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Working with fathers. Mary Ryan. (Pp 120, Paperback, £14.95) Oxford: Radcliffe Medical Press, 2000. ISBN 1857754875.
In 1995, the Department of Health publishedChild Protection: Messages from Researchwhich summarised the findings from 20 research studies commissioned following 1987 Cleveland enquiry. Not all of the findings found their way into print. This small book, which will be principally of interest to professionals working in the field of social paediatrics, summarises what research studies have to say about fathers and the professional response to them.
The evidence from these studies, which are all based on working with children in need and children in the child protection system, shows that professionals focus mainly on mothers. This is partly because professionals do not attempt to find out about or engage with fathers and partly because fathers distance themselves. This is not a problem specific to child protection but one which also occurs in mainstream paediatric practice. The findings pose a challenge to professionals who prefer to work with mothers and make assumptions about the fathers or father figures in a family.
There are some 28 million men in the United Kingdom, of whom 22 million are potential or actual fathers. There is surprisingly little data on the sociodemography of fatherhood in the UK at the beginning of the twenty first century. Whilst most would agree that the role of the father in the family has changed, the exact way in which this change has occurred and the involvement of fathers with their children remains relatively unexplored. The book contains some revealing information about fatherhood in the UK, and the changes which have occurred over the last 40 years. It also puts into context the variety of legal relationships which can exist between fathers and their children in present day society.
There is general agreement that working with and engaging fathers benefits children. There is less agreement and certainly less research on how professionals find out more about the father's role in the family. Paediatricians routinely obtain information about the age, employment status and general health of the child's father. It might, however, be more productive and ultimately of more benefit to a child to find out more about the father's social role in the family. What is his relationship, legal or otherwise to the children? Is he resident or non-resident? What is the nature of his continuing involvement in his children's lives and what are the risks or protective factor he poses in his relationship to the children? For a busy paediatrician taking a medical history it is very often difficult to ask these questions. We still find it easier to ask about a family history of asthma rather than ask about domestic violence or if a child has ever been on the child protection register.
The book raises questions about how much training and support is given to junior staff in this area. How do doctors and nurses in training work with violent or aggressive men? How are they helped to cope with the fears they can provoke? How are professionals working with children to engage men in the long term support of their children?
The majority of parents including fathers are committed to their children. Paediatricians should start from the assumption that it is always helpful to engage with fathers. Careful assessment and better training is needed to identify those fathers where engagement is likely to be counter productive. Services to meet the specific needs of fathers are generally thin on the ground. The book contains a useful resource list and some practical examples of services, which are available specifically for fathers.
Fathers still remain the invisible parent within paediatric and social care services. This book issues some timely challenges to practitioners in the field. Too often in this area we work from a background of prejudice based rather than evidence based medicine. When it comes to fathers, the evidence is thin on the ground and there are gaps for future research.