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Psicologia: teoria e prática

Print version ISSN 1516-3687

Psicol. teor. prat. vol.22 no.1 São Paulo Jan./Apr. 2020 



Group parental guidance programs: a systematic review


Programas de orientación de padres en grupo: una revisión sistemática



Thaís B. Benedetti; Isabela P. Rebessi; Carmem Beatriz Neufeld

University of São Paulo (USP), Ribeirão Preto, SP, Brazil





Parental guidance is essential for active parenting in child therapy. This study aimed to survey the main characteristics of parenting programs in a group of articles published in recent years, and to verify similarities and differences between them, correlating these with the outcomes of the selected articles. The systematic literature review method was used in PubMed, PsycINFO, LILACS, and SCIELO databases. The search was conducted from June to August 2019. It included articles published between 2013 and 2018, of group programs for parents, caregivers or family members, training/mentoring, and health promotion/prevention groups, with a minimum of four sessions. A total of 20 articles met all these criteria and were included in the present study. The articles included in the review showed gains and positive results from the interventions and their importance in the treatment and/or prevention, and health promotion of children.

Keywords: systematic review; programs; parental guidance; cognitive-behavioral approach; group.


La orientación de los padres es importante para la orientación de los padres en la terapia infantil. Este estudio tuvo como objetivo analizar las características principales de los programas para padres en un grupo de artículos publicados en los últimos años, y verificar las similitudes y diferencias entre ellos. El método de revisión sistemática de la literatura se utilizó en las bases de datos PubMed, PsycINFO, Lilacs y SciELO. La búsqueda se realizó de junio a agosto de 2019 e incluyó artículos publicados en los años 2013 a 2018 de programas grupales para padres y cuidadores, capacitación/ orientación, promoción/prevención de la salud, con un mínimo de cuatro sesiones. Veinte artículos fueron incluidos en este estudio. Los artículos incluidos en la revisión mostraron ganancias y resultados positivos de las intervenciones y su importancia en el tratamiento, prevención y promoción de la salud de los niños.

Palabras clave: revisión sistemática; programas; orientación de padres; enfoque cognitivo conductual; grupo.



1. Introduction

Among the most common reasons for children and adolescents being referred for psychotherapy are behavioral problems, such as aggression, tantrums and excessive disobedience, as well as difficulty with managing emotions (Petersen & Wainer, 2011). In recent decades, the number of studies that seek to understand the determinants of the emergence of prosocial and antisocial behavior, and the factors that favor adequate child development has increased. These studies highlight parenting practices as fundamental predictors of child behavior and consequent healthy child development (Dishion & McMahon, 1998; Salvo, Silvares, & Toni, 2005; Bolsoni-Silva, Silveira, & Marturano, 2008; Batista & Weber, 2014).

Questions about how best to raise children and questions about how to act in certain circumstances are common in the parenting environment. Many parents believe that their ways of educating are right because they were raised in the same way, however, they often do not know how to deal with the difficulties their children have. Considering the importance of intervening in the behavioral problems presented by children and adolescents, several interventions with parents have been developed (Bolsoni-Silva et al., 2008).

Therefore, it is obvious that parenting programs are extremely relevant, as they help in monitoring the clinical case of the parents' children, their education strategies, and their beliefs and feelings about the difficulty of the child or adolescent. Simultaneously, these programs seek to stimulate prosocial behaviors and reduce the maladaptive behaviors of the children, as they are mainly used to treat children that show problems with overt behavior, such as aggression, tantrums, and excessive disobedience. Parental guidance aims to intervene in the family context, seeking to observe which reinforcers contribute to the maintenance of the child's maladaptive behavior. This assumption indicates that, by acting on the modification of the elements that act on the child, the child may obtain more effective treatment (Caminha & Pelisoli, 2007).

Although Brazilian studies follow a tendency similar to international studies, they are scarce. However, they emphasize the importance of the quality of the relationship between the parents and children for the development of the children. Considering that there is a relationship between parenting styles and the later genesis of childhood behavioral problems (Carvalho & Gomide, 2005), several parenting interventions have been developed to help parents achieve a better relationship with their children (Bolsoni- Silva et al., 2008; Batista & Weber, 2014).

Systematic reviews of the area have addressed topics such as programs that improve parental behavior (Rios & Williams, 2008), parental psychological well-being (Barlow, Smailagic, Huband, Roloff, & Bennett, 2012), prevention of behavioral problems in children (Rios & Williams, 2008), effectiveness of programs to reduce risky parenting practices and increase positive parenting practices in low-income countries (Knerr, Gardner, & Cluver, 2013) and universal prevention programs against violence and abuse for parents (Altafim & Linhares, 2016). Aiming to broaden the knowledge on the subject in a comprehensive way, the objective of this review was to survey the main characteristics of parenting programs in a group of articles published in recent years, as well as to verify possible similarities and differences between them, correlating them with the outcomes of the selected articles.


2. Method

According to the steps required in the elaboration of a systematic review, the following research questions were defined:

• What are the characteristics of programs of Parental Guidance Groups? In what main features are these programs similar and different?

After defining the review questions, keywords were consulted in the Health Science Descriptors (DeCS), and the terms located were combined with the Boolean operators: (parent OR caregivers) AND (training OR orientation OR intervention) AND (program) AND (group) for searching the PubMed, PsycINFO, LILACS and SCIELO databases. The Systematic Review search was conducted between June and August 2019 for articles published from 2007 to 2018. However, due to the large number of publications on the subject in recent years, as well as the latest systematic reviews with the same theme covering articles published up to 2013, the publication criterion was changed to after 2013, to assess and compare the scientific advancement of group parenting programs with articles that were not included in other studies. Accordingly, articles published from 2013 to 2018 were selected, since no article published in 2019 met the inclusion criteria for this review.

After the initial search in the databases, an analysis of the titles and abstracts of the articles was made, and the articles published from 2013 to 2018, studies with humans and in the English, Portuguese and Spanish languages were selected. Theoretical articles, such as those that did not evaluate an intervention, literature review articles, programs that were not related to psychology and those that were applied to a context without a protocol, for a specific demand (such as patients that were victims of tragedies), that focused more on the outcomes for this particular demand than the impacts of the intervention on the way parents deal with their children, for example, were excluded. Articles of programs applied in the group format for parents, caregivers or family members, of training/counseling groups and health promotion and prevention, with a minimum of 4 sessions or totaling 4 to 8 hours of intervention, were included. Articles that met all these criteria were reviewed and read in full by the principal researcher and a research collaborator at the Laboratory for Research and Cognitive-Behavioral Intervention at the University of São Paulo (Laboratório de Pesquisa e Intervenção Cognitivo-Comportamental da Universidade de São Paulo - LaPICC-USP), and articles with the agreement of both were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) criteria were used to write the review report. The PRISMA criteria are used to guide the development of systematic review protocols (Shamseer et al., 2015).


3. Results

With the keywords used for searching the databases, 19,105 publications were retrieved. Initially, 17,303 publications were eliminated with the application of the filters: publications from 2007 to 2018, only articles in the English, Portuguese and Spanish languages, human studies and texts available for free. Next, the titles and abstracts of 1,802 articles were read and 51 articles were selected, according to the inclusion and exclusion criteria. As previously mentioned, due to the large number of publications on this topic in recent years and the latest systematic reviews of the same theme covering articles published up to 2013, the criterion was for them to have been published after 2013. Accordingly, 31 articles were excluded, and 20 articles met all eligibility criteria and were included in this review. All this information was summarized in the flowchart made, using the PRISMA method (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009).



Figure 3.2 illustrates the number of articles that were included in the systematic review by year of publication. There was a growth in the number of articles on group parenting programs over the time, up to 2017, in particular, in 2016, with 7 articles published, that is, 35% of the articles of this review.



Table 3.1 presents the titles of the articles reviewed, as well as their year, country and study aim. Regarding the study countries, it was noted that 30% (n = 6) were performed in Spain (5, 6, 7, 10, 12, 20), 20% (n = 4) in the United States (1, 2, 4, 8) and 10% (n = 2) in Brazil (3, 19). Each of the other articles (n = 8) were performed in separate countries: China, Norway, Korea, Mexico, Taiwan, Denmark, Sweden and Germany. Regarding the study aims, the most prevalent studies were studies of the effect, at 30% (n = 6), followed by studies of effectiveness, at 25% (n = 5), of efficacy, at 15% (n = 3), and of unspecified evaluation, at 10% (n = 2) of the programs evaluated.



Table 3.2 shows the characteristics of the studies specifying the methodology, intervention sample size, treatment target audience, the number, duration, and frequency of sessions, the topics addressed, the theoretical framework and the results of the studies. Regarding the methodology, 13 articles (65%) used experimental methodology (2, 4, 6, 7, 8, 9, 11, 13, 15, 16, 17, 18); four articles (20%) quasi-experimental methodology; one used pre-experimental methodology (5%); one used pre- and post-test design (5%); and one article (5%) did not specify this. In four articles (20%), a longitudinal evaluation of the results was performed, with one article (5%) presenting the follow-up of one and four years (11), another study (5%) of six months and one year (17), another one (5%) of one year (20) and the last (5%) of six months (18).

In 15 studies (75%), the intervention was only performed with parents, family members or caregivers. In five studies (25%), children or adolescents were treated in parallel with the parental intervention group. Regarding the sample size of the studies, these ranged from 17 to 1318 participants. Concerning the target public, nine studies (45%) did not have a specific demand or referred to the non-clinical community, four studies (20%) were with parents of children with Attention Deficit Hyperactivity Disorder, two studies (10%) with parents of children with behavioral problems, one study (5%) with the community at psychosocial risk, one article (5%) with caregivers of children with cancer, one study (5%) with parents of children with Autism Spectrum, one study (5%) with parents of children with epilepsy, and one study (5%) with caregivers of patients diagnosed with schizophrenia or schizoaffective disorder.

In the number of sessions of the programs, a variation from four to 14 sessions was observed. Regarding the theoretical framework mentioned in the programs, it was observed that, in 12 articles (60%), the specific theoretical framework of the program was not named (1, 5, 6, 9, 10, 12, 13, 14, 15, 16, 17, 18), in five articles (25%) the programs followed the behavioral framework (2, 3, 4, 8, 11), and in three programs (15%) that of Cognitive Behavior Therapy (7, 19, 20) was followed. Considering the results of the programs, 1 study did not present the post-intervention and follow-up data that was the focus of the article (17), and in all the articles the aims were achieved through the indication of improvements after the intervention in the parent group.

The programs generally showed satisfactory results from the interventions. Of the 20 articles, only one did not provide evidence that it could be considered a universal program for parent training (article 16), and another one did not specify the results of the intervention (the results of this study were later found in another article, published earlier than that of the search filter in this review). In the other 18 articles, although the topics covered were diverse and the duration and frequency of the groups varied, the parents reported improved relationships with their children, presented more positive parenting practices and fewer negative ones, improved communication with their children, increased the perception of competence to deal with their children's problems and, in some studies, they reported decreased symptoms in their children.

The main characteristics that were similar in the programs included the technical use of Problem Solving in the parental intervention, as well as the focus on developing positive parenting skills in the relationships with the children through the development of appropriate parenting practices. Eight of the 20 articles (40%) considered the theme communication/relationship between parents and children, and four, the self-regulation/emotional regulation of the parents as the subject of discussion. Another similar characteristic refers to the duration of the sessions of the programs, which ranged from 90 to 120 minutes, with the exception of article 17, with a 2.5h session, article 18, with duration of 14h over two or three days and article 19, with sessions that lasted for 1h. What differed most among the programs were the number of sessions of the interventions, with one intervention (5%) on a weekend (2 to 3 days) (18), five programs (25%) of four sessions (6, 9, 12, 14, 17), three programs (15%) of five sessions (2, 4, 5), one program (5%) with six sessions (11), four interventions (20%) with eight sessions (7, 8, 15, 16), one intervention (5%) with 11 sessions (10), four programs (20%) with 12 sessions (2, 13, 19, 20) and one (5%) with 14 sessions (1). The number of themes covered in the programs was also a big differentiator, with programs covering eight themes throughout their sessions and programs focusing on developing specific skills, such as solving problems or setting rules.


4. Discussion

This study, based on the systematic literature review methodology with the theme of "parental group guidance programs," was carried out to study the main characteristics of parental group guidance programs of articles published in recent years, as well as to verify possible similarities and differences between them, correlating these with the outcomes of the selected articles. In the process of searching the articles in the databases, a greater number of publications were found in the PubMed database. A total of 20 articles that met the criteria for inclusion in this review were analyzed. International literature studies predominated, specifically from Spain and the United States, with two Brazilian studies included.

A recent Brazilian systematic review study sought to analyze the characteristics of the empirical studies on group training for the parents of children and/or adolescents. The sample consisted of 27 articles, published between 2006 and June 2014 in the LILACS, SciELO, MEDLINE, and PsycINFO databases. The results showed a large number of articles with the randomized clinical trials design, the majority of international literature, with predominance of programs with cognitive behavioral techniques (Bochi, Friedrich, & Pacheco, 2016). These data are similar to the results of this systematic review, except for the theoretical frameworks, with the majority of the articles in this last review not naming the theoretical framework of the programs. The studies that did cite the theoretical framework referred to the behavioral approach. Some differences were observed between the systematic review by Bochi et al. (2016) and the present systematic review. Initially, it should be emphasized that 38.8% (n = 7) of the sample of articles was published in 2016, which does not cover the years of collection of the articles included in the first review. Another divergence refers to the search terms used and their combination. In the first review, the terms: parent training or family intervention were used in the MEDLINE and PsycINFO databases, and training or intervention and parents, family or parents and intervention in the LILACS and SCIELO databases. In the present review, the terms were carefully associated with the Boolean Operators (parent OR caregivers) AND (training OR orientation OR intervention) AND (program) AND (group) for the search in the PubMed, PsycINFO, LILACS, and SCIELO databases. Therefore, the present study found considerably more publications than the first review.

Data from this systematic review, consistent with the two Brazilian review articles on the topic of group parental guidance, refer to the details of the intervention procedure. The majority of the articles presented only the general themes of the intervention, with the structure and details of how it was addressed in the program not being presented. Few articles described the program in full session by session. This data is an important limitation when trying to identify the techniques that may favor better results and the replication of the programs. Regarding the target audience, it was observed that there was a higher prevalence of studies with parents in the general non-clinical community, followed by parents of children with ADHD and children with behavioral problems. The literature that encompasses parental guidance emphasizes the referral of children and adolescents to psychotherapy for manifest behavior problems, and reinforces the monitoring of the parents in the clinical case of their children to contribute to a more effective and lasting treatment (Caminha & Pelisoli, 2007).

Considering the inclusion and exclusion criteria selected for this review, the World Health Organization recommends two parenting programs (Hardcastle, Bellis, Hughes & Sethi, 2015), the Triple P-Positive Parenting Program, which did not appear in the selected articles (Sanders, Kirby, Tellegen, & Day, 2014), and the ACT-Raising Safe Kids program (Silva, 2009). The Triple P consists of a multilevel intervention, depending on the desired/required intensity and the possible contact with caregivers and applicators. Divided into five levels, it ranges from positive parenting communication strategies (level 1, less complex), to advanced interventions of 8 to 10 group or individual sessions for the discussion of positive parenting and additional problems (level 5, more complex) (Sanders et al., 2014). The ACT is considered an evidence-based parental intervention program, based on Bandura's social learning theory, which is most likely to be effective with families of younger children (Altafim, Pedro, & Linhares, 2016).

Validation studies and those that searched for efficacy and effectiveness of these programs have provided similar results to the studies included in this review, with improvements in the parents' interaction with their children, increases in positive parenting practices and decreases in risky parenting practices, despite the fact that the studies addressed here had a very varied number of sessions, while the Triple P and ACT work with 8 to 10 sessions in their programs. It should be highlighted that, in the case of the Triple P program, only the final intervention levels (levels 4 and 5), which consist of face-to-face sessions, resemble the group formats found in the present study (Silva, 2009; Sanders et al., 2014).

Article 17 of this review, which concerns the ABC for Parents program, did not explicitly report the results of the program. Searching for these results, it was found that the program is effective in increasing positive parenting practices, the perception of self-efficacy of the parents and the well-being of the child, with only four sessions (Enebrink et al., 2014). The varied number of sessions and the satisfactory results in both cases, in addition to the fact that the other levels of the Triple P program also yield results as satisfactory as the face-to-face sessions and that the ABC for Parents also shows effectiveness, even though it consists of only four sessions, makes it possible to hypothesize that the number of sessions in a parental guidance group can be varied as long as some key topics are addressed and the sessions have a duration between 60 and 120 minutes, depending on the number of sessions of the protocol.

Regarding the themes covered in the studies, it was noted that a common point among the programs was the use of the problem-solving technique in the parental intervention, as well as the development of positive parenting skills in the relationships with the children. The problem-solving technique has been used in conventional cognitive therapy as an important strategy, as it focuses on the here and now (Melo, Oliveira, Fava, & Bakos, 2014). The technique consists of identifying a problem for its subsequent specific verification and definition. Divergent and convergent thoughts are put forward regarding the problem and resources for its resolution that are thought out, which are, then, monitored and evaluated to understand whether the objective has been achieved (Sternberg, 2000; Melo et al., 2014). The use of this technique in parenting can bring numerous benefits, as it allows for a clearer and more accurate reflection on the problem to be solved, as well as it serves as a time-out for effective management of emotions, such as anger and stress, which may arise in the parents in moments of interaction with their children.

The development of positive parenting skills has been highlighted in several studies as a protective factor in the development of children and adolescents. The meta-analysis conducted by Pinquart (2016) integrated research from 1015 studies that investigated the association between family dimensions and parenting practices and internalizing symptoms, such as depressive symptoms, and externalizing symptoms, such as misconduct, in children and adolescents. The results of this research indicated that caring parenting practices, reasonable behavior control, guarantee of autonomy, and 'authoritarianism' showed very weak correlations with internalizing symptoms. In contrast, severe control, psychological blackmail, authoritarian styles and, in part, the negligent style were associated with higher rates of internalizing symptoms. Therefore, parenting programs that work on positive parenting and emotional regulation, aiming at reducing negative practices and authoritarian and neglecting parenting styles tend to provide positive results for both the parents and the children, as evidenced by the majority of the studies in this review.


5. Final Considerations

The results of the present work demonstrated some similarities and differences, in addition to the general characteristics, of parental guidance groups published in scientific articles over the previous six years. The main similarities include some of the themes covered, such as problem solving and the importance of positive parenting practices, as well as the emotional regulation of the parents and parent-child communication. The duration of the sessions of the majority of the studies was also similar, being between 90 and 120 minutes, depending on the number of sessions of the protocols. The main difference between the groups was the number of sessions in each program, which ranged from an intensive weekend to 14 sessions. The results from 18 of the 20 selected articles showed that the groups were effective in improving parent-child communication, increasing positive parenting practices, decreasing negative parenting practices, and improving emotional self-regulation skills. These findings suggest the hypothesis that, even with a large variation in the number of sessions, covering these key themes and ensuring a minimum duration of 60 to 90 minutes, depending on the protocol, it is possible for a parenting program to be effective.

This study advances the knowledge of this theme, since it demonstrates the possible flexibility in the number of sessions and shows the specific themes addressed by most of the parenting programs. Future studies are suggested to make specific revisions, separating health promotion and prevention groups from parenting groups for parents of children with some disorders, such as ADHD, in order to verify possible differences in the themes addressed and in the results.



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Isabela Pizzarro Rebessi
Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto
Avenida Bandeirantes, 3900
Ribeirão Preto, SP, Brazil. CEP 14040-030

Submission: 06/05/2019
Acceptance: 07/10/2019

Authors note
Thaís B. Benedetti, Department of Psychology, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo; Isabela P. Rebessi, Department of Psychology, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo (USP); Carmem Beatriz Neufeld, Department of Psychology, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo (USP).

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