About the program

PuP is an individualised home-visiting, case-management program designed for families where there are multiple issues that impact on family functioning such as depression, anxiety, substance misuse, family violence, financial stress, and where there is a high risk of child maltreatment. Various techniques are used to enhance the carer/parent-child relationship and to promote parent and child self-regulation.  

Program structure

PuP is underpinned by the PuP Integrated Theoretical Framework that draws from developmental psychopathology and attachment theory. This provides a framework to develop individualised support plans tailored to each family. A Parent Workbook contains 12 modules that can be used to support the delivery of the family support plan. The program can be delivered in flexible formats and duration depending on the needs of the family.

PuP practitioners have access to an Online Tool Kit that provides: 

1. standardized measures, scoring and feedback/interpretation to guide use the use of PuP and 
2. goal setting and goal attainment forms 
3. resources and links to other relevant websites. 

It is possible to use these measures for service evaluation with a specific report based on 12 months of data available on request. 

Evaluation and effectiveness

Three pre-post case study series (Dawe et al., 2003; Frye & Dawe, 2008; Hartnett et al, 2007); Australian RCT of families engaged in methadone treatment (Dawe & Harnett, 2007), a feasibility study of the PuP program for families with a child with FASD (2017), high risk pregnant women (Harnett et al, 2018); UK RCT of families engaged in community-based addiction services (Barlow et al., 2019).  

Findings include:  

• reduction in child abuse potential
• significant improvements in parental functioning, parent-child relationships
• reduction in parental stress, rigid parenting attitudes and child behaviour problems
• reduction in parental substance abuse and risk behaviour.

In a cost effectiveness study (Dalziel et al., 2015), the cost per expected case of child maltreatment prevented was calculated and compared with the estimated lifetime costs of maltreatment. Based on the assumption that 20 out of 100 families would be diverted from the child protection system, a net present value saving of an estimated AU$3.1 million (£1.7 million) would be made. 

References

Dawe, S., Harnett, P., Rendalls, V., and Staiger, P. (2003). Improving family functioning and child outcome in methadone maintained families: the Parents under Pressure program. Drug and Alcohol Review, 22(3), 299-307.

Dawe S., & Harnett, P. (2007). Reducing potential for child abuse among methadone-maintained parents: results from a randomized controlled trial. Journal of Substance Abuse and Treatment, 32(4), 226-235.

Dalziel. K., Dawe, S., Harnett, H., & Segal, L. (2015). Cost-effectiveness analysis of the parents under pressure program for methadone-maintained parents. Child Abuse Review, (24)5 317–331. DOI: 10.1002/car.2371

Reid, N., Dawe, S., Harnett, P., Shelton, D., Hutton, L., & O, C. F. (2017). Feasibility study of a family-focused intervention to improve outcomes for children with FASD. Research in Developmental Disabilities, 67, 34–46. https://doi.org/10.1016/j.ridd.2017.06.004

Harnett, P. H., Barlow, J., Coe, C., Newbold, C., & Dawe, S. (2018). Assessing Capacity to Change in High‐Risk Pregnant Women: A Pilot Study. Child Abuse Review, 27(1), 72–84. https://doi.org/10.1002/car.2491

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: 10.1016/j.drugalcdep.2018.08.044

Whittaker, A., Elliott, L., Taylor, J., Dawe, S., Harnett, P., Stoddart,A., Littlewood, P., Robertson, R.,  Farquharson, B., Strachan, H. (2022) The Parents under Pressure parenting programme for families with fathers receiving treatment for opioid dependence: the PuP4Dads feasibility study. Public Health Research, 10(3) 1 - 154. https://doi.org/10.3310/YOWK7214