Engaging fathers to strengthen the impact of early home visitation on physical child abuse risk: Findings from the dads matter-HV randomized controlled trial.

BACKGROUND: Despite growing recognition of the importance of fathers in child abuse risk, the field of perinatal home visitation has only begun to consider fathers' roles in the implementation of such services. OBJECTIVES: This study examines the effectiveness of Dads Matter-HV ("DM-HV"), a father-inclusion enhancement to home visitation, and hypothesized mediators of impact. METHODS: A multisite cluster randomized controlled trial was conducted with 17 home visiting program teams serving 204 families across study conditions. Program supervisors and their teams were randomized to deliver home visiting services plus DM-HV enhanced services (intervention) or home visiting services alone (control). Data were collected at three time points: baseline, 4 months post-baseline immediately following the intervention, and 12 months post-baseline. We employed structural equation modeling to estimate the effect of the intervention on physical child abuse risk and to trace hypothesized mediators, including the quality of the father-worker relationship, parents' partner support and abuse, and the timing of service initiation. RESULTS: Results indicated that the DM-HV enhancement improved home visitor relationships with fathers, but only for families receiving services initiated postnatally. For these families, the improved quality of the father-worker relationship predicted improved parents' support of one another and reduced bidirectional mother-father partner abuse at 4-month follow-up, which in turn lowered maternal physical child abuse risk and paternal physical child abuse risk at 12-month follow-up. CONCLUSIONS: DM-HV can strengthen the impact of home visitation services on physical child abuse risk for families when services are initiated postnatally.

The Effect of Dads Matter-HV on Father Engagement in Home Visiting Services.

Engaging fathers early in child and family services has the potential to promote positive father contributions towards positive child development, improve family well-being, and enhance service outcomes over time. However, low father engagement in child and family services remains a persistent problem, and few interventions designed to improve father engagement in these services have been rigorously tested. The current study assesses the effect of a service enhancement intervention called Dads Matter-Home Visiting (Dads Matter-HV) on biological father engagement in home visiting services when compared to home visiting services delivered as usual. To assess the efficacy of the Dads Matter-HV intervention, the research team used a stratified cluster randomized clinical trial design with five agencies delivering early home visiting service programs. Seventeen teams across the five agencies were randomly assigned to either the control group condition (i.e., standard home visiting services as usual) or the intervention condition (i.e., Dads Matter-HV). Data were collected from a total of 204 families at baseline, 4 months postbaseline (92% retention rate), and 12 months postbaseline (84% retention rate). The results suggest that Dads Matter-HV increases biological father engagement for fathers who begin services in the postnatal period, but reduces engagement when services are initiated prenatally. Findings suggest some pathways through which the intervention effects engagement.

The relationship between exposure of Palestinian youth to community violence and internalizing and externalizing symptoms: Do gender and social support matter?

BACKGROUND: Youth exposure to community violence (ECV) in the Palestinian society is an alarming problem. Yet, there is serious scarcity of research on its mental health consequences. OBJECTIVES: The study examined the relationships between youth ECV and internalizing and externalizing symptoms as well as the moderating and mediating effects of gender and support from family and teachers on these relationships. PARTICIPANTS, SETTING, AND METHOD: A cross-sectional survey was conducted among a systematic random sample of 1930 Palestinian junior and senior high school pupils (912 boys, 1018 girls, aged 12-19-year- old), using a self-administered questionnaire. RESULTS: The results revealed that the more Palestinian youth were exposed to community violence (CV) the more they demonstrated internalizing and externalizing symptoms. Palestinian boys who were victims of CV reported higher levels of externalizing symptoms, while girls reported higher levels of internalizing symptoms. Adolescents with higher levels of family support and teacher support reported lower levels of internalizing and externalizing symptoms. We have also found that gender can moderate the effects of CV victimization on internalizing symptoms and that family support can mediates the relationship between CV victimization and internalizing symptoms and moderate the relationships between ECV (both victimization and witnessing) and externalizing symptoms. CONCLUSIONS: The moderating and mediating effects of gender and social support on the relationship between ECV and mental health consequences are discussed. The implications of the results for future research and for prevention and intervention as well as the strengths and limitations of the study are also discussed.

The Roles of Family and Teacher Support in Moderating and Mediating Externalized and Internalized Outcomes of Exposure to Community Violence Among Arab and Jewish Adolescents in Israel.

The study examined family and teacher support as factors that can protect adolescents from internalized and externalized problems after exposure to community violence (ECV). Self-administered questionnaires were filled out by a sample of 1,832 Arab and Jewish Israeli high school students. The Arab adolescents reported significantly higher levels of community violence victimization, internalized problems, externalized problems, family support, and teacher support than the Jewish adolescents. The girls reported higher levels of internalized problems, and the boys reported higher levels of externalized problems. ECV predicted high levels of internalized and externalized problems, family support predicted low levels of internalized and externalized problems, and teacher support had no predictive role. Path analysis confirmed the significance of the relationships between ECV effects, support variables, and gender. The limitations of the study and implications of the findings for future research and for the development of family care and family intervention programs are discussed.

Promoting father involvement in early home visiting services for vulnerable families: Findings from a pilot study of "Dads matter".

Despite mounting evidence on the importance of fathers in children's development, evidence-based perinatal home visitation programs have largely overlooked fathers in the design and delivery of services. This paper describes the design, development, and pilot testing of the "Dads Matter" enhancement to standard home visiting services. Dads Matter is a manualized intervention package designed to fully incorporate fathers into perinatal home visiting services. Twenty-four families were enrolled in a pilot study to assess the feasibility, acceptability, and preliminary outcomes of the intervention. Using a quasi-experimental time-lagged design, 12 families received standard home visiting services and completed baseline and four-month post-tests. Home visitor staff were then trained and supervised to implement the Dads Matter enhancement in addition to standard services. Twelve additional families were then enrolled and completed baseline and four-month post-tests. Implementation data indicated that Dads Matter was implemented as planned. Cohen's d scores on outcome measures indicate positive trends associated with Dads Matter in the quality of the mother-father relationship, perceived stress reported by both parents, fathers' involvement with the child, maltreatment indicators, and fathers' verbalizations toward the infant. Effect sizes generally ranged from moderate to large in magnitude and were larger than overall effect sizes of home visitation services alone reported in prior meta-analyses. Dads Matter appears to be a feasible, acceptable, and promising approach to improving fathers' engagement in home visiting services and promoting family and child well-being.

Examining the effectiveness of home-based parent aide services to reduce risk for physical child abuse and neglect: six-month findings from a randomized clinical trial.

OBJECTIVE: This study set out to carry out a feasible, real-world, randomized clinical trial to examine the benefits of home-based paraprofessional parent aide services in reducing physical abuse and neglect risk in high-risk parents. METHODS: Families were randomly assigned to receive either parent aide plus case management services (n = 73) or case management services only (n = 65), collecting in-home data on physical child abuse and neglect and proximal risk and protective factors, just prior to service initiation, and again after six months of services. RESULTS: Mothers receiving parent aide and case management services reported significant improvements from baseline to six-month follow-up in self-reported indicators of physical child abuse risk, as well as improvements on parental stress, mastery, depression, and anxiety, whereas mothers receiving only case management services did not. The slopes of such observed changes across groups, however, were not found to be statistically significantly different. No discernable improvements were found with regard to indicators of risk for child neglect. CONCLUSIONS: As the first randomized clinical trial examining the effectiveness of parent aide services, this study provides the first controlled evidence examining the potential benefits of this service modality. This study suggests promising trends regarding the benefit of parent aide services with respect to physical child abuse risk reduction and related predictors, but evidence does not appear to suggest that such services, as they are presently delivered, reduce child neglect. PRACTICE IMPLICATIONS: These findings support the continued use of parent aide services in cases of physical child abuse and also suggest careful consideration of the ways such services may be better configured to extend their impact, particularly with respect to child neglect risk.

The rates and characteristics of the exposure of Palestinian youth to community violence.

The article presents the results of a study that explored the rates and characteristics of exposure to community violence (CV) and its relevance to several sociodemographic factors among a sample of 1,930 Palestinian youth (1,018 girls and 912 boys), aged 12 to 19 years residing in diverse residential areas in the West Bank and East Jerusalem. Data were collected using a self-report questionnaire. The frequency of boys' exposure to CV during the previous 12 months was significantly higher than among girls. The frequency of witnessing CV during that period was higher than the frequency of personally experiencing CV, and exposure to mild CV incidents during that period was higher than the frequency of exposure to severe CV incidents during the same period, with no significant relationship to sociodemographic factors. Participants reported higher rates of witnessing most CV incidents outside of the neighborhood. Nonetheless, they reported higher rates of experiencing most incidents of CV inside the participants' neighborhood. The implications of the results for theory development and future research are discussed.

Paternal psychosocial characteristics and corporal punishment of their 3-year-old children.

This study uses data from 2,309 biological fathers who participated in the Fragile Families and Child Well-Being Study (FFCWS) to examine associations between psychosocial characteristics and levels of corporal punishment (CP) toward their 3-year-old children over the past month. Results indicate that 61% of the fathers reported no CP over the past month, 23% reported using CP once or twice, and 16% reported using CP a few times in the past month or more. In multivariate models controlling for important sociodemographic factors as well as characteristics of the child, fathers' parenting stress, major depression, heavy alcohol use, and drug use were significantly associated with greater use of CP, whereas involvement with the child and generalized anxiety disorder were not. Girls were less likely to be the recipient of CP than were boys, and child externalizing behavior problems but not internalizing behavior problems were associated with more CP.

Young mother-father dyads and maternal harsh parenting behavior.

OBJECTIVE: This study examined whether the age of parents predicted maternal harsh parenting behavior, specifically whether younger mothers might be at higher risk than older mothers, and which paternal characteristics might be associated with maternal parenting behavior. METHODOLOGY: This study used data from the Fragile Families and Child Wellbeing (FFCW) study. In the present study, the authors examined a subsample of families for which complete data were available on all variables that were used in the analyses (n=1,597). Based on the parents' age at the time of the child's birth, mother-father age-dyad types were classified, and selected paternal factors were used to examine their association with maternal harsh parenting behavior. Psychological aggression, physical aggression, and self-reports of spanking were used as proxies for maternal harsh parenting behavior. RESULTS: Multivariate analyses indicated that adolescent mothers, regardless of how old their partners were, were at higher risk for harsh parenting behavior than older adult mothers. Regarding paternal factors, paternal coercion against mother and the fathers' use of spanking were significantly associated with all three proxies for maternal harsh parenting behavior. Fathers' employment was a risk factor for maternal physical aggression. CONCLUSION: This study supported findings from previous studies that younger mothers may indeed be at greater risk for harsh parenting behavior. It is critical, therefore, that they acquire appropriate parenting behavior and develop a healthy relationship with their children. Additional studies, both cross-sectional and longitudinal, are needed to involve their partners (i.e., their child's father) in order to shed light on ways of preventing harsh parenting behavior and examining the role of fathers in maternal parenting behavior. PRACTICE IMPLICATIONS: The present study calls for more attention to sex education and intervention programs in school and health care settings as important components of prevention services. Practitioners need to better understand the concept of harsh parenting behavior in order to work with young parents and prevent future physical child abuse. Policy makers should support these efforts and research should be done that engages both mothers and fathers and seeks to enhance and modify existing programs for youths.

Use of spanking for 3-year-old children and associated intimate partner aggression or violence.

OBJECTIVES: The objective of this study was to examine associations between maternal and paternal use of corporal punishment (CP) for 3-year-old children and intimate partner aggression or violence (IPAV) in a population-based sample. METHODS: The study sample (N=1997) was derived from wave 3 of the Fragile Families and Child Wellbeing Study. Mother and father reports regarding their use of CP and their IPAV victimization were analyzed. IPAV included coercion and nonphysical and physical aggression. RESULTS: Approximately 65% of the children were spanked at least once in the previous month by 1 or both parents. Of couples who reported any family aggression (87%), 54% reported that both CP and IPAV occurred. The most prevalent patterns of co-occurrence involved both parents as aggressors either toward each other (ie, bilateral IPAV) or toward the child. The presence of bilateral IPAV essentially doubled the odds that 1 or both parents would use CP, even after controlling for potential confounders such as parenting stress, depression, and alcohol or other drug use. Of the 5 patterns of co-occurring family aggression assessed, the "single aggressor" model, in which only 1 parent aggressed in the family, received the least amount of empirical support. CONCLUSIONS: Despite American Academy of Pediatrics' recommendations against the use of CP, CP use remains common in the United States. CP prevention efforts should carefully consider assumptions made about patterns of co-occurring aggression in families, given that adult victims of IPAV, including even minor, nonphysical aggression between parents, have increased odds of using CP with their children.

Parental perceptions of neighborhood processes, stress, personal control, and risk for physical child abuse and neglect.

OBJECTIVE: This study set out to examine whether mothers' individual perceptions of their neighborhood social processes predict their risk for physical child abuse and neglect directly and/or indirectly via pathways involving parents' reported stress and sense of personal control in the parenting role. METHODS: In-home and phone interview data were examined cross-sectionally from a national birth cohort sample of 3,356 mothers across 20 US cities when the index child was 3 years of age. Mothers' perceptions of neighborhood social processes, parenting stress, and personal control were examined as predictors, and three subscales of the Parent-To-Child Conflict Tactics Scale (CTS-PC) were employed as proxies of physical child abuse and neglect risk. Structural equation modeling (SEM) was employed to test direct and indirect pathways (via parenting stress and control) from perceived neighborhood processes to proxy measures of physical child abuse and neglect. Multiple group SEM was conducted to test for differences across major ethnic groups: African American, Hispanic, and White. RESULTS: Although perceived negative neighborhood processes had only a mild direct role in predicting risk for physical child abuse, and no direct role on child neglect, these perceptions had a discernable indirect role in predicting risk via parenting stress and personal control pathways. Parenting stress exerted the clearest direct role on both physical abuse and neglect risk. This predictor model did not significantly differ across ethnic groups. CONCLUSIONS: Although neighborhood conditions may not play a clear directly observable role on physical child abuse and neglect risk, the indirect role they play underscores the importance of parents' perceptions of their neighborhoods, and especially the role they play via parents' reported stress and personal control. PRACTICE IMPLICATIONS: Such findings suggest that targeting parents' sense of control and stress in relation to their immediate social environment holds particular potential to reduce physical child abuse and neglect risk. Addressing parents' perceptions of their neighborhood challenges may serve to reduce parenting risk via improving parents' felt control and stress.

Fathers, physical child abuse, and neglect: advancing the knowledge base.

Fathers are overrepresented as perpetrators of physical child maltreatment, particularly in its most severe forms. Despite this, the research literature continues to lack specificity regarding the role fathers play in risk for physical child abuse or neglect (PCAN). Furthermore, although fathers have received more attention with respect to child sexual abuse and its treatment, their influence has been largely disregarded in many intervention efforts to reduce PCAN. Inadequate attention to the role of fathers, both in research and practice, has numerous problematic implications for the prevention of child maltreatment. The goal of this special issue is to disseminate new research that examines fathers' roles by focusing on multiple fathering factors that may directly and indirectly shape both maternal and paternal risk of engaging in PCAN. In the introduction to the special issue, we highlight key questions in the research literature and present our perspective on how the articles included in this special issue address some of these gaps.

Fathers and maternal risk for physical child abuse.

This study set out to examine father-related factors predicting maternal physical child abuse risk in a national birth cohort of 1,480 families. In-home and phone interviews were conducted with mothers when index children were 3 years old. Predictor variables included the mother-father relationship status; father demographic, economic, and psychosocial variables; and key background factors. Outcome variables included both observed and self-reported proxies of maternal physical child abuse risk. At the bivariate level, mothers married to fathers were at lower risk for most indicators of maternal physical child abuse. However, after accounting for specific fathering factors and controlling for background variables, multivariate analyses indicated that marriage washed out as a protective factor, and on two of three indicators was linked with greater maternal physical abuse risk. Regarding fathering factors linked with risk, fathers' higher educational attainment and their positive involvement with their children most discernibly predicted lower maternal physical child abuse risk. Fathers' economic factors played no observable role in mothers' risk for physical child maltreatment. Such multivariate findings suggest that marriage per se does not appear to be a protective factor for maternal physical child abuse and rather it may serve as a proxy for other father-related protective factors.

Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children.

OBJECTIVES: We examined the associations of intimate partner violence (IPV) and maternal risk factors with maternal child maltreatment risk within a diverse sample of mothers. METHODS: We derived the study sample (N=2508) from the Fragile Families and Child Well-Being Study. We conducted regression analyses to examine associations between IPV, parenting stress, major depression, key covariates, and 4 proxy variables for maternal child maltreatment. RESULTS: Mothers reported an average of 25 acts of psychological aggression and 17 acts of physical aggression against their 3-year-old children in the year before the study, 11% reported some act of neglect toward their children during the same period, and 55% had spanked their children during the previous month. About 40% of mothers had experienced IPV by their current partner. IPV and maternal parenting stress were both consistent risk factors for all 4 maltreatment proxy variables. Although foreign-born mothers reported fewer incidents of child maltreatment, the IPV relative risk for child maltreatment was greater for foreign-born than for US-born mothers. CONCLUSIONS: Further integration of IPV and child maltreatment prevention and intervention efforts is warranted; such efforts must carefully balance the needs of adult and child victims.

Risk factors for paternal physical child abuse.

OBJECTIVE: This study uses the developmental-ecological framework to examine a comprehensive set of paternal factors hypothesized to be linked to risk for paternal child abuse (PCA) among a diverse sample of fathers. Attention was given to fathers' marital status and their race/ethnicity (White, African American, and Hispanic). METHODS: Interviews were conducted with 1257 married or cohabiting biological fathers who participated in the Fragile Families and Child Wellbeing Study. PCA was assessed when the index children were 3 years old. Analyses included a comprehensive set of self-reported paternal variables as well as controls for maternal variables linked to child maltreatment. PCA was measured using proxy variables: two questions assessing the frequency of spanking in the past month and Parent-Child Conflict Tactics Scales (CTS-PC) [Straus, M., Hamby, S., Finkelhor, D., Moore, D., & Runyan, D. (1998). Identification of child maltreatment with the parent-child conflict tactics scales: Development and psychometric data for a national sample of American parents. Child Abuse & Neglect, 22, 249-270] psychological and physical aggression subscales. RESULTS: Bivariate results indicated that Hispanic fathers were the least likely to spank or engage in psychological or physical aggression. Multiple regression analyses indicated that paternal employment and earnings were not significantly associated with PCA. Compared to cohabiting African American fathers, married African American fathers were found to be at greater risk for some forms of PCA. This pattern was not found for White or Hispanic families. CONCLUSIONS: In this diverse sample of involved, biological fathers, there appear to be multiple potential risk-heightening pathways that vary across race/ethnic groups. With the proper control variables, paternal employment and earnings may not be as directly linked to fathers' physical abuse risk as has been previously thought. PRACTICE IMPLICATIONS: There is a need for interventions within the child welfare system that better promote family wellbeing by including fathers in services. Patterns linking paternal socio-demographic and psychosocial factors to psychological and physical child abuse varied as a function of paternal race/ethnicity, indicating that race/ethnic differences are among the important factors that intervention efforts should take into account.

The role of fathers in risk for physical child abuse and neglect: possible pathways and unanswered questions.

Despite overrepresentation of fathers as perpetrators in cases of severe physical child abuse and neglect, the role they play in shaping risk for physical child abuse and neglect is not yet well understood. This article reviews the possible father pathways that may contribute to physical child abuse and neglect risk and their existing empirical support. The present empirical base implicates a set of sociodemographic factors in physical maltreatment risk, including fathers' absence, age, employment status, and income they provide to the family. As well, paternal psychosocial factors implicated in physical child maltreatment risk include fathers' abuse of substances, their own childhood experiences of maltreatment, the nature of fathers' relationships with mothers, and the direct care they provide to the child. However, the empirical base presently suffers from significant methodological limitations, preventing more definitive identification of risk factors or causal processes. Given this, the present article offers questions and recommendations for future research and prevention.

Advancing prevention research on child abuse, youth violence, and domestic violence: emerging strategies and issues.

Prevention research on the related problems of child abuse, youth violence, and domestic violence has grown at an accelerating pace in recent years. In this context, a set of shared methodological issues has emerged as investigators seek to advance the interpersonal violence prevention knowledge base. This article considers some of the persistent methodological issues in these areas and points out emerging research strategies that are forging advances in garnering valid, rigorous, and useful knowledge to prevent interpersonal violence. Research issues and emerging strategies in three key domains of prevention research are considered, including complexities in validly conceptualizing and measuring varying forms of violence as specific targets for preventive intervention, research issues and strategies designed to reliably predict and identify future violence risk to be targeted by preventive intervention, and research issues and emerging strategies in the application of empirical methods to forge specific advances in preventive intervention strategies themselves.

Acculturation and parental attachment in Asian-American adolescents' alcohol use.

PURPOSE: To test whether the degree of acculturation predicts subsequent alcohol use among Asian-American adolescents, and to test the moderating effect of parental attachment. METHODS: This was a prospective study using a subsample of the National Longitudinal Adolescent Health data set. A nationally representative sample of 714 Asian-American boys (n = 332) and girls (n = 382) in grades 7-12 was analyzed. In-home self-report data were collected on two types of acculturation status, alcohol use, demographics, and parental attachment. After controlling for acculturation status and background variables at Wave I, logistic regression analysis was used to estimate the odds ratios to assess the association between acculturation and alcohol use at Wave II for adolescents. RESULTS: Asian-American adolescents with the highest level of acculturation (English use at home, born in the United States) were identified as the highest risk group. For adolescents with low parental attachment, the odds of alcohol use were 11 times greater in the highly acculturated group than in the least acculturated group. However, the odds of alcohol use for adolescents with moderate or high levels of parental attachment did not vary across acculturation groups. CONCLUSIONS: Overall, a greater level of acculturation was associated with greater alcohol use. However, when parental attachment was taken into account, highly acculturated adolescents with moderate or high parental attachment had no greater risk than adolescents with same levels of parental attachment who were less acculturated. Thus, it appears that acculturation per se was not a risk factor unless it was accompanied by a low level of parental attachment.

Adolescent victimization and subsequent use of mental health counseling services.

PURPOSE: To test the extent to which adolescent victimization predicts subsequent use of mental health services in a prospectively assessed nationwide sample of high school students. METHODS: Data were analyzed from 4590 adolescents participating in Waves I and II of the National Longitudinal Survey of Adolescent Health. In-home self-report data were collected on four types of personal victimization, mental health service use, demographics, psychological symptoms/needs, and family connectedness. Using logistic regression analysis, adolescents' victimization and background variables at Wave I were entered as predictors of subsequent mental health service use, measured at Wave II. RESULTS: In this national sample, 19.6% of the respondents stated that they had experienced at least one of four forms of personal victimization in the prior year. Of those reporting personal victimization, 11.0% stated they had used mental health services at 1-year follow-up, as compared to 9.2% of those who did not report any personal victimization. After controlling for background variables in logistic regression analyses, however, adolescents' victimization reported at Wave I was associated with significantly lower odds of subsequent mental health service use at Wave II. CONCLUSIONS: Evidence does not indicate that adolescents' victimization prompts mental health service use, and rather indicates that in some instances victimization is associated with lower odds of subsequent mental health service use. These findings raise questions about the degree to which adolescents receive needed professional mental health supports in the wake of serious violence exposure.