Associate Professor Richard Fletcher

There is increasing recognition of the issues facing men in the perinatal period. Vulnerability factors and issues in the partner relationship contribute to mental health risk and can impact the quality of the father¿infant relationship. Yet, there is limited understanding of fathers¿ help-seeking when they or their partner are experiencing mental health issues in the context of caring for a new baby. The present study examines fathers¿ contacts with the Perinatal Anxiety and Depression Australia (PANDA) National Helpline. The study reviewed contacts from fathers and their identified needs for assistance, relationship issues, and support needs; 70% of male callers (N = 129) reported concerns about the mother's mental health, and 57% were concerned about relationship breakdown. Significant numbers of men raised issues about their own mental health (43%) and many were concerned about the impact of maternal mental state on the relationship with the infant. When compared to community data, there were elevated rates of concerns about depression and anxiety. Men also described difficulties with the fathering role and with regulating their own feelings of guilt and frustration. These findings highlight the needs of men for support when a mother experiences perinatal problems and also the risk for distress in fathers.

A growing number of individuals expressly choose to remain childless, yet research exploring these intentions in men remains scarce. This study examines the experiences, subjective reasoning, and decision-making processes of voluntarily childless Australian men near the median age for first-time fatherhood. Semi-structured interviews were conducted with 11 Australian-resident men (28¿34 years; M = 31; SD = 1.48). Participants were selected from the Men and Parenting Pathways longitudinal cohort study (N = 609) based on having stated they did not want to have children ¿at all.¿ Data were collected and analyzed using interpretative phenomenological analysis. Analysis identified a superordinate theme; Fatherhood: The door is still ajar, which was marked by the men¿s reluctance to unequivocally commit to a childless future. Subordinate themes were The Realization, The Talk (or lack of¿), The Rationale, and The Pressure. At the normative age for transitioning to parenthood, role choices are salient. Overall, men¿s decision-making process to not have children appears to be fluid and influenced by intrinsic and extrinsic factors. Despite changing social trends and acceptance of divergent life trajectories, these men are acutely aware that their intentions place them outside the norm. In policy and practice, it is important to recognize the changing norms around fatherhood timing and support voluntarily childless men and couples in constructing their identities, life course, incongruent decisions, and relationships.

In developed countries, antenatal education aims to reduce difficulties that mothers and fathers experience during transition to parenthood. However, fathers are often distracted from preparing themselves by the attention given to preparing and supporting mothers. Developments in digital communication present alternative means of supporting fathers at this time. Studies, across a range of health concerns, have reported successful outcomes from text-based interventions. Text messaging, focusing on the issues that cause paternal distress at this time, could provide timely, targeted, and effective support to fathers in their transition to parenthood. This study aimed to develop a corpus of messages that could be sent to new fathers during pregnancy and in the months after birth. Messages were intended to support new dads in caring for their own physical and mental health, nurturing strong relationships with their child, and developing strong parenting partnerships. The process employed in message development was similar to that previously employed in developing messages for people who had experienced a cardiac event. A corpus of messages and linked information focusing on fathers¿ relationships with their children, partners, and themselves were initially developed by a core group. The corpus was then culled, refined, and expanded by a larger, more diverse, group of experts (n = 46), including parents, academics, and practitioners. The iterative, consultative process used in this study proved to be a functional way of developing and refining a large corpus of timed messages, and linked information, which could be sent to new fathers during their transition to fatherhood.

Objective: This paper will describe the development of a programme of SMS messages including parenting information and support to be sent to the mobile phones of mothers with severe mental illness (SMI) and their partners from early pregnancy to 24 weeks post birth. Method: Text messages (total 176) designed and tested for fathers (SMS4Dads) addressing father-infant attachment, co-parenting and self-care (including Mood Tracker texts asking fathers to rate their mood) were adapted by an expert advisory group of clinicians with experience across perinatal mental health services. Messages were rated on importance, clarity, acceptability (separately for mothers and fathers) and being consistent with current evidence. Additional messages were developed specifically for this population and all messages were tested for literacy level. The SMS4dads ¿Mood Tracker¿ was redesigned to address common stress-inducing parenting issues such as infant crying, lack of sleep, and self-doubt about capacity to parent with an escalation process in cases of significant distress. Results: Separate protocol tested text-message banks for mothers (141 messages), and fathers (141 messages) were developed. Fourteen Mood Tracker topics were developed with two levels of distress escalation linked to local mental health services. Discussion: The need for accurate descriptions of health interventions processes is widely recognised, particularly in the case of digital mental health. This study provides a detailed description of the adaptive design by clinicians and researchers of brief text messages suitable for mothers with severe mental illness and their partners.

Healthy Dads Healthy Kids (HDHK) was the first program internationally to specifically target overweight and obese fathers to improve their children's health. In previous randomized controlled trials, HDHK generated meaningful short-Term improvements in the adiposity, physical activity, and eating behaviors of both fathers and children. The aim of this dissemination trial was to evaluate the 12-month impact of HDHK when delivered by trained facilitators across four low socioeconomic and regional communities in the Hunter Region, Australia. The study was a nonrandomized, prospective trial with minimal eligibility criteria (i.e., father body mass index [BMI] ? 25 kg/m2 and children aged 4-12 years). HDHK included eight weekly practical and theoretical sessions. Assessments were baseline, 3 months (post-intervention), 6-months, and 12-months. The primary outcome was fathers' weight. Secondary outcomes included child BMI z-score and validated lifestyle behavior measures (e.g., physical activity, diet). Overall, 189 fathers (mean age: 40.2 years, BMI: 32.6 kg/m2) and 306 children (mean age: 8.1 years) participated in one of 10 HDHK programs in four areas. Intention-To-Treat linear mixed models revealed a significant mean reduction in fathers' weight at post-intervention (?3.6 kg, 95% confidence interval: ?4.3, ?2.9), which was maintained at 12 months (71% retention). Corresponding improvements were also detected in children's BMI z-score and a range of lifestyle behaviors for both fathers and children. Attendance and satisfaction levels were high. Positive intervention effects observed in previous randomized controlled trials were largely replicated and sustained for 12 months when HDHK was delivered by trained local facilitators in underserved communities. Further investigation into the key systems, processes, and contextual factors required to deliver HDHK at scale appears warranted.

Abstract: Parent-child play directly influences child development. One aspect of parent-child play that is gaining interest is a form of physical play, ¿rough-and-tumble play¿ (RTP), or roughhousing. RTP is most often played by fathers and has been shown to have positive benefits for children. However, little is known about parents¿ perceptions of this type of play, although beliefs and values about learning through play shape parents¿ interactions with their children. In this study, we investigated parents¿ beliefs and knowledge about father¿child RTP. A qualitative design was used to create a conceptual description of parents¿ views, and 52 (31% male) Australian parents participated in semi-structured interviews supported by a video stimulus of father¿child RTP. Three conceptual themes characterized parents¿ perspectives on RTP: Strength Challenge describes the physicality and inter-personal challenge of the game; Dynamic Bonding describes how parents view RTP as fostering close father-child relationships, confidence and a playful state of mind; the final theme, Context and Caveats, integrates the contended and contingent aspects of RTP perceived to influence the short and long-term effects of this play. The study provides insight into how parents perceive the broad function of parent-child RTP and fathers¿ role within this play.

Paternal perinatal depression and anxiety is a common, though under-recognized mental health condition experienced by men during their transition to fatherhood. An opportunity to screen for paternal mental health issues occurs when parents present for assistance with the care of their baby at early parenting services (EPSs). There are 10 EPSs located across Australia that provide specialist, multidisciplinary interventions to support parents experiencing complex parenting difficulties. Using structured telephone interviews, this qualitative study explored the views of 18 professional staff from nine EPSs regarding screening, referral processes and acceptability of screening fathers for mental health issues. A thematic analysis revealed that most EPSs screened fathers for depression. Participants agreed screening was important and that routine approaches to screening would help normalize the process for both men and services. Despite this, no uniform, comprehensive approach to identifying the mental health needs of fathers was found. EPSs provide a unique opportunity to address the mental health needs of fathers. Results from this study point to the need for a national approach to the development of father-specific screening guidelines for EPSs to improve family well-being, in parallel to those informing the Australian National Perinatal Mental Health Initiative for mothers.

Young Aboriginal fathers face social and emotional challenges in the transition to fatherhood, yet culturally appropriate support mechanisms are lacking. Peer mentoring to develop online- and mobile phone-based resources and support may be a viable approach to successfully engage these young men. This feasibility study engaged two trusted Aboriginal mentors and researchers to partner with one regional and two rural Aboriginal communities in New South Wales, Australia. Early in the research process, 20 young Aboriginal fathers were recruited as co-investigators. These fathers were integral in the development of web-based resources and testing of mobile phone-based text messaging and mood-tracking programs tailored to provide fathering and mental health support. Overwhelmingly positive feedback from evaluations reinforced community pride in and ownership of the outcomes. The young men's involvement was instrumental in not only developing culturally appropriate support, but also in building their capacity as role models for other fathers in the community. The positive results from this feasibility study support the adoption of participatory approaches in the development of resources for Aboriginal communities.

The coparenting relationship has been linked to parenting stress, parenting self-efficacy and many other concerns associated with the development of children with ASD. Parents of children with ASD (N = 22) were interviewed to explore three domains of their coparenting relationship; (1) adaptation to the emergence of their child¿s autism, (2) parenting their child with ASD, (3) expectations for their child¿s developmental outcomes. The concept of coparenting competence, developed during analysis, describes collective perceptions of parenting efficacy. Parents linked perceptions of coparenting competence to their, ability to cope with diagnosis and parenting, motivation to do what they could for their child, and hopes for their child¿s development. The concept of coparenting competence could play an important role in future research and intervention.

This paper draws from an ongoing exploratory qualitative study, which uses semi-structured interviews to investigate the views of fathers about strategies to encourage men¿s participation in early childhood education in one of the townships in the Eastern Cape Province. The study aims to contribute to knowledge about fathers¿ participation in early childhood education in general and on the participation of black fathers in particular. Informed by Uriel Bronfenbrenner¿s ecological model, the literature review explores the current state of fathers¿ participation during the early beginning of the child; barriers to sustained fathers¿ participation; and current strategies in place to encourage sustainable and meaningful father participation in the early education of their children. This paper argues that what is currently known about black fathers¿ participation in the early education of their children is grossly inadequate. Given limited information on Black fathers¿ participation in the education of their children in South Africa, this paper concludes that more research on Black fathers and their participation in early education of children is therefore required. Some implications for research and policy are also discussed.

Objective: The project aimed to test of the quality and acceptability of researcher-developed Short Message Service (SMS) messages designed to support fathers of infants aged 12 months or less. Background: The findings of previous studies suggest antenatal and postnatal depression among fathers¿ impacts negatively on the health of family members. Method: Draft messages were first modified based on expert review. In a second phase, parents (mothers n¿=¿56; fathers n¿=¿46; unknown n¿=¿4) were recruited through two early childhood parenting services to rate the clarity, usefulness and relevance of the 70 SMS messages using a paper-based survey. In a third phase, 15 fathers were recruited to receive texts at different times over three weeks. Results: Findings suggest that SMS items were easily understood by the majority of parents, with only 3% of responses indicating an item was ¿not easily understood¿. Feedback from parents indicated that negatively rated SMS messages were considered as either poorly phrased, lacking enough information or as not offering sufficient support. The majority (88%) of the SMS items were also rated as ¿useful¿ by the parents. Conclusion: Fathers¿ responses indicated that receiving the texts at different times was acceptable and that message content was relevant to their fathering. The study has produced a set of brief text messages suitable and acceptable to new fathers and their partners.

Unintentional injury is an important cause of infant and child hospitalisation and parents play a key role in reducing children's risk-taking behaviour. Studies show that maternal and paternal parenting and supervision of children differ, but there is little research showing how fathers¿ parenting may influence children's tendency to engage in risk-taking behaviour. Recent theoretical developments suggest that father's parenting may be particularly effective in encouraging safe risk taking. In this study, we examine how well parenting practices typically undertaken by fathers predict rates of children's injury risk at three years. Questionnaire data were collected from 46 fathers. Results show that both duration of rough-and-tumble play and fathers¿ encouragement of perseverance predicted lower rates of injury behaviours, while their stimulation of risk taking predicted higher rates of injury behaviours. The results are discussed in the light of developmentally appropriate risk taking and fathering.

SYNOPSIS: Objective. Coparenting quality has been linked to both parenting stress and parenting self-efficacy in families of typically developing children, but little is known about relations between these factors in families where there is a child with an autism spectrum disorder (ASD). This study employed structural equation modeling to explore relations among coparenting quality, autism-specific parenting self-efficacy, and parenting stress in mothers and fathers of children with an ASD. Design. A cohort of biological mothers (n = 80) and fathers (n = 72) who were caring for their young child (age < 13) with a diagnosed ASD self-completed validated surveys assessing parenting stress, coparenting quality, and autism-specific parenting self-efficacy. Results. Both mothers and fathers reported high and similar levels of parenting stress which shared predictive relations with both coparenting quality and autism-specific parenting self-efficacy. Structural equation modeling demonstrated that the relations between perceptions of autism-specific parenting self-efficacy and parenting stress were mediated by coparenting quality. Conclusion. Coparenting quality shares an important relation with parenting stress in both mothers and fathers of children with an ASD, and enhanced perceptions of autism-specific parenting self-efficacy are unlikely to influence parenting stress when parents experience poor quality coparenting.

The present-day involvement of men in many facets of childrearing stands in contrast to previous eras when men accepted that the major task of fathering was to provide a secure income to support the family. This imperative often required long hours away from the family. However, when men whose contact with children has been limited due to work and cultural constraints retire, their newly acquired lifestyle may bring fresh opportunities for involvement with grandchildren. An important question therefore concerns the impact of caring for young children on men's perceptions of their role as grandfathers. This interview study explores the experiences of 19 Australian grandfathers. The analysis found themes that relate to relationships and change, as well as themes concerning core beliefs and existential questions. The findings demonstrate the potential for insight into family relationships and personal growth in older age when studying the topic of grandparenting and caring from the male perspective. © 2014, Baywood Publishing Co., Inc.

Objective: To evaluate the effectiveness of the 'Healthy Dads, Healthy Kids (HDHK)' program when delivered by trained facilitators in community settings. Method: A two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age=40.3 [5.3] years; BMI=32.5 [3.8] kg/m2) and their primary school-aged children (n=132) from the Hunter Region, Australia. In 2010-2011, families were randomized to either: (i) HDHK intervention (n=48 fathers, n=72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors. Results: Linear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P < .001, d= 0.24), with HDHK fathers losing more weight (- 3.3. kg; 95%CI, - 4.3, - 2.4) than control fathers (0.1. kg; 95%CI, - 0.9,1.0). Significant treatment effects (P < .05) were also found for fathers' waist (d= 0.41), BMI (d= 0.26), resting heart rate (d= 0.59), energy intake (d= 0.49) and physical activity (d= 0.46) and for children's physical activity (d= 0.50) and adiposity (d= 0.07). Discussion: HDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting. © 2014 Published by Elsevier Inc.

Birth data from developed countries indicates that the average paternal age is increasing. As the trend to older fatherhood has become established, concerns have been raised that this may be linked to adverse outcomes, such as pregnancy complications, congenital anomalies, and long-term health implications for the child. Since the sperm of older fathers may be impaired due to the general effects of ageing, their offspring may be at risk due to defects in sperm quality at conception. A literature search was performed to identify pregnancy complications, fetal anomalies and health issues for the child when the father is in an older age bracket. Evidence for impairment in the sperm and genetic material of older fathers was reviewed. With an older father, there is evidence of an increase in stillbirths and a slightly increased risk of autism, bipolar disorder and schizophrenia in the offspring later in life. The increased risk of achondroplasia has long been recognised. For the mother, there is an increased rate of Caesarean section. Investigations of other possible adverse outcomes have produced mixed findings. Further robust and longitudinal studies are needed to clarify these issues.

Energetic, competitive, body-contact play (rough and tumble play (RTP)) is commonly observed among young children and is reported as an important feature of father-child relationships. Animal studies have demonstrated positive developmental effects of peer-peer play-wrestling, influencing cognitive and social outcomes. The purpose of this paper is to discuss the nature of RTP between father and child and its relationship to child development and to describe a theoretically informed measure of the quality of father-child RTP. © 2013 Copyright Taylor and Francis Group, LLC.

A significant proportion of fathers living with their natural, adopted, step or foster children experience mental illness. Psychiatric illness among fathers can have a devastating impact on children's wellbeing, and even milder forms of paternal mental illness can have serious developmental effects on children. While several pathways linking paternal mental illness with poor child outcomes have been identified, fathers' impaired parenting is an important, potentially malleable factor. Clinicians can assist fathers with mental illness and their families by proactively inquiring about children and by exploring fathering-focused psychological support.