Scholarly article on topic 'Working with fathers of at-risk children: Insights from a qualitative process evaluation of an intensive group-based intervention'

Working with fathers of at-risk children: Insights from a qualitative process evaluation of an intensive group-based intervention Academic research paper on "Sociology"

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Children and Youth Services Review
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{Fathers / Parenting / Intervention / Attachment / "Process evaluation" / "Mellow parenting"}

Abstract of research paper on Sociology, author of scientific article — Jonathan Scourfield, Clare Allely, Amanda Coffey, Peter Yates

Abstract This article is based on qualitative research with fathers who attended Mellow Dads, an intensive ‘dads only’ group-based intervention underpinned by attachment theory for fathers of at-risk children. Specifically the article draws on data from a process evaluation of the programme in order to explore the challenges of engaging men in effective family work. The methods used to undertake the process evaluation included participant observation of one complete Mellow Dads course, interviews with fathers and facilitators, interviews with the intervention author and a study of programme documentation. The article focuses on the theoretical underpinning of the programme, its acceptability to the fathers and the challenges faced by facilitators in delivering the programme as intended. The fathers appreciated the efforts of facilitators to make the group work, valued the advice on play and parenting style as well as the opportunity to meet other fathers in similar circumstances. However, there were obstacles that impacted on the effectiveness of the programme. These included the considerable time required to get the men to attend in the first place and then to keep them coming, the lack of practice of parenting skills when fathers were not living with their children, and the difficulties of sharing personal information. The challenges identified raise questions about how much change can be expected from vulnerable fathers and whether programmes designed for mothers can be applied to fathers with little adaptation. The article aims to contribute to ongoing dialogue about the best way to successfully engage fathers in children's well-being, and raises the question as to whether working with fathers requires different skill-sets and approaches from the more familiar social work territory of working with mothers.

Academic research paper on topic "Working with fathers of at-risk children: Insights from a qualitative process evaluation of an intensive group-based intervention"

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Children and Youth Services Review

journal homepage: www.elsevier.com/locate/childyouth

Working with fathers of at-risk children: Insights from a qualitative process evaluation of an intensive group-based intervention

Jonathan Scourfield a* Clare Allely b, Amanda Coffey a, Peter Yatesc

a Cardiff University, UK b University ofSalford, UK c Edinburgh Napier University, UK

CrossMark

ARTICLE INFO

Article history:

Received 25 March 2016

Received in revised form 30 August 2016

Accepted 30 August 2016

Available online 31 August 2016

Keywords:

Fathers

Parenting

Intervention

Attachment

Process evaluation

Mellow parenting

ABSTRACT

This article is based on qualitative research with fathers who attended Mellow Dads, an intensive 'dads only' group-based intervention underpinned by attachment theory for fathers of at-risk children. Specifically the article draws on data from a process evaluation of the programme in order to explore the challenges of engaging men in effective family work. The methods used to undertake the process evaluation included participant observation of one complete Mellow Dads course, interviews with fathers and facilitators, interviews with the intervention author and a study of programme documentation. The article focuses on the theoretical underpinning of the programme, its acceptability to the fathers and the challenges faced by facilitators in delivering the programme as intended. The fathers appreciated the efforts of facilitators to make the group work, valued the advice on play and parenting style as well as the opportunity to meet other fathers in similar circumstances. However, there were obstacles that impacted on the effectiveness of the programme. These included the considerable time required to get the men to attend in the first place and then to keep them coming, the lack of practice of parenting skills when fathers were not living with their children, and the difficulties of sharing personal information. The challenges identified raise questions about how much change can be expected from vulnerable fathers and whether programmes designed for mothers can be applied to fathers with little adaptation. The article aims to contribute to ongoing dialogue about the best way to successfully engage fathers in children's well-being, and raises the question as to whether working with fathers requires different skill-sets and approaches from the more familiar social work territory of working with mothers.

© 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license

(http://creativecommons.org/licenses/by/4.0/).

1. Introduction

Engaging fathers in parenting programmes is a relatively recent phenomenon. There has been an increasing recognition that social work services for children and families at risk have conventionally focussed on women and (their) children, on mothers rather than parents (Featherstone, 2004; Scourfield, 2003), and an increased awareness of the need to develop services and interventions that can support men as parents in vulnerable families, including those subject to child protection processes. The research on fathers involved in child welfare cases remains limited, although recent research has shown that some fathers do want 'to be listened to, believed, and given the chance to prove themselves' (Zanoni, Warburton, Bussey, & McMaugh, 2014: 92). In attempting to shift these established practices, some family workers have encouraged men to join in with parenting courses alongside mothers. Others have offered parenting groups or other interventions

* Corresponding author at: Cardiff School of Social Sciences, Glamorgan Building, King Edward VII Avenue, Cardiff CF10 3WT, UK.

E-mail address: Scourfield@cardiff.ac.uk (J. Scourfield).

specifically for fathers (see Dolan, 2013; Ewart-Boyle, Manktelow, & McColgan, 2015). This article draws on a qualitative process evaluation of an intensive attachment-based programme for fathers, in order to explore the effectiveness of and challenges to engaging fathers of at-risk children in meaningful family work.

The programme discussed in the article - Mellow Dads - is distinct from some other interventions in a number of ways. It is a highly intensive programme, which is focused on a particularly challenging client group and is based on an attachment rather than behavioural approach. It is an approach which has previously been used exclusively with mothers and has relatively recently been adapted for use with fathers. This provides the opportunity to consider a particular case study of wider efforts to engage men, as non-traditional clients, in programmes and interventions designed to support parents in at-risk families.

The study was a process evaluation, which sought to explore context, implementation and mechanisms (Moore et al., 2015). The research questions addressed are these:

— RQ1 : What are the theoretical underpinnings of Mellow Dads?

— RQ2: How was the programme received by fathers?

http://dx.doi.org/10.1016/j.childyouth.2016.08.021

0190-7409/© 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

— RQ3: What does the implementation of Mellow Dads tell us about the practical reality of working with fathers whose children are at risk?

In terms of the purposes of process evaluation (Moore et al., 2015), RQ1 is primarily focused on mechanisms and RQs 2 and 3 on implementation and context.

In the next section of this article we provide a brief overview of the development of parenting programmes for fathers, before describing the Mellow Parenting programme approach, its theoretical underpinnings and known effectiveness. The article then moves on to describe the methods used to undertake a process evaluation of the fathers' programme, before offering insights regarding what the evaluation tells us about engaging fathers in parenting support and how this differs from working with mothers.

1.1. Parenting programmes for fathers

In practice, most parenting programmes are largely attended by women. For example, Lindsay et al. (2011) found that of the 6095 parents attending certain evidence-based parenting programmes in England in their study, 13% were men. There are many possible reasons for this gendered pattern, including men's reluctance - based on a traditional gendered model of family life - to see child care as a shared responsibility (Maxwell, Scourfield, Featherstone, Holland, & Tolman, 2012) and the fact that settings such as family centres tend to be women-friendly spaces that are not well suited to recruiting men as clients (Ghate, Shaw, & Hazel, 2000). Because men are a small minority of those attending such programmes, and the sample sizes of studies are often relatively small, there is very little evidence on the effectiveness of parenting programmes for fathers specifically (Panter-Brick et al., 2014). What evidence does exist suggests that parent education attended by both parents is more effective than programmes attended by mothers alone (Lundahl, Tollefson, Risser, & Lovejoy, 2008) but that the effects of attending programmes are less favourable for fathers than for mothers (Sanders, Kirby, Tellegen, & Day, 2014).

Most of the consideration of culturally adapting interventions focuses on adaptation for different ethnic and linguistic groups (e.g. Castro, Barrera, & Holleran Steiker, 2010). However, in the light of the gendered pattern of parenting programme attendance, some thought has been given to whether programmes need to be adapted for fathers. Meyers (1993), for example, has argued that in the light of the differences between fathers and mothers in terms of their observed parenting styles, adaptations are needed for parent education programmes so that they better meet the needs of fathers. Adapted structural aspects recommended by Meyers include active recruitment of men via traditionally masculine social spaces, proactively featuring images of men in advertising, providing other kinds of practical help of interest to men alongside parenting support, planning the timing of programmes to suit working hours, trying out alternative venues such as workplaces and family homes and targeting hard-to-reach groups of men. Meyers also recommends tailoring content to fathers. He argues fathers have a greater need for knowledge about child development and child care and a greater need for social support, in both cases because they are likely to have greater deficits in these areas than mothers. He further argues that fathers need to be encouraged through the programme to be more involved in the practical care of their child and that they need additional help with communication skills, both in relation to their partner and their child. All these content recommendations are made in the light of the reality of gendered patterns of parenting.

Adaptations such as these, and especially the structural aspects, were found in a recent survey in the UK (Scourfield, Cheung, & Macdonald, 2014), which aimed to find out what approaches were commonly being used with fathers. The survey found that a large majority of practitioners (85%) who responded to the survey were working with

fathers in mixed parenting programmes rather than in programmes for fathers only. These tended not to have adapted content but practitioners were trying out structural changes to make the programmes more attractive to fathers. Of those who were working with father-only programmes, most were using unique interventions with fathers. Only a minority were using named programmes which replicated approaches taken elsewhere, for example from programmes for mothers or 'parents'. The most popular intervention theories were cognitive and behavioural. As noted earlier, the particular intervention focused on in this article is primarily focused on attachment rather than behaviour.

Î.2. Mellow parenting

Mellow Parenting is a parenting programme for families where young children (0-5 years) are either already identified as in need of protection, or where the extent and nature of associated risk factors for child development give significant concern that the child may soon come to be in need of protection (see www.mellowparenting.org). A Scottish-based charity with programmes delivered internationally, Mellow Parenting is underpinned by psychological approaches to understanding early parent-child relationships, most notably attachment theory. It was developed for families where there were deemed to be severe parent-child relationship problems. Mellow Parenting comprises several key components that aim to facilitate attendance and empower parents to reflect and learn from their own experience, including the use of video feedback as a means of encouraging parents to consider their own behaviour and the response of their children. The value of this method has been supported by research showing that positive video feedback is a powerful tool in changing behaviour (Bakermans-Kranenburg, Van Ijzendoorn, & Juffer, 2003).

A programme originally designed for mothers, and drawing on structured observations of mother-child interaction where it has been possible to distinguish problem dyads (Puckering, Rogers, Mills, Cox, & Mattsson-Graff, 1994), Mellow Parenting runs for one day a week over a period of fourteen consecutive weeks, combining both support for parents (mothers) and direct parenting work including modelling positive play and encouraging positive interaction. The programme encourages reflection on the parents' own childhood as well as their current experiences. Most sessions are discussion- or activity-based, placing low demands on the parents' literacy skills. Typically the parents will gather for a morning session exploring their own issues while their children are looked after in a crèche. Parents and their children come together for lunch followed by a play or art and craft-based activity, giving an opportunity for observation and filming of realistic parent-child interactions. In the afternoon parents gather on their own again in order to watch and discuss excerpts from the lunchtime activities and to discuss other issues relating to parenting skills and capacity.

Mellow Parenting is considered as a 'preventative intervention', helping to prevent the risk of developing conduct disorders in children (Goldsack & Hall, 2010). The programme is thought successfully to engage parents, who are 'at the extreme end of the spectrum' (Puckering, 2004). Part of the rationale for the Mellow Parenting approach is that some other major parenting programmes such as the 'Incredible Years' programmes (Webster-Stratton & Herbert, 1994) and the 'Triple P' programme (Sanders & Dadds, 1993) may, despite their effectiveness when delivered fully, actually be failing to engage families that are the most vulnerable and in need (Puckering, 2004). The Triple P programme, for example, has been shown to be an effective intervention for children over the age of three with milder behavioural problems and where families are literate and strongly motivated (e.g., Sanders et al., 2014). For families with additional needs (for example low levels of literacy, personality disorders, severe parental depression), what has been shown to be more effective are more intensive interventions, including those that harness video feedback to parents (Bakermans-Kranenburg et al., 2003). Many parenting programmes

focus on managing children's behaviour, as this is often the key concern for parents (and other practitioners). Managing behaviour is, however, only one element of parenting and is perhaps more applicable to children older than about two. Mellow Parenting particularly focuses on families with young children (under five years). Those at-risk families considered most in need of support for managing their child's behaviour are often not ready to consider and implement the suggested strategies because of their own issues, and so often continue to fail to follow behavioural programmes. Mellow Parenting aims to reach these parents by providing a more nurturing context in which to develop their own relationships, explore their own childhoods, and develop their own skills, alongside applying these to the relationships with their child. Thus there is particular focus on the transmission of attachment, and the impact of early relationship styles on the parents' capacity to parent.

There is, to date, no evidence about Mellow Parenting from randomised controlled trials (RCTs), and further evaluation work is needed (Wilson, Minnis, Puckering, & Bryce, 2007). Current empirical support for Mellow Parenting rests mostly on encouraging findings from small-scale pre-post and quasi-experimental studies, most of which involve the programme author. A systematic review and meta-analysis were conducted exploring Mellow Parenting interventions for parent-child dyads at high risk of adverse developmental outcomes, with eight papers (comprising of nine data sets overall) identified and effect sizes were investigated in a meta-analysis of five of the eight papers (MacBeth et al., 2015). When compared with comparison groups on maternal well-being and child problems, this review found evidence of a medium treatment effect of Mellow Parenting. The authors also highlighted some of the limitations of the studies evaluating Mellow Parenting to date, specifically that the data were heterogeneous and there is evidence of methodological bias (small sample sizes). Despite these potential limitations the meta-analysis conducted by MacBeth et al. (2015) reveals evidence which offers some limited support for Mellow Parenting's claim of the effectiveness for "families with multiple indices of developmental adversity" (MacBeth et al., 2015, pp.1119).

To date there has been no specific evaluation of Mellow Parenting programmes for fathers. This paper thus makes a contribution to the literature by evaluating the implementation of an intensive, attachment-based programme for fathers, whose children are at-risk or subject to child protection procedures.

2. Research methods

The article draws on a qualitative process evaluation of a 'Mellow Dads' parenting course. The study consisted of qualitative interviews with participants, facilitators and the programme author, observation of sessions and study of programme manuals. Group and individual interviews were conducted with six fathers who had attended either a Mellow Parenting group for fathers (n = 3) or the adapted Mellow Dads group (n = 3), all in the same local authority in central Scotland. The adaptation of the programme from Mellow Parenting to Mellow Dads is explained in the research findings section of the article. Interviews were also carried out with five staff members who had been directly involved in providing the Mellow Parenting interventions for fathers either as fathers' group facilitators or as children's workers. There were also two interviews conducted with the intervention author Christine Puckering. Apart from Christine, all other interviewees have been given pseudonyms in the article. In addition to the interviews, 72 h of participant observation of one Mellow Dads group was conducted over 12 weeks of meetings. Detailed fieldnotes were written up with particular attention paid to how the programme theory was put into practice. The research team also had access to the programme manuals and materials. All interview transcripts and fieldnotes were thematical-ly analysed, with coding facilitated by N-vivo software.

The study therefore draws data from a variety of sources including in-depth interviews and direct experience of an entire Mellow Dads course. Where fathers were interviewed in a group following a support group meeting, the family support worker facilitating the group was also present, perhaps making it less likely that fathers would voice critical opinions about the intervention. Only fathers who attended a whole course (either a Mellow Parenting intervention for fathers or a Mellow Dads programme) were interviewed.

It will certainly be important in future work to also hear the views of fathers who have refused the offer of attendance or who have dropped out before the end. We know, for example, that there are incongruities between child welfare workers' views of fathers in families subject to child protection procedures, and the views of researchers. Child welfare workers interact with all families subject to child protection procedures, including those where fathers do not engage or are absent, and their views of fathers tend to be negative. Researchers, on the other hand, tend to conduct research with those fathers who are or have been in receipt of support services (Zanoni et al., 2014). By definition those fathers who are actively engaged with services and support are 'trying', and by contrast 'those fathers who are not interested in their children, are attempting to shirk their parental responsibilities, or who are avoiding child protection services' (Zanoni et al., 2014; 85) are less likely voluntarily to engage in intervention programmes. This study offers detailed insight into the process of delivering a Mellow Dads programme and the experiences of those involved, and does not attempt to measure the impact of the programme in terms of outcomes for parents and children.

In the sections that follow, analysis and insights from the study are presented. Firstly we outline the theoretical underpinnings of the Mellow Parenting programme and how the intervention was adapted for fathers (RQ1); secondly we explore the reception to and engagement with the programme by fathers (RQ2); and thirdly we document some of the ways in which the intervention was put into practice, and in doing so identify some of the opportunities and challenges raised for working with fathers, whose children are at risk (RQ3).

3. Research findings

3.1. The theory of 'Mellow Dads'

3.1.1. Core elements

All the core elements of the programme theory are taken directly from the original Mellow Parenting programme for mothers. The programme is clearly targeted on an understanding of those in the greatest need. This is partly pragmatic. Christine Puckering, the author of the Mellow Parenting programme, noted that although the group content of 'Mellow Dads' could in fact apply to any father, it would be 'difficult to justify that amount of spending unless there was some level of need'.

The target fathers for 'Mellow' intervention are, according to Puckering, 'vulnerable', often with complex and multiple problems including substance misuse, mental health problems and domestic violence, as well as typically unemployment, financial difficulties, offending behaviour, poor education and poor literacy. The targeting on 'vulnerability' is no different from Mellow Parenting for mothers, but the issues presenting will undoubtedly be gendered, for example with men more likely to be perpetrators of domestic violence and more likely to have criminal justice involvement. A core aspect of the Mellow philosophy is that the programme should be voluntary. As Puckering stated, 'we go in with an offer, not with an assessment'.

Attachment theory underpins the programme philosophy and content, a theory considered to be relevant 'across the age span', according to Puckering. In particular, there is a connection made between parents' own up-bringing and their current and potential attachment to their children; 'Parents who are dismissive or preoccupied by attachment issues are more likely to have insecurely attached children' (Mellow Parenting Going Mellow manual, p. 6). In relation to Mellow Parenting

for fathers, attention is therefore paid to repairing fathers' ability to attach to children, particularly through reflection on their own childhoods. The Going Mellow manual cites the 'Adult Attachment Interview' (van Ijzendoorn, 1995) to support the idea that successful attachment to a child is more likely if a parent has an autonomous state of mind (which is seen as analogous to a secure attachment in childhood). However, it also notes that even for someone with a difficult attachment history, security (and positive attachment) can be gained through learning to make sense of one's childhood.

It is important to know that it is not just whether you had a good childhood that defines your state of mind with respect to attachment, but whether you have been able to make sense of this. Parents who have had a very rough time as children can still develop what is known as "earned" security.

[(Mellow Parenting Going Mellow manual, p. 6)]

This emphasis on processing of difficult past experiences has several purposes. Firstly, it is designed to influence the capacity for attachment: 'nurturing the parent to enable the parent to nurture the child', as described by Puckering during interview. Secondly, and more pragmatically, it maintains investment in the programme. Allowing parents to talk about their own lives and difficulties they have experienced originally came into Mellow Parenting following feedback from mothers who had originally attended a programme with a more exclusive focus on behaviour management. These mothers wanted space to deal with their own difficulties in addition to learning parenting skills. Mellow Parenting now assumes that without this focus on parents' own lives, it would be very difficult to maintain attendance from the most vulnerable parents who are the key target group for the programme. The third purpose is that a 'closed and contained' group allows fathers to build strong relationships with each other. Fourthly, these reflective discussions allow for difficult but important issues such as mental health and domestic violence to be aired, discussed and made sense of, with a view to positive change.

Like the intervention for mothers, the programme is aimed at fathers with children under five years of age, and where child protection issues are confirmed or where families are seen as being at considerable risk. The intervention consists of fourteen meetings over fourteen weeks, with each meeting lasting a whole day. As with Mellow Parenting, the morning is typically devoted to topic-based discussion of fathers' own lives. The lunchtime is an important element, when fathers join up with their child to eat together, followed by a play or craft activity, which may be very new to the fathers. This is seen as providing a safe space for developing nurturing relationships, which offers a realistic parenting scenario in which father-child interactions can be observed and filmed for later discussion. There is a conscious modelling process: as Puckering notes, 'you don't think to do these things with your child if you've never had that experience yourself'. The fathers and children then separate again, and the afternoon session consists of group feedback on father-child videos, including both the filming of lunchtime interactions and videos made in family homes. The intention is that both facilitators and the other fathers will make micro-level commentary on father-child interactions. Considerable emphasis is placed on pointing out existing strengths in the fathers' parenting styles, although there should also be attention to aspects that are less positive or that they found difficult. Despite the focus on parenting skills in the afternoon session, Mellow Dads is, according to Puckering, distinct in its approach from behaviour-focused parent training: 'Although (...) with various parts of the programme, we would be discussing behavioural management, that's not where we start from; we start from relationships'. This approach also guides the approach to staffing and facilitating the intervention. In order to 'try and reduce the social demand gradient between the practitioner and the participants' (Puckering), facilitators also take part in all activities and self-disclosure in that context is expected from the facilitators. The intervention also models 'wrap-around

care', with fathers transported to and from the venue and children looked after in a crèche during the group sessions.

3.1.2. Adaptation for fathers

The core elements of the Mellow approach, as described above, draw directly on the programme as it was designed and intended for mothers. Of the fathers interviewed as part of this study, some had attended an all-male Mellow Parenting group, before the intervention was repackaged as Mellow Dads. Others attended the tailored Mellow Dads programme that we observed. An important reason why we have considered the fathers' views on Mellow Parenting to be relevant, as opposed to only the views of fathers attending Mellow Dads, is that there has in fact been very little adaptation of Mellow parenting in creating Mellow Dads. There is inevitably some tailoring of material. The sessions on 'you and your body' and 'pregnancy and birth' were clearly different in content from the equivalent sessions for mothers. Interestingly, the session on self-esteem from the mothers' programme has been replaced with 'being a Dad'. Other sessions which might have been further distinguished - violence in the home being the most obvious, given the gender differences in experience of violence - are in fact not adapted at all but remain the same on the basis that they are thought to be equally applicable to all parents.

One important aspect of adapting Mellow Parenting into Mellow Dads is the strong steer for mixed-sex staffing. This is considered especially important in the fathers' group but also for the children's participation, as it helps with modelling of gender equality and non-traditional roles for men. Facilitators spoke of a previous group having been challenging as some powerful group members had fixed ideas about a traditional gendered division of labour in families: 'I'm never in the kitchen; I never do that; that's a woman's job' (Lisa, fathers' group facilitator). The facilitators had taken a deliberate decision that the male staff member would clear up food mess at lunchtime and bottle-feed one of the babies in order to model men's participation in such tasks. It was considered important to counteract 'myths that they maybe have grown up with about how a female should be' by also consciously providing a model of a 'strong female' (Catriona, fathers' group facilitator).

The rationale for offering single-sex interventions was evidenced from other parenting programmes (Bakermans-Kranenburg et al., 2003), in that fathers being present can 'dilute the effect on mums' (Puckering, at interview). Also it is thought that some women would find the more personal discussions difficult in the presence of men if they have experienced domestic violence or sexual abuse. However, it is worthy of note that in both New Zealand and Germany, Mellow Parenting programmes have been run with fathers and mothers in separate groups in the morning and then merged for the afternoon to discuss parent-child videos.

3.2. Reception by fathers

All the fathers interviewed as part of the study told us their expectations before attending had not been good. There was considerable nervousness as to what the group would be like and what would be expected:

I had a view in my mind that it would be (...) pretty intense, we would all be talking about stuff that we didn't want to talk about and things like that.

[(Joe, father)]

That's how I felt before I went to the group - what's it going to be like? What are the people going to be like? Sitting staring at me?

[(Eddie, father)]

I felt really withdrawn, frightened, scared, there is going to be drug addicts, is it going to be this and that? You know, I had my own

problems I didn't want to speak about. Nobody is going to notice if you are in the background. But you know, I just wanted to be the wallpaper the first week.

[(John, father)]

A common theme from the fathers was a fear of public scrutiny. There was a shared reluctance to speak in front of strangers, perhaps especially so about personal matters. John, for example, made an explicit connection between this reluctance to talk and what is typically expected of men, when he said 'I don't know if it's something to do with their manhood or whatever' but that some men would not want to 'talk or open up or anything', at least for the first few weeks. This resonates with work looking at masculinity and fathering identities in the context of 'dads only' parenting programmes, where some aspects of involved fathering and the sharing expected by parenting support arenas may clash with certain masculinities sensibilities (Dolan, 2013).

While the fathers in the group we observed did open up more as the programme progressed, it was noted that it seemed particularly difficult for fathers to talk about feelings of vulnerability early on in the programme. For example, one exercise was to roll a 'feelings dice' with emotions written on each face and select which described how they felt. The first father rolled 'scared', said 'no', then 'anxious', to which again he said 'no', then 'sad' - again a 'no', and then finally 'happy', at which point he spoke about a recent betting win. Most of the fathers seemed able to acknowledge feelings of anger and frustration but found it much harder to acknowledge more vulnerable feelings, such as anxiety. One did speak of his anxiety about coming to the group, but embarrassment, loneliness and sadness were not mentioned.

In conversations with the fathers, it appeared that the fears about public scrutiny were not in fact realised, with facilitators succeeding in creating a 'relaxed' atmosphere, perhaps against the odds. The 'relaxed and happy' feel of the facilitators at the start of the day was said to be infectious: 'it kind of makes you change and you feel relaxed and ready for the day' (Joe, father). There was surprise expressed about the fact that humour was allowed, given that an 'intense' environment had been expected. Joe was pleased that it was quite acceptable to have 'a laugh and a joke but at the end of the day we still get the work done at the same time'. Also the fathers valued the facilitators sharing their own experiences:

They were down to earth, they felt like one of us sort of thing. They didn't come across as too authoritative or anything like that.

[(Brian, father)]

We still talk to them like we'd talk to a pal in the street, in that context.

[(Phil, father)]

The participant observation supported the fathers' accounts. It was evident that the men were initially nervous and defended, but became more relaxed in response to skilled facilitation.

Another dad seemed quite defended to begin with - arms crossed, leaning back, face set - but soon started to relax and was quite open in his contributions. All the dads ended up contributing quite a lot to the discussions and certainly seemed to relax considerably as the day went on.

[(Excerpt from fieldnotes, session 1)]

Facilitators manage to get away from an 'us and them' feel to the group - quite jokey, telling funny stories from their own family experiences, generally quite light-hearted. They take part in the activities themselves and give plenty of encouragement and praise.

[(Excerpt from fieldnotes, session 4)]

who are in similar current circumstances or who have had some similar experiences in life:

It kind of makes something click and you say to yourself, this person has been through or is going through the same as you. It might be worth having a listen and bouncing a few ideas off each other.

[(Joe, father)]

After a few times, I was, like, 'this is good', because I actually learned things really. I'm not the only person stressed out with my life. Other people have stress in them.

[(John, father)]

This was especially so for those fathers who chose to attend the monthly post-Mellow Dads support group. Some of these men had in fact requested the group be set up, to offer them on-going support, because they were missing the group. The excerpts below illustrate the importance of ongoing support from other fathers. The 'Neil' mentioned by Brian is another father from the group he attended.

It helped me quite a lot when it was there, because it brought me out of my depression quite quick, and I've got two or three good mates that I keep in touch with, sometimes. But if I've got a problem, I'll give Neil a phone and have a blether.1

[(Brian, father)]

You know, we were in limbo after it finished, because we enjoyed going there that much. So we decided to start this group, and carry on.

[(Eddie, father)]

As well as the opportunity for social bonds, some fathers made specific comments about valuing the lunchtime activities and the video feedback, which are key aspects of the Mellow Parenting intervention. The first example below concerns strengths-based commentary on videoed interaction, which this father had appreciated. The second is about one specific play activity, which the father had used several times since encountering it at Mellow Dads:

Getting to watch the video back and seeing his development (...) when I first came and I was rubbing his back, I have always done that and I never knew that I done it. And people pointed it out and said it was a comfort thing. That makes you feel better about yourself.

[(Joe, father)]

My wee boy enjoyed most of them. It was all right. I didn't know how to make playdough or nothing so after a couple of wee things like that. My wee lassie that is what we make just about every weekend now.

[(Brian, father)]

Significantly, the fathers spoke of practical changes in their parenting that had directly resulted from attending Mellow Dads. When asked what they gained from attending, it was the practical lessons they recalled, rather than any therapeutic gain from talking about past difficulties. This is illustrated in the examples below. The first is of learning to distract a child from a bad mood and the second is of learning to be calmer and less authoritarian in parenting style:

Onetime, (...) we were talking about getting children out of moods, and I started mucking about making him dance, dragging him off the chair and making him dance, or tickling him, things like that. And that worked a lot.

[(Eddie, father)]

Relationships with other fathers in the group were also seen as important. The fathers spoke of valuing time spent with other people

1 Chat.

I used to be a 'do as you're told, end of!' Sergeant Major type person.

Now I'm more, 'OK, you've done that, it's not the end of the world.'

Slight change. So now I can handle lots of situations where, beforehand, I would have just lost my rag.2

[(John, father)]

The participant observation also noted claims of progress in parenting. In session 5, after looking at a video, one father said he felt that he was more involved in the play with his child these days, and had many more ideas for activities he could do with his child. He had taken some books and toys along to his contact session for his baby to play with, and we were told that previously he had usually or even always turned up to contact empty-handed.

Fathers who had taken part in Mellow Dads claimed the programme had made a positive difference to the ways in which they interacted with their children. This resonates with the findings of Dolan (2013). This, alongside the opportunity to meet other fathers in similar circumstances, would suggest that the impact of the intervention was positive for the men we interviewed. However, as will be discussed in the next section, there are challenges in putting into practice the principles and philosophy of an attachment-based group intervention for fathers whose children are at risk.

33. Theory into practice

The qualitative process evaluation of the Mellow Dads intervention, as part of considering implementation, set out to assess the fidelity to the programme principles. It was not so relevant to assess fidelity to the programme manual, since this is not a highly manualised programme with detailed prescription of content. Instead, what follows is commentary on some of the difficulties that were encountered with putting Mellow Parenting principles into practice in a 'dads only' context. Some of these difficulties may be surmountable, but others are arguably inherent to the context for this client group. If you aim to work with vulnerable fathers of at-risk children, you are likely to experience the challenges distinctive to this group.

The first issue to note is the principle of voluntary attendance. This principle, of course, is not unique to the Mellow Parents programme (see Zanoni et al., 2014; Dolan, 2013). In practice this is a principle that is hard to achieve, not least because of the context of many of the children being caught up in the child protection process. With children at risk of coming into foster care, it is not surprising that some of the fathers would feel coerced - not by Mellow Dads staff necessarily, but certainly by social workers with a child protection brief expecting them to attend a parenting intervention, and seemingly judging their commitment to their children in terms of whether or not they attend. One of the fathers said 'the first group is the one you feel you're forced to go on sometimes, because you get referred by social workers' (John, father). However, workers were sometimes successful in conveying the voluntary nature of attendance. Another father told us 'I accepted it a bit better 'cos it was voluntary' (Brian, father). In our observation of session 2, one of the fathers commented that the group felt very relaxed and he that he got some time to spend with his child without social workers looking over his shoulder. He said that he felt 'like a dad for a change'.

The number of fathers attending the group we observed was small. Twelve initial referrals had been received, out of which six fathers attended at least once but only three completed the programme in full. When the numbers of men attending programmes are low, practitioners may find it more difficult rigidly to apply criteria for cohesive group membership. For example, in the group we observed, the ages of children ranged from four months to nine years. This wide age-range is difficult in terms of finding appropriate activities and in terms of sharing experiences across the group. The practical parenting issues

2 Temper.

that arise in the later primary school years are quite different from those which arise with very young children. Staff facilitating the sessions expressed some frustration with local services for not referring greater numbers of fathers. Danny (fathers' group facilitator) said 'I don't believe for one minute that there's not, you know, possibly half a dozen dads that health visitors could be referring'. Having low numbers also means that any non-attendance threatens the viability of the group. Difficult decisions needed to be made in those circumstances:

One of the fathers has found work, so will no longer be able to attend the group. Another had to view a flat and had an appointment with his drugs worker; one was in court for having breached his bail conditions; another was off sick with a stomach bug. The facilitators said during the break they will need to discuss how many sessions a dad can miss before being asked to go onto another programme.

[(Excerpt from fieldnotes, session 5)]

The facilitators of the group we observed put considerable time and effort into contacting non-attenders, including visiting them at home, to ensure the group had enough core members to survive. The programme was reduced to 12 weeks from 14 for various logistical reasons. Other sessions had to be moved around and two additional afternoon sessions missed out because of low numbers at some sessions (although some missed topics were reprised in later weeks). For example, the session on 'life stories', regarded by the facilitators as of crucial importance, had to be postponed as only one father attended the planned session (week five).

Another distinctive feature of Mellow Parenting is its focus on a specific client group of families most in need. For many families this might well mean that children do not always live with their fathers. In fact, of the three men who completed the Mellow Dads programme we observed, none was currently living with the child about whom concern had originally been expressed and a referral received. This meant that it was very difficult to instill a culture of completing video and homework tasks from the start, with the dads not enjoying regular and frequent contact with their children in between Mellow Dads sessions. Indeed, one of the incentives for attending the group expressed by the fathers was that it gave them a precious opportunity to spend time with their child. The only contact this man had with his child was during the lunchtime activity at the Mellow Dads programme. He became very upset and angry if, for practical reasons, their child was not able to be brought to the session.

The complex transport arrangements involved with bringing children from school, foster carers and separated ex-partners to the centre where Mellow Dads was taking place also took additional hours away from the group sessions, meaning that for this group of men, the exposure to the parenting intervention was not what it was intended to be. Not all planned sessions could be used or topics covered as planned because of time being restricted by often complex transport logistics. These included sessions on relaxation and common mental health problems.

Non-attendance was also exacerbated by a seeming lack of support from other local agencies. There were instances where other social welfare agencies the fathers were involved with made 'essential appointments' which clashed with Mellow Dads sessions. In one particular instance we observed, this was made by the same child welfare charity which had referred the father to the group in the first place. Another was an appointment for drug counselling, as noted earlier. The facilitators took the view that the same issue would not have arisen for mothers, since attendance at a parenting course is a more generally accepted good use of mothers' time and more likely to be seen as part of an essential service. The reason for one of the fathers failing to complete the programme was finding work, an issue which again is arguably more likely to affect fathers than mothers.

Because the three fathers who completed the group intervention we observed did not have their children living with them, they were

preoccupied by and frustrated with social work decisions they did not agree with. Facilitators put in considerable efforts outside the group to mollify these frustrations, especially when giving the fathers lifts to and from the centre, although sometimes these concerns came into the group itself. Allowing space for the fathers' pressing concerns could be seen to be in tension with fidelity to the programme. This emerged from the participant observation:

During the sessions so far the facilitators have always taken the time to listen to current and pressing issues for the dads and this has sometimes been to the cost of the planned exercise.

[(Excerpt from fieldnotes, session 5)]

At the end of each dad's life story discussions, significant time was given to talking through the dad's current circumstances. I would say that more time was given to talking about the current circumstances than the life story work.

[(Excerpt from fieldnotes, session 6)]

The facilitators dealt with the fathers' concerns about the child protection process very skillfully, allowing some strong feelings to be aired but helping the men to re-frame the situation as one where they needed to display their responsible fatherhood, rather than one simply their feelings of persecution. The following instance from the group we observed illustrates the skilful handling of one case:

One of the facilitators brought up the subject that this dad would need to sort out with the boy's mother how they set consistent boundaries for him. The facilitator clearly said that they thought that at present this child was at risk. The dad responded very openly to this conversation, and I do not think this would have been possible without the positive and encouraging relationship they have so far worked hard to build.

[(Excerpt from fieldnotes, session 6)]

Although it is not a specific aim of Mellow Dads to help fathers better manage their dealings with social services, we did in fact observe some positive indications, at least with regard to more positive attitudes displayed in the group. Some good quality motivational and social skills work had been undertaken by the facilitators and arguably it was attending the Mellow Dads group, with its emphasis on nurturing fathers and respecting their views, which made this work achievable. We could speculate that the fathers took advice on dealing with statutory child protection processes much better from the Mellow Dads staff, with whom they had built good rapport, than from the statutory caseworkers from social services who are responsible for child protection.

There were a number of other ways in which working with this population of fathers raised distinctive issues. One father was prescribed methadone because of an opiate addiction. He sometimes fell asleep in group sessions. This issue could also arise in a mothers' group, but it is more likely to arise with fathers because the use of Class A drugs (UK classification) is more common in men than in women (Hay et al., 2010). Group dynamics were also very slow to get going in the Mellow Dads group we observed, not helped by the variable attendance and despite the facilitators' highly skilled attempts to get the men to cohere as a group. For a group of vulnerable men to relate to each other on a personal level may well be more of a challenge than it would be for women, because women are typically socialised to have closer emotionally dependent relationships on each other than are men (Barbee et al., 1993). John was hinting at this in the earlier section on fathers' views, when he said it was perhaps 'manhood' which held back fathers from fully participating at first. Dolan (2013), in his work on men attending a dads only parenting programme, observed similar tensions between the development of capacities as involved fathers and masculine ideals and understandings of traditional fathering.

It was noted above that Mellow Dads is avowedly strengths-based and that feedback on videoed interaction includes comment on positive aspects of parenting style. In the group we observed, the feedback on videos was almost exclusively strengths-based. The influence of more than one different parenting programme could be seen. Although Christine Puckering explained that noting strengths was very important, in her account this should be balanced with some discussion of interactions that did not work so well. This should then be shared in the group to ask for support in generating solutions. She explicitly contrasted this approach with Video Interaction Guidance (Tooten et al., 2012), which takes a solely positive approach to feedback. One of the facilitators, however, referred to training in Video Interaction Guidance as influencing his practice. There were instances when fathers were clearly looking for advice on aspects of parenting they found difficult, but advice-giving is not the approach of Mellow Parenting. Facilitators tended to respond with more examples of things they were already doing well or with questions designed to elicit from the father himself or from other group members. Input from other group members was more difficult to generate, not least because of the small size of the group.

There are some general reflections to be made on the more personal morning sessions in the Mellow Dads programme. The aim of repairing damaged attachment styles is a very ambitious one. For vulnerable fathers from very challenging backgrounds who do not take easily to 'talking therapy', it may be too ambitious. The participant observer noted the following for one of the fathers:

The first dad's life story was full of significant gaps, such as not explaining why he was taken into care as a young child, not explaining why his son has been taken into care and not making sense of any of his childhood relationships. The facilitators made quite a few attempts to fill in some of the gaps, but in the end I felt the dad's story remained quite incoherent and left many unanswered questions. With the dads coming from such difficult backgrounds, I do wonder if this one session is anywhere near sufficient to be able to come up with a coherent life story. I asked the facilitators about this at lunchtime. They said that the exercise is designed to get dads to think about their own lives by doing the private preparation work, and the sharing of the stories is really about group bonding.

[(Excerpt from fieldnotes, session 6)]

There may be limits to what can be opened up in the morning session, especially since the session is short and the fathers are soon to meet and spend time with their children. There is no expectation that facilitators have any particular level of therapeutic training. The facilitators themselves saw a limit to what could be opened up in the morning session. One commented to the observer during a break in a Mellow Dads session that it was not a 'therapy group'. In a joint interview at the end of the course the two facilitators discussed the difficulty in knowing how to respond to the father who had 'hinted' at his experience of childhood sexual abuse, although without explicitly disclosing it. They had some concern about lacking 'the expertise, skills or training to pick up the pieces for him if he discloses too much'. They contrasted their professional background as family support workers with the ability to do more therapeutic work. The issue of sexual abuse they saw as more suitable for one-to-one work, rather than in-depth discussion in front of the whole group, just as you would 'never do counselling session downstairs in the middle of a waiting room'.

This does not mean to suggest that trying to encourage talking about past difficulties does not have other kinds of benefits, such as helping to build relationships between group members and with the facilitator, allowing for the facilitators' advice (when it comes) to be heard and respected, as was noted above in connection with managing statutory social work contact. Indeed, the particular father who had hinted at a history of childhood sexual abuse was in fact seen as something of a

Mellow Dads success story. He had been spurred on by attendance at the group to seriously address his substance misuse and by the end of the Mellow Dads programme was seen as much better able to care for his child. There may well be limits to what can be achieved through a programme such as Mellow Dads, because of the low level of parenting ability the fathers tend to be starting from. The facilitators made comments along these lines during the Mellow Dads course. Given that the fathers' problems were deep-rooted and almost always ongoing, they thought that possibly the best that could be achieved was relatively subtle improvements in parenting.

One final comment to make about theory into practice is that the issue ofviolence was fairly marginal to the programme content. The session on violence in the home from the manual was used, with the main focus being on the distinction between assertiveness and aggression or passivity. This lesson was applied to discussion of meetings with social workers more than to intimate relationships at home. The session included discussion of fathers as victims of violence but not as perpetrators. This was surprising, since although domestic abuse is a complex phenomenon with several different possible scenarios (Johnson & Ferraro, 2000), women experience more serious and more frequent domestic assaults than men (Brookman & Robinson, 2012) and there is evidence of a connection between the abuse of women and child maltreatment (Edleson, 1999). The Mellow Dads material on violence is not intended to be different from that used with mothers. Given that many fathers are referred to the programme because of their domestic abuse (although not for the particular course observed for this study) and most domestic abuse is highly gendered, it seemed odd that materials were not more highly differentiated.

4. Concluding comments

Mellow Dads could be seen as an example of cultural adaptation, insofar as it is a mothers' group adapted for fathers. This raises the interesting question of whether the same gains can be achieved with fathers as with mothers, and whether there are, or should be, differences in supporting mothers and fathers from families at risk or subject to child protection procedures. A logic model for Mellow Dads is presented in Fig. 1. This is based on formal programme theory as outlined by the intervention author and in the Mellow Parenting manuals, but it has been modified in the light of our findings on fathers' reception of the programme and the apparent challenges of putting theory into practice. In particular, the aspiration of repairing attachment styles through the

morning's more personal group session has been toned down. In the logic model it is recognised that improved attachment is the aim. It is suggested, however, that this might perhaps be achieved in a slightly different way from how it is envisaged in formal programme theory. It is possible that a warm, respectful, nurturing atmosphere is created and maintained by the morning session, which then opens up fathers to learning the more practical lessons about parenting style. These include raised awareness about impact of the specific problems addressed by the morning topics on relationships with their children and parenting tips which are picked up, through video feedback in particular. The aspiration of repairing attachment styles is laudable and very understandable when programmes are under pressure to articulate theories of change. It may be that the Mellow Parenting group for mothers does manage to achieve this goal. This process evaluation has not included any study of mothers' groups so it is not possible to comment in this regard. However, a more mundane and practical aim may simply be more realistic for a fathers' group. Transformational change would probably require more than fourteen weeks and some intense inputs on specific problem behaviours such as domestic violence, not really covered as part of the Mellow Dads brief. If Mellow Dads is to be successful, this may be in relation to fairly modest improvements in both fathers' own well-being and their ability to relate to their children. If so, it will be important in the child protection process not to overstate the potential for change in troubled and vulnerable fathers. Equally, if men are genuinely to be supported to play an important and valuable role as fathers in the lives of their children, then all agencies need to subscribe to this aim and to recognise and support the particular needs of vulnerable fathers.

Most parenting help will be equally useful for either set of parents; however, men are non-traditional clients of family services, meaning it will be difficult to fill a group with consistently sufficient numbers of fathers to avoid a number of problems related to group process and content. Vulnerable fathers will have a range of distinctive problems, including some which can interfere with group attendance and engagement. Dominant models of masculinity make any kind of approach to parenting help which is rooted in talking therapy difficult to deliver (Courtenay, 2000; Dolan, 2013). Where studies have disaggregated effect sizes for fathers from those for mothers, the effects are smaller (Sanders et al., 2014). In this article we and raise some questions about how a programme with a clearly articulated theoretical basis can work on the ground and in practice. We suggest some of the ways in which working with fathers from families at risk or subject to child

Transport artel crèche Visits to non-atteriders

Mixed sex facilitation team

r ^ Nurture fathers by acknowledging difficult past experiences f Raise awareness of problem behaviours through discussion Model play activities with children f i Fccdbackon father-child videos encourages positive parenting style r Improvement in fathers' attachment to children

J L i L /

Homework tasks Build up fathers' relationships with each other

Fig. 1. Mellow Dads logic model (theory in practice).

protection procedures might be particularly challenging, not least given the limited opportunities such fathers might have to practise parenting. More qualitative process studies are needed, as well as robust outcomes research using experimental and quasi-experimental designs.

Acknowledgements

We are very grateful to the fathers and staff from who allowed Peter Yates to observe a Mellow Dads course. We are also grateful to all fathers and staff who agreed to be interviewed. The research is funded by Economic and Social Research Council as part of a research fellowship grant RES-070-27-0040 and additional research expenses were provided by Mellow Parenting.

References

Bakermans-Kranenburg, M. J., Van Ijzendoorn, M. H., &Juffer, F. (2003). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129,195-215. Barbee, A. P., Cunningham, M. R., Winstead, B. A., Derlega, V. J., Gulley, M. R., Yankeelov, P. A., & Druen, P. B. (1993). Effects of gender role expectations on the social support process. Journal of Social Issues, 49,175-190. Brookman, F., & Robinson, A. L. (2012). Violent crime. In M. Maguire, R. Morgan, & R. Reiner (Eds.), Oxford handbook of criminology (pp. 563-594) (5th Edition ). Oxford: Oxford University Press. Castro, F. G., Barrera, M., & Holleran Steiker, L. K. (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology, 6, 213-239. Courtenay, W. H. (2000). Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science & Medicine, 50(10), 1385-1401. Dolan, A. (2013). 'I've learnt what a dad should do': The interaction of masculine and fathering identities among men who attended a 'dads only' parenting programme. Sociology, 48(4), 812-828. Edleson, J. (1999). The overlap between child maltreatment and woman battering.

Violence Against Women, 5(2), 134-154. Ewart-Boyle, S., Manktelow, R., & McColgan, M. (2015). Social work and the shadow father: Lessons for engaging fathers in Northern Ireland. Child and Family Social Work, 20,470-479.

Featherstone, B. (2004). Family life and family support: A feminist analysis. Basingstoke: Palgrave.

Ghate, D., Shaw, C., & Hazel, N. (2000). Engaging fathers in preventive services: Fathers and

family centres. Joseph Rowntree Foundation. Goldsack, T., & Hall, K. (2010). Mellow parenting evaluation - August 2008 (final version completed September 2010). Wheatley Children's Centre: Doncaster Educational Psychology Service.

Hay, G., Gannon, M., MacDougall, J., Eastwood, C., Williams, K., & Millar, T. (2010). Opiate and crack cocaine use: A new understanding of prevalence. Drugs: Education, Prevention and Policy, 17(2), 135-147. Johnson, M. P., & Ferraro, K.J. (2000). Research on domestic violence in the 1990s: Making distinctions. Journal of Marriage and Family, 62, 948-963.

Lindsay, G., Strand, S., Cullen, M. A., Cullen, S., Band, S., Davis, H.....Evans, R. (2011).

Parenting early intervention program evaluation. London: Department for Education Research Report DFE-RR121(a).

Lundahl, B. W., Tollefson, D., Risser, H., & Lovejoy, M. C. (2008). A meta-analysis of father involvement in parent training. Research on Social Work Practice, 18, 97-106.

MacBeth, A., Law, J., McGowan, I., Norrie, J., Thompson, L., & Wilson, P. (2015). Mellow parenting: Systematic review and meta-analysis ofan intervention to promote sensitive parenting. Developmental Medicine and Child Neurology, 57(12), 1119-1128.

Maxwell, N., Scourfield, J., Featherstone, B., Holland, S., & Tolman, R. (2012). Engaging fathers in child welfare services: A narrative review of recent research evidence. Child and Family Social Work, 17(2), 160-169.

Mellow Parenting (2012). Going mellow: An introduction to mellow parenting programmes. Glasgow: Mellow Parenting.

Meyers, S. A. (1993). Adapting parent education programs to meet the needs of fathers: An ecological perspective. Family Relations, 42(4), 447-452.

Moore, G. F., Audrey, S., Barker, M., Bond, L., Bonell, C., Hardeman, W.,... Baird, J. (2015). Process evaluation of complex interventions: Medical Research Council guidance. British Medical Journal, 350, h1258.

Panter-Brick, C., Burgess, A., Eggerman, M., McAllister, F., Pruett, K., & Leckman, J. F. (2014). Practitioner review: Engaging fathers - Recommendations for a game change in parenting interventions based on a systematic review of the global evidence. Journal of Child Psychology and Psychiatry, 55(11), 1187-1212.

Puckering, C. (2004). Mellow parenting: An intensive intervention to change relationships. The Signal, Newsletter of the World Association for Infant Mental Health, 12(1), 1-5 (January-March 2004).

Puckering, C., Rogers, J., Mills, M., Cox, A. D., & Mattsson-Graff, M. (1994). Process and evaluation of a group intervention for mothers with parenting difficulties. Child Abuse Review, 3(4), 299-310.

Sanders, M. R., & Dadds, M. R (1993). Behavioural family intervention. Needham Heights, MA: Allyn and Bacon.

Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The triple P-positive parenting program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 34(4), 337-357.

Scourfield, J. (2003). Gender and child protection. Basingstoke: Palgrave.

Scourfield, J., Cheung, S. -Y., & Macdonald, G. (2014). Working with fathers to improve children's well-being: Results of a survey exploring service provision and intervention approach in the UK. Children and Youth Services Review, 43,40-50.

Tooten, A., Hoffenkamp, H. N., Hall, R A., Winkel, F. W., Eliens, M., Vingerhoets, A. J., & van Bakel, H. J. (2012). The effectiveness of video interaction guidance in parents of premature infants: A multicenter randomised controlled trial. BMC Pediatrics, 12, 76. http://dx.doi.org/10.1186/1471 -2431-12-76.

van Ijzendoorn, M. H. (1995). Adult attachment representations, parental responsiveness, and infant attachment: A meta-analysis on the predictive validity of the adult attachment interview. Psychological Bulletin, 117(3), 387-403.

Webster-Stratton, C., & Herbert, M. (1994). Troubled families-problem children: Working with parents: A collaborative process. Chichester, England: Wiley and Sons.

Wilson, P., Minnis, H., Puckering, C., & Bryce, G. (2007). Discussion paper: A model for parenting support services in Glasgow.

Zanoni, L., Warburton, W., Bussey, K., & McMaugh, A. (2014). Are all fathers in child protection families uncommitted, uninvolved and unable to change? Children and Youth Services Review, 41, 83-94.