Fathers in home visiting: An examination of father participation in Iowa MIECHV
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Iowa State University Capstones, Theses and
Graduate Theses and Dissertations
Dissertations
2018
Fathers in home visiting: An examination of father
participation in Iowa MIECHV
Neil Alan Rowe
Iowa State University
Follow this and additional works at: https://lib.dr.iastate.edu/etd
Part of the Developmental Psychology Commons, and the Pre-Elementary, Early Childhood,
Kindergarten Teacher Education Commons
Recommended Citation
Rowe, Neil Alan, "Fathers in home visiting: An examination of father participation in Iowa MIECHV" (2018). Graduate Theses and
Dissertations. 16452.
https://lib.dr.iastate.edu/etd/16452
This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University
Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University
Digital Repository. For more information, please contact digirep@iastate.edu.Fathers in home visiting: An examination of father participation in Iowa MIECHV
by
Neil A. Rowe
A dissertation submitted to the graduate faculty
In partial fulfillment of the requirements for the degree of
DOCTOR OF PHILOSOPHY
Major: Human Development and Family Studies
Program of Study Committee:
Kere Hughes-Belding, Major Professor
Carla Peterson
Gayle Luze
Janet Melby
Megan Gilligan
The student author, whose presentation of the scholarship herein was approved by the program
of study committee, is solely responsible for the content of this dissertation. The Graduate
College will ensure this dissertation is globally accessible and will not permit alterations after a
degree is conferred.
Iowa State University
Ames, Iowa
2018
Copyright © Neil A. Rowe, 2018. All rights reserved.ii
TABLE OF CONTENTS
Page
ABSTRACT .................................................................................................................................... v
CHAPTER 1. INTRODUCTION ................................................................................................... 1
Dissertation Organization ........................................................................................................... 4
CHAPTER 2. LITERATURE REVIEW ........................................................................................ 5
Introduction ................................................................................................................................. 5
Fathers ......................................................................................................................................... 6
Vulnerable Fathers .................................................................................................................. 7
Home Visiting ............................................................................................................................. 9
Father Participation in Home Visits.......................................................................................... 12
Presence ................................................................................................................................ 13
Involvement .......................................................................................................................... 13
Father Availability ................................................................................................................ 14
Home Visitor Practices with Fathers ........................................................................................ 15
Home Visit Quality and Father Involvement ............................................................................ 16
Conceptual Framework ............................................................................................................. 17
Current Study ............................................................................................................................ 19
Research Questions ................................................................................................................... 20
CHAPTER 3. METHODOLOGY ................................................................................................ 21
Participants ................................................................................................................................ 21
Home Visitor Characteristics ................................................................................................ 22
Procedure .................................................................................................................................. 23
Measures ................................................................................................................................... 24
Family Characteristics .......................................................................................................... 24
Home Visitor Characteristics ................................................................................................ 25
Observational Measures ........................................................................................................ 25
CHAPTER 4. RESULTS .............................................................................................................. 31
Home Visit Characteristics ....................................................................................................... 32
How Present, Available, Engaged and Included are Fathers During Home Visits? ................. 33
Father Presence ..................................................................................................................... 33
Father Availability ................................................................................................................ 33
Father Engagement ............................................................................................................... 34iii
Home Visitor Inclusion of Father ......................................................................................... 34
What is the Content and Nature of Home Visitor Interactions with Fathers? .......................... 35
Content .................................................................................................................................. 37
Nature .................................................................................................................................... 38
How do Home Visitor and Family Characteristics Relate to Father Involvement and
Inclusion? .................................................................................................................................. 38
Home Visitor Characteristics and Father Involvement and Inclusion .................................. 38
Family Characteristics and Father Involvement and Inclusion............................................. 40
How do Home Visitor Practices Relate to Father Involvement and Inclusion? ....................... 40
Quality of Home Visitor Practices and Father Involvement and Inclusion .......................... 41
Father Involvement and Home Visitor Practices .................................................................. 41
What Home Visitor Practices and Family Characteristics Predict Father Involvement? ......... 41
Predicting Father Engagement with Father Inclusion ........................................................... 43
What Home Visitor Characteristics Predict Home Visitor Inclusion of Fathers? .................... 44
Predicting Father Inclusion with Home Visitor Educational Background ........................... 45
CHAPTER 5. DISCUSSION ........................................................................................................ 47
Father Presence ......................................................................................................................... 47
Father Availability .................................................................................................................... 48
Father Engagement ................................................................................................................... 49
Home Visitor Inclusion of Father ............................................................................................. 49
Content and Nature of Home Visitor-Father Interactions......................................................... 51
Home Visitor Characteristics and Father Involvement and Inclusion ...................................... 52
Family Characteristics and Father Involvement and Inclusion................................................. 53
Home Visitor Practices and Father Involvement and Inclusion ............................................... 53
Father Inclusion and Father Involvement ............................................................................. 55
Home Visit Activity Content and Nature and Father Involvement ...................................... 55
Predicting Father Involvement and Inclusion ........................................................................... 55
Predicting Father Engagement .............................................................................................. 56
Predicting Home Visitor Inclusion ....................................................................................... 57
Limitations ................................................................................................................................ 57
Conclusions, Implications and Future Directions ..................................................................... 58
REFERENCES ............................................................................................................................. 61
APPENDIX A. HVOF-R CATEGORICAL CODES ................................................................... 73iv APPENDIX B. IRB APPROVAL FORM .................................................................................... 74 APPENDIX C. PERCENTAGE OF TOTAL HOME VISITOR INTERACTIONS WITH FATHERS BY CONTENT........................................................................................................... 75 APPENDIX D. PERCENTAGE OF TOTAL HOME VISITOR INTERACTIONS WITH FATHERS BY NATURE ............................................................................................................. 76
v
ABSTRACT
In this dissertation, father participation in early childhood home visits was examined using
observational data from 50 Maternal Infant Early Childhood Home Visiting (MIECHV) home
visits where a father figure was present for a visit with a mother receiving services and a target
child two years old or younger. The sample included 34 different home visitors. Videos were
coded using the HVOF-R and HOVRS A+ observational tools. Fathers were more present and
available during home visits than previous research indicates (Holmberg & Olds, 2015; McBride
& Peterson, 1997; Raikes, Summers & Roggman, 2005). A father-figure was present in 25.1% of
the initial home visit videos with a mother recorded for the state-led MIECHV evaluation. When
fathers were home during the visit, they were available for 76.4% of parent-involved home visit
activities. Average father engagement when he was available was 3.5 on a 1 to 7 scale. When
available, fathers were included in parent-involved home visit activities by the home visitor an
average of 42.5% of the time. Roggman, Boyce and Innocenti’s (2008) developmental parenting
approach for early childhood practitioners and Korfmacher et al’s (2008) model for influences on
parent involvement in early childhood home visiting were used as a conceptual framework. No
home visitor practices were significantly related to father availability. Home visitor inclusion of
the father was the only home visitor practice in this study significantly predictive of his
engagement. Father engagement increased .053 (p < .01) for each percent increase of father
inclusive practices by the home visitor. In addition, father inclusive practices explained a
significant proportion of variance in father engagement, R2 = .702, F(1, 48) = 112.43, p < .001.
The home visitor having a social science degree resulted in an increase in father inclusive
practices by 14.50% (p < .05).1
CHAPTER 1. INTRODUCTION
Fathers uniquely contribute to child outcomes independent of the mothers influence
(Zanoni, Warburton, Bussey & McMaugh, 2013). Positive play interactions between fathers and
their babies in early childhood support greater cognitive development at 24 months (Shannon,
Tamis-LeMonda, London & Cabrera, 2002). Accordingly, early childhood family support
programs have increased attention to engaging fathers in services. Though more research is
necessary, current research on father involvement in early childhood home visiting programs has
yielded promising outcomes. Fathers involved in home visiting services through Early Head
Start (EHS) engaged in greater play complexity with their toddlers (Roggmann, Boyce, Cook,
Christianson & Jones, 2004). Home visiting has also been utilized successfully to improve
father’s skills at promoting cognitive growth in their infants (Magill-Evans, Harrison, Benzies,
Gierl & Kimak, 2007). Expansion of home visiting services through the Patient Protection and
Affordable Care Act (2010) provided the opportunity to reach more fathers in at-risk families.
In 2012, grant funding through the Health Resources and Services Administration
(HRSA) expanded home visiting services in 15 at-risk Iowa communities identified through a
home visiting needs assessment (Iowa Department of Public Health [IDPH], 2010). These
communities were identified as at-risk through an examination of rates of premature birth, low
birth weight, infant mortality, overall poverty, child poverty, unemployment, child abuse and
neglect, high school dropout, alcohol bingeing, crime, juvenile crime, domestic violence,
smoking in the 3rd trimester of pregnancy, maternal education, and 4th grade reading proficiency.
Since the expansion in 2012, Iowa home visiting services have shown improvements in mother
and infant health, child injuries, school readiness, crime, domestic violence, family economic
self-sufficiency and community resource coordination and referrals (IDPH, 2016).2
More than 160,000 families were served through MIECHV-funded home visiting
services in 2016 alone (Health Resources and Services Administration, 2017); however, most
home visiting program models are largely mother-focused and many fail to engage fathers or
father figures to either build on protective strengths or mitigate risks. A focus group conducted
by the Child and Family Research Partnership (CFRP, 2013) revealed many fathers felt home
visiting was for women because all home visitors were women and marketing information did
not address or reference fathers. Furthermore, fathers who need the most support are the least
likely to be engaged in home visits (Roggman, Boyce, Cook & Cook, 2002). It is also difficult to
evaluate the impact of home visiting services on at-risk fathers when they are engaged. Fathers
who are working class, less educated and/or have infants who are unplanned, have a difficult
temperament or are less healthy are the least likely to participate in research (Costigan & Cox,
2001). While home visiting can be an effective resource for promoting positive father
interactions with their child, father participation in home visits remains low (Homberg & Olds,
2015) despite efforts drawing more attention to father engagement.
Most father participation rates in home visiting programs range between 12 and 18
percent (McBride & Peterson, 1997; Duggan, et al., 2004; Raikes, Summers & Roggman, 2005;
Holmberg & Olds, 2015). Measurement of participation remains a problem because many studies
rely on one global measure of participation, generally number of home visits attended.
Additionally, participation has been defined differently across studies. Participation has been
described as father attendance at the visit, father involvement in the visit, and father engagement
during the visit. Most studies have relied either on mother report, father report or home visitor
report in home visit records.3
The current study measured three aspects of father participation through direct
observation using an adapted version of the Home Visit Observation Form-Revised (HVOF-R:
McBride & Peterson, 1996). Father presence is defined as the father being physically in the room
at any time during the home visit. Father involvement is separated into two domains: father
availability and father engagement. Father availability, is the proportion of parent-involved home
visit activities the father was accessible for interaction during the visit. Lastly, father
engagement, is a rating of the father’s interest, attention and initiation of his own involvement in
the visit.
The current study also examined home visitor practices with fathers using observational
data coded using the HVOF-R (McBride & Peterson, 1996) and Home Visit Rating Scales-
Adapted and Extended to Excellence version 2.0 (HOVRS A+ v2.0; Roggman et al., 2014). The
HVOF-R was used to identify the interactors involved in activities, the content of home visit
activities, the nature of what the home visitor was doing during activities and father inclusion.
Content is defined as the proportion of time spent in interactions within a particular focus or
topic, such as the target child’s development or family issues. Nature is the percentage of time
the home visitor engaged in parent-centered and separately, child-centered interactions. Father
inclusion is described as the percentage of parent-involved interactions the father was recognized
by the home visitor as an interactor in the activity or conversation. The HOVRS A+ was used to
assess quality of home visitor practices. Quality of home visiting practices is defined as the mean
rating ranging between 1 and 7 of the home visitors’ observed abilities across the domains of
responsiveness, non-intrusiveness/collaboration, facilitation of parent-child interactions and
relationship with the family.4
Home visitor and family characteristics were examined as correlates of father
involvement and father inclusion. Additionally, the relationship between home visit practices and
father involvement was explored. Finally, home visitor practices and family characteristics were
tested as predictors of father involvement and home visitor characteristics were tested as
predictors of father inclusion.
Dissertation Organization
This study explores father participation during home visits. For the purposes of this
dissertation, the term father represents men who are present in the home and engage in home
visit activities to varying degrees and in a variety of ways.
Chapter 2 provides an extensive literature review examining the importance, relevance
and past research of father involvement in home visiting services. Chapter 3 covers the methods
of data collection and measurement. Chapter 4 details the study results, examining each of the
study’s research questions. Chapter 5 includes a discussion of the study’s results, organized by
each research question. Chapter 5 also identifies the study’s limitations, implications, future
research directions and conclusions.5
CHAPTER 2. LITERATURE REVIEW
Introduction
The 1970’s marked a shift in research from primarily looking at mothers as the sole
parental contributor to children’s development to fathers and mothers being understood as co-
contributors (Fitzgerald, Mann & Barratt, 1999). The focus of fatherhood research has evolved
since then from merely evaluating the effects of father presence and absence to assessing the
quality of father-child interactions and the impact of father characteristics on child
developmental outcomes (Bocknek, Hoassain, & Roggman, 2014). Specifically, early father-
infant and father-toddler interactions are linked to cognitive, social, emotional and language
development as well as academic achievement (Lamb, 2004; Tamis-Lemonda & Cabrera, 2002;
Cabrera, Tamis-Lemonda, Bradley, Hofferth, & Lamb, 2000; Amato & Rivera, 1999). This is
critical considering father are taking on nearly double the family responsibilities they were 50
years ago (Parker & Livingston, 2017).
Men are engaging in more direct child caretaking and domestic responsibilities than in
the past. According to a Pew Research Center report, fathers spend 7 hours per week providing
physical care for their children, up from 2.5 hours in 1965 (Parker & Wang, 2013). They are also
spending 10 hours per week on housework, up from 4 hours. In addition, 2 million fathers are
currently stay-at-home dads (Parker & Livingston, 2017). Moreover, 20% of fathers are the
primary caregivers for their children under age 5 years (U.S. Census Bureau, 2011). Time use
surveys show fathers averaging 1 hour and 37 minutes engaged with their child 0-2 years old on
weekdays with an additional hour and 31 minutes of time where they are accessible (Yeung,
Sandberg, Davis-Kean, & Hofferth, 2001). On weekends, father engagement time with a 0-2-
year-old child averages 3 hours and 45 minutes with an additional 2 hours and 47 minutes where6
fathers were present and available to the child. However, despite increased family involvement,
only 54% of fathers agreed or somewhat agreed with feeling adequately prepared for fatherhood
when they first became fathers (National Fatherhood Initiative, 2006). Assisting fathers with
their engagement in developmentally supportive parent-child interactions could have a lasting
impact on child outcomes.
Fathers
High quality father-child interactions are linked to better cognitive and language
development outcomes while low quality or negative interactions are connected to later
internalizing and externalizing child behaviors. Specifically, withdrawn and depressive behaviors
in father-infant interactions is related to lower cognitive development when the child is two years
old (Sethna et al., 2016). Also, disengaged and remote early father-infant interactions have
independently predicted externalizing behaviors as early as one year old (Ramchandani et al.,
2013). The book reading frequency of low-income fathers in an EHS study of 430 families
predicted their child’s book knowledge at 5 years old as well as their language and cognitive
development at 3 years old (Duursma, 2014). Fathers in another EHS study engaged in more
non-immediate talk (speech which is not directly reading the words or describing the pictures of
the book) than mothers when reading a book with their child at ages 2, 3 and 5 years (Duursma
& Pan, 2011). When controlling for parental education levels and child care quality, Pancsofar &
Vernon-Feagans (2006) reported father vocabulary usage at 24 months as the only parental
language predictor of child language development at 3 years old, explaining 9% of the variance.
Early father-child interactions are linked to child outcomes, but these interactions may be
indicative of the father-child relationship. Fathers may also need support in developing their
relationship with their baby.7
Father-child relationships have been linked to later father-child interactions, academic
achievement, and behavior problems. In addition, paternal attachment representations at 6
months have predicted the quality of father-child play behavior at two years old (Hall et al.,
2014). Much of the research literature has focused on father presence or absence with regard to
non-resident fathers and child outcomes. A meta-analysis on the contributions of non-resident
fathers to child well-being concluded that child outcomes were not related to the amount of
contact fathers had with their child (Amato & Gilbreth, 1999). Rather, relationship closeness and
authoritative parenting were positively related to academic success and negatively related to
internalizing and externalizing behavior. Consequently, supporting fathers in developing positive
relationships with their child is important.
Vulnerable Fathers
Contrary to assumptions about high father absenteeism in low-income families, the Early
Head Start Research and Evaluation Project (EHS) reported more than 80% of 2-year old
children in the EHS study saw their biological father in the past 3 months (Cabera et al., 2004).
Seventy-four percent of children saw their biological father a few times a month and 64% of
children saw their biological father a few times a week. Nearly 54% of married fathers and 61%
of cohabiting fathers reported looking after their child nearly every day while the mother was
doing something else. In addition, 49% of non-resident boyfriend fathers reported doing this as
well. Using a nationally representative sample, Cabrera, Hofferth and Chae (2011) demonstrated
cohabiting fathers were more engaged in physical play and caregiving with their infants than
married fathers. Cabrera and colleagues (2004) also reported significantly greater caretaking
among cohabiting fathers. In addition, African American and Latino fathers were more engaged
in these same activities than white fathers. These differences were significant even after8
controlling for human capital, infant age, couple conflict and hours worked. Higher reported
couple conflict and father depressive symptoms were both predictive of lower father-infant
engagement. The majority of fathers, regardless of residential status and relationship status with
the mother, are present in the lives of their infant or toddler. Further, a large proportion of fathers
in a relationship with the mother spend some time as primary caregiver for their infant on an
almost daily basis. Since many non-resident boyfriend fathers, cohabiting fathers, African
American fathers, and Latino fathers are involved in caretaking of their infant, it is even more
critical to attempt to engage them along with mothers in services which support families with
babies. Efforts have been made, but a gap still remains between the resources available and the
agencies and practitioners who work directly with families.
Despite a dedication of billions of dollars in funds towards the Child Support
Enforcement Program and Fatherhood Initiative, 150 million dollars for Healthy Marriage and
Responsible Fatherhood programs (Responsible Fatherhood Working Group, 2012) and a host of
best practices, recommendation tool kits and father engagement resources available, family
support programs continue to have difficulty engaging fathers (Zanoni, Warburton, Bussey &
McMaugh, 2013). The United States Departments of Health and Human Services and Education
(2016a, p. 7) recommend the following:
In order to realize the potential benefits of family engagement, early childhood programs
should systematically include specific, measurable, and evidence-based family
engagement strategies that are attuned to the needs and interests of a diverse array of
primary caregivers, including but not limited to fathers and other male caregivers,
mothers and other female caregivers, young parents, grandparents, and foster parents,
among others.9
Despite barriers for non-residential and working fathers, home visiting programs offer a
tremendous opportunity to engage fathers because services are provided at the family’s residence
providing both convenience and a comfortable setting. Palm and Fagan (2008) promote home
visitation as possibly the best service to begin father participation in early childhood education.
Home Visiting
The Health Resources and Services Administration (HRSA) provides funding for the
Maternal Infant Early Childhood Home Visiting (MIECHV) program through the Maternal and
Child Health Bureau. Federal expansion funding focused attention on at-risk communities that
were identified through state needs assessments. The percentages of MIECHV families served in
2014 who met a risk factor identified by the Health Resources and Services Administration (U.S.
Departments of Health and Human Services and Education, 2016b) include: 79% below federal
poverty guidelines, 55% parents under 25 years old, 69% single, 66% unemployed and 69% with
a high school diploma, GED or less education.
Current best practices in home visiting services suggest the home visitor act as a
facilitator to promote parent engagement in responsive, developmentally supportive interactions
with their infant (Roggman, 2016). In a study of parent ratings of early intervention programs,
both mother and father ratings of the helpfulness of the program were significantly correlated to
their ratings of benefits to the father (Upshur, 1991). Thus, it makes sense to target fathers as
well as mothers as a recipient of services. A challenge to engaging fathers is that more than 95%
the workforce who works directly with infants and toddlers are women (McHale & Phares, 2015)
and many women in the field report being inexperienced in working with fathers and
uncomfortable engaging with them (Dion & Strong, 2004). In a study of Healthy Families
Alaska, home visitors felt less effective in working with fathers than mothers (Caldera et al.,10
2007). In addition, many fathers have reported feeling home visiting is mother-focused (CFRP,
2013). Unfortunately, even if a father is present during a home visit, there is a lack of methods
for documenting home visitor interactions with fathers or the time dedicated to the father
(McHale & Phares, 2015), so evaluation of current home visitor practices in regard to fathers
remains difficult. In view of these issues, knowing how home visiting programs approach fathers
is critical to successful engagement.
Expansion funding for MIECHV through the affordable care act primarily supported 4
national evidence-based program models (Michalopoulos et al., 2015). These included Early
Head Start (EHS), Healthy Families America (HFA), Nurse-Family Partnership (NFP) and
Parents as Teachers (PAT). Table 1 describes each program’s approach to fathers.
Father Involvement in Parenting Support Programs and Child Outcomes
Peterson et al. (2012) reported higher family involvement in Early Head Start home
visiting services was related to better child development outcomes at prekindergarten and fifth
grade. In addition, highly involved families provided more nurturing and stimulating settings for
their children at home at prekindergarten and fifth grade. Involvement was a latent variable
which included a quality rating of overall family engagement, duration of family participation
since enrollment and intensity of family participation. It is clear higher family involvement in
home visiting can influence parenting behavior and child outcomes, however little of this
research specifically examines fathers, disaggregating mothers from fathers in both data
collection and analysis.11
Table 1
Father Approaches of National MIECHV-Funded Evidence-Based Program Models
Father
Model Approach
“A program must recognize parents as their children’s
primary teachers and nurturers and implement intentional
strategies to engage parents in their children’s learning and
EHS
development and support parent-child relationships,
including specific strategies for father engagement”
(Administration for Children and Families, 2016, p. 43).
No specific approach to fathers. Fathers, mothers and all
other primary caregivers are described in program standards
as “family.” Upon service initiation, “site staff must identify
HFA
positive ways to establish a relationship with a family and
keep families interested and connected over time” (Healthy
Families America, 2015, p. 41).
Enrollees must be a first-time pregnant mother. “Fathers are
encouraged to be part of visits when possible and
appropriate” (Nurse Family Partnership, 2010, p. 8). “NFP
NFP
nurses promote: Mothers’ and fathers’ care of the child…
[and] parents’ life course development” (Nurse Family
Partnership, 2010, p. 28).
No specific approach to fathers. PAT offers a promoting
responsible fatherhood toolkit for parent educators. “It is
important to encourage all caregivers in the family to
participate and to monitor visit and group participation rates
PAT
on an ongoing basis, using a variety of strategies to address
family engagement… Parent educators strive to involve both
parents and/or caregivers of the child in the visits” (Parents
As Teachers, 2015, p. 17; 20).
Dads Matter is a home visiting service enhancement developed to engage fathers along
with mothers in home visiting (Guterman, 2012). The enhancement focuses on improving father
knowledge, skills and commitment as well as co-parenting. Implementation of the Dads Matter
home visiting service enhancement has been related to improved mother ratings of the father’s
involvement with their child as well as higher father reported relationship quality with the home
visitor when compared to families receiving home visiting services without the enhancement.12
Increasing father involvement with their child should improve child outcomes, but this study,
like most home visiting research on fathers, did not measure child outcomes. The broader
intervention research literature suggests a relationship between father intervention involvement
and child outcomes. For example, Head Start adapted their normal parent engagement activities
for fathers at four intervention sites (Fagan & Iglesias, 1999). When compared to control sites,
fathers who were highly involved in the intervention had children with significantly higher
change in mathematics readiness when compared with the children from the control group.
Research even suggests father interventions that target both parents may have a more robust and
lasting impact on the family. When comparing different Supporting Father Involvement
intervention groups (fathers only versus mothers and fathers), the intervention with couples had
decreases in parenting stress and stable relationship satisfaction while the intervention with only
fathers had no change in parenting stress and decreased relationship satisfaction (Cowan, Cowan,
Pruett, Pruett, & Wong, 2009). Both interventions saw increases for fathers in engagement and
daily care of their child. Additionally, child behavior problems were stable in the intervention
groups, while the control group saw increases in behavior problems across all 4 domains. When
fathers are involved in interventions that address their needs and effectively engages them,
fathers are likely to become more involved with their children resulting in improved child
outcomes. Unfortunately, fathers tend to have low participation rates in home visiting programs,
which have the potential to improve their involvement with their children.
Father Participation in Home Visits
Father participation has been broadly defined across the home visiting literature.
Researchers use the term participation to illustrate the quantity of visits fathers attended, the
quantity of visits in which fathers were actively involved, and the quality of father involvement13
in home visits. There is also a dearth of father data beyond a single measure of participation.
Korfmacher et al. (2008) breaks down parental involvement in early childhood home visiting
into quantity (participation) and quality (engagement) dimensions. Research literature is
summarized using these categories, starting with quantity dimensions and then quality. Research
is organized first by father presence or attendance, then involvement and finally availability and
engagement.
Presence
The most frequent measure of father participation in home visiting has been father
attendance. For example, Holmberg and Olds (2015) reported fathers attending an average of 2.4
Nurse Family Partnership visits by the time the child was 12 months old, which constitutes
approximately 12% of visits. Fathers were observed present in 15% of home visits for Project
Home Visit (McBride & Peterson, 1997). Fathers were observed to be present at 24% of Early
Head Start visits (Peterson, Luze, Eshbaugh, Jeon & Kantz, 2007). In another Early Head Start
study, 32% of fathers reported themselves attending at least 1 home visit, while 17% of fathers
reported attending monthly (Raikes, Summers & Roggman, 2005).
It is unclear if attendance in these studies meant the father was present for the entire visit
or if attendance means they were present for at least part of a visit. Because of this ambiguity, the
term presence is used in lieu of attendance. For the purposes of this research, father presence
describes fathers who are physically at home at any time during a home visit whether they
participate or not. Identifying father presence in the home rather than attendance or in addition to
a measure of participation or engagement could allow researchers and practitioners to more
accurately document father involvement and potential for involvement.
Involvement14
Father involvement has referred to documented active participation in the visit beyond
attendance or presence. Research reporting percentages of visits where a father was an active
participant include a report from a Healthy Start Program where overall, fathers participated in
18% of visits; domestic fathers and fathers who frequently visited the mother participated in 24%
of visits (Duggan et al., 2004). In Texas, 12% of fathers were always involved in MIECHV home
visits, while 27% of fathers were sometimes involved (Osborne & Falcon, 2015).
Father Availability
It is unclear how home visitors designate fathers as active participants in their home visit
records and service providers likely use different criteria, if documented at all. For instance, if a
father sits on the couch with the mother throughout the visit, is he involved? Reviews of father
participation in home visitation services have not provided information on how available the
father is for interaction during visits when he is present. Therefore, for the purposes of this
research, father involvement is separated into two domains: availability and engagement.
Availability is the potential for involvement and demonstrates the degree to which the father is
accessible to the home visitor. It is the percentage of a home visit where the father is available
for home visit activities. While this conceptualization of father availability has been overlooked,
father engagement has received some attention in research literature. Father engagement is the
quality of father involvement when he is participating. Engagement has been measured
differently across research studies.
For example, Roggman et al. (2002) used home visitor ratings of father engagement
based on five 5-point scales which included father participation in EHS home visits, the home
visitor-father relationship and child engagement. They also rated improvement in participation
and child engagement. Fathers had an average engagement score of 2.3, an average relationship15
score of 2.9 and an overall mean score of 2.6 for engaging with the baby. Fathers with greater
relationships with the home visitors were more likely to be rated as engaged during home visits,
showing interest, paying attention and initiating interactions.
A primary strategy fathers use to initiate interactions with the home visitor is to ask
questions. Osborne and Falcon (2015) reported 37% fathers asked the home visitor questions at
least sometimes during Texas MIECHV visits. Father engagement is a distinct domain within
involvement focused on what the father does to contribute to his involvement. Father
engagement describes the degree of the father’s interest in, attention to and initiation of home
visit activities. While some research has examined father engagement and initiation, what home
visitors do with fathers mostly remains a mystery. Home visitor observed attention to,
acknowledgement of and initiation of activities with fathers has not been documented or
explored.
Home Visitor Practices with Fathers
Research on what strategies interventionists use during home visits has relied primarily
on home visitor report. Home visitors report both the importance of and their use of modeling
and coaching strategies as primary methods to engage parents in interactions with their child
during home visits (Peterson, McBride, Larson, Seifert, & Riggs, 1995). These self-reports may
be unreliable, though, because observations of home visitors demonstrate low use of these
strategies (McBride & Peterson, 1997; Peterson, Luze, Eshbaugh, Jeon, & Kantz, 2007). Instead,
observations show home visitors spending most of their time in conversations with adults.
Unfortunately, even when fathers are present, observations have not categorized fathers
separately from mothers when identifying the interaction partners during home visits (McBride
& Peterson, 1997; Peterson, Luze, Eshbaugh, Jeon, & Kantz, 2007). When both parents are16
present, it is unclear how often home visitors interact with fathers, the content of their
interactions, and the nature of those interactions. Adaptation of current observational coding
systems could “open up the black box” on home visitor practices with fathers in order to
illuminate their experiences.
Home Visit Quality and Father Involvement
Roggman’s (2016) evidence-based developmental parenting home visiting practices
emphasize home visitor engagement of the whole family in positive relationships with an
emphasis on child development, responsiveness to family strengths and activities, facilitating
parent-child interactions which support positive development and collaboration with parents
without being intrusive. These practices are related to positive outcomes for both parents and
children. Research has also identified relationship quality between the parents and home visitor
as an important contributor to program effectiveness as well as parent engagement and
involvement (Korfmacher, Green, Spellman & Thornburg, 2007; Korfmacher et al., 2008;
Roggman, Boyce, & Innocenti, 2008). McAllister, Wilson and Burton (2004) reported one of the
most successful strategies for involving fathers is through the home visitor intentionally building
a relationship with the father as they do mothers, demonstrating care for him and establishing
trust. Despite ample evidence linking Roggman’s (2016) developmental parenting home visiting
practices to greater parent involvement, research has not investigated the impact of the quality of
these practices on father involvement during the home visit when he is present.
Parent engagement during the home visit is an important variable related to improved
parent and child outcomes (Heinicke, Fineman, Ponce & Guthrie, 2001; Heinicke, Goorsky,
Levine, Ponce, Ruth, Silverman & Sotelo, 2006; Lieberman, Weston, & Pawl, 1991;
Korfmacher, Kitzman & Olds, 1998; Raikes, Green, Atwater, Kisker, Constantine & Chazan-17
Cohen, 2006; Roggman, Boyce, Cook & Jump, 2001). Home visiting practices should engage
parents in interactive home visit activities, with each other and with their child (Roggman, 2016).
Home visitors in an EHS study who were observed successfully engaging parents during the visit
and engaging them with their child had the families who were rated most improved (Roggman,
Boyce, Cook & Jump, 2001). Additionally, home visitors who spend more time on child
development content are more likely to have better home visit outcomes (Peterson et al., 2013).
These results are promising, but research currently combines father and mothers in observational
analyses. In addition, research is lacking on the relationship between specific home visiting
practices and father involvement.
Conceptual Framework
This study uses Roggman, Boyce and Innocenti’s (2008) developmental parenting
approach for early childhood practitioners as a model for predicting father involvement from
home visiting practices. The developmental parenting approach involves providing high quality
home visiting services, which incorporate specific home visiting practices that promote parent
engagement. Parent engagement fosters developmental parenting practices by the parents and
thus cultivates child development (Figure 1). This study focuses on the pathway between home
visiting strategies and parent engagement. Additionally, the current study incorporates
Korfmacher et al.’s (2008) multidimensional model of parent involvement which emphasizes
home visitor characteristics such as their background and training as well as family
characteristics such as demographics and family context as predictors of parent involvement
(Figure 2).18
Home
Parent Developmental Child
Visiting
Involvement Parenting Development
Practices
Figure 1. Roggman, Boyce & Innocenti’s (2008) developmental parenting approach for early
childhood practitioners.
Program Home Visitor
Factors Factors
Parent Parent
Factors Involvement
Figure 2. Korfmacher et al.’s (2008) multi-dimensional model of parent involvement.
This research examines home visitor and family characteristics as predictors of home
visiting practices and father involvement, respectively, combining the frameworks of Roggman,
Boyce and Innocenti (2008) and Korfmacher and colleagues (2008). The link between home
visitor factors and home visitor practices, rather than father involvement directly as in
Korfmacher et al.’s (2008) model, is more important because although home visitor factors are
largely static, their practices are malleable. In combining these frameworks, the assumption is
made that home visitor factors influence their practices, which then affect father involvement.
Figure 3 displays the measurement model, which details the measurement of home visiting
practices, parent involvement, home visitor and family characteristics used in this research.19
Age Mother Age
Ethnicity Mother Education
Education Level Mother Marital Status
Educational Field Mother Ethnicity
Paid Training Hours Child Gender
Experience Family Income
Home Visitor Family
Characteristics Characteristics
Home
Father
Visiting
Involvement
Practices
Father Inclusion Father Availability
Activity Content Father Engagement
Home Visitor Nature
Practices Quality
Figure 3. Measurement model.
Current Study
This study is the first to examine multiple dimensions of father participation in a single
home visit using observational data. This research quantifies father presence at both pre-natal
and post-natal visits. This study also quantifies father availability and engagement during home
visits. The home visitor’s involvement of the father in the activities and conversations of the visit
is also quantified. Additionally, this research describes based on observations how home visitors
interact with fathers including how often and what the content of those interactions are. Finally,
this research attempts to predict father involvement based on observed home visiting practices.20
Research Questions
1. How present, available, engaged and included are fathers during home visits?
2. What is the content and nature of home visitor interactions with fathers?
3. How do home visitor and family characteristics relate to father involvement and
inclusion?
4. How do home visitor practices relate to father involvement and inclusion?
5. What home visitor practices and family characteristics predict father
involvement? What home visitor characteristics predict home visitor inclusion of
fathers?21
CHAPTER 3. METHODOLOGY
The United States Health Resources and Services Administration (HRSA) MIECHV
expansion grant #D89MC23537 supported the Iowa MIECHV II evaluation. This research was a
part of the larger Iowa MIECHV II evaluation.
Participants
Thirteen hundred and fifty-four families enrolled in MIECHV II programs between
January 2012 and August 2015. Home visitors invited 835 families who met evaluation criteria
to participate in the evaluation project. Four hundred and thirty-seven families consented and
video recordings of at least one home visit was obtained from 337 families. The current study
examined observations from 50 families who had a home visit with the mother and a father-
figure present as well as their infant or toddler who was awake and available for interaction at
least half of the time. These home visits were conducted by 34 different home visitors.
Table 2 displays the demographics of the population of families in Iowa who received
MIECHV II home visits and the demographics of those in the study sample. The study sample
had a higher proportion of: mothers under 18, mothers who earned a high school diploma or
GED, and mothers who identified as white than the population of families served by MIECHV.
Family Characteristics
More than half of the mothers in this study were between the ages of 18 and 25. Half of
the mothers’ highest level of education was either a high school diploma or GED. Over 90% of
mothers identified as white with six and eight percent identifying as African American and
Hispanic respectively. Full distributions for age, education and race are detailed in Table 2.
Mean family income for the sample was $20,747 (SD = $17,560). Sixty-two percent of the22
primary caregiving mothers were unmarried. Eight percent were either divorced or separated.
Thirty percent were married. The majority of the target children were female (58%).
Table 2
Demographics of Families Who Received MIECHV II Grant-Funded Home Visiting Programs
(N=1354) and Study Sample (n=50) at Enrollment
MIECHV Study Sample
Percentage Percentage
Primary Caregiver Age
25 33.3 22.0
Primary Caregiver Education
Less than HS Diploma/GED 30.9 20.0
HS Diploma/GED 36.4 50.0
Some College or Training 24.8 28.0
Bachelor’s Degree or Higher 3.1 2.0
No Education Data 4.8 0.0
Primary Caregiver Race/Ethnicity*
White 74.3 94.0
Black/African American 23.2 6.0
Asian/Native American/Pacific Islander 6.1 2.0
No Race/Ethnicity Provided 1.0 0.0
Hispanic** 16.1 8.0
*Participants could select more than one
**Hispanic was a separate item from race on the form
Home Visitor Characteristics
Home visitor characteristics are summarized in Table 3. Home visitor experience ranged
between 0 and 25 years (M = 3.1, SD = 4.8). Most home visitors (76%) were in their 20’s or
30’s and greater than 70% had less than 3 years of experience as a home visitor. Almost 40% had
less than a year of experience. Approximately 90% were white and 94% had a bachelor’s degree
or higher education. Home visitors in this study had a wide range of educational backgrounds
with some holding multiple degrees (n = 9). The following educational backgrounds were
represented: psychology (n = 9), nursing (n = 7), sociology (n = 6), social work (n = 5),23
elementary education (n = 4), human/family services (n = 5), public health (n = 2), criminal
justice (n = 2), child development (n = 2), early childhood education (n = 2), speech pathology (n
=1), biology (n = 1), and journalism (n = 1). While two-thirds of home visitors received the
equivalent of 3 days of paid training over the last year, 12% received less than 1 ½ days of paid
training.
Table 3
Characteristics of Home Visitors (N = 34)
Frequency Percentage
Age 20-29 13 38.2
30-39 13 38.2
40-49 6 17.6
50-59 2 5.9
Race/Ethnicity White 30 88.2
Black/African American 1 2.9
Hispanic/Latino 2 5.9
Asian/Pacific Islander 1 2.9
Education Two Year Degree 2 5.9
Four Year Degree 27 79.4
Graduate Training 2 5.9
Graduate Degree 3 8.8
Paid Training 11 or less 3 9.7
1
Hours 12-23 6 19.4
24 or more 22 71.0
Experience as Less than 1 year 13 40.6
2
Home Visitor 1-3 years 10 31.2
More than 3 years 9 28.1
1
Three home visitors did not report their paid training hours (n=31)
2
Two home visitors did not report their experience (n = 32)
Procedure
The Iowa MIECHV II evaluation began collecting data from home visitors and families
in the summer of 2013. Home visitors receiving state MIECHV funding were required to
participate in the evaluation as part of their contract with the Iowa Department of Public Health;24
however, participation in the research component was voluntary. The Iowa State University
Internal Review Board approved of all procedures and measures for the research components
(see Appendix B for approval letter). Home visitor involvement in the evaluation included filling
out yearly home visitor surveys, recruiting families to participate, video recording a complete
home visit with participating families once per year for 3 years, and filling out an online survey
related to each visit with the family. Families were recruited prenatally or if their child was under
1 year of age. In order to participate in the research project, families had to be comfortable
speaking either English or Spanish. When the child was between 4 and 12 months, trained
research assistants conducted an assessment visit with the family. During the visit, the research
assistants assessed the child’s development using a developmental inventory, videotaped semi-
structured parent-child interactions, and provided surveys for the parent to complete. Research
assistants conducted a second assessment visit when the child was between 24 and 30 months.
Participants received a $50 gift card for participating in the research and completing the first
assessment visit and a $60 gift card for their continued participation and completion of the in the
second assessment visit.
Measures
Family Characteristics
Family characteristics and demographics were obtained and entered into a state database
by home visitors. This information was obtained through a data sharing agreement with the Iowa
Department of Public Health. Data collected from MIECHV families did not include information
distinguishing biological fathers from non-biological fathers. Additionally, data was not
collected about fathers unless they were the primary caregiving parent who was enrolled in25
services. For the purposes of this study, the men present during home visits were considered as
father figures, but are referred to as fathers for simplicity.
Home Visitor Characteristics
Home visitor characteristics and demographics were collected through a mailed 27-
question survey. This was included in an envelope with an informed consent form, materials
explaining the purpose of the research evaluation, as well as procedures for home visitors to
recruit families and collect data from participating families. All home visitor characteristics were
taken directly from the initial home visitor survey except for one participant who left the
education fields blank and they had completed a follow-up survey, which included the
information.
Observational Measures
Home visit recordings were coded by trained observers using two observational coding
systems. An adapted version of the HVOF-R (McBride & Peterson, 1996) was used to quantify
how the home visitors devoted their time during home visits by their interaction partners and the
content and nature of their interactions. The adapted HVOF-R quantified fathers’ availability for
interaction with the home visitor as well as the degree to which home visitors included or
excluded the father from activities or conversations when he was available. The adapted HVOF-
R was also used to assess father engagement during visits separately from mothers. The HOVRS
A+ (Roggman et al., 2014) was used to measure quality of home visit practices.
Home visit observation form-revised (HVOF-R). The HVOF-R (McBride & Peterson,
1996) is an interval observation coding system that describes the primary interaction partners,
content of interaction, and nature of the home visitor behavior, every 30 seconds. Additionally,
the engagement of family participants is rated on a 1 to 6 scale every 10 minutes. Each personYou can also read
