On 4 June 2025, the report Evaluation of Parents Under Pressure Programme in the Community: A Coolmine-Led Initiative was launched.1 In attendance were staff from Coolmine Therapeutic Community (referred to as ‘Coolmine’ for the rest of this article), parents who had taken part in the Parents Under Pressure (PuP) programme, policy-makers, and other stakeholders. The evaluation is the work of a team from Coolmine. At the launch, the organisation’s Chief Executive, Pauline McKeown, described PuP as “core to Coolmine services”.

PuP programme

The PuP programme targets high-risk families who are facing multiple adversities. Its primary aim is to work with parents to support them in developing positive and secure relationships with their children and creating a nurturing family environment. “It combines psychological principles relating to parenting, child behaviour and parental emotion regulation within a case management model” (p. 3).1 A focus of the PuP programme is the connection between quality parenting and parental well-being. While the programme has been found to work with parents in a variety of situations, evidence shows it to be particularly effective in improving the functioning of parents who are using drugs.2, 3

PuP in the community

Since 2014, the PuP programme has become firmly embedded in Coolmine’s work with families impacted by drug use. A qualitative evaluation was carried out on its delivery in the organisation’s residential therapeutic community in 2018. It was found to have had benefits for participants in terms of parenting practices, emotional well-being, and reductions in drug-related harms.4 As part of that evaluation, it was recommended that this service should be provided to families in community-based non-residential settings. Coolmine secured funding to deliver PuP through a home and agency visiting service within local communities to people who were not necessarily engaged with addiction services. The 2025 report is an evaluation of this service.

Methodology

The research was carried out by an internal team at Coolmine. It captures findings from data used to support the implementation and monitoring of the programme, as well as the case management of participants (for example, sociodemographic data on participants and referral sources). The research team attempted to measure changes in emotional well-being using the Depression, Anxiety and Stress Scales (DASS) screening tool at three points over time. The DASS screening tool is designed to measure the severity of relevant symptoms and was applied to parents who exhibited behaviours that raised concerns among programme staff. The resulting report focuses on the feasibility of delivering the PuP programme in the community and does not explore its long-term impact with the parents or any changes in outcomes for the children.

Between January 2024 and March 2025, 96 parents accessed the programme – 18 fathers and 78 mothers. Twenty of the mothers were referred through the Dóchas Centre (a closed, medium-security prison).

Findings

Overall, the findings in the report were positive. Some examples of these positive findings are that the programme was successful in engaging the target population, it delivered the intervention in a flexible way that could meet the wide-ranging needs of participants, and it succeeded in effective interagency working both in terms of sourcing referrals and working together to meet participants’ needs. Among participants who responded to the DASS screening tool over the course of the programme (n=18), a pattern of improvement in their mental health was found.

Some of the features of the programme that were particularly valued by participants were that it was flexible and practical; it was delivered in a non-judgemental and compassionate way; there were strong collaborations between services to support participants, which supported shared case management; and the mindfulness/reframing element of the work was particularly helpful for parents.

Recommendations

Based on the findings, the report authors make recommendations under three interconnected domains with the role of family in both prevention and treatment at the core:

1   Policy level

a.  Meaningfully recognise that many clients in treatment are parents with caregiving demands that are closely intertwined with their substance use.

b.  Integrate parenting support in addiction services as standard practice, with systemic, collective responsibility across relevant agencies. 

2   Strategic direction

a.  Shift service delivery towards a whole-family approach, addressing the needs of both children and parents.

b.  Position recovery pathways within primary care and community-based settings.

3   Service provision

a.  Expand PuP in the community across all Integrated Healthcare Areas.

b.  Allocate targeted funding to community-based organisations in order to support the effective delivery of PuP.

Concluding comment

The findings of any internal evaluation carried out by the provider of an intervention need to be treated with caution. However, the report presents valuable insights into the delivery of the PuP programme in a community setting and the opportunities this approach presents to meeting the needs of parents who may not otherwise access supports. It also suggests that there is a culture of ongoing learning and reflection on practice within Coolmine. The report’s conclusion calls for investment in research to support a more “robust understanding of how best to support parents who use substances and their children” (p. 19).1 

1.   Harris A and Niece E (2025) Evaluation of Parents Under Pressure Programme in the Community: A Coolmine-Led Initiative. Dublin: Coolmine. Available from: https://www.drugsandalcohol.ie/43376/

2.   Dawe S and Harnett P (2007) Reducing potential for child abuse among methadone-maintained parents: results from a randomized controlled trial. J Subst Abuse Treat, 32(4): 381–390.

3.   Barlow J, Sembi S, Parsons H, et al. (2019) A randomized controlled trial and economic evaluation of the Parents Under Pressure program for parents in substance abuse treatment. Drug Alcohol Depend, 194: 184–194.

4.   Ivers JH, Harris A, McKeown P and Barry J (2021) Mothers experiences of the Parenting Under Pressure Program (PuP) in a Residential Therapeutic Community: A qualitative study. J Psychoactive Drugs, 53(3): 230–237.