This is a post I wrote last September when I had the privilege of visiting the Family Action Centre at the University of Newcastle in NSW, Australia. I’m re-posting today as part of International Fathers Mental Health Day to help raise awareness of some of the ways we can support fathers during the perinatal period.
Recent reports about ways to get fathers more involved in services around the time of having a baby suggest that shifts in the way services work are needed. This might include more flexible working hours, joint invitations to appointments, or posters and leaflets that are more relevant to fathers. At the Family Action Centre (FAC) within the University of Newcastle, the team researching fatherhood, led by Associate Professor Richard Fletcher, have come up with some different ideas. They believe that the sorts of changes in services will do little to encourage fathers because the spaces in antenatal clinics, perinatal services, and children’s centres are so culturally geared towards women and infants that men are likely to continue feeling on the outside. Instead, their approach has been to find novel ways of including fathers in the transition to parenthood. Last September I met with the team in their offices on the leafy campus of the university to find out more…
The SMS4Dads project has just completed a very successful pilot and is looking to expand. This project involves sending regular SMS messages to dads from 6 months into the pregnancy to 3 months after the baby is born. Messages include things about the baby (e.g. although s/he cannot tell you, you are very important to your baby), the relationship with their partner (e.g. some babies are still waking a couple of times a night at 6 months. Being kind to each other can help get through this time), and the man’s own health and well-being (e.g. it’s ok to ask for help. We all need it at some point). In addition to the messages he is asked to complete a ‘mood tracker’ every 3 weeks and if his response is negative this triggers a call from a perinatal support service to check how he’s doing and if he’d like any support. The pilot included 520 men, a huge 87% of whom kept receiving the messages throughout the study (men can opt out at any time), and it has had some good feedback. Men reported that the timing is important – messages relevant to what is happening during the pregnancy and at different stages of infant development help them to understand the process, and they also reported that the messages helped start conversations with their partner about how they’re doing.
The pilot study included anyone who was willing to sign up to the project. There are now plans to target specific groups, for example, men whose partners have mental health difficulties, families where there is alcohol misuse, and aboriginal communities. This is a wonderful way to keep men engaged and involved in the whole process of having a baby and help them reflect on and understand the transition to fatherhood. Further feedback and measurements in the next phase will help the team at FAC to understand the specific things which are helpful about the messages and the ways they might link to better outcomes for families. Richard Fletcher’s team suspect there may be something about relationships at work, whereby the messages are conceived of almost like a therapeutic relationship, with men feeling held in mind and considered as important. If so, the hope is that this would boost self-efficacy when it comes to parenting, encouraging further involvement, and also help parents to communicate better, maintaining a strong relationship throughout all the changes. Some of the messages are written from the point of view of the baby e.g. ‘Just because I’m sucking my hands doesn’t always mean I’m hungry. It might be my way of chilling out’. Therefore they also have the potential to encourage ‘mind-mindedness’ of the infant. This refers to the ability to think about the mind of the baby and what might be behind different behaviours, and is linked to better outcomes for children.
Clearly there is a lot of potential in this work and it will be interesting to see how the next phases of the project pan out. If successful, perhaps this is something the UK could make use of.
The other key area of research at FAC relevant to engaging fathers is that around parenting partnerships. The support that someone feels from their partner and the strength of the relationship has been linked to a number of outcomes e.g. child behaviour, parenting satisfaction and breastfeeding rates. How can practitioners target this relationship with only the mother in the room? This is something I’ve come across in my own practice, where women talk about relationship difficulties as the key factor affecting their mood, but their partner is unable or unwilling to come into the clinic. This issue is also present in other services such as health visiting where practitioners are used to dealing with women and may actually be reluctant to involve the father, despite the fact he is key to healthy family functioning.
Dr Chris May has developed a tool for health visitors which may help to bring partners into the system without them having to be physically present. This is a card sorting task which health visitors give to families to do in their own time.There is a set of cards for mum, one for dad, and one for the couple. The cards have examples of different worries or concerns that each person may have about different aspects of family life and have to be sorted into those areas which are a high priority for change and those that are medium and low priority. The idea is to stimulate thought and reflection about current circumstances and also encourage a conversation between partners about how they’re doing. The results can then be discussed with the HV to help think about any areas where there may be extra support available. One outcome would therefore be for the HV to have a better understanding of the family’s needs which would lead to more targeted support. However, a more subtle and potentially longer lasting outcome would be to strengthen the communication and support between partners, helping couples to understand each other’s concerns and talk about their views. A pilot of this tool is just about to begin to see if families are willing to complete it and what they think of it. Again, if successful, this is something that could help fathers in the UK to be brought into the thinking and practice around the perinatal period without relying on big changes in the way services function.
There is a lot more work going on at the FAC which there isn’t space to talk about here, but certainly there is a lot that we can learn from their work about novel ways to encourage a whole family approach, involve fathers, and strengthen the parenting partnership.
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