Home-based, case management model to improve family functioning.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
Parents Under Pressure (PuP) is a home-based program that combines psychological principles relating to parenting, child behaviour and parental emotion regulation within a case management model. PUP is highly individualised and is designed to help parents facing adversity develop positive and secure relationships with their children. The program targets problems including depression and anxiety, substance misuse, family conflict and severe financial stress.
Aims
- Improve family functioning
- Improve relationships between parents and their children
- Help parents and children learn to self-regulate behaviours.
Impact
Evidence suggests that PUP was effective in improving child’s mental health and behaviours and parenting skills. Results for improving parental mental health and behaviours was mixed. The program incurred a higher cost for participants who underwent PUP as compared to those who did not.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| Child | Mental health/behaviour | Yes | Not found | Not found |
| Parent/caregiver | Mental health/functioning | Yes | Yes | Not found |
| Parent/caregiver | Parenting | Yes | Not found | Not found |
| Parent/caregiver | Substance abuse | Yes | Yes | Not found |
| Cost | Cost effectiveness | Not found | Not found | Yes |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
PuP has an evidence rating of Well-supported.
This means that PuP has evidence from at least 2 randomised controlled trials (RCT) and/or quasi-experiments (QE) demonstrating positive, short-term impact on at least one child and family outcome.
This assessment is based on 2 research outputs from 2 RCTs. PuP has not received a Very well-supported rating as a rigorous systematic review with meta-analysis has not been conducted.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 2 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of evidence from the included studies.
One study was conducted in Australia, but we do not have sufficient information to know if Aboriginal children and families were included in the study.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The studies were conducted in Brisbane, Australia and the United Kingdom (UK).
Sample characteristics
- 64 parents (22 intervention 1, 23 intervention 2 and 19 control) participated in the Australian study and 100 families (52 intervention, 48 control) participated in the UK study.
- Participants in the Australian study were full-time primary carers of at least one child aged 2 to 8 and receiving Methadone.
- Participants in the UK study were primary carers of children under age 30 months and receiving treatment for a drug or alcohol problem.
- Participants in the UK study identified as White (86%) and other (14%).
Implementation
Delivery model, mode and setting
- PuP is delivered in-person, on a one-to-one basis to parents in their homes by PuP therapists.
Target cohort
- Families with many difficult life circumstances that impact on family functioning
- Families with children up to age 12.
Program delivery
- The program is highly individualised to suit each family. For many parents, this becomes a personal journal of their treatment experience.
- A Parent Workbook is given to families and forms the basis of the treatment program. It contains 12 modules:
- Starting the PuP journey: Assists parents to understand the diverse problems through a shared understanding of current concerns, strengths and areas of difficulty.
- Planning my PuP journey: Provides feedback on the assessment and arrive at shared goals to work towards, and develops a way of monitoring progress towards goals.
- View of self as parent: Helps parents reflect on their view of themselves as parents and their parental competency.
- Connecting with your child to help them feel loved and safe: Promotes a positive parent-child relationship through encouraging sensitive and responsive parenting.
- Understanding what may happen when their children are exposed to trauma or loss: Addresses trauma and loss.
- Health check your child: Opens up a discussion on health, hygiene and nutrition.
- How to manage emotions when under pressure: increasing mindful awareness: Teaches and encourages the use of emotional regulation and self-soothing skills.
- Supporting your child to develop self-regulation: Provides parents with strategies they can use to improve their child's self-regulation.
- Managing substance use problems: Ensures that parents are not drinking at risky levels or at risk of developing substance abuse problems.
- Connecting with family, community and culture
- Life skills: Teaches parents practical life skills where these do not exist.
- Relationships: Addresses issues around communication skills and other problems in adult relationships.
- 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 standardised measures, scoring and feedback/interpretation to guide use the use of PuP and goal setting and goal attainment forms and 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.
Manuals and guides
- A Therapist Manual provides the theoretical overview behind the PuP program and the Parents Workbook is given to the family and forms the basis of the treatment program.
Additional information
- The Parents Under Pressure website has more information on the program.
Staffing
- There are no formal qualifications i.e., psychology or social work, in order to become a PuP Therapist. A commitment to working with multi-problem families using a systemic approach of home visiting, intensive case management and therapy are essential. Further, the PuP program is intensive, thus it is strongly recommended that clinical staff only consider embarking on the training program with the support of their organisation to ensure that they have the necessary time to work with three families during the Accreditation process.
- To receive accreditation as a PuP Clinical Supervisor, a clinician must first be an Accredited PuP Therapist.
Training
- In order to use the PuP program in clinical settings, a clinician is required to have training and clinical supervision in the PuP model.
- The training model used by the PuP program involves intensive training in the underlying theoretical background of PuP combined with clinical supervision that adds up to 30 hours. The initial 2 days provides an integrative model of parenting drawn from attachment theory and behavioural family therapy combined with contemporary approaches to affect regulation based on mindfulness approaches. Learning is consolidated by the process of clinical supervision which focuses on how to put the PUP program into practice.
To our knowledge, PuP is available in all states and territories across Australia.
The Parents Under Pressure has the contact details of trained therapists by state and territory.
Cost
The training and clinical supervision costs are $3000 per therapist and $2000 per supervisor. Costs for training a practitioner will be reduced to $1500 if the agency has a trained supervisor.
References
Studies identified and included in the review
- Barlow J, Sembi S, Parsons H, Kim S, 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, 193:184-194.
- Dawe S & Harnett P (2007). Reducing potential for child abuse among methadone-maintained parents: results from a randomized controlled trial. Journal of Substance Abuse Treatment, 32(4):381-390.
Studies identified but not counted towards the evidence rating due to study quality
- van der Put CE, Assink M, Gubbels J & Boekhout van Solinge NF (2018). Identifying effective components of child maltreatment interventions: A meta-analysis. Clinical Child and Family Psychology Review, 21(2):171-202.