The acceptability and feasibility of implementing and evaluating the Parents under Pressure (PuP) parenting programme with opioid-dependent fathers and their families: results from the PuP4Dads study.

Background: There is a dearth of evidence on parenting programmes that are appropriate and effective for drug dependent fathers and their families. Our study aimed to test the acceptability and feasibility of implementing and evaluating the Parents under Pressure (PuP) parenting programme for fathers on opioid substitution therapy (OST) in order to establish the parameters for a larger evaluation.

Methods: Mixed methods feasibility study. Setting: two family support services for drug dependent parents in Scotland. Intervention: PuP4Dads, a home visiting programme designed to improve parenting and child welfare, delivered flexibly over 6-12 months by accredited practitioners. Sample: 25 fathers on OST and 17 partners/mothers (with children aged 0-8 years). Quantitative measures: parental emotion regulation, confidence, stress and abuse risk; relationship functioning; child development; parent-child relationship; substance use; child protection; economic data. Pre-set progression criteria: recruitment target (24 fathers); father engagement (66% complete programme; minimum 10 complete measures at 0, 6, 12 months); post-intervention qualitative interviews (10 fathers minimum; 90% of PuP practitioners and 80% managers); referrer focus groups (80% uptake); acceptability; fidelity; no adverse events.

Results: Deliverability, acceptability and suitability of the programme were rated highly. Five fathers did not start PuP4Dads. Twenty fathers and fourteen mothers engaged in the programme with comparable attendance rates (mean 71%) and retention (median PuP sessions: fathers 13 [1-26 weeks], mothers 14.5 [1-30 weeks]). Measures were well tolerated and completion rates were high. Staff training and fidelity were adequate. Benefits of PuP4Dads from the perspective of fathers, mothers, practitioners and managers included: therapeutic focus on men’s parenting; improved parental emotion regulation; understanding and responding to children’s needs; reduced substance use; improved multi-agency working; and fit with policy.

Conclusion: A larger evaluation of PuP4Dads is feasible. Future research should demonstrate effectiveness, cost benefits, and how the intervention works (mechanisms), for whom and under what circumstances.