Working out dads (WOD): a study protocol for a randomised controlled trial of a group-based peer support intervention for men experiencing mental health difficulties in early fatherhood.

BACKGROUND: Approximately one in ten men experience mental health difficulties during the early years of fatherhood, and these can have negative impacts on children and families. However, few evidence-based interventions targeting fathers' mental health are available. The aim of the trial is to evaluate the effectiveness and cost-effectiveness of Working Out Dads (WOD) - a facilitated peer support group intervention for fathers of young children, in reducing psychological distress and other mental health symptoms. METHODS: This trial will employ a parallel-arm randomised controlled trial (RCT) to evaluate the effectiveness and cost effectiveness of WOD peer support group intervention compared to usual care (a 30-min mental health and service focused phone consultation with a health professional). A total of 280 fathers of young children (aged 0-4 years) who are experiencing mental health difficulties and/or are at risk of poor mental health will be recruited. Randomisation and analyses will be at the level of the individual participant. The primary outcome is psychological distress symptoms, measured by the Kessler Psychological Distress Scale (K10) from baseline to 24 weeks post randomisation. A range of secondary outcomes will be assessed including suicidal ideation; mental health disorders, specific symptoms of depression, anxiety, and stress; social support, quality of life, health service use, and health care costs. Data will be collected at baseline, 10- and 24 weeks post-randomisation. DISCUSSION: This trial will examine the effectiveness of a novel group-based peer support intervention in reducing the psychological distress and other mental health symptoms of fathers compared to usual care. The economic and process evaluation will guide policy decision making along with informing the future implementation of WOD on a larger scale if effectiveness is demonstrated. TRIAL REGISTRATION: The current trial has been registered with ClinicalTrials.gov (Registration ID - NCT04813042 ). Date of Registration: March 22nd, 2021.

Preservation and reunification for families of young children: case file review of a home-visiting program.

OBJECTIVE: The Home Parenting Education and Support (HoPES) programme is a new intensive 8-week home-visiting intervention supporting the preservation and reunification of families with young children (aged 0-4 years) receiving child protection services following child abuse and/or neglect in Australia. The aims of the study were to (a) describe families who had participated in HoPES, (b) describe the key education content and support activities of the programme, and (c) identify the enablers and challenges in implementing HoPES. BACKGROUND: Intensive home-based family preservation programs are designed to improve parenting skills, reduce specific abusive behaviours, and address child, parent and contextual risk factors for child maltreatment and its recurrence. METHODS: A casefile review and document analysis of 34 families who enrolled in HoPES was conducted. RESULTS: Families enrolled in HoPES were experiencing significant parent and child risk factors for child maltreatment and recurrence. Despite challenges in supporting families experiencing many complex social health issues and stressful life circumstances, there was evidence of intervention tailoring and use of strengths-based approaches to meet the needs of families. CONCLUSION: This casefile review gathered rich evidence to inform further development of a trauma informed and culturally sensitive intervention to support family preservation and reunification, and to guide the next stage of evaluation research to generate a more robust level of evidence.

The experience of the COVID-19 pandemic for families of infants involved with Child Protection Services for maltreatment concerns.

The COVID-19 pandemic and associated physical distancing restrictions have exacerbated social, economic and health disadvantage within our communities. With increases in mental health difficulties and family violence already being seen, there is concern that the risk of child maltreatment risk may also be increased. The current study aimed to explore the experience of the COVID-19 pandemic for families identified to be at risk of child maltreatment in Victoria, Australia. Understanding the experiences of the pandemic for families already at risk is essential in identifying how to best support vulnerable parents and young children during this challenging time. Interviews were conducted with 11 parents currently involved with Child Protection Services, and nine clinicians working within a child and family health services, supporting clients with child protection involvement. Parents and clinicians described a range of pandemic related stressors including employment and financial stress, worry about infection and changes to service access. In addition, parents with children in out of home care discussed decreased access to their children resulting from physical distancing restrictions. Parents and clinicians perceived the pandemic to be having a negative impact on parent mental health, parenting stress and isolation. Although parents raised minimal concerns about the impact of the pandemic on child well-being, clinicians expressed concerns about the rise in risk factors for child maltreatment. Parents discussed a range of coping strategies which they perceived to be helpful during the pandemic, and clinicians and parents described the need for additional mental health support and support to access basic needs. The study highlights the importance of ensuring at risk families have access to parenting and mental health support throughout the pandemic and the importance of ensuring children within at-risk families are sighted and their safety assessed.

A mixed-methods feasibility study of the Home Parenting Education and Support Program for families at risk of child maltreatment and recurrence in Australia.

BACKGROUND: Efforts to prevent child maltreatment and its recurrence in infancy and early childhood are critical to disrupting pathways to poor physical and mental health and interpersonal relationships across the life course. The Home Parenting Education and Support (HoPES) program is an intensive 8-week home-visiting intervention for families of infants and young children (0-4 years) receiving child protection services or welfare services. OBJECTIVE: The aims of this feasibility study were to: (a) explore parents' and clinicians' perceptions of the outcomes related to participation in HoPES, and (b) obtain preliminary data about potential intervention outcomes related to parent-child interactions, parent mental health, and parenting self-efficacy. PARTICIPANTS AND SETTING: HoPES was delivered to 30 families by a child and family health service. Seven mothers and eight HoPES clinicians also participated in qualitative interviews. METHODS: A mixed-methods evaluation was conducted incorporating qualitative interviews and self-report pre-post intervention data was conducted. RESULTS: Interviews with mothers identified perceived benefits for parent mental health and wellbeing, parenting, and relationships with children. This was further supported by clinician interviews and by the analysis of pre-post assessment data which revealed moderate to large decreases in maternal stress (d = 0.35) and increases in parental self-efficacy (0.76). CONCLUSIONS: The findings of this study have important implications for further development of HoPES, and the design of a rigorous evaluation in next stage of evaluation research.

"We're in the background": Facilitators and barriers to fathers' engagement and participation in a health intervention during the early parenting period.

ISSUES ADDRESSED: Little is known about the barriers and facilitators associated with engaging fathers in interventions targeting their physical and mental health. The current research therefore aimed to explore fathers' perceived barriers and facilitators to engagement and participation in a health intervention delivered during the early parenting period. METHODS: Eleven fathers of young children (0-4 years) were interviewed about their perceptions and experiences of facilitators and barriers to engaging and participating in an intervention (Working Out Dads) to target their mental and physical health. Interviews were recorded and transcribed. Transcripts were analysed using thematic analysis. RESULTS: Fathers identified a number of program-related and father-related facilitators and barriers which impacted their engagement and participation. Program-related facilitators included: accessibility of the program; father advocacy of the program; group fitness/exercise component; and having a father-specific program. Facilitating factors related to fathers included: making social connections; learning how to be a better dad/partner; and partner support and encouragement to attend. Program-related barriers included: travel; lack of awareness; and gender roles. While father-related barriers included: being time poor; sacrifices to family; and apprehension. CONCLUSIONS: The current findings identified many areas that facilitate, encourage and motivate men to participate in interventions which support their mental and physical health during the early parenting period. RELEVANCE: Generating evidence on barriers and facilitators to health interventions is important to improving the current intervention along with informing the development of engaging and targeted health interventions for fathers in early parenthood.

Assisting clients experiencing family violence: Clinician and client survey responses in a child and family health service.

AIMS AND OBJECTIVES: To determine the baseline levels of training, knowledge and confidence working in the area of family violence in staff at a public child and maternal health service in Melbourne, Australia, as well as perceived staff barriers to working effectively in this area. This study also aimed to explore the client perception of existing screening practices. BACKGROUND: Family violence is a global concern with pregnancy and the postnatal period times of particularly high risk. Child and maternal health services are well placed to screen for violence, yet clinician and client perceptions of screening remain poorly characterised. DESIGN: Thirty-five staff and 15 mothers participated in this cross-sectional, mixed-method study, via an online survey. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used. RESULTS: The majority of staff screened clients for family violence, at least some of the time, with over 50% often or always screening. However, only half of staff respondents indicated that they believed they knew how to screen appropriately. Screening occurred most often over the phone or at the first service visit. The most commonly reported barriers to screening were suspected perpetrators being present during consultations and language barriers. Most clients reported being screened for physical violence and safety in the home with few being asking about financial and sexual abuse, or psychological violence and coercive control. Clients who disclosed violence reported being well supported. CONCLUSION: While some baseline staff knowledge and skills have been identified, further support for clinicians is needed to ensure best practice and improve services and outcomes, particularly in regard to screening for different types of violence across the spectrum. RELEVANCE TO CLINICAL PRACTICE: This study helps to inform clinical screening practices in maternal health services through an exploration of facilitators and barriers in the screening process.

A pilot evaluation of 'Working Out Dads': promoting father mental health and parental self-efficacy.

AIM: Approximately one in 10 fathers experience mental health difficulties in the early years of parenting, yet there is a dearth of evidence-based interventions to promote fathers' mental health at this time. Therefore, the aims of this study were: (1) to obtain preliminary data on the short-term changes in mental health symptoms and parenting self-efficacy for fathers of young children (aged 0-4 years) participating in Working Out Dads (WOD) and (2) to explore fathers' experiences of participation in WOD. METHOD: The sample consisted of 57 fathers who had at least one child aged between 0 and 4 years. Participants completed pre- and post- measures to assess the severity of depressive, anxiety and stress symptoms and parenting self-efficacy. A brief survey of fathers' experiences in WOD was also completed. RESULTS: There was a significant reduction in fathers' reports of depressive and stress symptoms from pre- to post-intervention, and no significant change in anxiety symptoms. Parenting self-efficacy significantly increased from pre- to post-intervention. All changes were associated with moderate to large effect sizes. Fathers indicated that they were satisfied with the programme and that they were more confident in managing the stress of parenting and in their overall role as a father. CONCLUSIONS: This is the first study to evaluate WOD and provides promising preliminary evidence for its short-term effects on fathers' mental health and parenting self-efficacy. Pilot results are positive and are a critical first step, informing the design of a more robust evaluation in the future.