Preparing Fathers for Parenthood: A Prenatal Program Supports Dads, Moms and Babies

00:00:01:02 - 00:00:23:24
Tom Haederle
Welcome to Advancing Health. Today's podcast celebrates Father's Day. Wrenetha Julion from Rush University Medical Center and Paul Florsheim from the University of Wisconsin Milwaukee, Zilber School of Public Health joined the AHA’s Julia Resnick to share the impact of father inclusive prenatal health care.

00:00:23:26 - 00:00:44:01
Julia Resnick
Wrenetha, Paul, so happy to be here with you today to talk about this really important topic. And just so glad that we can release this podcast for Father's Day. So during pregnancy, there's always a lot of focus on the mom for understandable reasons. But we also know that fathers are experiencing a major life event in becoming a parent.

00:00:44:03 - 00:00:52:00
Julia Resnick
Can you talk a little bit about why a father inclusive approach is so important for both maternal and infant outcomes? Paul, why don't we start with you?

00:00:52:03 - 00:01:21:07
Paul Florsheim, Ph.D.
To some extent, it's similar to moms and that particularly for, of course, new fathers that very few young men or even not young men, you know, sort of know a whole lot about how to prepare for parenting, how to parent an infant in particular. Many of them are sort of both excited and intimidated by the idea of having an infant.

00:01:21:09 - 00:01:50:22
Paul Florsheim, Ph.D.
You know, the transition to parenting always involves a lot of relationship challenges. It's a pretty common phenomenon that new parents report their relationship as or aspects of their relationship of having been lost. And so the challenges of sort of managing the connection part, the romantic part of the relationship is something that many of our couples sort of want to talk about when we're working with them.

00:01:50:24 - 00:02:19:01
Paul Florsheim, Ph.D.
I would just add that part of that is that some of these couples and we approach our couples that we work with, as we don't know whether you're going to stay together or split apart, and we don't really have, you know, sort of a stake in that. That's for you to decide and we don't push it one way or the other, but we do want you to be able to work together as a co-parenting team, regardless of what happens to that relationship.

00:02:19:07 - 00:02:37:23
Paul Florsheim, Ph.D.
And so that's another reason that I think men it's important to include the fathers in the process so that they have those skills, the communication skills to navigate even a breakup in that relationship, that they're able to co-parent as well.

00:02:37:25 - 00:02:40:16
Julia Resnick
Absolutely. Wrenetha, anything you want to add?

00:02:40:18 - 00:03:19:27
Wrenetha Julion, Ph.D., R.N.
Fathers have questions. Fathers want to be helpful. They want to be there and I think that they have a really important role in helping keep mothers safe during labor and delivery, and to really be a buffer for her for all that's going on around her. So that every question, everything doesn't come directly to the mother. And then I think there is a lot of information out there about how fathers presence and involvement is beneficial not only to themselves, but to the mothers and to the babies.

00:03:19:29 - 00:03:32:13
Wrenetha Julion, Ph.D., R.N.
So there are multiple reasons why fathers need as much attention, really, as mothers do. Maybe not as much physical attention, but otherwise they need just as much attention as mothers do.

00:03:32:15 - 00:03:49:03
Julia Resnick
Absolutely. And I think that piece about, you know, being in this is a partnership. I want to dive into the work that you're doing with the preparing for Parenthood program, which is going on in the Chicago area through Rush University Medical Center where you work, Wrenetha. And I know that you partner with a lot of community stakeholders.

00:03:49:09 - 00:03:53:15
Julia Resnick
So can you tell us more about the community that your hospital serves?

00:03:53:17 - 00:04:23:24
Wrenetha Julion, Ph.D., R.N.
Our hospital is positioned, I would say towards the center of the city. And so there are numerous neighborhoods that surround us. So there are Latino families. There are African-American families. There are other ethnic origins and other groups that surround us...so we really we speak to the importance of being sensitive and responsive to the communities that we serve.

00:04:23:26 - 00:04:42:27
Wrenetha Julion, Ph.D., R.N.
So it's a really nice, I think, hodgepodge of communities. And so it really is good to be in this space and to serve a large group of people, all of whom may have some challenges. They may not. They may be fine. So it fits with our mission and vision for sure.

00:04:42:27 - 00:04:52:21
Julia Resnick
And knowing Chicago, like I do, you're really at the crossroads of so many different communities. Paul, I know you're based in Wisconsin, so can you talk a little bit about what your role is with the program?

00:04:52:24 - 00:05:17:19
Paul Florsheim, Ph.D.
So, Wrenetha and I are really co-directors of the program. We applied for the grant together. You know, you sort of have to choose a community to do this in. I'm back and forth to Chicago quite a bit. And so we ran this through Rush. You know, Chicago has both a lot to offer, but also, we felt like it was a good place to do a fatherhood program.

00:05:17:21 - 00:05:40:11
Julia Resnick
Wonderful. So we've been dancing around the idea of the program, and I really want to dive into what the Preparing for Parenthood program is. Renee knows this from when I talk to her. I learned about the program when I was riding the train in Chicago and saw an ad for it and said, I absolutely need to know more about the work that they're doing because this is so hugely important for families in Chicago and for other communities across the country.

00:05:40:14 - 00:05:44:14
Julia Resnick
So can you share more about what the program is and what you do?

00:05:44:16 - 00:06:10:01
Paul Florsheim, Ph.D.
So one of the key features of it is that I think we've already sort of talked about a little bit is, is that it is offered in collaboration with prenatal care. And we do that quite intentionally, partly as a preventative program. Like we want to sort of reach fathers as they're getting ready for parenthood, but it's also the case that it's a really nice vehicle for connecting with fathers.

00:06:10:02 - 00:06:33:00
Paul Florsheim, Ph.D.
It's kind of hard to find fathers if you don't go through the services that are being provided to mothers, and mothers we have found to be very invested in fathers getting some services. It's also the case that prenatal care providers have an importance in the lives of both mothers and fathers that sort of lends legitimacy to what we're doing.

00:06:33:00 - 00:07:01:05
Paul Florsheim, Ph.D.
And so that's really helpful in terms of engaging, particularly young men who may not be all that interested in engaging with sort of social service agencies, mental health institutions, that sort of thing. We feel as though through prenatal care, we're able to reach a broader part of the young male population. The program focuses on essentially three things. The co-parenting piece,

00:07:01:07 - 00:07:23:03
Paul Florsheim, Ph.D.
and we sort of talk about that in a different ways. But one of the ways that I like to sort of talk about it is communication skills development. A lot of couples readily acknowledge that communication is an issue for them, and so they kind of resonate with that right away. It's tailored like a prenatal care in a prenatal care setting.

00:07:23:07 - 00:07:48:15
Paul Florsheim, Ph.D.
We work with couples individually in the sense that it's couple by couple rather than groups of couples. And part of the reason we do that is that we like to customize the program to meet the particular needs and wants of those couples. And it's not always the same. So we tailor those communication skills to what the couple is asking for, what they're presenting to us.

00:07:48:18 - 00:08:13:22
Paul Florsheim, Ph.D.
We shift at some point to parenting skills. So, you know for new parents, we of course focus on you know, sort of some basic parenting skills for newborns. We have expanded to also including not just first time parents. And so we also focus on, you know, sort of how to parent with another new child, as well as toddler kinds of issues.

00:08:13:24 - 00:08:38:21
Paul Florsheim, Ph.D.
And then we have case management services - we call care coordination services. And that's a variety of things could be related to jobs, housing and legal entanglements, all the sort of things that some of our couples are challenged by. And we can't really get to the parenting stuff or the co-parenting stuff unless we also attend to all that other stuff.

00:08:38:22 - 00:08:47:19
Paul Florsheim, Ph.D.
You know, in some cases are the social determinants of health. So that's it in a nutshell. And Wrenetha can tell me if I forgot anything.

00:08:47:21 - 00:09:30:21
Wrenetha Julion, Ph.D., R.N.
I'd like to add, which is really our funders require us to include something that's going to support fathers primarily, but we also support mothers in whether or not someone decides they want to continue their education. They want to pursue a new trade or new career. So our workforce development component connects fathers and mothers with a program that's here in the city of Chicago that helps with that. And starts off with preparing to get a job and completing your resume and job interviewing and workplace conflict, potentially.

00:09:30:21 - 00:09:56:21
Wrenetha Julion, Ph.D., R.N.
So how do you handle things when you're at work and something comes up? And so all of those pieces fit into the workforce development component, which I think is what in particular excited me about this opportunity, because there's an awareness that families need more than communication and co-parenting and knowing how to raise children. A lot of families need a job,

00:09:56:21 - 00:10:21:18
Wrenetha Julion, Ph.D., R.N.
want a job, want to do something differently. And then one final thing I think that, when Paul mentioned the parenting, we have specific content that was developed for fathers in that piece because most things are targeted towards mothers. And so how to soothe the baby? What happens when why is your baby crying all the time? Or you know, how can you hold them to make them more comfortable?

00:10:21:18 - 00:10:33:22
Wrenetha Julion, Ph.D., R.N.
And the safety piece is about putting them down to sleep on their back and all those kinds of things. So that's also something I think is important in what we are providing to families.

00:10:33:25 - 00:10:58:26
Julia Resnick
Absolutely. And there are so many parts of this program that are exciting, and I love that you bring them in as a couple. So it's not just fathers together and mothers together, but really focusing on like the couple as a co-parenting unit. It's just really great. And that that whole person approach, recognizing that it's not just about parenting skills, but like feeling economically secure and stable in your community and as parents.

00:10:58:28 - 00:11:06:27
Julia Resnick
So I'm just curious, like you know, if a couple decides to join this program, like, can you walk me through what your experience would look like?

00:11:06:29 - 00:11:38:20
Wrenetha Julion, Ph.D., R.N.
So as we talked about the couples experience and why we work couple by couple. We start with what we call the parent prep check, and we interview the mother and the father to try to get a sense of where they are as a couple, where their relationship is, their hopes and dreams in terms of thinking about what they want as parents and how they want to experience and live through parenthood.

00:11:38:22 - 00:12:02:09
Wrenetha Julion, Ph.D., R.N.
Which is why that couples approach is so important, because in a group setting, you can imagine you've got, say, five groups. You may have five different areas to focus on at the same time. But us starting with that couple is that we can really hone in on what the couple wants and what the couple needs and what they identify as their strengths and opportunities.

00:12:02:12 - 00:12:14:18
Wrenetha Julion, Ph.D., R.N.
So that's the really, I think, fun part about this is because we want to address the couple's needs and starting where they are. I miss something, Paul?

00:12:14:21 - 00:12:41:24
Paul Florsheim, Ph.D.
No, I think that's it. I mean, that's sort of how we have designed the intake process to be very engaging and to make that point...well, we make a couple points. One is that we want to really tailor this to your needs. The other is that we're very deliberate in saying, you know, we are about the co-parenting relationship, and we don't want to sort of assume that this is a relationship that both of you necessarily want to be in or that you don't.

00:12:41:24 - 00:13:07:27
Paul Florsheim, Ph.D.
You know, we want to take the pressure off of that, as well, so that they feel comfortable sort of moving forward with us. The other thing that I would say is, is that, you know, it can be a little intimidating to come in and talk to...like for me, we don't assume that everybody who's delivering the father inclusive prenatal care services is a mental health professional.

00:13:07:27 - 00:13:32:08
Paul Florsheim, Ph.D.
I happen to be a mental health professional. Some of the couples do come in with some pretty significant issues. And so we do want to make sure that they feel comfortable talking about those in a way that feels safe. So we really emphasize we're not about digging into your deep, you know, sort of histories. And we really are oriented towards figuring out how do you guys move forward together.

00:13:32:14 - 00:13:46:08
Paul Florsheim, Ph.D.
And I often say I act as kind of a coach and a referee, so that if it starts to get too stressful in here, you know, I'm going to say, hold on, let's take a timeout.

00:13:46:10 - 00:13:57:14
Julia Resnick
That's great. So after five years of running this program, how are you measuring the impact and what are you seeing that you think is particularly meaningful?

00:13:57:17 - 00:14:21:27
Wrenetha Julion, Ph.D., R.N.
So I'm going to leave the metrics to Paul and talk a little bit about the quality, like we call the qualitative component. And I'll give an example of a father that we interviewed at the second interview, second time point. He spoke about how much he was learning about and from his daughter and how much he enjoyed that relationship that they had developed.

00:14:21:27 - 00:14:53:06
Wrenetha Julion, Ph.D., R.N.
And there were times when he gave her space to explore and to, quote unquote, fail if you will. You know, and it's like, pick yourself up, okay, we're going to keep on moving. And just the joy in listening to this father's interview, that was one of the best interviews that I've heard in this program, is hearing how he felt about himself, how he felt about his daughter, and how they were growing and learning together.

00:14:53:08 - 00:14:57:23
Julia Resnick
That's so special. Paul, do you have the hard quantitative metrics?

00:14:57:26 - 00:15:28:25
Paul Florsheim, Ph.D.
Yeah, I mean, we do quite a bit of measuring, particularly at the follow ups. And we do focus on things like the quality of the co-parenting relationship. Anything from, you know, preventing intimate partner violence to just being, you know, sort of warm and supportive of each other. We also focus on the parenting relationship and sort of how they're feeling about themselves as parents, but also how they are actually parenting, you know, or at least based on their own self-report.

00:15:28:25 - 00:15:53:18
Paul Florsheim, Ph.D.
Previous sort of versions of the of the program, we did videotaped parent child interaction to code the quality of those relationships. So our goal really is to either improve the quality of the co-parenting relationship if they are having a lot of challenges or prevent the development of problems so that down the road they're able to manage that relationship regardless.

00:15:53:21 - 00:16:26:01
Paul Florsheim, Ph.D.
And in a way, I mean, it's always it's hard as someone who works with these couples to not be a little bit invested in their relationship, staying together as a romantic relationship. But honestly, you know, when I think about it, you know, sort of more broadly than that, it is very gratifying as a provider to see them find ways to parent apart if they're able to do that successfully.

00:16:26:03 - 00:16:39:11
Julia Resnick
Wrenetha, Paul, thank you so much for sharing the work that you do and your expertise. But more than that, thank you for the work that you're doing for families in Chicago. It's just such incredibly important and powerful work.

00:16:39:13 - 00:16:42:03
Paul Florsheim, Ph.D.
Well, thanks for the opportunity to talk about our work.

00:16:42:05 - 00:16:44:23
Wrenetha Julion, Ph.D., R.N.
Absolutely. Thank you for having us.

00:16:44:25 - 00:16:53:07
Tom Haederle
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