Fathers for Change (F4C) - Promising Futures

• Individual
• Dyadic

• In-Person
• Virtual
• Hybrid

• Licensed/Certified Professional Led

• Domestic Violence
• Child Abuse
• Family Separation
• Reunification

• Talk-Based
• Experiential
• Play-based

• Tertiary Prevention
• Intervention

• Greater than 12 weeks

• Home
• Residential
• Correctional
• Mental Health Setting
• Community Based Agency

Type of services provided:

Fathers for Change (F4C) is a fatherhood focused individual and family intervention that addresses co-occurring intimate partner violence and child maltreatment. The intervention can be used by child protection services to assess individual family needs and provides services to fathers and all family members. The intervention combines attachment and cognitive behavior theories with a focus on emotion regulation and reflective functioning. F4C uses a family systems framework to examine multigenerational patterns and experiences. Originally developed for fathers in outpatient substance use treatment programs, F4C has been modified for residential treatment programs, outpatient community mental health settings and other community settings. Fathers for Change has been implemented in a statewide initiative in Connecticut and by several child welfare affiliated agencies in Virginia.

F4C begins with comprehensive assessment using a range of measures to assess history of intimate partner violence, substance misuse, co-parenting, mental health symptoms, emotion regulation difficulties and childhood history of trauma. F4C is structured in 4 progressive phases: 1) assessment and motivation, 2) self-focused emotion regulation and reflective functioning, 3) coparenting communication, and 4) restorative parenting. The topics, which are designed to achieve cessation of family violence through improved emotion regulation and reflective functioning, are delivered in 60-minute, weekly individual therapy sessions as follows:

• 9 individually-focused core topics
• 4 coparent focused topics
• 5 father-child focused topics

In the beginning of the intervention, sessions focus on the role of men as fathers, child development, how to understand children’s symptoms due to exposure to intimate partner violence, the impact of violence and substance misuse on parenting and fathers’ childhood experiences of family substance misuse and trauma as well as exploring the multigenerational history of these problems. There is a strong emphasis on skill development in the following areas:

• Identification of unhelpful and/or hostile thoughts and their origins
• Understanding feelings, emotion regulation and distress tolerance
• Reflective functioning related to self, co-parenting and children
• Communication skills, giving compliments and problem-solving around co-parenting
• Restorative parenting, making amends, emotion coaching

Fathers who meet pre-determined milestones during the individual-focused sessions can progress to optional co-parent communication-focused sessions if the co-parent wants to participate and the clinician feels it is safe. There is also the option of restorative father-child parenting sessions when mothers consent to their child’s participation. Fathers are assisted by the therapist to take responsibility for their past behaviors and work toward making amends with their children.

Program setting:

Outpatient, community, in-home or residential treatment programs

Length of program/number of sessions:

60-minute weekly sessions of individual treatment for 18-24 weeks in outpatient or community treatment programs; weekly 60-minute individual sessions for 12 weeks in residential substance use treatment programs followed by 4 booster sessions following discharge from the residential setting.

Type(s) of trauma/concerns addressed:

Intimate partner violence, , child maltreatment, fathers with substance use problems

Education level of providers:

Master’s level or above clinical degree (MSW, MFT, Ph.D., etc.)

Unique/Innovative Characteristics:

• This fatherhood intervention works with men to address the intersections between intimate partner violence, substance misuse, fathers’ parenting skills and co-parenting skills
• Fathers for Change works on emotional regulation with fathers applied to their own behavior first and then to their skills to co-parent and parent their children
• Fathers for Change has demonstrated a reduction in intimate partner violence (IPV) and children’s exposure to conflict; results from a statewide implementation of F4C demonstrated medium to large effect sizes for the reduction in IPV and children’s exposure to conflict
• Fathers for Change supports relapse prevention for men exiting residential substance misuse treatment facilities
• Fathers and children learn coping and relaxation skills together in dyadic father-child sessions. Fathers learn communication skills to talk to their children about their substance use issues, their past violent behavior in the family and their intention to change.
• Fathers for Change has consistently high completion rates

Date Added/Updated:

08/15/2022

• 0-5 (Early Childhood)
• 6-12 (Childhood)
• 12-25 ( Young Adult)
• 25 and up (Adult)

• English
• Spanish

• Black or African American
• Hispanic or Latino
• White

• Parent who uses Violence
• Child
• Survivor parent

Age range of children served:

Under 12 years old

Are parent/adult caregiver(s) included in intervention?

Yes, this is a fatherhood intervention with the option for mothers to participate

Ethnic/racial and other groups served:

In a pilot study to evaluate the feasibility of F4C, the court-referred study population was 70% Hispanic and 30% African American. In a community-based statewide implementation project that included 373 fathers, the population was: 37% Non-Hispanic White, 30% Hispanic/Latino, 22% Non-Hispanic African American/Black, and <10% multiracial or ‘other’ race/ethnicity. There were no differences in program completion based on race/ethnic categories.

Specific cultural adaptations:

None indicated.

Languages that service/resource is available:

English and Spanish

Goals of the program/services:

• Cessation of violence and aggression
• Maintained abstinence from substances
• Improved parent-child interactions
• Improved co-parenting

Has there been any evaluation?

Yes

Key evaluation results:

In a statewide evaluation of Fathers for Change (F4C) with six sites in the State of Connecticut, 373 fathers were referred to F4C by child protection service agencies. Seventy-three percent (73%) of fathers completed the program statewide; participation was voluntary, not court-ordered. Unlike evaluation data from batterers’ intervention programs, father age, education and severity of intimate partner violence were not associated with dropping out of the intervention.

Study outcomes include:

• Significant reduction in maternal reports of fathers perpetrating intimate partner violence from pre- to post-intervention
• Significant reduction in mother’s reports of children’s exposure to conflict from pre- to post- intervention
• Significant reduction in father’s emotion dysregulation, anger arousal, responses to anger eliciting situations, hostile outlook, negative emotionality and pre-mentalizing based on fathers’ scores on pre- and post-intervention standardized measures

Smith Stover C., Beebe R., Clough M., DiVietro S., Madigan L, Grasso D. J. (2020). Evaluation of a statewide implementation of Fathers for Change: a fathering intervention for families impacted by partner violence. Journal of Family Violence. 

In an open trial of initial feasibility with ten fathers, the completion rate was 80% in the pre-pilot phase. All fathers who completed the program remained non-violent during treatment, 80% reduced their substance use and 80% became abstinent during treatment based on self-reports in weekly logs. Fathers reported high levels of satisfaction with the program.
Stover Smith, C. (2013). Fathers for Change: A new approach to working with fathers who perpetrate intimate partner violence. Journal of the American Academy of Psychiatry and the Law, 41(1):65-71.

In a community pilot study, 18 fathers were randomized to Fathers for Change (F4C) or Individual Drug Counseling. The F4C intervention group was more than twice as likely to complete treatment (67% vs. 33%). Fathers receiving F4C showed a trend towards less intimate partner violence following treatment compared to Individual Drug Counseling recipients based on fathers’ self-reports. Reductions in substance abuse was comparable for both interventions. Men who received F4C showed less intrusiveness during free play interactions and more consistency of style in parenting post-intervention based on video-taped interactions with their children. The F4C intervention group reported significantly greater satisfaction with their program.

Stover Smith C. (2015). Fathers for Change for substance use and intimate partner violence: Initial Community Pilot. Family Process, 54(4):600-609.

Fathers for Change was modified for residential treatment programs and evaluated in a pilot study with 44 fathers. Interviews were conducted at baseline and follow-up along with focus groups to gain further insights into fathers’ needs and recommendations. There were significant reductions in anger related thoughts and affect regulation problems from baseline to follow-up. Participants were highly satisfied with the program and 84.1% completed the program.
Stover Smith C., Carlson M., Patel S. & Manalich R. (2018). Where’s dad? The importance of integrating fatherhood and parenting programming into substance use treatment for men. Child Abuse Review, 27(4):280-300.

In a randomized trial, 62 fathers (74% Euro-American heritage) were randomized to Fathers for Change or a psychoeducational intervention focused on child development and behavioral parenting skills (Dads ‘n’ Kids) for 12 weeks while in residential substance use treatment. Both intervention groups received weekly individual sessions and 4 aftercare sessions following discharge (3-month follow-up following intervention). Both intervention groups showed significant reductions in affect dysregulation, anger, intimate partner violence and coparenting problems based on fathers’ self-reports. There were no significant differences between groups on intimate partner violence but the Fathers for Change group was significantly less likely to use substances after leaving residential treatment and showed significantly greater decreases in affect dysregulation problems.
Stover Smith C., McMahon T. & Moore K. (2019). A randomized pilot trial of two parenting interventions for fathers in residential substance use disorder treatment. Journal of Substance Abuse Treatment, 104:116-127.

Data on a statewide initiative of Fathers for Change in Connecticut is reported on the Fathers for Change website (https://medicine.yale.edu/childstudy/education/practitioner/fathers/evidence_base/). Fathers for Change was part of a larger initiative, Intimate Partner Violence Assessment Intervention Response (IPV-FAIR; profile available on this website), that was implemented by the State of Connecticut Department of Children and Families. Based on 4 years of data, Fathers for Change has a 73% completion rate. Pre-post assessments indicate significant reductions in intimate partner violence and children’s exposure to conflict based on mothers’ reports as described in Stover et al, Journal of Family Violence, 2020 (see above). In addition to the outcomes published in Journal of Family Violence article, fathers also reported significant reductions in PTSD, depression and anxiety symptoms. Mothers who chose to participate in the co-parenting sessions reported improved mental health symptoms in their children.

Other Publications:

Stover Smith, C., Carlson M., & Patel S. (2017). Integrating intimate partner violence and parenting intervention into residential substance use disorder treatment for fathers. Journal of Substance Abuse Treatment, 81:35-43.

• English

• Yes

Training manuals/protocols:

Treatment manual, training PowerPoint slides with sample session videos to facilitate learning

Training Costs:

$5000 for 2-day, in-person basic training; 12 months consultation calls at $200 per call for a group of 12 clinicians per call

Carla Smith Stover

203-785-3486

carla.stover@yale.edu

www.medicine.yale.edu/childstudy/education/practitioner/fathers/