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Parents under pressure: a programme for families with parental substance misuse: an evaluation of impact, process and cost-effectiveness

Many babies in the UK are born to substance-dependent parents, and dependence on psychoactive drugs during the postnatal period is associated with high rates of child maltreatment. Around a quarter of children subject to a child protection plan have families with parental substance misuse. Parents who are dependent on psychoactive drugs are at risk of a wide range of parenting problems, and studies have found reduced sensitivity and responsiveness to both the infant’s physical and emotional needs. The poor outcomes that are associated with such drug-dependence appear to be linked to the multiple difficulties experienced by such parents.

An increase in the understanding of the importance of early relationships for infant wellbeing has led to a focus on the development and delivery of services that are aimed at supporting parenting and parent–infant interaction. The Parents under Pressure (PuP) programme is aimed at supporting parents who face multiple adversities, including dependence on psychoactive drugs or alcohol, by providing them with methods of managing their emotional regulation, and of supporting their new baby’s development. An evaluation of the PuP programme in Australia with methadone-maintained parents of children aged 3–8 years found significant reductions in child abuse potential, rigid parenting attitudes (for example, measured using the Child Abuse Potential Inventory), parental psychological problems, child behaviour problems and prescribed methadone dose.