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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)
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