Early intervention work with

fathers:

Evidence from the work of the

Family Nurse Partnership

Professor Harry Ferguson

Cardiff/Manchester

31st March 2015

@harr_ferguson

The journey

• From dangerousness or fecklessness/absence (Scourfield, 2003; Ferguson & Hogan, 2004)

to

• Fathers as resources - caring men -as well as risks (Featherstone, 2003; 2009 …).

Family Nurse Partnership

• Programme ‘is offered to first time

vulnerable teenage mothers’ (DoH, 2009)

• Home visits by ‘Family Nurses’ during

pregnancy and for 2 years following birth

• Baby care, diet, smoking, contraception,

relationships, therapy (MI), child protection.

The study

• Characteristics of the fathers?

• How do FNP engage (more) fathers?

• Questionnaire to 114 fathers re age, work etc;

experiences of fatherhood & of FNP

• 54 returned (47%)

• Interviews with 24 fathers.

Characteristics of the fathers

• Aged from 17 to 37 years

• 86% under 25

• 38% were teenagers

• 3% were over 30

• 17% from BME backgrounds

• 50% in employment

• 91% baby’s biological father

• 60% still in a relationship with child’s mother

• 44% of the men living full-time with mother.

• High levels of vulnerability:

- troubled adolescence, left home young

- low educational attainment, anti-social or

criminal behaviour

- grew up in reconstituted families, with step-

fathers, relationships of mixed quality

• Poor: low pay, benefits, or no income

• 25% were or had been in contact with social

care

• 8% on child protection plans.

FNP contact with fathers

• 48% of fathers felt the FN involved them asfully as the mother on home visits

28% felt ‘well involved’

26% did not feel involved, despite him

being there

And some didn’t want involvement.

Supporting the developmental

transition to fatherhood

I used to be a bit stupid when I was out. ... Getting into trouble. Used to be out with my mates and I used to drink when I used to go out sometimes, but I don’t do any of that any more ... Once he was born I just didn’t seem to do any of that any more, or want to do it any more. I don’t know what ... well it must have been him being born that changed it, but I just stopped. There’s no other reason that I stopped apart from when he was born, it just didn’t happen any more, I just didn’t want to go out and do that.

(Father 18; child 7 months)

What was helpful began in

pregnancy

Yeah it was kind of weird, obviously you’ve got this little baby and you’re holding it, and you don’t want to drop it, you don’t want to drop her. Yes, she [Family Nurse] teaches about that yeah, before [baby’s name] was born she brought a baby round, a fake baby, and she was telling us how to hold it and stuff like that, yeah.

(18 year old father of 7 month old daughter)

• She has helped when playing with and

talking to the baby, showing us games

and activities, like showing us how to

encourage him to walk. … She has

helped me understand that [partner]

needs a break, and how to avoid post

natal depression.

(20 yr old father of 11 month old son)

Building confidence, acceptance

• “She has said I’m doing really well, and

that I’m a good dad lots of times. She is

not judgmental, even when I talk about

drinking …, she is dead good with us.”

(Father 31; child 13)

Where engagement worked for

fathers

• Felt helped holistically, with

- practical skills of child care

- their confidence & identity as fathers

- getting jobs, on courses …

- understanding their partner’s needs & relationship

• Given time

• Therapeutic skill (MI), values, equality

• A relationship developed

• Respected & made to feel they matter as fathers.

How (working class) men show love

Tattoos as

‘Inscriptions of love’

(Les Back, 2007)

Young men’s bodies

becoming ‘a figure on

which emotions,

affinities and

devotions are

inscribed’ (P.93).

Present but not engaged fathers

“I think I was embarrassed really because I didn’treally know anything and was learning all the stuff. Idon’t think she helped me get over being embarrassed… She was more focussed on [partner]. She didn’tinvolve me a lot. I guess I could involve myself moresaying “can I do this”, but I am actually embarrassedto butt in. If he [son] was born now I’d be a bit morepushy. I don’t think I was bothered because I wasyoung.”

(Father 18, child 15 mths)

Complexity of (non)engagement

Father’s receptiveness to help

Discomfort with feelings, needing help

Passivity & other signals he gives out perceived as lack of interest or avoidance

Confused about prof’s role & service

High support needs of the mother

Mother as gate-keeper to the service

Prof’s (low) expectations of (some) men

Organisational policy not father-centred.

Non or hostile engagement • “I think I’ve met her about twice. She wrecks my head.

She’s just too nosy. She just asks questions that aren’t relevant really. Things that have nothing to do with her. I used to just go out or I’d be at probation. I just don’t like her and I’m not bothered if she knows I don’t like her. I don’t even get why she comes round. … She tried to give me leaflets and something to fill out, but I don’t know if I done it. She gave them to me and told me what I had to do with them and that’s it. I didn’t fill them in. She’s just a head wrecker. She’s like she’s part of the relationship. She wants to know too much.”

• Interviewer: “Is there nothing you feel you have needed help with as a dad?”

• Father: “Nope! … I don’t like her. She just annoys me, the shit she asks about. She may think it’s relevant, I don’t.” (Father 20 yrs; child 5 months)

• Adverse childhood experiences, fear of

vulnerability, deep distrust of authority &

probing

• Relationship-based approach experienced as

invasion, intimidation, control

• Proactive engagement so as not to fulfil

man’s worst expectations that he will be let

down.

From avoidance to engagement

• “In the beginning I would go up and hide in

the bedroom, so I did not have to speak to

her, but after a couple of times we spoke,

and she was a lovely lady, and it was dead

easy to get on with her.”

(Father 31; child 13 months)

Creative persistence

• Having a repertoire of tactics to encourage men into involvement

• Letting him & his partner know he matters

• “Because you are there to praise the mums but the dads almost need it more: they need a bit more encouragement and a lot of nurturing in themselves. But I kept on and on involving him and asking him questions and his opinions and now he’s great.”

(Family Nurse)