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A randomized controlled trial and economic evaluation of the Parents Under Pressure program for parents in substance
Jane Barlow1, Sukhdev Sembi2, Helen Parsons3
1Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Insights
Parenting support for substance misusing parents significantly improved child abuse potential using the Parents under Pressure (PuP) program. This intensive intervention demonstrated better outcomes than Treatment as Usual (TAU).
Area of Science:
- Addiction research
- Child development
- Public health
Background:
- Growing interest in providing parenting support for parents with substance misuse issues.
- Substance-dependent parents of young children are a vulnerable population requiring targeted interventions.
Purpose of the Study:
- To compare the effectiveness of an intensive one-to-one parenting program (Parents under Pressure, PuP) against Treatment as Usual (TAU) for substance-misusing parents.
- To evaluate the impact of the PuP program on child abuse potential and parental emotional regulation.
- To conduct a prospective economic evaluation of the PuP program.
Main Methods:
- Pragmatic, multi-center randomized controlled trial in the UK.
- Inclusion of parents in community-based substance misuse services, with children under 2.5 years of age.
- Primary outcome: child abuse potential; Secondary outcomes: parental emotional regulation; Economic evaluation.
Main Results:
- Significant improvement in child abuse potential for the PuP group compared to TAU.
- Deterioration in child abuse potential observed in the TAU group over time.
- Higher rates of reliable change (improvement) in the PuP group (30.6%) versus TAU (10.3%).
- Lower rates of deterioration in the PuP group (3%) versus TAU (18%).
Conclusions:
- A modular, one-to-one parenting program (PuP) can effectively support up to one-third of substance-dependent parents of children under 3 years.
- The PuP program shows promise for improving parenting in this population.
- Further research is recommended to build upon these findings.
Background:
There is growing interest in the provision of parenting support to substance misusing parents.
Methods:
This pragmatic, multi-center randomized controlled trial compared an intensive one-to-one parenting program (Parents under Pressure, PuP) with Treatment as Usual (TAU) in the UK. Parents were engaged in community-based substance misuse services and were primary caregivers of children less than 2.5 years of age. The primary outcome was child abuse potential, and secondary outcomes included measures of parental emotional regulation assessed at baseline, 6 and 12-months. A prospective economic evaluation was also conducted.
Results:
Of 127 eligible parents, 115 met the inclusion criteria, and subsequently parents were randomly assigned to receive PuP (n = 48) or TAU (n = 52). Child abuse potential was significantly improved in those receiving the PuP program while those in TAU showed a deterioration across time in both intent-to-treat (p < 0.03) and per-protocol analyses (p < 0.01). There was also significant reliable change (recovery/improvement) in 30.6% of the PuP group compared with 10.3% of the TAU group (p < 0.02), and deterioration in 3% compared with 18% (p < 0.02). The probability that the program is cost-effective was approximately 51.8% if decision-makers are willing to pay £1000 for a unit improvement in the primary outcome, increasing to 98.0% at a £20,000 cost-effectiveness threshold for this measure.
Conclusions:
Up to one-third of substance dependent parents of children under 3-years of age can be supported to improve their parenting, using a modular, one-to-one parenting program. Further research is needed.
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