Adapting a Co-Parenting Prevention Program to Home Visiting: The Family Foundations Trial
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1 Adapting a Co-Parenting Prevention Program to Home Visiting: The Family Foundations Trial Robert T. Ammerman, Ph.D. Cincinnati Children s Hospital Medical Center & Every Child Succeeds) 2016 Ohio Fatherhood Summit Columbus, Ohio May 26, 2016
2 Colleagues and Collaborators Mark E. Feinberg, Ph.D. (Pennsylvania State University) Kari-Lyn K. Sakuma, Ph.D. (Oregon State University) Judith B. Van Ginkel, Ph.D. (Cincinnati Children s Hospital Medical Center & Every Child Succeeds) Angelique R. Teeters, Psy.D. (Cincinnati Children s Hospital Medical Center & Mercy Health Systems)
3 Common Elements in Home Visiting Enrollment early in the child s life Engagement of mothers (and fathers) early in their parenting roles Strengthening protective factors & mitigating risk factors to promote positive trajectory Multiple strategies, comprehensive curricula Frequent contact and extended duration
4 Unique Opportunities-I Engaging mothers & families early in child s brain development and emerging cognitive capacities Engaging families when they are most open to and seeking of information and help Reaches families who struggle to consistently attend center-based programs Home is excellent setting in which to address parenting issues
5 Unique Opportunities-II Relationship between mother and home visitor can be leveraged to optimize parenting Extended contact permits addressing of parenting across development Parenting is addressed along with other important issues Improving other aspects of maternal and family functioning also boosts parenting
6 ELEMENTS OF HOME VISITING Referral Frequent home visits that taper Graduation and transition Nurses Bachelor s level Associate s level Paraprofessionals Healthy pregnancy & birth outcomes Child development Child health Nurturant parenting Attachment Stimulating environment Maternal lifecourse Information Modeling Guided practice Links to community 6
7 Families Served Annually: est. 650,000 AFFORDABLE CARE ACT Maternal, Infant and Early Childhood MOST REPRESENTED MODELS Home Visiting Program (MIECHV) Managed by HRSA and ACF $1.5 billion over 5 years, extended for two years Nurse-Family Partnership Healthy Families America Parents as Teachers Early Head Start HIPPY 7
8 Every Child Succeeds Collaboration between Cincinnati Children s Hospital Medical Center, United Way, and 9 community agencies Three home visiting models: Healthy Families America, Nurse-Family Partnership, Early Head Start Enrolled prenatally and postnatally and can continue to receive services until the child is 3 years of age 1 st time and 2 nd + time mothers and fathers with demographic risks in southwestern Ohio and Northern Kentucky Since 1999: 24,000 families and 525,000 home visits OPTIMIZE DEVELOPMENT PREVENT ABUSE PROMOTE ATTACHMENT NURTURING ENVIRONMENT STIMULATING HOME MEDICAL HOME IMMUNIZATIONS EMERGING LITERACY SMOKING CESSATION SUBSTANCE ABUSE EDUCATION EMPLOYMENT HEALTHY RELATIONSHIPS SOCIAL SUPPORT
9 An Example of Enhancing Home Visiting Programs: Moving Beyond Depression In-Home Cognitive Behavioral Therapy Diagnosed with Major Depressive Disorder 15 weekly sessions with a booster session one month later. Treatment provided by a Master s level therapist Supervision provided by a team leader Explicit collaboration with the home visitor to optimize treatment outcomes 100.0% 50.0% 0.0% 74.8% with trauma history 12% receive mental health treatment 100.0% 100.0% 29.3% 69.8% 20.1% Pre Post FU 52.6% IH CBT THV
10 Focus Groups with Fathers, Mothers, & Home Visitors Learn about experiences of fathers in home visiting Ascertain common issues among mothers and fathers in home visiting Solicit both parental and home visitor perspectives Adapt evidence-based co-parenting program (Family Foundations) for clinical trial
11 7 couples.all enrolled in home visiting & baby 1 yr Mother and Father Demographics Mother Father Age Race Cauc=2 Cauc=1 AA=5 AA=6 HS degree yes=7 yes=6 Employed yes=2 yes=3 Marital Status married 1 unmarried, cohab. 6
12 Home Visitor Demographics 10 home visitors Mean age=38.3 (26-54) Caucasian=7, African American=2, Biracial=1 Bachelors degree=9, masters degree=1 Years experience as HV: 7.3 (1-13)
13 Expectations and Realities Tangible needs underappreciated [F, M, HV] Fathers more likely to anticipate that it will be easy [HV] Dad s look forward to child being older [F, HV] Younger fathers more disengaged from process [HV]
![anticipate that it will be easy [HV] Dad s look forward](/docs-images/47/19826455/images/page_13.jpg "to child being older [F, HV] Younger fathers more")
14 Living Apart Father perceived by mother as less committed [HV] Father involvement with child is intermittent [F, M, HV] Mothers are less trusting of fathers caregiving abilities [F, M, HV] Mother is a gatekeeper who can control father access [HV] Other children and relationships is a complicating feature and potential source of conflict [F, M, HV]
![abilities [F, M, HV] Mother is a gatekeeper who can control father access [HV] Other](/docs-images/47/19826455/images/page_14.jpg "children and relationships is a complicating feature and potential source of conflict")
15 Family Support Families can be very supportive (tangible and emotional) [F, M, HV] Approval and respect from families is highly valued by mothers and fathers [F, M] Cultural values and practices are important [HV] Other children and relationships diffuse resources [M, HV] Families can abandon couples [HV] Mothers and fathers feel judged by family [F, M] Families can reject father and be a gatekeeper for father access [F, M, HV]
![[HV] Other children and relationships diffuse resources [M, HV] Families can abandon couples [HV] Mothers](/docs-images/47/19826455/images/page_15.jpg "and fathers feel judged by family [F, M] Families can reject father and be a gatekeeper for father access")
16 Negotiating Roles Belief in fair distribution of responsibilities [F, M, HV] Father denied role or perceived mixed messages [F, M, HV]
![[F, M, HV] Father denied role or](/docs-images/47/19826455/images/page_16.jpg "perceived mixed messages [F, M,")
17 Fathers and Home Visiting Home visiting is helpful [F, M] Home visitors are a source of positive energy [F, M] Home visitors provide specific help to fathers [F] Important to engage fathers early [F, HV] Less of a role for fathers prenatally [HV] Home visitors care more about mothers than fathers [F] Concern about another male in the home [F] Home visiting is for mothers and children only [F, HV]
![[F, HV] Less of a role for fathers prenatally [HV] Home visitors care more about mothers than](/docs-images/47/19826455/images/page_17.jpg "fathers [F] Concern about another male in the home [F] Home visiting is for mothers and children")
18 Communication and Conflict Benefits of talking together [F, M, HV] Diffusion of tense situations [F, M, HV] Avoidance & unresolved conflict [F, M, HV] Passive-aggressive strategies [F, M, HV] Need more intensive approach to learning communication and conflict resolution skills [F, M, HV]
![conflict [F, M, HV] Passive-aggressive strategies [F, M, HV] Need more](/docs-images/47/19826455/images/page_18.jpg "intensive approach to learning communication and conflict resolution")
19 What we learned Challenges are amplified by poverty, low resources, adverse childhoods, and poor role models Issues related to communication and conflict resolution are among the most significant faced by couples in home visiting Home visiting is an opportunity to engage fathers, particularly during pregnancy and shortly after the baby s birth Engaging fathers requires individualized targeting and rebranding to explicitly create a welcoming setting
20 Family Foundations: Basic Principles Transition into parenthood is challenging but also offers opportunities Mothers and fathers want to be good parents Teaching the skills needed to build a co-parenting relationship can be taught A strong co-parenting relationship is good for the child, mother, and father A strong co-parenting relationship can prevent negative family outcomes BASED ON PREVENTION SCIENCE
21 Family Foundations Universal prevention program for first-time, expectant parents Provides both prenatal and postnatal classes, originally designed to be delivered in a group setting led by both female and male facilitators Designed to promote successful co-parenting Classes include a mix of video vignettes, worksheets, power point slides, and discussion Curriculum domains Working as a team Understanding emotions in parents and babies Communication around parenting Supporting each parent s confidence in their new role Keeping parents relationship strong 2 CLINICAL TRIALS HAVE ESTABLISHED THE EFFICACY OF FF
22 Features of Family Foundations 11 weekly sessions, 6 prenatal & 5 postnatal (2 months after birth) Male and female facilitators Highly structured and manualized Skills building Experiential exercises Repetition and overlearning Culturally relevant Building a team on behalf of the child DVD vignettes, role playing, engaging discussion
23 Adaptions to FF Curriculum Provided in the home Prenatal or postnatal enrollment More experiential activities to make concepts more concrete and fun Decrease in use of acronyms and use of repetition for those that remained FTC Simplified worksheets Repetition, repetition, repetition Two father sessions with male facilitator Role of father in home visiting
24 Collaborating with Home Visitor Recruitment and engagement Scheduling assistance Provision of historical information Problem-solving environmental issues Identifying other needed services
25 Implementing Family Foundations in the Home Opportunities Convenience for families Ability to observe environmental context Greater comfort for families Challenges Environmental issues Others in the home Trying to create a professional space
26 One on One Father Sessions Two throughout course of intervention Opportunity for fathers to talk about expectations for parenthood Sharing concerns and engaging in problem solving Providing resources Common themes Anxiety about becoming a father but also excited Desire to be there for their child Lack of male role model for how to be a father Concerns over providing for their child
27 Session by session progression S1: Building a strong team S2: First the child S3: Feelings S4: Conflict S5: Communication S6: Here we go! First father one-on-one Prenatal or postnatal
28 Session by session progression S7: Adjusting to parenthood S8: Security and stress S9: Parenting S10: Support S11: Parenting team Second father one-on-one Postnatal
29 Emphasized themes First the Child Team Breathing Speak Out-Listen Up Awareness and recognition of emotions Experience and practice doing Reviews and reminders
30 Challenges in Implementing FF in Home Visiting Insufficient courtship and relationship instability Clinical issues and childhood maltreatment history Fathers and mothers with multiple children Domestic violence Influence of other family members Service disruption
31 Questions, Comments, Discussion
32 Contact information: Robert T. Ammerman Mark Feinberg Family Foundations website:
33 Acknowledgements The Eunice Kennedy Shriver National Institute on Child Health and Development (NICHD) Margaret Clark, Jennifer Berndsen, Audrey Norris, Katrina DeDona, Justine Teeters, Patrick Voegele, Kristin Vaughn, Sarah Millard, Evan Ammerman, Lori Barrett, Ron Rucker, Cory Pfefferman, Kianna Mullins, Margaret Clark, Stephen Fortson, and Jennifer Berndsen Every Child Succeeds families and home visitors
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