Background: Improving family functioning and child outcomes in families with multiple and intersecting problems—such as parental substance misuse, mental health difficulties, financial stress, and parental histories of childhood maltreatment—is essential to breaking intergenerational cycles of adversity. The Parents under Pressure (PuP) program is an evidence-based intervention that addresses these complex needs through a strengths-based, trauma-informed framework grounded in developmental psychopathology and attachment theory. While the program has demonstrated effectiveness in clinical trials, translating evidence into sustainable practice across child protection and family support systems presents considerable challenges.
Method: In response, the PuP program developers have drawn on Proctor's Implementation Model to design a structured training and implementation process, ensuring practitioners from diverse disciplines can deliver the program with fidelity. Dissemination required the development of an integrated theoretical framework to scaffold practice, alongside flexibility to tailor family support plans.
Results: Over 400 agencies worldwide have now been trained in the PuP program. Implementation experience demonstrates the importance of strong practitioner training, supervision, and organisational support to address barriers such as workforce turnover and engagement difficulties with highly vulnerable families. The journey of implementation will be illustrated through two case examples: (i) training in a nongovernment organsation across 4 sites in Syria, and (ii) integration into services in the Republic of Ireland. Outcomes are described at organisational, practitioner, and family levels, highlighting improvements in practitioner confidence, family engagement, and child wellbeing.
Conclusions: Dissemination of evidence-based practice in child protection requires more than proof of efficacy. Success depends on developing a coherent framework of practice, embedding flexible but clearly articulated program components, and aligning training, supervision, and policy supports. The PuP program illustrates how implementation science principles can overcome dissemination challenges, sustain fidelity, and ensure that families with complex needs benefit from interventions capable of transforming long-term trajectories.