Parents Under Pressure (PuP)

Families with mental health challenges including trauma, substance misuse, family conflict, and severe financial stress

The PuP program is designed for families in which there are many difficult life circumstances that impact on family functioning. Such problems may include mental health challenges including trauma, substance misuse, family conflict, and severe financial stress. The program is individually tailored to suit each family. Parents are given their own Parent Workbook. For many parents, this becomes a personal journal documenting their strengths and achievements. The PuP program can be delivered in families’ homes, community settings, residential treatment facilities or a combination of any of these.

Paul Harnett

• Title: Co-developer
• Website: https://www.pupprogram.net.au/
• Email: p.harnett@griffith.edu.au

Sharon Dawe

• Title: Co-developer
• Website: https://www.pupprogram.net.au/
• Email: s.dawe@griffith.edu.au

Publicly available information indicates there is some training available for this program. See contact info.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Child Welfare Outcome: Child/Family Well-Being

• Dawe, S., & Harnett, P. H. (2007). Reducing child abuse potential in methadone maintained parents: Results from a randomized controlled trial. Journal of Substance Abuse Treatment, 32(4), 381–390. https://doi.org/10.1016/j.jsat.2006.10.003

  Type of Study: Randomized controlled trial

  Participants: 64 families

  Sample / Population:

  • Age — Mean=30.34 years
  • Race/Ethnicity — Not specified
  • Gender — 84% Female
  • Status —

    Participants were parents who were on methadone maintenance and had children aged between 2 and 8 years.
    

  Location/Institution: Two inner-city community methadone clinics in Brisbane, Australia

  Summary:

  The purpose of the study was to report on the results of a randomized controlled trial with families having a parent on methadone maintenance in which an intensive, home-based intervention, the Parents Under Pressure (PUP) program, was compared to standard care. Participants were randomly assigned to one of three treatment conditions: 1) PUP, 2) a brief intervention group that received a two-session intervention based on traditional parent training skills, or 3) a standard care group that received routine care provided by the methadone clinic staff. Measures utilized include the Parenting Stress Index (PSI) Short Form, the Child Abuse Potential Inventory (CAP), the Alcohol Use Disorders Identification Test (AUDIT), and the Strengths and Difficulties Questionnaire (SDQ). Results indicate that at 3- and 6-month follow-up, PUP families showed significant reductions in problems across multiple domains of family functioning, including a reduction in child abuse potential, rigid parenting attitudes, and child behavior problems. Families in the brief intervention group showed a modest reduction in child abuse potential, but no other changes in family function. There were no improvements found in the standard care group and some significant worsening was observed. Limitations include the period in which the families were followed up was only 6 months posttreatment, reliance on self-reported measures, and the active ingredient for those receiving the home-based PUP program may have been professional contact rather than the specific content of the intervention.
  

  Length of controlled postintervention follow-up: 6 months.

• Barlow, J., Sembi, S., Parsons, H., Sungwook, K., Petrou, S., Harnett, P., & Dawe, S. (2019). A randomized controlled trial and economic evaluation of the Parents under Pressure program for parents in substance abuse treatment. Drug and Alcohol Dependence, 194, 184–194. https://doi.org/10.1016/j.drugalcdep.2018.08.044

  Type of Study: Randomized controlled trial

  Participants: 100 families

  Sample / Population:

  • Age — Mean=30.8 years
  • Race/Ethnicity — 86 White British, 9 Other, and 5 Missing/Refused
  • Gender — 96 Female
  • Status —

    Participants were parents who were receiving treatment for a drug or alcohol problem (opioid replacement treatment, relapse prevention, counseling) and were a primary carer of a child under the age of 2.5 years.

  Location/Institution: United Kingdom

  Summary:

  The purpose of the study was to compare Parents under Pressure (PuP) with treatment as usual (TAU) in the United Kingdom. Participants were randomly assigned to receive PuP or TAU. Measures utilized include the Timeline Follow-Back Interview (TLFB), the Severity of Dependence Scale, the Risk Abuse Scale from the Brief Child Abuse Potential Inventory (BCAP), the Difficulties in Emotional Regulation Scale (DERS), and the Personality Assessment Inventory-Borderline Scale (PAI-BOR). Results indicate that child abuse potential was significantly improved in those receiving the PuP program while those in TAU showed a deterioration across time in both intent-to-treat and per-protocol analyses. There was also significant reliable change (recovery/improvement) in 30.6% of the PuP group compared with 10.3% of the TAU group, and deterioration in 3% compared with 18%. The probability that the program is cost-effective was approximately 51.8% if decision-makers are willing to pay £1000 for a unit improvement in the primary outcome, increasing to 98.0% at a £20,000 cost-effectiveness threshold for this measure. Limitations include the actual quality of the delivery of the intervention was not measured, there was a range of community-based addiction services supporting parents, and reliance on self-reported measures.

  Length of controlled postintervention follow-up: 6 months.

• Dawe, S., Harnett, P., Gullo, M. J., Eggins, E., & Barlow, J. (2021). Moderators and mediators of outcomes of parents with substance use problems: Further evaluation of the Parents under Pressure programme. Addiction, 116(11), 3206–3218. https://doi.org/10.1111/add.15579

  Type of Study: Randomized controlled trial

  Participants: 100 families

  Sample / Population:

  • Age — Mean = 30.8 years
  • Race/Ethnicity — 86 White British, 9 Other, and 5 Missing/Refused
  • Gender — 96 Female
  • Status —

    Participants were parents attending community-based addiction services with children aged 2.5 years or younger.
    

  Location/Institution: United Kingdom

  Summary:

  The study used the same sample as Barlow et al. 2019. The purpose of the study was to identify mediators and moderators of change in a pragmatic, multisite, randomized controlled trial of the Parents under Pressure (PuP) program, a family-focused intervention for parents with substance use and other problems, and treatment-as-usual (TAU). Participants were randomly assigned to receive PuP or TAU. Measures utilized include the Timeline Follow-Back Interview (TLFB), the Severity of Dependence Scale, the Risk Abuse Scale from the Brief Child Abuse Potential Inventory (BCAP), the Difficulties in Emotional Regulation Scale (DERS), and the Personality Assessment Inventory-Borderline Scale (PAI-BOR). Results indicate that increased child age at baseline was associated with greater reductions in child abuse potential for PuP program participants compared with TAU. Poorer parental emotional regulation was associated with greater reductions in child abuse potential for all participants. Parental substance use (either recent use or primary substance of concern) did not alter any treatment effects on child abuse potential. The mediation analysis showed that PuP produced greater improvements in emotional regulation at post-treatment compared with TAU, which predicted lower child abuse potential at 6-month follow up. Limitations include the range of potential mediators was limited in both number and reliance on self-reported measures.

  Length of controlled postintervention follow-up: 6 months.

There are currently no references available for Parents Under Pressure.