Evaluation of Parents Under Pressure™ What works to help parents with drug or alcohol problems improve their parenting skills

Father with babyNot all children whose parents misuse alcohol or drugs are at risk of harm, but parents who drink or use substances can find it particularly challenging to take care of their children.

We delivered Parents Under Pressure™ (PUP) to support mums and dads who are on a drug or alcohol treatment programme. It aims to teach them parenting skills and improve their relationship with their children.

We carried out 2 evaluations so we could find out more about the needs of the families who took part in PUP and the impact PUP had on their lives.

Our findings suggest that parents facing challenges including substance misuse can make positive changes with the right support.

Vicki Hollis, Richard Cotmore, Helen Fisher, Paul Harnett and Sharon Dawe.
An evaluation of ‘Parents Under Pressure’: a parenting programme for mothers and fathers who misuse substances.

Jane Barlow, Sukhdev Sembi, Stavros Petrou, Helen Parsons, Sharon Dawe and Paul Harnett.
Parents Under Pressure: a programme for families with parental substance misuse. An evaluation of impact, process and cost effectiveness (RCT).

Published: 2018

We commissioned the University of Warwick to carry out a multicentre randomised controlled trial (RCT) of PUP across 7 of the 11 sites that were delivering the service. This helped us find out if parents who took part in PUP experienced more positive changes than a group of parents who didn’t take part in PUP, but received the usual treatment for their drug and alcohol problems (depending on what was available in their local area). We explored the changes they experienced until 6 months after the programme finished, asked parents what they thought of the programme and looked at its cost-effectiveness.

We also conducted our own service evaluation of PUP, based on analysis of the practice measures that were used by our practitioners during the programme. This included a larger sample of parents across all 11 sites and was designed to complement the RCT by focussing on how change occurs during the programme and what factors affect that change.

The RCT included the parents of children up to 2 and a half years whilst the service evaluation included the parents of children up to 5 years of age.

The parents enrolled in PUP often experienced other difficulties alongside substance misuse. This included:

  • domestic abuse; 
  • financial problems; 
  • relationship issues; and 
  • mental health problems.

By the end of PUP, children whose parents had taken part were at less risk of abuse.

  • PUP significantly reduced the risk of child abuse for almost one third of the parents who took part in the programme. Those who received treatment as usual showed an increased risk of child abuse over time.
  • The service evaluation showed that the number of children on a child protection plan reduced and the number of children who were not involved with children’s services almost doubled.
  • However there was also an increase in the number of children who were no longer living with their parents by the end of PUP. This may be because PUP helps professionals gain a more informed assessment of the family’s needs, helping to better protect the child.

PUP helped parents to manage their emotions.

  • By the end of PUP, parents’ overall psychological wellbeing had improved. The RCT found sustained improvements in parents’ levels of depression and overall emotional wellbeing 6 months after the programme ended.
  • Parents with clinically significant levels of depression, anxiety and/or stress saw the greatest improvements in their emotional wellbeing.
  • Parents who took part in PUP said they felt more able to use mindfulness strategies as part of their parenting practice.

Parents made significant improvements in other areas too.

  • The RCT found that parents who took part in PUP were more able to regulate their emotions and identify problems.
  • Parents made the most significant improvements in the first half of the programme, and the RCT showed that changes were sustained 6 months after PUP finished.
  • The interviews carried out with parents for the RCT highlighted that the relationship between parent and practitioner was critical to parents’ capacity to change.

It was harder to identify what changed for the children whose parents took part in PUP because of the small numbers involved and the short duration of the follow-up.

  • However parents in the service evaluation reported significant positive changes in their child’s social and emotional wellbeing between the start and the end of the programme.

The parents who were most likely to complete the programme were:

  • those who had less family support; and
  • those who had already had children removed from their care.

These parents may have been more motivated to engage with the programme as they may have felt they had more to gain from it.

The interviews with practitioners for the RCT found:

  • Practitioners valued the PUP programme, which they felt was distinctive and offered a level of detail and flexibility not found in other parenting programmes.
  • Practitioners highlighted the importance of ongoing training and clinical supervision.
Acknowledgements 5
Executive summary 6
An evaluation of Parents Under Pressure 13
Background 13
Parents Under Pressure 15
NSPCC evaluation of PuP 19
Methods 21
Findings 26
Discussions 50
Conclusion 63
References 65
Acknowledgements 5
Executive summary 6
Introduction 10
Methods 13
Outcome measures 18
Results 22
Economic evaluation 29
Qualitative results 32
Practitioner experiences 38
Discussion 63
Conclusions 69
References 70
Appendix 75

“I think I trusted my PUP worker more than anything.”

“Before I even started the course I’d like shout a lot. Now I don’t shout at all really. It’s the mindful thinking part of it. It’s useful. I don’t get so anxious all the time.”

Please cite as: Hollis, V. et al (2018) An evaluation of Parents Under Pressure™; a parenting programme for mothers and fathers who misuse drugs and alcohol. London: NSPCC.

Barlow, J. et al (2018) Parents Under Pressure™: report of an RCT. London: NSPCC.

Got a question?

Our Knowledge and Information Service answer over a thousand enquiries every year helping professionals find the information and resources they need to keep children safe.

Send us your enquiry

Related resources

Parents who misuse substances: learning from case reviews

Lessons from case reviews published since 2010, where substance misuse is a key factor.
Find out more

Family Environment: Drug Using Parents (FEDUP): final evaluation

Evaluation of a programme aiming to reduce the impact of parental drug and alcohol misuse on children. Part of the NSPCC's Impact and evidence series.
Find out more

Parents Under Pressure™

Improving parenting in families with drug or alcohol issues.
Parents Under Pressure™ service

Parents Under Pressure™ - Evidence, impact and evaluation

How the impact of the NSPCC Parents Under Pressure service is evaluated.
Parents Under Pressure - Evidence, impact and evaluation

Family Environment: Drug Using Parents (FEDUP)

Protecting children living with adult drug and alcohol misuse.
FEDUP - Family Environment: Drug Using Parents service

Deliver NSPCC services in your area

Find out how our Scale-up unit supports organisations to deliver our evidence-based services.
Learn more

Positive parenting

Tips to help cope with all the demands of parenting. Advice on setting boundaries for your child, building relationships and keeping your cool. 
Find out more

Parental substance misuse

Supporting children living with parents who misuse alcohol and drugs.
Read more about parental substance misuse

Sign up to CASPAR

Subscribe to CASPAR, our current awareness service for child protection practice, policy and research.
Sign up to CASPAR

Information Service

Our Information Service provides quick and easy access to the latest child protection research, policy and practice. 
Find out more about our Information Service

Follow @NSPCCpro

Follow us on Twitter and keep up-to-date with all the latest news in child protection.

Follow @NSPCCpro on Twitter

Library catalogue

We hold the UK's largest collection of child protection resources and the only UK database specialising in published material on child protection, child abuse and child neglect.

Search the library

Sign up to New in the Library

Subscribe to receive weekly alerts on new additions to the library collection.
Sign up

Helping you keep children safe

Read our guide for professionals on what we do and the ways we can work with you to protect children and prevent abuse and neglect.

Read our guide (PDF)

Impact and evidence insights

Each week we’ll be posting insights from professionals about evaluation methods, issues and experiences in child abuse services and prevention. 
Read our blogs

Training and consultancy

Grow your child protection knowledge and skills with CPD certified courses delivered by our experts nationwide and online.
Get expert training