Social value case study: Improving fathers' involvement and emotional wellbeing in public health nursing

Invisible Dads was a practitioner-led quality improvement project in public health nursing focused on improving how fathers are involved before and after the birth of their baby. In response to evidence that universal services do not consistently involve fathers, the project aimed to increase fathers’ inclusion in care, support fathers’ emotional wellbeing, and strengthen outcomes for the whole family by engaging both parents in health visiting contacts and support. 

The challenge

The project responded to evidence highlighted in The Myth of Invisible Men (The Child Safeguarding Practice Review Panel, 2021), which found that universal services such as midwifery and health visiting do not regularly, significantly and substantially involve fathers before and after birth. Before the pilot began, practitioners met with several fathers who described feeling ignored at appointments and excluded from care and decision-making. Some said they had been traumatised by the birth of their baby but had no opportunity to talk about their experience. Fathers reported that this affected their mental health and their relationships with their partner and baby. They said they wanted to be asked how they were coping, to know how they could connect with other dads, and to feel listened to.

Project description

The team introduced a pilot to improve fathers’ involvement and assess their emotional wellbeing during routine health visiting contacts. This included inviting fathers to antenatal groups, the baby’s new birth visit and the maternal wellbeing visit at 6–8 weeks. A ‘Plan, Do, Study, Act’ approach was used to test change, including the introduction of fathers’ emotional health screening. The project was informed directly by fathers’ experiences before the pilot began, which helped shape a more inclusive approach. Practitioners created opportunities to offer emotional wellbeing screening using the PHQ9/GAD7 tool, listen to their concerns and signpost them to appropriate local father support and mental health support when needed. A directory of support for fathers identified with emotional wellbeing needs was also produced.

Outcomes

The project showed strong early impact. More than 90% of fathers seen at a Health Visitor contact completed the emotional wellbeing screening, and just over 6% were identified with perinatal depression and anxiety and signposted to their GP for follow-up. Staff reported that once the change was introduced, it quickly became clear how effective it was to invite fathers to key contacts and groups. They found that supporting fathers’ emotional health also supported mothers’ emotional health, and that providing information to both parents at the same time benefited each parent and their baby. Fathers’ feedback was also positive, with many saying they were glad to be asked about their emotional health, that it was encouraging to see fathers considered, and that they felt part of the whole process rather than watching from the sidelines. One practitioner shared the story of a father working two jobs to support his family, whose exhaustion, frustration and low mood had never previously been explored. After being asked how he was feeling and signposted to support, he engaged fully with subsequent Health Visitor visits and reported positive outcomes for himself, his children and his partner.

Lessons learned

A key lesson from the pilot was that fathers respond positively when they are actively included and asked about their emotional wellbeing. Listening to fathers early helped shape a more responsive and relevant approach. Staff also learned that involving fathers is not separate from supporting mothers and babies; it strengthens outcomes across the family. The pilot reinforced the value of building fathers into routine contacts rather than treating their involvement as optional or additional. It also highlighted the importance of having clear signposting routes in place for fathers who need further support.

Emotional wellbeing screening is now embedded into routine practice, with fathers routinely invited to key health visiting contacts.

Next steps

Universal screening of father’s emotional wellbeing is now embedded in practice across Hertfordshire. Our plan is to build on the positive outcomes which are already being achieved. This includes:

• Up to 45% of fathers seen at the new birth visit are screened in some areas – we continue to aim to increase number of fathers screened. 
• A directory of available support given to all fathers
• Routinely signpost to Families First support — we aim to enhance and expand the advice, guidance and support so that it includes as well as dads, step-dads, male carers and men that act as a role model in a child or young person’s life.
  

Contact information

Cecilia Ward, Community Service Lead 0-19 Public Health Nursing