A Pilot Study on the Feasility and
Efficacy of the Parents Under Pressure
(PuP) Programme in Coolmine Therapeutic Community
Anita Harris, Sharon Dawe, Paul Harnett.
Pauline McKeown, Catherine Meleady
www.pupprogram.net.au
6/05/2014

• Established in 1973 as a male only residential centre
Therapeutic Community is
• Highly structured,
• Peer Led
• Self Help
• Community as Method
• Significant changes and modifications over the years
including a women’s only residential treatment
Coolmine Therapeutic Community
Parenting program at
COOLMINE

• Introduction of the mother and child programme in 2008
to its already existing womens’ residential centre –
• Aimed at reducing the barriers experienced by women
wishing to enter treatment
• Mothers can access residential treatment accompanied
by their children for the duration of their treatment (under
5 years)
• On site creche
• Older children are accomodated at weekends
Mother and ChildMother and Child
ProgrammeProgramme

Evolution of the Mother andEvolution of the Mother and
Child ProgrammeChild Programme

However something was missing???
Attachment between mother and child
•Research has shown that generally, behavioural parent
training programmes for substance abusing parents have
not led to lasting improvements in parent child relationships
or children’s psychological development
•How effective parenting skills programmes are, often
depends on the emotional state of the parent
•One reason noted for this is the lack of focus or attention
to the emotional state of the parent and the quality of the
parent child relationship (Suchman, 2004)
Mother and ChildMother and Child
ProgrammeProgramme

Introduction of
Parents Under Pressure
Programme in July 2014
Introduction of PuPIntroduction of PuP

•In February 2014, Coolmine TC introduced PuP to Ashleigh House as
its parenting component of it’s already existing programme.
• To date 9 staff members have been trained to deliver PuP and two of
these staff members acted as facilitators of the 12 week programme
•Programme was open to both men and women of Coolmine services
•Aim of this study was to evaluate the efficacy and feasibilty of the
programme in a residential drug free setting
Introduction of PuP

• To examine any changes in parent/ child functioning
• To explore the extent to which it can improve the parent
child relationship
• To investigate the mechanisms by which it may helpful to
parents
• To examine the percieved efficacy and feasibilty of the
programme in the context of a drug free TC
ObjectivesObjectives

Mixed methods approach employing both quantitative and qualitative
methods
Measures included:
•Depression, Anxiety, Stress scale (DASS-21)
•Daily Hassles Scale
•Brief Infant and Toddler Socio Emotional Adjustment Scale (BITSEA)
•Strengths and Difficulties Questionnaire (SDQ)
Carried out prior to intervention, mid way through intervention and
immediately following completion of group programme.
7 Semi Structured Individual Interviews were also carried out (5 with
PuP participants and 2 with staff members who acted as facilitators of
the programme – immediately following completion of PuP
MethodologyMethodology

Residential facility gives lots of opportunity for integrating PuP into day
to day lives of residents and their children – therapuetic opportunities
around mindful parenting in particular
In addition there is one to one work that includes working with the
Parent Workbook
Use of video is welcomed by many parents and have been a powerful
therapeutic tool
This is further consoldated by a PuP group
All staff are trained in the PuP model so even the night time workers
are able to help to impliment and consolate PuP principles
How PuP works at Coolmine

• Trauma, attachment history and intergenerational addiction
were key themes:
• Four out of five clients grew up in households where either one or
both parents had addiction problems
• Almost all had experienced maltreatment and physical violence by
their parents
• Childhood feelings of isolation, abandonment, rejection, humiliation
and confusion resonate deeply from the interviews
• A deep distrust of social workers and social services feature
strongly
Qualitative findings from 5Qualitative findings from 5
clientsclients

•All spoke highly of the PuP programme citing it as a beneficial and
valuable programme with real percieved gains
•For all, it was the workshops and knowledge around attachment and
detachment that made it different to other parenting programmes and
made it a valuable programme
Qualitative findings from fiveQualitative findings from five
clientsclients

• All stated they are now aware that they were physically there for
their children when in addiction but not emotionally
• “I got up and I dressed them, I fed them, I got them to school so I
thought I was managing but I wasnt there emotionally, they needed
love and attention and I couldn’t give it to them, I just wanted my
drugs”
• All state that participation in PuP has helped them realise where
their detachment originated from:
“I was detached from a young age, my mother used to leave me alone
for days and go to England and I’d have to fend for myself on the
streets and I just detached form everyone, I didn’t care about
anyone”
• All participants noted that Pups focus on parents emotional state
more so than parenting skills and has helped them build on their
parent child relationship
Qualitative findings cont.Qualitative findings cont.

• It became clear that clients view of themselves at the
beginning of the programme was very negative.Low self
worth, hopelessness and feelings of failure emerged
strongly from the interviews, particularly with regards to
parenting
• “ I just felt like a scumbag, a complete scumbag, I wasn’t
good enough and my children deserved to be in care”
(Lisa)
• I knew I wasn’t a good mother, I chose drugs over my
kids, I didn’t try hard enough ( Claire)
• It felt sometimes like there’s just no way out of this pain,
it’s like every second of every minute is like a painful
hour ( Louise)
Qualitative findings:

Significant reductions in reported levels of depression at end of Pup:
•For many PuP has helped gain an understanding of how to be mindful
parents and accept of their limitations whilst in addiction
•Speaking about the guilt and shame they felt with regards to their
children appeared to be hugely beneficial/liberating for many clients
•The safety of the group, (it was a closed group), identification with
other members of the group and the fact that it was delivered in- house
by non-judgemental facilitators that clients were already familiar with,
appeared to allow clients to be honest and open about their feelings of
shame and guilt and for one client bring issues to the forefront that she
had never spoke of before.
Quantatitive findings

To be able to say I am really struggling with feelings towards my child ,I
don’t think I have any,was really emotional for me,
I would have never said that before because I’d be afraid they’d be
taken off me, and it was making me seriously depressed because I
thought there was something wrong with me...something seriously
wrong, but then others related to me and (the facilitator) talked about
detachment and it clicked for me...
I understood then that I was detached from everyone, not just my child
and it went far beyond me drinking as well, I was detached from
small.....and straight away I felt so much better about myself and
hopeful that I can get it back (louise)
Quantitative
findingsfindings

Results from
COOLMINE
DASS Anxiety score
Sample Questions:-
• I was aware of dryness in my mouth
•I felt I was close to panic
•I felt scared without any good reason

Fear and anxiety surrounding parenting appeared to a be strong theme
emerging from the data. For many participants, they had never
parented without the use of substances
Difficulties regarding parenting that caused much anxiety included:
•Setting boundaries (particularly with older children)
•Access visits (for those whose children were in care)
•Overcompensating
•Talking to their children, playing with their children, being “fully
present” with their children
•Fear of social services removing their child from their care
•“I remember having him that morning after 15 hours in labour and I l
just burst into tears, with happiness but also fear that the social worker
was going to take him
Quantitative
findingsfindings

Efficacy of PuP in relation to anxiety:
•Mindful parenting module appeared to be very beneficial, being taught
how to be in the moment with their child
•Perhaps one of most noted benefits cited was becoming aware of their
own anxiety and how this was impacting on their childs behaviour.
•Setting achievable goals e.g preparing for access visits with a focus
on quality of visits as opposed to quantity
Quantitative
findings

Results from
COOLMINE
DASS Stress
Sample Questions:-
• I tended to over react to situations
•I felt I was rather touchy
•I found myself getting agitated

• Living in a TC can be very intense and stressful, particularly when
accompanied by a child
• Clients reported initial high levels of stress trying to participate in
their daily structure in addition to managing their own child in the
context of other children residing there also
• Awareness of stress appeared to be key in reducing this
• Identifying support networks
• Through learning a number of mindfulness techniques in PuP and
another programme (MBRP), becoming aware of when stress is
building up has been hugely beneficial in diffusing a number of
situations that would otherwise have been hugely stressful
Quantitative
findings

Results FROM
COOLMINE
SDQ Scores on 5 children
Sample Questions:-
• Considerate of other peoples feelings
• Often loses temper
•Gets along better with adults than children

• Therapuetic comment on good quality caregiving: the little things
count
• Helping put structure and routine in place without rigidity, support
rather than “rules”
• Mothers said that identifying parents and childs strengths as
opposed to weakness or deficits was one of the best parts of PuP
• Data suggests a shift in perception at this point
On receiving feedback from video footage, one mother noted:
“looking at (Son) on video, at first I was waiting on the negative of what
I should be doing, but looking at him, I was like ah God, he’s
gorgeous and he is actually so good and actually I’m not too bad
either, it was lovely
Building parent childBuilding parent child
relationshipsrelationships

• Goals and skills only appropiate to younger children
• Clients noted that it doesn’t address working with teenage children
• More than 12 weeks desired by a nunber of participants
Limitations of PuPLimitations of PuP

5 factors that will determine whether an organisation will
adopt a practice (Rogers, 2003)
1.Relative Advantage
2.Compatibility
3.Simplicity
4.Triability
5.Observability
ImplementationImplementation

Findings suggest both staff and clients perceived the
programme to be
1.Relative advantage- better than any parenting programme they had
previous experience of-dealt with the core of many clients problems
with their children (attachment)
2.Compatability- compatable with Coolmines CRA approach/relapse
prevention and its commitment to improving mother and child
relationships
3.Simplicity- Easy to understand for both facilitators and participants
4.Triability- Although compulsory, feedback always requested
5.Observability- Both clients and staff state observing immediate
benefits of the programme in their daily structure
ImplementationImplementation

• Findings suggest PuP fits well within the context of Coolmine’s
approach to treatment and relapse prevention
• Parents can be observed in the context of residential treatment
• PuP recognises the extent to which parents are successful depends
on external influences such as housing, financial strain etc as well
as focusing on the emotional quality of parent child relationships
• Coolmine also recognise that treating addiction in isolation is
unlikely to be effective without addressing key context issues- as
such CRA attempts to address these key environmental factors
• Findings suggest that the goals of PuP appears to compliment the
goals of CRA.
• Mindful parenting is a key component of PuP, which fits well with the
mindfulness-based relapse prevention programme already being
delivered across the Coolmine services
In the context of CoolmineIn the context of Coolmine’’ss
approachapproach