Parents Under Pressure™ Evidence, impact and evaluation

We're evaluating 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 baby.

How abuse in infancy affects children

Babies under one are particularly vulnerable to abuse and neglect. One third of serious case reviews in England relate to babies under the age of 1 year (Brandon et al, 2012). In England and Wales, babies are seven times more likely to be killed than older children (ONS, 2015).

Abuse has life-long impacts, and early adversity can cast a long shadow. Recent neurological and psychological research highlights more clearly than ever before how critical pregnancy and the first years are to a baby's development. They provide the essential foundations for all future learning, behaviour and health.

Read more about the importance of early intervention

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

Not all parents who drink or take drugs harm their children, but studies suggest that parental substance abuse is a feature for at least a quarter of children on a child protection register (ACMD, 2003; Forrester and Harwin, 2006). It is estimated that 1 in 7 babies under one live with a substance misusing parent (Manning, 2011).

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.

How we're evaluating this service

The University of Warwick is evaluating the Parents Under Pressure programme using a randomised controlled trial to measure service impact on families with a child under the age of two and a half where the primary carer is in treatment for either drug or alcohol abuse.

The aim of the evaluation is to determine the effectiveness and cost effectiveness of Parents Under Pressure™ and its acceptability to service users.

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

Details of challenges faced and relevant solutions will follow the completion of recruitment to the randomised controlled trial.

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)

Progress of the evaluation

The recruitment to the randomised controlled trial is due to finish in October 2015, with final reporting due by the end of 2016.

In addition to the outcome measures, interviews have been undertaken with parents and practitioners to explore their experiences of delivering and receiving the programme.

Find out more about the tools used to measure outcomes

Contact Richard Cotmore for more information.

What we're doing next

We’re working with Warwick University to evaluate Parents Under Pressure™.

We want to measure how successful it is at:

  • preventing abuse
  • improving the attachment, or relationship, between a child and their main carer.

Our aim is to reduce the number of babies and toddlers harmed by parents with severe drug and alcohol problems. The independent evaluation report is due to be completed in 2016.

Impact and evidence hub

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

Your donation can take a child anywhere

Our services help children and families who need support. With your help, we can make sure even more children are free from abuse and free to dream. 

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  1. Brandon,M. et al (2012) New learning from serious case reviews: a two year report for 2009-2011  London: Department for Education.

  2. Forrester, D., and Harwin, J. (2006) Parental substance misuse and child care social work: findings from the first stage of a study of 100 families. Child and Family Social Work 11(4): 325-335. [Freely view abstract or access full text by subscription: Child and Family Social Work 11(4): 325-335].

  3. Manning, V. (2011) Estimates of the number of infants (under the age of one year) living with substance misusing parents. London: NSPCC.

  4. Office for National Statistics (2015) Focus on violent crime and sexual offences, 2013/14. Newport: ONS