The goal of this clinical trial is to test the efficacy of Fathers for Change (F4C) compared to standard Batterer Intervention for fathers with a history of Intimate Partner Violence. The main question\[s\] it aims to answer are: 1. Is F4C more efficacious than standard BIP in reducing family violence and child mental health impairment? 2. What are the trajectories of therapeutic change targets across interventions? 3. Does father's emotion regulation and reflective functioning mediate the relationship between the two interventions and child-related outcomes? Participants will be randomized to either Fathers for Change on Batterer Intervention.
Children's exposure to intimate partner violence (IPV), often perpetrated by fathers, has been described as a gateway to other adversity, with more than a 50% co-occurrence of direct forms of child maltreatment (CM). IPV exposure can wreak havoc on children, with risk for psychosocial impairments, including posttraumatic stress disorder (PTSD), that can emerge early and cascade across development. Lacking are interventions that adequately address the complex nature of IPV in families, including fatherhood and coparenting. This gap reflects a bias towards excluding offending fathers from child-focused work and an overreliance on batterer intervention programs (BIPs), which have shown negligible effects in meta-analyses and fail to address the roots of offending behaviors in fathers. Consequently, IPV exposed children remain at risk and fathers' personal and interpersonal functioning, including the father-child relationship, does not improve. In effect, there is an urgent need for effective interventions for fathers and their families. Fathers for Change (F4C) is a novel fatherhood-focused intervention with a dual focus on IPV and CM that focuses on identifying, understanding, and managing emotions to reduce aggression and improve partner and parent-child interactions. F4C has a growing evidence-base demonstrating significant reductions in family violence, improved father-child interactions, and in one open trial, improved child mental health. Proposed therapeutic mechanisms of F4C include reflective functioning (RF), the capacity for parents to understand their own and children's actions as a function of underlying states and motivations, and emotion regulation (ER), the capacity to exert control over emotional states and reactions to threat. Poor RF and ER have been associated with increased family violence and stress-related psychopathology, suggesting key focal points for intervention. To date, there have been no empirical examinations of ER and RF as therapeutic change mechanisms for reducing family violence and improving father-child interactions and child mental health. Proposed is a dual-site, multi-modal examination of ER and RF in fathers (of children 4-7 y.o.) randomized to F4C (N=180) or the Duluth Model (N=180), a BIP serving as active control. In-session observational coding will assess adaptive and maladaptive ER and RF across treatment. Weekly self-ratings will assess at-home ER and RF. Aims will (1) assess efficacy of F4C compared to a standard BIP in reducing family violence and child mental health impairment, (2) map and compare trajectories of therapeutic change targets across interventions, and (3) examine the mediating role of father's ER and RF on child-related outcomes. This proposal will grow the evidence-base for F4C and advance our understanding of therapeutic mechanisms through which F4C exerts its effects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
1,080
18 week individual therapy focused on fathers' emotion regulation, reflective functioning and family communication.
18 week individually delivered psychoeducation and CBT focused program focused on intimate partner violence
Yale
New Haven, Connecticut, United States
RECRUITINGUCONN Health Center
West Hartford, Connecticut, United States
RECRUITINGChange in Physical Intimate Partner Violence (IPV) overtime
The Physical Intimate Partner Violence Subscale of the Family Socialization Interview-Revised will be used to assess physical IPV. Items are coded on a 4-point scale for severity from 0 (none) to 4 (severe). Scores are averaged to achieve a total score with a range of 0 to 4. Higher scores indicate greater frequency and severity of Physical IPV.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
Change in Verbal Intimate Partner Violence (IPV) overtime
The Verbal Intimate Partner Violence Subscale of the Family Socialization Interview-Revised will be used to assess verbal IPV. Items are coded on a 4-point scale for severity from 0 (none) to 4 (severe). Scores are averaged to achieve a final score with a range of 0 to 4. Higher scores indicate greater frequency and severity of verbal IPV.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
Change in Physical Child Maltreatment overtime
Family Socialization Interview-Revised will be used to assess physical child maltreatment. The Physical scale will be used for this outcome. Items are ranked on 0-4 point scale from 0 (none) to 4 (severe) and averaged for a final score with a range of 0 to 4 with higher scores indicating greater frequency and severity of physical child maltreatment risk.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
Change in Verbal Child Maltreatment overtime
Family Socialization Interview-Revised will be used to assess physical child maltreatment. The verbal scale will be used for this outcome. Items are ranked on 0-4 point scale from 0 (none) to 4 (severe) and averaged for a final score with a range of 0 to 4 with higher scores indicating greater frequency and severity of verbal child maltreatment risk.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
Change in Child Posttraumatic Stress Symptoms overtime
The Child Trauma Symptom Checklist will be used to assess child PTSD symptoms. Each symptom item is rated according to its frequency of occurrence using a four point scale ranging from 0 ("never") to 3 ("often"). The PTSD total raw score is converted to a t-score based on measure norms with scores ranging from 0 to 100. Higher scores indicate greater severity of posttraumatic symptoms.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
Change in Father-child interactions overtime
Child interactive behavior coding based on 15 minute play assessment coded for dyadic reciprocity, fluency, conflict and hostility. Scores are on a 1 to 4 point scale. An average score is generated for a range of 1 to 4. Higher scores indicate more of the coded behavior.
Time frame: Baseline, 19 weeks, and 70 weeks
Change in Coercive Controlling Intimate Partner Violence (IPV) overtime
The Coercive Controlling Intimate Partner Violence Subscale of the Family Socialization Interview-Revised will be used to assess verbal IPV. Items are coded on a 4-point scale for severity from 0 (none) to 4 (severe). Scores are averaged to achieve a final score with a range of 0 to 4. Higher scores indicate greater frequency and severity of coercive controlling IPV.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
Change in Child Anxiety Symptoms
The Child Trauma Symptom Checklist will be used to assess child Anxiety symptoms. Each symptom item is rated according to its frequency of occurrence using a four point scale ranging from 0 ("never") to 3 ("often"). The Anxiety subscale score is converted to a t-score based on measure norms with scores ranging from 0 to 100. Higher scores indicate greater severity of anxiety symptoms.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
Change in Child Depression Symptoms
The Child Trauma Symptom Checklist will be used to assess child Depression symptoms. Each symptom item is rated according to its frequency of occurrence using a four point scale ranging from 0 ("never") to 3 ("often"). The depression subscale score is converted to a t-score based on measure norms with scores ranging from 0 to 100. Higher scores indicate greater severity of anxiety symptoms.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
Change in Child Aggression Symptoms
The Child Trauma Symptom Checklist will be used to assess child aggression symptoms. Each symptom item is rated according to its frequency of occurrence using a four point scale ranging from 0 ("never") to 3 ("often"). The Aggression subscale score is converted to a t-score based on measure norms with scores ranging from 0 to 100. Higher scores indicate greater severity of aggression symptoms.
Time frame: Baseline, 19 weeks, 43 weeks and 70 weeks
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