Home visitation is a prevention program for sociodemographically high risk, first-time mothers and their families that is designed to optimize child health and development. Most home visitation programs seek to engage fathers in the service and promote greater positive involvement with their children, although systematic and efficacious strategies to achieve this have not been developed and tested. Yet, it is well-documented that positive father involvement and mutually supportive relationships between fathers and mothers impart direct benefits to both children and their parents. Building upon previous efforts to incorporate evidence-based interventions into the home visitation setting, this study seeks to adapt Family Foundations, a coparenting intervention with a strong empirical foundation, as an augmented strategy in ongoing home visitation. In a first phase of qualitative investigation, we will adapt the format and content of Family Foundations for implementation in the home, addressing the needs of high risk mothers and fathers, and integrate it into standard home visitation services. In a second phase, a clinical trial will be conducted to determine the efficacy of the adapted intervention (HVFF) in contrast to a control condition of home visitation alone (HVA). Specifically, 300 mother/father dyads in home visitation will be recruited prenatally and randomly assigned to HVFF and HVA conditions. HVFF will consist of 8 in-home and 2 group sessions administered weekly and in two equal parts at approximately 2 months before birth and 4 months postpartum. Both the HVFF and HVA participants will be assessed at pre-intervention, post-intervention (5 months postpartum), and 9 and 18 month follow-ups. A comprehensive assessment battery will be administered at each assessment measuring parental cooperation, quality of parental relationship, father involvement, beliefs about parenting, parental psychological adjustment, and intimate partner violence. After the child's birth, child development and social/emotional adjustment will be measured and parenting practices will be videotaped and subsequently rated for parenting quality. It is hypothesized that, relative to controls, fathers in the HVFF condition will participate more frequently and more positively in standard home visits and will be more involved with their children;mothers and fathers in the HVFF condition will have higher levels of coparenting, and lower levels of depression, parental stress, and child abuse potential;and children in the HVFF condition will be more behaviorally and emotionally well- adjusted. Mediators of intervention outcomes will also be explored. HVFF will be manualized and readily disseminated to other home visitation programs. Results from this study will have significant public policy implications given the sizable public investment that has been made in home visitation around the country.

Public Health Relevance

Engagement of fathers in the lives of their young children and a positive working relationship with mothers is essential to optimizing child outcomes. Home visitation provides a platform through which to engage and intervene with high risk mothers and fathers to promote coparenting. By adapting and incorporating Family Foundations, an evidence-based coparenting intervention, into home visitation, it will be possible to enhance the impacts of home visitation and improve developmental trajectories of young children. Results from this study will have profound public health implications through demonstrating the effectiveness of a readily disseminated intervention for sociodemographically high-risk parents and their children.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Esposito, Layla E
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Cincinnati Children's Hospital Medical Center
United States
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