Parents Under Pressure™ - Evidence, impact and evaluation At a glance

We've evaluated Parents Under Pressure™ to see what difference it makes to helping parents who are in drug and alcohol treatment improve their parenting skills and bond with their child.

How families' multiple and complex needs affect children

There is a growing emphasis on the need for more effective early intervention to help support families who have multiple and complex needs. Research (Devaney et al, 2013) suggests that the majority of serious child abuse cases involve families where parents are experiencing multiple challenges.

Experiencing social isolation, substance misuse, domestic abuse or mental health problems can make it harder for parents to deal with family life and put pressure on relationships. Those exposed to multiple adversities in childhood are at increased, cumulative risk of negative psychological, emotional and health-related outcomes in later life (Davidson et al, 2012).

Babies are particularly vulnerable to abuse and neglect. Of the serious case reviews carried out in England between 2011and 2014, 41% were about children aged under one (Sidebotham et al, 2016).

Read more about child abuse and neglect.

How Parents Under Pressure™ is helping prevent child abuse and neglect

Not all parents who drink or take drugs harm their children, but we know that substance misuse is a common factor in case reviews (Sidebotham et al, 2016).

By working closely with the parents over a number of months, Parents Under Pressure™ aims to:

  • help parents develop their parenting skills
  • develop safe, caring relationships between parents and their children.

Parents Under Pressure™ takes a strengths-based approach. It focuses on things parents are good at to help them:

  • increase their understanding of child development
  • be aware of and respond to their child's emotional needs
  • improve interactions with their child.

Parents Under Pressure™ was first developed in Australia for delivery to parents in drug treatment with a child aged 2 to 8 years old. In Australia it's been shown to help keep children safe and enable parents to build better relationships with their children. We deliver the service to the parents of children aged 0-8 years and have evaluated it to see if it works.

How we evaluated this service

We asked the University of Warwick to carry out a randomised controlled trial. This measured whether parents who took part in Parents Under Pressure™ experienced more positive changes than a group of parents who didn’t take part, but who still received treatment for their drug and alcohol problems. This evaluation included the parents of children aged 2 and a half and under.

We also conducted a service evaluation of Parents Under Pressure™, based on analysis of the practice measures that were used by our practitioners. This evaluation included the parents of children up to the age of 5 and was designed to complement the RCT.

Our evaluations aimed to find out how successful Parents Under Pressure™ is at preventing abuse and improving the relationship between a child and their main carer. We also wanted to determine the cost effectiveness of the programme and find out what the people taking part thought of it.

The evaluations were granted ethical approval from the Biomedical Research Ethics Committee at the University of Warwick and by the NSPCC’s Research Ethics Committee.

The following measures are being used in the evaluation:

  • Parent-toddler interaction: The infant and toddler versions of the CARE-Index.
  • Child abuse potential: the Brief Child Abuse Potential Inventory (BCAPI).
  • Parental psychological functionality: The Depression, Anxiety and Stress Scale (DASS-21).
  • Parenting stress: The Parenting Stress Index Short-Form.
  • Emotional Regulation: The Difficulties in Emotional Regulation Scale (DERS).
  • Severity of borderline personality: the Personality Assessment Inventory – Borderline (PAI-BOR).
  • Infant social and emotional adjustment: The Brief Infant and Toddler Socio-emotional Adjustment Scale (BITSEA).
  • Parental drug/alcohol use: The Timeline Follow-back (TLFB).
  • Process measures: The Working Alliance Inventory-Short form (WAI-SR).
  • Interpersonal mindfulness in parenting scale- infant version (IMP-I).
  • Alcohol Use Disorders Identification (AUDIT-C).
  • Multidimensional Scale of Perceived Social Support. (MSPSS).
  • We also used the ‘Parenting support Scale’, ‘Life Events Scale’ and ‘daily parenting hassles scale’ which were designed by the programme developers.

Find out more about the tools used to measure outcomes

Contact Richard Cotmore for more information.

What we're doing next

Our evaluations found that Parents Under Pressure™ had a positive impact on the wellbeing of the parents and children who took part. And by the end of the programme, the children whose parents had taken part were at less risk of abuse.

We’re now considering the best way of enabling more children and families to benefit from Parents Under Pressure™.

Impact and evidence

Find out how we evaluate and research the impact we’re making in protecting children, get tips and tools for researchers and access resources.

Our impact and evidence

Support our services

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  1. Davidson, G., Bunting, L. and Webb, M.A. (2012) Families experiencing multiple adversities: a review of the international literature (PDF). Belfast: Barnardo's Northern Ireland.

  2. Devaney, J., Bunting, L., Hayes, D. and Lazenbatt, A. (2013) Translating learning into action: an overview of learning arising from case management reviews in Northern Ireland 2003-2008. Belfast: Department of Health, Social Services and Public Safety (DHSSPS).