Father Involvement

1
Father Involvement FASD Developing Best
Practices 6th Annual Fetal Alcohol Canadian
Expertise (FACE) Research Roundtable

• Robin Gearing, MSW, RSW, Ph.D. (cand.)
• Hospital for Sick Children University of
  Toronto
• September 9, 2005

2

• Acknowledgements
• Ted McNeill, Ph.D., R.S.W.,
• Fernand A. Lozier, M.Ed.
• Public Health Agency of Canada
• The Hospital for Sick Children
• Journal of FAS International http//www.motherisk.
  org/JFAS/ (keyword father)

3
Overview

• Introduction A) Objective Father involvement
• B) Method
  Investigating FASD and Fathers
• Fathers and FASD
• Statistics
• Economic Costs
• Fathers
• Fathers and FASD
• Father Involvement Developing Best Practices
• The Self
• The Couple Relationship
• The Family
• The larger Environmental Factors
• Future Directions
• Question Answer Period

4
Objective

• One fundamentally important, but frequently
  minimized and ignored factor is the role of
  fathers in FASD.
• From a population health perspective fathers are
  associated with a number of determinants of
  health including a number of genetic, relational,
  familial, and environmental factors that either
  contribute to or protect against maternal alcohol
  consumption.

5
Introduction to Investigating FASD and Fathers

• Since FASD was defined some 32 years ago in 1973-
  the problem/concern of FASD has not gone away or
  been addressed
• Father involvement has been absent/missing
• In the 30 years since this disability was
  identified, we have made too little progress in
  preventing it and in knowing how to help those
  who are affected (Devries Waller, 2004, p. 125)

6
Statistics and FAS

• One half of all pregnancies in the U.S. are
  unplanned (Forrest, 1994)
• 90 of the general U.S. population believed
  drinking alcohol could adversely affect the
  unborn baby and 64 had heard of FASD (Williams
  Gloster, 1999)
• National U.S. Study 1991
• 60 of women drink occasionally 44 of women in
  a were considered light drinkers, 12 moderate
  drinkers, and 3 were classified as heavy
  drinkers (Leonardson Loudenburg, 2003)
• In a large (9,845) cohort study- 20 of the male
  partners of pregnant women were drinkers daily
  before conception, and 8 were considered
  moderately heavy to very heavy drinkers (Passaro
  et al., 1998)
• About 75 of children born with FAS have
  biological fathers who are heavy drinkers and
  alcoholics (Abel, 1983 Abel, 2004)

7
Economic Costs and FASD

• Life time costs for each case of FASD ranges from
  US 1, 000, 000 to US 2, 000, 000
• (Abel Sokol, 1987Burg, 2004)
• Annual U.S. costs 5 Billion to 10 Billion
• (Burd et al., 2003 Weinberg, 1997)
• Impossible to directly measure the real economic
  costs, let alone the indirect societal or
  familial expenses

8
Overview Fathering Literature

• Positive child outcomes associated with involved
  fathers
• Negative child outcomes associated with
  absent/abusive fathers
• Do fathers make unique contributions?
• Need to understand fathers' experiences in context

9
Understanding Fathers

• Social ecological model
• Factors influencing fathers at biological,
  individual, family, and broader social context
• Critical realism
• Balancing individual responsibility for behaviour
  and social/structural factors that shape behaviour

10
Reviewing the Research

• A review of the current literature on fathers and
  FASD.
• A specific focus on four distinct spheres in
  which fathers influence this condition emerge
  from the literature genetics, being in couple
  relationship, part of a family, and in the larger
  environment.

11
The Self Genetic Impacts of Paternal Alcohol Use

• The focus on the singular role of the pregnant
  female in the health of the fetus and neonate has
  tended to minimize concern for possible
  male-mediated effects (Friedler, 1996).
• Animal studies
• Males who drink alcohol are exposed
• Paternal alcohol use negatively impacts

12
The Couple Fathers and Relationships

• Male involvement in a relationship with women of
  childbearing years
• The relationships environment
• The supportive or stressful nature of the couple
  relationship
• The level of relationship stability

13
The Family Paternal Influences in Extended
Families

• Role models
• Childhood physical and sexual abuse
• Supporting adult daughters and sons
• Support network

14
The Environment Structural and Societal Factors

• Socioeconomic status (SES)
• Ethnicity

15
Areas for Best Practices

• Self
• Couple
• Family
• Larger Environmental Factors

16

• Men, however, are more likely to correctly
  indicate that the fathers alcohol intake does
  not directly affect the unborn baby,
  biologically
• (Williams Gloster, 1999, p. 835)

17
The Self Individual Involvement and FASD Best
Practices Guidelines (1 of 2)

1. Alcohol is a toxin that impacts their health
2. Alcohol is a recognized teratogenic drug that
   potentially affects semen
3. Alcohol is associated effects on testicular
   function, spermatogenesis, less sperm
   concentration output
4. When men drink alcohol contribute to a
   pregnancy, animal models suggest that they have
   done so with semen that may possess toxins, which
   can damage genetic material of the children
5. Alcohol consumption in males is an associated
   risk to a number of birth malfunctions and
   abnormalities

18
The Self Individual Involvement and FASD Best
Practices Guidelines (2 of 2)

• 6. Alcohol consumption in fathers has been
  associated with a number of health problems in
  their children (ventricular sepal deficits,
  hormonal nervous system abnormalities,
  spontaneous abortions)
• 7. Paternal alcohol use in the preconception
  period can negatively impact intelligence
  cognitive ability in their children
• 8. Paternal alcohol use in preconception, during
  pregnancy, and after birth is associated in
  hyperactivity oppositional behavioural in kids
• 9. Paternal drinking without maternal alcohol
  consumption can not cause Fetal Alcohol Spectrum
  Disorder however, fathers who drink may
  contribute to this condition through their
  influence on womens alcohol use in pregnancy

19

• parents typically receive inadequate
  information on the management and course of the
  illness
• (Devries Waller, 2004, p. 122)

20
The Couple Fathers in Relationships and FASD
Best Practices Guidelines (1 of 2)

1. Men women in a relationship affect each others
   behaviours
2. Male partners who drink foster an environment
   where alcohol use is tolerated encouraged
3. Male partners who are opposed to the mothers
   intention to stop drinking may influence her
   inability to reduce alcohol consumption
4. Males are responsible for their own drinking
   behaviour and its potential impact on others
5. Males can directly and indirectly oppose abuse of
   females in any form (e.g., perpetrate, engage,
   condone, minimize, justify, association, passive
   observer)
6. Professional support may help to end abuse in
   relationships

21
The Couple Fathers in Relationships and FASD
Best Practices Guidelines (2 of 2)

• 7. Males females are responsible for the
  promotion of a stable committed relationship
• 8. Males females in relationships considering
  children may want to plan together their use of
  alcohol
• 9. Males females can positively encourage
  support each other in reducing and/or eliminating
  their drinking before conception
• 10 Males females can actively support assist
  each other in family planning (e.g., birth
  control, time, finances, relationships stability)
• 11 Males females can actively participate in
  the preparations for the new child (e.g.,
  attending medical appointments, planning)
• 12 Males females can promote, support,
  advocate for a nurturing home environment

22

• In the case of FAS, the single-minded focus on
  alcohol as the sole cause of the observed outcome
  blinded doctors to the social context in which
  prenatal exposure to alcohol occurred and to any
  potential ameliorating or exacerbating factors
• (Armstrong, 1998, p. 2028)

23
The Family Paternal Influences in Extended
Families FASD Best Practices Guidelines (1 of 2)

• Fathers have the opportunity to set a positive
  role model for their children by not abusing
  substances
• Children are more likely to become alcoholics as
  adults if their fathers are alcoholics
• Physical or sexual abuse of children by father is
  associated with children abusing alcohol as
  adults
• Fathers mothers can support both yearly
  education in
• K-12 programs at school and discussions at home
  on FASD with their sons and daughters

24
The Family Paternal Influences in Extended
Families and FASD Best Practices Guidelines (2 of
2)

• 5. Fathers can capitalize on their role to
  encourage alcohol free pregnancies in their
  daughters
• 6. Fathers support is associated with increased
  success rates of adult daughters who are trying
  to reduce or eliminate alcohol consumption during
  their pregnancies
• 7. Fathers promotion of their adult daughters
  support network is associated with women who
  achieve absenteeism in alcohol consumption during
  their pregnancies
• 8. Fathers mothers can promote, support,
  advocate a nurturing home environment

25
The Environment Structural and Societal Factors
and FASD Best Practices Guidelines (1 of 2)

1. Men can positively influence become involved in
   larger societal factors that impact FASD
2. Males females can choose to no longer accept
   the incorrect assumption that FASD is an
   individual issue
3. Victim blaming does not help in reducing FASD
4. Males females can promote FASD national social
   health issues
5. Males can lend their voices as fathers to the
   advocating, promotion, creation, development,
   implementing, and monitoring of FASD programs and
   policies
6. Males females can be involved with FASD policy
   planning, delivery, and implementation around the
   needs of families
7. Males females can encourage greater
   collaboration between those providing health
   services education with individuals impacted by
   FASD

26
The Environment Structural and Societal Factors
and FASD Best Practices Guidelines (2 of 2)

• 8. Males females can encourage increased
  professional training (medicine, healthcare,
  legal system) on FASD
• 9. FASD strategies (prevention education) need
  to include the community
• 10 FASD strategies need to reach out to diverse,
  ethnic, economically disadvantaged, and
  underserved populations
• 11 Greater linkages between service providers,
  educators, govts
• 12 Males females can advocate for education
  that targets both knowledge transmission
  behavioural changes
• 13 Men can effectively add their voice to the
  promotion of a National Strategy (education,
  research, service delivery, programs) for FASD

27

• Influences on maternal drinking are complex and
  originate from a combination of factors
  biological, familial, social, and psychological
• (Gomberg, 1993 Viljoen et al., 2002)

28
Conclusion

• The complex factors that contribute to and
  support maternal drinking need to be addressed in
  confronting this national health issue.
• FASD is not an individual issue rather, FASD is
  a population health issue that requires
  prevention and treatment to consider related
  social determinants of health.
• Fathers and their involvement is a distinct and
  significant factor that unmistakably exerts
  positive and/or negative influence on FASD across
  a number of domains, specifically genetics,
  partnering relationships, family life, and larger
  environmental and structural conditions.

29
Future Directions

• The US National Task Force, chartered in 2000,
  for Fetal Alcohol Syndrome did not mention or
  make any reference to fathers in their
  recommendations
• The time for father involvement is now

30
Future Directions

• The inclusion of fathers in the education,
  treatment, and prevention of this burdensome
  illness requires a number of changes.
• End mother blaming
• Support the inclusion active participation of
  fathers
• Greater research support activities
• More concerted approaches that incorporate
  educators, service providers, families, health
  care professionals, and the various levels of
  government

31

• More active father involvement will not end
  FASD, but in stepping forward, exerting their
  influence, and adding their voices, fathers can
  contribute to prevention and assist those with
  this condition.

32

• Robin Gearing, Ph.D. (cand.), MSW, RSW
• The Hospital for Sick Children
• Department of Social Work
• 555 University Avenue
• Toronto, Ontario M4C 3X3
• E-mail robin.gearing_at_sickkids.ca