Communities for Children Facilitating Partners Evidence-based programme profiles

Parents Under Pressure (PuP)


Parents Under Pressure (PuP)

Target audience

Infants (0-2 years)
Early childhood (3-5 years)
Middle childhood (6-12 years)
At-risk or vulnerable

CfC Objective

Healthy Young Families
Supporting Families and Parents


Parents under Pressure

Delivery Setting



Intensive home-visiting, case-management model programme designed for families where there are multiple issues that impact on family functioning such as depression, anxiety, substance misuse, family violence, financial stress, and where there is a high risk of child maltreatment. Cognitive mindfulness techniques are used to improve family functioning, develop secure parent/child attachments, increase parental capacity, and promote a positive, nurturing environment. Programme is tailored to suit the needs of each family.

Delivered to

Families with infants and children up to eight years with multiple risk factors; with a high risk of child maltreatment; on methadone treatment programme; or referred by child protection agencies.

Delivered by

Trained support workers.

Program Structure

PuP is a 12-module programme delivered on a one-to-one basis in participants' homes by a PuP worker. Parents receive a parent workbook, which forms the basis of the treatment.

PuP practitioners have access to an Online Tool Kit that provides (i) standardized measures, scoring and feedback/interpretation to guide use the use of PuP and (ii) goal setting and goal attainment forms (iii) 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.


Practitioners must undergo training and supervision with an accredited PuP practitioner. This involves a combination of training/instruction on PuP theoretical principles and 30 hours of clinical supervision in which practitioners are required to take on cases with a minimum of 3 families.

Download the training overview PDF (255KB):

  • $3000 for training and clinical supervision per practitioner.
  • $2000 for training as a PuP Supervisor.
  • Costs for training a practitioner will be reduced to $1500 if the agency has a trained supervisor.
  • Larger scale training price will be provided on application.

Phone: Prof. Sharon Dawe - (07) 3875 3371

Evaluation and effectiveness

A pre- and post–test study (no control group) (Dawe et al., 2003) and an RCT (Dawe et al., 2007) found:

  • significant improvements in parental functioning, parent-child relationships;
  • reduction in parental stress, rigid parenting attitudes and child behaviour problems;
  • reduction in child abuse potential; and
  • reduction in parental substance abuse and risk behavior.

In a cost effectiveness study (Dalziel et al., 2015), the cost per expected case of child maltreatment prevented was calculated and compared with the estimated lifetime costs of maltreatment. Based on the assumption that 20 out of 100 families would be diverted from the child protection system, a net present value saving of an estimated AU$3.1 million (£1.7 million) would be made.

Dawe, S., Harnett, P., Rendalls, V., and Staiger, P. (2003). Improving family functioning and child outcome in methadone maintained families: the Parents under Pressure program. Drug and Alcohol Review, 22(3), 299-307.

Dawe S., & Harnett, P. (2007). Reducing potential for child abuse among methadone-maintained parents: results from a randomized controlled trial, Journal of Substance Abuse and Treatment, 32(4), 226-235.

Dalziel. K., Dawe, S., Harnett, H., & Segal, L. (2015). Cost-effectiveness analysis of the parents under pressure program for methadone-maintained parents. Child Abuse Review. DOI: 10.1002/car.2371