Parents Under Pressure™


Improving parenting in families with drug or alcohol problems

Parents Under Pressure™ aims to support parents who are on a drug or alcohol treatment programme.

Getting parents the right help and support as early as possible is crucial in helping them to develop secure and healthy relationships with their children.

How it works

How Parents Under Pressure works

Parents Under Pressure is available to parents of children under the age of 8.

Practitioners visit parents or carers at home. The visits are designed to meet the individual needs of each family. The whole programme is intended to last for 20 weeks.

We help parents with the pressure and stress of looking after a young child and managing their drug or alcohol treatment.

This service provides advice to parents on how to deal with challenging behaviour and how to deal with their own emotions. This includes:

  • using praise and reward to encourage good behaviour
  • developing a good relationship with their child, recognising their feelings and needs (attachment theory)
  • dealing with their emotions, allowing them to keep calm and focus on being a parent
  • extending support networks, in order to sustain the positive outcomes achieved beyond the length of the service.

Using mindfulness to help parents

Mindfulness encourages people to focus on a feeling of relaxation and inner calm. It helps to boost happiness and confidence levels while also reducing anxiety, stress and irritability.

Working together to help children and families

We work alongside other agencies involved with the family, such as drug and alcohol teams, local children’s services, GPs and other local health services.

Evidence base

The evidence base

Not all parents who drink or take drugs harm their children. However substance misuse is often one of a number of difficulties faced by families, and these multiple adversities present a cumulative risk to children (Manning et al, 2009; Patwardhan et al, 2017; NSPCC, 2018).

> Find out more about the impact of parental substance misuse

Integrated models, such as the ecological model used by Parents Under Pressure, allow for a whole-system approach, which is suited to addressing complex and multiple problems (Davidson, Bunting and Webb, 2012).

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 (Dawe and Harnett, 2007; Barlow et al, 2013; Dalziel et al, 2015). We have adapted the programme to work with younger children, as research suggests they are particularly vulnerable to abuse (Cuthbert et al, 2011).

Who it is for

Who is Parents Under Pressure for?

This programme is aimed at parents, both mothers and fathers and/or their partners, as well as mothers who are in the last trimester of their pregnancy who may be experiencing difficulties with mental health and substance misuse. They do not need to be engaged with other support services to access the programme.

Eligibility requirements

To be referred to the programme, parents and/or their partners will need to meet the following criteria:

  • have a child of primary school age or younger or be in their last trimester of pregnancy
  • if subject to a child protection plan or child in need process, the case will need to have an allocated worker in children’s social care and have been assessed
  • the parent(s) will need to have their child living with them, or be having regular contact and a rehabilitation plan in place for the child to return to parental care, including shared care
  • parents will need to be able to understand spoken English

Unfortunately, we are unable to accept parents:

  • if there is active domestic abuse taking place in the home
  • if the child is not resident in the parent’s care and a rehabilitation plan is not in place
  • who suffer from severe mental illnesses and/or are expressing suicidal ideation
  • where there is ongoing, chaotic substance misuse.

Making a referral

To see if Parents Under Pressure is delivered in your area or to make a referral, email


Evaluation of Parents Under Pressure

Two evaluations of Parents Under Pressure (PUP) were carried out to find out more about the needs of the families involved and the impact PUP had on their lives. As part of the evaluation, the outcomes for parents and children who took part in PUP were compared with those who received the usual treatment for their drug and alcohol problems.

What we learnt

Findings from our evaluations include:

  • 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.
  • By the end of PUP, parents’ overall psychological wellbeing had improved. We found sustained improvements in parents’ levels of depression and overall emotional wellbeing six months after the programme ended.
  • We found that parents who took part in PUP were more able to regulate their emotions and identify problems.
  • Parents reported significant positive changes in their child’s social and emotional wellbeing between the start and the end of the programme.
  • Practitioners valued the PUP programme, which they felt was distinctive and offered a level of detail and flexibility not found in other parenting programmes.

> Read our evaluation reports

You can find a full list of evaluation reports for this service in our references and resources section.

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 only the parents of children aged two and a half and under.

The NSPCC also conducted a service evaluation of Parents Under Pressure, based on analysis of parents’ self-report measures collected by our practitioners. This evaluation included the parents of children up to 5 years of age.

Evaluation tools

The following measures were used in the evaluation:

  • Alcohol Use Disorders Identification (AUDIT-C)
  • Brief Child Abuse Potential Inventory (BCAPI)
  • Brief Infant and Toddler Socio-emotional Adjustment Scale (BITSEA)
  • CARE-Index – infant and toddler versions
  • Depression, Anxiety and Stress Scale (DASS-21)
  • Difficulties in Emotional Regulation Scale (DERS)
  • Interpersonal mindfulness in parenting scale – infant version (IMP-I)
  • Multidimensional Scale of Perceived Social Support (MSPSS)
  • Parental drug/alcohol use: The Timeline Follow-back (TLFB)
  • Parenting Stress Index Short-Form
  • Personality Assessment Inventory – Borderline (PAI-BOR)
  • Working Alliance Inventory – Short form (WAI-SR).

We also used the following measures, which were designed by the programme developers:

  • Daily Parenting Hassles Scale
  • Life Events Scale
  • Parenting Support Scale.
References and resources

References and resources

Evaluation reports

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.

Evidence base

Barlow, J. et al 2013. An evaluation of the Parents under Pressure programme: a study protocol for an RCT into its clinical and cost effectiveness. Trials, 14: 210.

Cuthbert, C., Rayns, G. and Stanley, K. (2011) All babies count: prevention and protection for vulnerable babies. London: NSPCC.

Dalziel, K. (2015) Cost-effectiveness analysis of the parents under pressure programme for methadone-maintained parents. Child Abuse Review, 24(5): 317-331.

Dawe, S. and Harnett, P.H. 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.

Manning, V. et al (2009) New estimates of the number of children living with substance misusing parents: results from UK national household surveys. BMC Public Health, 9: 377.

NSPCC (2018) Children living in families facing adversity: NSPCC helplines report. London: NSPCC.

Patwardhan, I. et al (2017) Child maltreatment as a function of cumulative family risk: findings from the intensive family preservation program. Child Abuse and Neglect, 70: 92-99.