Core Components

PuP is a therapeutic, home based programme that provides support to parents who have experienced complex life problems, including substance abuse, financial crises, mental health problems, etc. It is targeted at parents with young children (under 8 years), and teaches these parents to strengthen their parenting skills, and build a strong, positive relationship with their children.  A therapist manual given to practitioners provides a theoretical outline of the programme, and a parent workbook given to parents provides a basis for the PuP programme. 

PuP programme provides one-to-one intervention that assesses the multifaceted problems unique to each family situation. It then delivers individualised therapies that address the problem areas. The focus of these therapies includes quality of caregiving and parental emotional regulation. The programme is composed of 12 modules. The first module assesses the multiple problems present in families, and helps parents and therapists agree on specific areas to be targeted for change. Other modules include priorities and goal setting; view of self as parent; managing emotions under pressure; kids health check; connecting with child and encouraging good behaviour; mindful child management; managing substance problems; extending support networks; life skills; and relationships. There is a non-sequential method to delivering the modules within this programme. The modules delivered, the order of modules delivered, and the dose of the content of modules is determined by the outcome of the assessment carried out in module one. Each module also has several exercises that help parents strengthen their parenting skills, deal with children’s difficult behaviours, and parents own emotions. Mindfulness is a key part of the PuP programme as it promotes parents awareness of their emotional state, and enhances parent-child connection. 

PuP programme is taught by trained PuP therapists, in 1-2 hour sessions over 20 weeks. The sessions can be delivered to both the parent and child, or just the parent depending on the family circumstances. Methods used for programme delivery include mindfulness exercises, completion of parent workbook exercises, and video feedback. 

Fidelity

Fidelity is ensured by adherence to the strategies listed below:

• Use of therapist manual by PuP therapist.  Manual provides theoretical outline of the PuP programme

• Ensuring programme is delivered to parents by PuP therapists who have been trained in the PuP programme model and theoretical background 

• Reviewing of parent completed checklist to identify what the practitioner addressed, and if core themes were covered 

• Reviewing and auditing of individual casefiles

Modifiable Components 

PuP programme is delivered in Australia, United Kingdom and Republic of Ireland. The programme is only available in English. 

Support for Organisation/Practice

Implementation Support

PuP programme is owned and disseminated by Griffith University, Australia, with a non-exclusive licence granted to the University of Queensland. It was developed in Australia by Professor Sharon Dawe and Dr Paul Harnett, and they (Dawe and Harnett) provide organisations with support needed to implement PuP. 

Prior to programme implementation, PuP programme developers meet remotely with organisations looking to implement PuP. They discuss the PuP programme overview and provide organisations with a list of readings to support programme delivery. These include information on the PuP framework, PuP practitioner training process and PuP contract details. 

To support programme delivery, PuP therapists have access to an online toolkit. This toolkit provides a set of standardised measures for family assessment. It provides online scoring of measures of child and family functioning; goal setting and goal attainment monitoring systems; and other programme monitoring systems. It also provides a form feedback, which gives practitioners feedback to interpret the scores and guide the family support plan.   

Licence Requirements

There are no licence requirements.

Start-up Costs

Training of PuP therapists cost £1,100 per practitioner, and every 7^th practitioner gets complementary training (i.e. the 7^th practitioner is trained at no cost). PuP clinical supervisor training costs £850. If an organisation has a PuP clinical supervisor, subsequent training of PuP Therapists is reduced to £750 per practitioner. Training costs are not inclusive of travel costs. If overnight stays are necessary, accommodation and meals are charged at £180 per night.

Building Staff Competency

Qualifications Required

Typically, PuP training is delivered to front line family support practitioners, who sometimes have social work degrees. However no formal qualification is required to become a PuP therapist. A commitment to working with families with complex problems, using the approach taught in the PuP model (home visiting, case management and therapy) is essential.

Training Requirements

The training process to become accredited PuP therapists involves 6 days of training. This includes an initial 2-day training that provides an overview of the PuP model; and teaches practitioners to support families recognising their strengths and challenges.  This is followed by 3 case review days (at month 2, 4 and 8) and a final development day (at month 12). The focus of the case review days include; importance of developing individualised support plans for families; practical implementation of PuP; emotional regulation training; and process issues associated with PuP programme delivery (including engagement, retention and assessing capacity to change). For the final development day, topics that reflect organisation needs are addressed.

As part of the training process, PuP trainees are also required to complete case summaries for at least 3 families. This allows practitioners demonstrate their competences in using the PuP model. Organisational support to PuP trainees is strongly recommended to ensure that PuP trainees have the time to complete the three case summaries required for accreditation. Training and clinical supervision is provided by PuP trainers and clinical supervisors.

PuP clinical supervisor training help agencies build sustainability, and reduce longer term training cost. Accreditation as a PuP therapist is required before a practitioner can become a PuP clinical supervisor. Training as PuP clinical supervisor involves at least 5 hours of clinical supervision provided by the PuP trainer. Practitioners undergoing training to become PuP clinical supervisors are required to provide clinical supervision to at least 1 practitioner undergoing PuP therapist training. 

Supervision Requirements

Training, support, guidance and supervision to potential PuP therapists are provided by PuP trainers and PuP clinical supervisors. PuP clinical supervisors provide clinical supervision to PuP trainees, while PuP trainers provide intensive training. In addition, PuP trainers evaluate the three case summaries completed by the PuP trainees, and provide feedback for each of the case summaries. This is to ensure the trainees demonstrate an understanding of the PuP programme, and can effectively deliver the programme. 

PuP trainers provide clinical supervision to PuP therapists training to become PuP clinical supervisors. To ensure the PuP practitioners demonstrate competencies as PuP clinical supervisors, they are required to present one videotaped clinical supervision session, as well as the review of that session.  

Training is provided in-person, while clinical supervision is provided by a combination of in-person and telephone discussions. 

Theory of Change 

PuP is guided by attachment theory, behavioural parenting theory and adult psychopathology. This is evident in the PuP programme content, as well as the PuP primary focus of strengthening primary carer/parent-child relationship. This strengthened relationship promotes normal social and emotional development in child. These theories provides the framework for the ecological model of the PuP programme, as PuP identifies and resolves the multifaceted problems present in these families.

Values

PuP programme is an individualised, home visiting, treatment programme that provides support to parents who have experienced complex life problems (including substance abuse, mental health problems, family and financial crises). PuP assesses the multifaceted problems unique to each family situation, and delivers individualised therapies that address these problem areas. PuP equips these parents with parenting skills, and helps them strengthen their relationships with their children. 

• Is this what your organisation would like to achieve?

Priorities

• Is your organisation looking to implement a home visiting programme?
• Is providing a targeted parenting programme that supports parents who have experienced complex life problems priority for your organisation?
• Would your organisation deliver this programme to families that have experienced specific challenges (e.g. substance abuse only)?
• Would an individualised programme be a better fit for your organisation, or would a group intervention suit your organisation better?

Existing Initiatives 

• Does your agency have existing parenting programmes that support parents who have experienced complex life problems? Are the existing programmes for parents with children under 8 years?
• Are the existing initiatives effective? Do the existing initiatives fit your current and anticipated future requirements?
• Are the existing programmes individualised or group interventions? Do they address similar outcomes as PuP?
• Are there components within the PuP programme that are not met by existing programmes?

Workforce

Six training days is required for practitioners to become accredited PuP therapists. A commitment to working with families with complex problems, using the approach taught in the PuP model (home visiting, case management and therapy) is essential. Organisational support to PuP trainees is strongly recommended to ensure that PuP trainees have the time to complete the three case summaries required for accreditation. Additional clinical supervision is required for practitioners who want to become PuP clinical supervisors. No formal qualification is required.

• Does your organisation have practitioners who are interested in learning and delivering this programme?
• How many families will your organisation support in the first year? Based on this number, how many practitioners will require training as PuP therapists?
• Would your organisation also train practitioners as PuP clinical supervisors?
• Can your organisation provide practitioners with the support needed during the accreditation process, bearing in mind the time commitment required for accreditation?

Technology Support

Clinical supervision is provided face-to-face and via telephone. Practitioners training to become PuP clinical supervisors are required to present at least one videotape of a clinical supervision session, and a review of that session. PuP practitioners have access to online toolkit which provides online scoring of measures of child and family functioning; goal setting and goal attainment monitoring systems; and other programme monitoring systems. 

• Does your organisation have the technology (computers/ tablet/ smartphone and broadband) to enable practitioners access the online toolkit? Can the technology be purchased?
• Can your organisation provide the technology for PuP trainees to consult remotely with their PuP trainers?
• To support practitioner accreditation as PuP clinical supervisor, can your organisation also provide the technology to record videos for review?

Administrative Support

PuP is a home visiting programme. Practitioners training to become PuP clinical supervisors are required to present at least one videotape of a clinical supervision session, and a review of that session.

• Can your organisation provide the administrative support required for a home visiting programme, e.g. travel, documentation, etc.
• Are there policies and procedures in place regarding the video recording and storing of these recordings?

Financial Support

Training of PuP therapists cost £1,100 per practitioner, and every 7th practitioner gets complementary training (i.e. the 7th practitioner is trained at no cost). PuP clinical supervisor training costs £850. If an organisation has a PuP clinical supervisor, subsequent training of PuP Therapists is reduced to £750 per practitioner.  

• How many practitioners would your organisation like to train? Will your organisation be training practitioners as PuP therapists and PuP clinical supervisors?
• Can this be supported financially?

Comparable Population 

PuP is a targeted parenting programme that provides support to parents who have experienced complex life problems. The individualised programme teaches these parents to strengthen their parenting skills, and build a strong, positive relationship with their children.

• Is this comparable to the population your organisation would like to serve?
• Has your organisation identified families who may benefit from this programme? Is there a need for this programme?

Desired Outcome

PuP programme is associated with significant reductions in several outcomes, including child problem behaviour, child abuse potential, and parenting stress.

• Are the above outcomes priorities for your organisation? Are there other primary outcomes that your organisation would like to achieve, which are outside the premise of the PuP programme?
• Does your organisation have other systems in place that effectively and efficiency address the above outcomes?