]. There has been no empirical research on this issue to date, so the extent to which mothers’ attitudes and behaviors influence father participation is unknown. However, for families where only the mother attends an initial appointment, practitioners could benefit from eliciting mothers’ attitudes towards father engagement, emphasizing the importance of father engagement to the success of the intervention and maintenance of treatment gains, and exploring mothers’ willingness to facilitate father engagement. In other words, practitioners need to develop confidence and skills in engaging fathers indirectly through mothers, as well as engaging them directly.

Practitioner attitudes towards father engagement were overwhelmingly positive, with over 9 in 10 practitioners reporting a belief that interventions are more effective if fathers are involved. While on the one hand this finding suggests that practitioners are already aware of the importance of fathers to the success of parenting interventions, it is also possible that practitioners who held positive views of fathers were more likely to participate in this study, indicating potential sampling bias. It was also encouraging to find that most practitioners felt either very or extremely confident in engaging fathers. However, when examining competence, which combined both confidence and frequent use of strategies to engage fathers, only one in four were classified as high in competence, which indicates that practitioners’ skills in engaging fathers may need to be enhanced.

In terms of confidence with specific skills or client vulnerabilities, the areas where practitioners were least confident were working with fathers who have been violent or abusive, and working with fathers who have substance use issues, with only around a quarter of practitioners indicating they were very or extremely confident in dealing with these issues. It is not surprising that these are the areas in which practitioners felt least confident, as they are challenging clinically, and are possibly areas in which practitioners receive little or no training. However, it is important to bear in mind that these findings may not specifically relate to fathers, and practitioners may also be low in confidence when working with mothers who have been violent or those using substances. In addition, less than half of practitioners indicated they were very or extremely confident in topics such as dealing with resistance from fathers, managing conflict between mothers and fathers, and engaging fathers who are reluctant to attend. Together these findings suggest that there may be a need for more training in therapeutic strategies to address these issues. Only around one quarter of practitioners indicated that they had participated in a training program focused on father engagement, which suggests that they may not be widely available. Indeed, other researchers have described the limited provision of training and professional development in father engagement for professionals working with families [1, 28], and such training is not usually part of undergraduate or postgraduate courses for health professionals [37].

In terms of strategies that practitioners used to engage fathers, ‘explaining to mothers the importance of engaging fathers’ was the most frequently used strategy overall (and used more frequently than ‘personally inviting fathers to attend’), providing further evidence that mothers may often be the initial contact point and the ‘gatekeepers’ for engagement. This is also supported by the very low rates of father referrals to the service or program, although we did not ask about rates of mother referral to enable a comparison. This finding suggests that fathers are not the primary instigators of help-seeking. While there is a lack of research on gender differences in help-seeking for child mental health problems, previous research suggests that the presence of a father in the home may inhibit children receiving mental health treatment, possibly because fathers may be more resistant to treatment [38]. There were a number of relatively easy-to-implement strategies that less than two-thirds of practitioners reported using frequently, such as directly inviting fathers to attend, and problem-solving barriers to father attendance. As highlighted by Duhig et al. [25], it is critical for practitioners to talk to fathers directly where possible, in order to invite their participation, educate them about the program, and emphasize the importance of their involvement (and that of the core parenting team) to the success of the intervention [39]. Thus, future training programs should include active skills training for practitioners in inviting fathers to participate and problem-solving barriers to attendance, as these are likely to be important, easy-to-implement strategies for enhancing rates of father engagement.

Two-thirds of practitioners reported that their organization frequently collects data from fathers as well as mothers. This finding is relatively positive, given that a lack of outcome measures for fathers has been consistently highlighted as a key gap in research on parenting interventions [6, 8]. Obtaining assessment information (such as standardized questionnaires about child behavior) from mothers, fathers and other relevant informants (such as teachers) is critical to treatment conceptualization, because of the unique information provided by each informant [25]. In addition, repeated assessment at post-intervention is important for determining intervention effectiveness, especially as there is evidence that fathers may benefit less from parenting interventions (in terms of level of change in parenting and child behavior) than mothers [4, 6, 10]. Practitioner training should emphasize the need for ongoing assessment of all available caregivers, in an effort to enhance treatment conceptualization and evaluation of treatment effectiveness. Less than two-thirds of practitioners indicated that their organization frequently used strategies such as advertising that the program is for fathers as well as mothers, and highlighting the importance of fathers at intake. These strategies are relatively easy to implement and should be included in future training programs in an effort to increase father-inclusive practice in organizations.

Just under one in five practitioners reported that their organization runs father-only groups. There may be some circumstances where father-only groups are appropriate, such as for single-father families or gay fathers. However, practitioners should be cautious in providing father-only groups in two-parent families (as they should in relation to mother-only groups), due to the possibility of reduced effectiveness, or even unintended negative effects. For example, a randomized controlled trial (RCT) of a father-only parenting intervention found the intervention resulted in significant decreases in child behavior problems as rated by fathers relative to a control group, but mothers’ ratings increased, and father ratings of the quality of the partner relationship appeared to decrease in the intervention group [40]. Similarly, an RCT of a preventive parenting intervention that randomized parents to a father-only group, a couple group or a control condition, found that the father-only group showed declines in relationship satisfaction over time as rated by both parents [35]. These findings suggest that exclusion of mothers may have deleterious effects on the partner relationship and even on ratings of child behavior. While these findings highlight the importance of not actively excluding a parent from an intervention, it is also important to note that both parents may not necessarily have to participate directly in the intervention to experience benefits. It is possible that indirect participation can be effective, for example when one parent participates and communicates the information to the second caregiver [20], yet there is scant research about indirect participation and the circumstances under which it is effective.

This study also examined practitioner and organizational factors that predicted practitioner competencies and rates of father engagement. There was partial support for Hypothesis 1, in that participation in training predicted higher practitioner competence, and both male gender and high levels of organizational support were not significant predictors. While these findings are broadly consistent with previous research [26, 28], contrary to expectation and previous research [28], experience did not predict practitioner competence. This suggests that competence is not necessarily dependent on greater experience, and participation in training may be important. This has recently been shown in a study reporting that a one-day father-focussed workshop for health visitors in the UK resulted in improved practitioner knowledge, attitudes and behaviors related to engagement of fathers [41].

More support was found for Hypothesis 2 in that moderate father attendance (sometimes vs. rarely) was significantly predicted by greater years of experience, and high father attendance (often vs. rarely) was predicted by greater years of experience, high competence, and higher levels of organizational support for father-inclusive practice, findings which are also consistent with previous research [25, 26, 28]. Male gender did not emerge as a significant predictor of father engagement, which was in keeping with the findings of Duhig et al. [25] and Lazar et al. [26], in relation to father engagement in two-parent families. Contrary to expectations, the current study did not find an association between participation in training on the topic of father engagement and higher rates of father attendance, although this approached significance. Previous research has found training and/or professional development activities such as completion of seminars, courses and reading to be associated with increased father attendance [25, 26], yet these studies did not ask about participation in training specifically on the topic on father engagement. Thus, further research is needed, especially as one study found that a brief training program on strategies to enhance parental engagement resulted in significant improvements in parental attendance and reductions in attrition in a community mental health clinic [42], although this study did not specifically focus on fathers. Further research examining the association between training and attendance should aim to use experimental designs to evaluate whether training in skills to enhance father engagement results in significant improvements in rates of father engagement over time, and what potential mechanisms may play a role in this relationship.

In relation to the finding that a high level of father attendance was associated with greater organizational support, other research has found that practitioners perceive organizational support to be an important factor for father engagement, and one of the factors that is most feasible to change [22]. This suggests that organizations should increase their support for father-inclusive practice, and further research should explore methods for achieving this. This may include implementing organizational policies, training programs, staff supervision and/or professional development activities focussed on enhancing father-inclusive practice. Training or education programs should aim to include those in managerial positions, in order to bring about systems-level change. While most practitioners reported that their organization was very or extremely supportive of father-inclusive practice, one-third indicated that their organization was only somewhat supportive, again indicating the need for increased organizational support.

There are a number of limitations that should be considered when interpreting these findings. First, as previously mentioned, our sample of practitioners may not be representative of practitioners who deliver parenting interventions in the community. We did not obtain data from practitioners about geographic location and therefore we cannot say whether our sample was nationally representative. In addition, our sample had generally positive attitudes towards father engagement and had, on average, over a decade of experience in working with families. Furthermore, one quarter of participants in the survey were male, and this proportion may be higher than the predominantly female workforce who work with families, although it is consistent with the proportion of psychologists in Australia who are male [43]. As the survey was voluntary, it is possible that respondents were motivated to participate as they had more experience with fathers and/or an existing interest in engaging fathers. Future research should aim to include a more representative sample of practitioners, including practitioners with fewer years of experience working with families. Second, it is important to keep in mind that the regression analyses indicated only associations between variables, rather than causal relationships, and these associations may not be in the expected direction. For example, rather than training resulting in high levels of competence, it is possible that those higher in competence may be more likely to participate in training. Future experimental studies are needed to clarify the causal relationships between variables examined in this study. Third, there were a number of questions that were not included in the current research which may have shed more light on the findings, such as cost of the service and rates of mother referral. Fourth, as practitioners were not asked about their skills and confidence in engaging mothers, it is not possible to know whether competencies and perceptions of barriers to engagement differ for engaging mothers versus fathers. Finally, while we contrasted the findings of this practitioner survey with a recent survey of community fathers, to better compare fathers’ and practitioners’ perceptions, it would be worthwhile to include a sample of fathers and practitioners from the same service or program in future research studies.

While further research is needed to replicate these results with more representative samples of practitioners who work with families, this survey is an important step towards understanding current levels of practitioner competencies, rates of father engagement and barriers to father engagement. As such, there are several implications of the findings of this study to the development of policies and practices to both increase practitioner competencies and promote the engagement of fathers in evidence-based parenting interventions. First, there is a need to provide and evaluate training programs on the topic of engaging fathers, since a minority of practitioners reported participating in such training, and participation was associated with higher levels of competence. It is important that any future training programs are evaluated using experimental trials, where possible, and examine the impact on rates of father participation over time. Second, practitioners could increase their use of fairly simple engagement strategies such as directly inviting fathers to attend and problem-solving barriers to attendance. Third, at the organizational level, there is opportunity to increase strategies such as emphasizing the importance of father attendance at intake and advertising that the program is for both fathers and mothers. There is also a clear need for flexible service delivery and for programs to be available outside of working hours, and for assessment data to be collected from both parents throughout intervention. Organizational support appears to be important for achieving high rates of father engagement, and training provided should include strategies for bringing about changes at the organizational level.