The Parents under Pressure parenting programme for families with fathers receiving treatment for opioid dependency: the PuP4Dads feasibility study

Abstract

Background: The impact of parental drug use on children is a major public health problem. However, opioid-dependent fathers have been largely ignored in parenting research. Objective: Implement and test the feasibility and acceptability of the ‘Parents under Pressure’ parenting programme for opioid-dependent fathers and their families (PuP4Dads) and determine whether a full scale evaluation could be conducted. Design: Mixed methods feasibility study. Setting: Two non-NHS family support services for parents who use drugs in Scotland. Participants: Fathers prescribed Opioid Substitution Therapy (n=25), their partners (n=17) and children; practitioners; supervisors, service managers; referrers. Intervention: Home-visiting programme, including an integrated theoretical framework, case formulation, collaborative goal setting, and modules designed to improve parenting, the caregiving environment and child welfare. Delivered flexibly over six months by accredited practitioners. Main outcome measures: Feasibility progression criteria: recruitment target (n=24 fathers); acceptability of PUP; father engagement in the study (66% complete programme; minimum 10 complete baseline and post-treatment interviews); engagement in qualitative interviews (fathers n=10 minimum; practitioners 90% uptake; managers 80% uptake); focus groups (referrers 80% uptake); adequate fidelity; no adverse events. Data sources: Researcher administered validated questionnaires: Brief Child Abuse Potential; Parenting Sense of Competence; Difficulties in Emotion Regulation; Paternal/Maternal Antenatal Attachment; Emotional Availability (video); Infant Toddler Social Emotional Assessment/Strengths and Difficulties; Conflict Tactics Scale; Treatment Outcomes Profile; EQ-5D-5L. Other sources: Parent-completed service use (economic measure); Social work child protection data; NHS opioid substitution therapy prescription data. Practitioner reported attendance data. Interviews with fathers, mothers, practitioners (n=8), supervisors (n=2), service managers (n=7); focus groups with referrers (n=28); ‘expert event’ with stakeholders (n=39). Results: PuP was successfully delivered within non-NHS settings and acceptable and suitable for the study population. Referrals (n=44) resulted in 38 (86%) eligible fathers, of whom 25 (66%) fathers and 17 partners/mothers consented to participate. Most fathers reported no previous parenting support. Intervention engagement: 248 sessions delivered to 20 fathers and 14 mothers who started the intervention; 14 fathers (10 mothers) completed ≥ six sessions; six fathers (4 mothers) completed ≤ five sessions. Father and mother attendance rates were equal (mean: 71%). Median length of engagement: fathers 26 weeks, mothers 30 weeks. Research interview completion rates for fathers: 23 at baseline, 16 follow-up one, 13 follow-up two. Measures: well tolerated; suitability of some measures dependent on family circumstances; researcher administered questionnaires resulted in little missing data. Perceived benefits of PuP4Dads from parent, practitioner and manager perspectives: therapeutic focus on fathers, improved parental emotion regulation; understanding and responding to child’s needs; better multi-agency working; programme a good fit with practice ‘ethos’ and policy agenda. Learning highlighted importance of: service-wide adoption and implementation support; strategies to improve recruitment and retention of fathers; managing complex needs of both parents concurrently; understanding contextual factors affecting programme delivery and variables affecting intervention engagement and outcomes. Limitations: Lack of emotional availability and economic (service use) data. Conclusions: A larger evaluation of PuP4Dads is feasible. Future work: Demonstrating the effectiveness of PuP4Dads and the cost implications. Better understanding of how the intervention works, for whom, under what circumstances, and why.