Addressing Risk Behaviors, Service Needs, and Mental Health Issues in Programs for Young Fathers

ABSTRACT

Young fathers (N = 143) ages 16-33 participated in an assessment of risk behaviors, service needs, and mental health issues upon entering a fatherhood program. Almost 70% were unemployed, 39% were school dropouts, 47% used alcohol, 40% had problems with the law, and 42% had been in jail. The most frequently reported mental health issues were problems related to relationships, neighborhood, family, tobacco use, police, and being a parent. Fathers also identified feeling states of anger, sadness/depression, nervousness/tension, helplessness, and aggression. Although risk behaviors and mental health issues were identified, fathers did not request services to address them; rather, their most frequently requested service needs were related to jobs and vocational training. The article suggests that an assessment of mental health issues that focuses on a strengths perspective might yield a better evaluation of both mental health issues and service needs. The article addresses ways that program planners could enhance realistic participation.

Adolescent fatherhood is an issue of great national concern, as increasing numbers of young men become fathers at an early age. For example, the author of the Youth Risk Behavior Survey of 4,159 students in 59 randomly selected public high schools in Massachusetts found that of the 824 sexually active males, 12% had been involved in a pregnancy (Nock, 1998). Likewise, data from the Rochester Youth Development study showed that among public school students, 28% of males became fathers by age 19 (Thornberry, Smith, & Howard, 1997). In their longitudinal Pittsburgh youth study, Stouthamer-Loeber and Wei (1998) also found that among a group of 506 inner-city adolescent males in a public school, 12% participated in conception of at least one pregnancy.

Youth development and clinical studies have suggested that adolescent fatherhood is associated with multiple risk factors. For example, the authors of the longitudinal Pittsburgh Youth Study that examined risk behaviors among 506 inner-city adolescent males found that young fathers were twice as likely as nonfathers to be classified as serious delinquents (Stouthamer-Loeber & Wei, 1998). Being delinquent and a young father were both related to early sexual experience, drug exposure, cruelty, and antisocial behavior. Young men who were involved in a pregnancy had other problem behaviors such as substance use, violence, multiple sex partners, and fighting. The data from the National Longitudinal Survey of Youth (Nock, 1998) and data from the National Longitudinal Survey of Labor Market Experience-Youth Cohort (Pirog-Good, 1996) showed that teen fathers were more likely than nonfathers to live with single parents in impoverished backgrounds, to become involved in drugs and crime at earlier ages, and to experience school failure and low wages. A recent longitudinal investigation of the antecedents and pathways to teen parenthood among 227 males from the Carolina Longitudinal Study suggested that five characteristics predicted teen fatherhood among young men: aggression, popularity with aggressive peers, low academic competency, age-grade discrepancy, and low socioeconomic status (Xie, Cairns, & Cairns, 2001). Finally, a study among a group of 399 male adolescents at an outpatient clinic showed that young men who reported a pregnancy history were 14 times more likely to report multiple sex partners in the previous year, 5 times more likely to report an STD history, 3 times more likely to test positive for drugs, and 2.5 times more likely to be inconsistent users or nonusers of condoms compared with young men without a history of pregnancy (Guagliardo, Huang, & D'Angelo, 1999).

These multiple behavioral problems compromise the long-term commitments of young fathers to parenthood and to the relationship with the child's mother (Cox, & Bithoney, 1995). Florsheim, Moore, Zollinger, MacDonald, and Sumida (1999) found that expectant adolescent fathers with behavioral problems carried those problems into fatherhood. The authors examined 35 expectant adolescent couples in Salt Lake City and 35 expectant adolescent couples in Chicago. All participants were between the ages of 14 and 19 and were expecting their first child. In general, the young men's hostility, parental stress, and antisocial behaviors, particularly in relationships with the mother, worsened after the birth of the child. Cochran's (1997) review of the literature suggested that the joint effects of poverty, crime, and low educational attainment, coupled with risk behaviors, explain why teen fathers do not provide financial support for their children.

Contemporary research studies have pointed to the importance of fatherhood involvement in protecting children from the adverse effects of poverty and school problems, as well as lifelong problems of substance abuse, repeated cycles of pregnancy, and crime (Argys, Peters, Brooks-Gunn, & Smith, 1998; Lerman & Sorensen, 2000; Rhein et al., 1997). However, young fathers have not received the types of services similar to those of unwed mothers (Rangarajan & Gleason, 1998). More recently, various types of programs have been developed to address the special needs of fathers. Most projects have attempted to promote positive outcomes by providing jobs or job training, sex education, counseling and peer support, incentives for establishing child support, and encouragement for fathers to take an interest in their children. The importance of employment has been emphasized in most programs because of the relationship between earnings, involvement with children, establishment of paternity, and the likelihood of marriage. However, few programs provide comprehensive services or evaluate whether the services are desired or used (Lane & Clay, 2000). In reviewing the results of programs for young fathers, Kost (1997) found that fathers expressed the need for emotional support, which usually exceeded what the program could offer. Staff members noted that feelings of depression and hopelessness were evident among young fathers.

Securing positive outcomes in fatherhood programs is challenging and complex. Many need employment as a first step in building their confidence. However, low school performance, legal issues, and substance use are major barriers. Additionally, there appears to be some support for the idea that adolescent fathers have emotional needs that have not been emphasized in programs. Our experience in evaluating fatherhood programs led us to suspect that mental health issues might be an important barrier to employment success (Weinman, Smith, & Buzi, 2002). Therefore, in our current study, we intended to examine self-reported risk behaviors and mental health issues among participants in a program for young fathers and whether their requests for services reflected these issues.

Method

Participants

The population selected for this study comprised minority males between the ages of 16 and 33 (N = 143) who enrolled in Fatherhood Initiative in the southwest part of the United States between September 2002 and February 2003(Table 1). The main goals of Fatherhood Initiative are to develop skills and behaviors that reinforce messages of pregnancy prevention, strengthen vulnerable families, promote a healthy lifestyle, prevent school dropout, and encourage self-sufficiency. A variety of services such as employment opportunities, fatherhood development, health awareness and enhancement, information on reproductive health and HIV, and information on agencies are provided to male participants. This program is under the aegis of the Teen Health Clinic that provides free, comprehensive family planning and reproductive health services to indigent adolescents who reside in the inner city.

Instruments

The program assessed participants' current behaviors and their service needs at entry to the program. The assessment was done by using a questionnaire that recorded demographic information, language preference, fatherhood status, and marital status. Risk behaviors such as sexual activity, condom use, a history of STDs, smoking, drinking, substance use, and problems with the law were also documented in this questionnaire.

Participants were also given a list of 23 services and were asked to indicate their service needs. Participants also completed a modified mental health form querying about mental health problems and feeling states. The questionnaire was originally developed for use by a local nonprofit mental health service agency and a school-based clinic to assess the mental health problems of pregnant and parenting teens in a school setting (Weinman, Smith, Solomon, Green, & Buzi, 2001). The questionnaire for this particular study was modified to include additional problems and feeling states that have been frequently encountered in the clinic, and the questions were based on input obtained from clinicians, clients, and administrators in a focus group. Young fathers were given a list of these problems and feeling states and were asked to rate their intensity. All items were rated on a 4-point scale (1 = Does not bother me at all, 2 = Bothers me somewhat, 3 = Bothers me a lot, 4 = Bothers me all the time). Participants completed the Problem checklist (15 items). This covered a range of issues including problems with parenting, peer friendships, relationships, family, and sexual activity. Also included were problems with school, law, substance abuse, and eating disorders. Participants also completed the Feeling State checklist (8 items). Participants were queried about their feelings, which included anger, nervousness, depression, fear, loneliness, suicide, self-esteem, and aggression. The problems and feelings were not overly defined in order to have general usability for exploratory purposes. The instrument was tailored to a seventh-grade reading level. Bilingual staff members assisted adolescents who were not proficient in English.

Procedure

Participants were referred to the program by clinic staff from the six clinic sites, schools, and other community agencies. Two case managers facilitated recruitment to the program. The purpose of the program was explained to participants, and informed consent was obtained before participants completed the study instruments. The study questionnaire was completed at entry to the program. Parental consent for clinical services was solicited but not required because minors who receive services are not required to have parental consent by state statutes. Both case managers distributed the questionnaire among participants and were available to clarify any questions. The Institutional Review Board of the affiliated medical school approved the program instruments. Following the assessment, all the young men who enrolled in the program were assigned a case manager who was responsible for coordinating the services needed, providing referrals, and monitoring progress.

Results

Sociodemographic Profile

The mean age of the fathers was 21.64 (SD = 3.13, range = 16-27). The majority (72.7%, n = 104) were African American. Slightly over one third (35.8%) reported they were living in the same neighborhood they grew up in, 55 (39%) were school dropouts, 92 (68.1%) never married, and the majority (62.7%, n = 84) had one child. Less than half (41.5%) had established paternity, and 25 (19.7%) reported they had a court order to pay child support. Only 41 (30.1%) were employed.

Problems, Feelings and Behaviors

Table 2 presents problems and feelings identified by participants. From a list of 15 problem areas, 6 problems were identified by at least 25% of the young fathers. These problems in descending order were related to relationships, neighborhood, family, tobacco use, police, and problems with being a parent. From a list of 8 feelings states, 5 were identified by at least 25% of the young fathers. They were in descending order feelings of anger, sadness/depression, nervousness/tension, helplessness, and aggressiveness.

Table 3 presents the risk behaviors that were identified by participants. Among the 11 risk behaviors examined, 7 were identified by at least 25% of the young fathers. In descending order they were sexual activity, smoking cigarettes, alcohol use, being in jail, problems with the law, condom use, and drug use. Of the 23 listed service needs, those with the highest frequency were job related. This included job referrals, vocational education, job readiness, and parenting education. The most frequent services requested were related to job referrals, vocational education, job readiness, parenting education, GED, paternity establishment, medical care, and child support(Table 4).

Discussion

The purpose of our study was to examine self-reported risk behaviors and mental health issues among participants in a program for young fathers and whether their service requests reflected these issues. Although participants identified risk behaviors and mental health issues, their most frequent requests for services were employment related, a result that is similar to those of other studies (Barnett; 1997; Lane & Clay, 2000; Mazza, 2002). This incompatibility may be related to issues of adolescence. Some researchers have suggested that insufficient attention has been placed on the adolescent man, separate from parenting, and that interventions have focused too much on issues of fatherhood rather than issues of adolescence (Allen & Doherty, 1996). Furthermore, designers of young father programs often assume that if services are offered they will be used. Studies have shown that even when practical needs such as job training, job placement, and information about legal rights were offered, enrollment was low (Barnett, 1997; Mazza, 2002). Additionally, low-income adolescents may not perceive early fatherhood as troublesome or particularly disruptive to their lives. Barnett (1997) noted some other difficulties in the engagement of fathers. The role of the teenage mother may affect the ability of the father to get involved. Many young mothers may construe the role of the father solely in term of being a breadwinner, and because this does not usually occur among adolescent fathers, they may deny him access to their children. Therefore, motivation to contribute to emotional support for their children and the mother or assisting in childcare may not be encouraged. These factors may also explain why employment services are the most requested among young fathers. Our study suggested that young men take pride in their independence and ability to handle their lives despite the setbacks they experience, or they assume relationship problems can be fixed by employment. In addition, adolescent parenthood may be one more challenge they encounter.

Given these types of issues, it appears that programs for young fathers should address three factors. First, they can assume that mental health issues are present and therefore examine how they contribute to the overall ability of a young father to effectively participate in a fatherhood program. Some young fathers may need to receive counseling for more serious problems before they can accomplish other tasks. Second, programs have to provide access to the types of services that are requested. Although there are multiple barriers to employment and job training among adolescent men with a criminal background, reaching them through innovative approaches such as employment incentives may also facilitate their access to their children. Finally, to get a proper assessment of problems, risk behaviors, and needs, one may have to use multiple approaches. Because it appears that young fathers perceive mental health issues as a weakness, focusing on a strengths paradigm might be more feasible. For example, program managers could assess behaviors with questions such as, "In the last 3 months, what situations made you unlikely to drink or use drugs?" or "What assets do you have that enable you to stay out of trouble?" Questions pertaining to service needs may be presented as, "What are the conditions that would help you return to school?" or "What steps would you be willing to take to help you get a job?"

Our study supports the notion that programs that focus on encouraging young fathers to become involved in their children's lives must start with a proper assessment of the risk factors that preceded fatherhood. Focusing on failures in the initial assessment may discourage young men from self-disclosure. Programs that emphasize strengths may be more time consuming, but they may empower the fathers to believe in their ability to make progress. Additionally, young fathers may have unrealistic expectations about employment and job readiness. As depression and other mental health issues might affect employment success, it seems reasonable that job readiness classes might also offer a level of mental health counseling and support. Programs for young fathers cannot erase their previous problems such as school dropout, substance use, and legal problems. However, teaching prosocial skills such as learning to cope with frustration, learning to interview, and learning to accept entry-level jobs should all be considered employment services. Although case management services are essential, they cannot replace supportive counseling that reflects a personal interest in a young father. The challenge for program administrators is to develop effective services and to find ways to conduct assessments that provide a realistic view of the young men's assets and problems without destroying their motivation to enroll and continue in the program.

Implications for Programs

Adolescent fathers are hindered in becoming involved parents by risk behaviors that preceded fatherhood and continue into parenthood. By the time the adolescent father has a child, he has already experienced deviant behaviors, gang membership, and early sexual activity. Black adolescent fathers are a particularly hard-to-reach population because few seek out social service agencies. When they do come to social service agencies, they request job training and placement (Smith, 1988). Program planners struggle with meeting this need as young fathers with little education and a background of risk behaviors are difficult to place for employment. Service providers tend to believe that other services such as mental health counseling, health services, and parenting classes are more important for social stability. Recognizing this lack of congruence, Mazza (2002) suggested that casework intervention might help young men recognize their strengths and talents so that they can face the world of work with more confidence and can eventually become successful. Moreover, Smith's (1988) review showed that service providers assumed Black adolescent fathers are antagonistic to the values and interests of society and particularly those related to the family. However, data from focus groups have suggested that young fathers care about their children (Rhein et al., 1997). Therefore, programs that focus on promoting responsible fatherhood should capitalize on the fathers' motivation to be involved in the lives of their children.

Interventions for teen fathers must be comprehensive and take into account the early risk factors and accumulated risk factors that affect fatherhood. Thus, early prevention in elementary and middle schools should focus on improving basic skills and life options for urban youth. Thornberry et al. (1997) suggested that programs should emphasize achievement of school goals and avoidance of negative peer environments. Multiservice youth centers should focus on increasing positive life options by designing mentoring and outreach programs. These programs should also include sex education components that emphasize the consequences of early sexual activity. Furthermore, programs must actively reach out to young fathers in places like ball courts, community centers, and barbershops.

One promising approach that has been effective in enhancing behavior change in the area of public health is social marketing. Social marketing strategies put the responsibility to initiate and maintain normative social behaviors on the community. The techniques target specific populations and invest them in the change process. Social marketing techniques appear to be helpful in reducing the spread of HIV/AIDS worldwide and have shown success when specifically targeted to populations in the United States (Cohen et al., 1999; Key, 1999; Panford, Nyaney, Amoah, & Aidoo, 2001).

By utilizing social marketing approaches, program planners might be able to motivate teen fathers to become active participants in fatherhood programs. This would include involving the natural community where teen fathers live in recruitment and retention of program participants. The community could also participate in designing public service advertisements focusing on responsible fatherhood, as well as on identifying innovative recruitment strategies such as T-shirt campaigns. Other activities that fit into local community resources can be explored as well.

Finally, there is also a need for theoretically driven qualitative and quantitative research that can help social work professionals understand the sociopolitical, psychological, and emotional factors that precede fatherhood and subsequent behaviors that impede parental responsibilities. Promoting responsible fatherhood cannot be accomplished without political advocacy that focuses on enhancing young fathers' human capital as a national priority.

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Maxine L. Weinman, LMSW-ACP, Dr. PH, is professor and doctoral program director, University of Houston Graduate School of Social Work. Dr. Weinman has worked in adolescent healthcare for over 25 years as a researcher and clinician. Ruth S. Buzi, LMSW-ACP, PhD, is assistant professor, Teen Health Clinic, Baylor College of Medicine. Dr. Buzi has worked at the Teen Health Clinic for 11 years as a researcher and clinician. Peggy B. Smith, PhD, is professor and director, Teen Health Clinic, Baylor College of Medicine. Dr. Smith has worked in the field of adolescent health care for over 30 years. Correspondence regarding this article may be addressed to the first author at mwepstein@uh.edu or University of Houston, 237 Social Work Building, Houston, TX 77204-4013.

Authors' note. This paper was supported in part by funding from The Hogg Foundation for Mental Health and the John P. McGovern Foundation.

Manuscript received: September 23, 2003

Revised: May 20, 2004

Accepted: May, 21, 2004

Copyright Families in Society Apr-Jun 2005
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