Parents Plus Systemic, Solution‐Focused Parent Training Programs: Description, Review of the Evidence Base, and Meta‐Analysis

• Author: Dan Hartnett,Alan Carr,Eileen Brosnan,John Sharry
• Published date: 01 September 2017
• Date: 01 September 2017
• DOI: http://doi.org/10.1111/famp.12225

Parents Plus Systemic, Solution-Focused Parent

Training Programs: Description, Review of the

Evidence Base, and Meta-Analysis

ALAN CARR*

DAN HARTNETT*

EILEEN BROSNAN

†

JOHN SHARRY*

,†

Parents Plus (PP) programs are systemic, solution-focused, group-based int erventions.

They are designed for delivery in clinical and community settings as treatme nt programs

for families with child-focused problems, such as behavioral difficulties, disruptive behav-

ior disorders, and emotional disorders in young people with and without developmental

disabilities. PP programs have been developed for families of preschoolers, preadolescent

children, and teenagers, as well as for separated or divorced families. Seventeen evaluation

studies involving over 1,000 families have shown that PP programs have a significant

impact on child behavior problems, goal attainment, and parental satisfaction and stress.

The effect size of 0.57 (p<.001) from a meta-analysis of 10 controlled studies for child

behavior problems compares favorably with those of meta-analyses of other well-estab-

lished parent training programs with large evidence bases. In controlled studies, PP pro-

grams yielded significant (p<.001) effect sizes for goal attainment (d=1.51), parental

satisfaction (d=0.78), and parental stress reduction (d=0.54). PP programs may be facil-

itated by trained front-line mental health and educational professionals.

Keywords: Parent Training; Solution-Focused Therapy; Systemic Child-Focused

Intervention

Fam Proc 56:652–668, 2017

INTRODUCTION

Parents Plus (PP) programs are systemic, solution-focused, group-based interventions

for families with child-focused problems. They are designed for delivery in clinical and

community settings for families of children with clinical and subclinical difficulties. Their

systemic and solution-focused theoretical basis distinguishes them from other evidence-

based group parenting training programs, such as the Incredible Years (Menting, Orobio,

& Matthys, 2013) and Triple P (Sanders, Kirby, Tellegen, & Day, 2014) programs. Like

these, they have been designed to equip families with the skills for dealing mainly with

disruptive behavior disorders, but also with emotional disorders. International epidem io-

logical surveys show that such childhood disorders occur in 10–20% of young people

(Rahman & Kieling, 2015).

*School of Psychology, University College Dublin, Dublin, Ireland.

†

Parents Plus, Dublin, Ireland.

Correspondence concerning this article should be addressed to Alan Carr, School of Psychology, Univer-

sity College Dublin, Newman Building, Belfield, Dublin 4, Ireland. E-mail: alan.carr@ucd.ie

652

Family Process, Vol. 56, No. 3, 2017 ©2016 Family Process Institute

doi: 10.1111/famp.12225

The aims of this study were to offer an overview of PP programs; identify all significa nt

empirical studies in the PP evidence base; provide a narrative account of key findings of

these studies; and present the results of a meta-analysis indicating overall e ffects of PP

programs and moderators of these effects.

Parents Plus programs help families develop (a) positive family relationships and (b) a

constructive approach to discipline issues and conflict management. The current suite of

developmentally staged programs evolved from the original PP program (Sharry & Fitz-

patrick, 1997), which was designed for families of children aged 4–11 years. In light of evi-

dence for the effectiveness of this program (Behan, Fitzpatrick, Sharry, Carr, & Waldron,

2001; Quinn, 2005; Quinn, Carr, Carroll, & O’Sullivan, 2006, 2007), clinical feedback on

ways it could be refined, and the demand for similar programs for preschool children and

adolescents, three developmentally staged versions of the intervention were developed.

The current suite includes the PP Early Years Program (Sharry, Hampson, & Fanning,

2013) for families of young children aged 1–6 years; the PP Children’s Program (Sharry &

Fitzpatrick, 2008) for families of children aged 6–11 years; and the PP Adolescents Pro-

gram (Sharry & Fitzpatrick, 2012) for families of teenagers aged 11–16 years. For families

of adolescents with emotional disorders, the Working Things Out program (Brosnan, Beat -

tie, Fitzpatrick, & Sharry, 2011) has been specifically designed for teenagers to attend

while their parents concurrently attend PP Adolescents Program. For families where sep-

aration or divorce has occurred, the Parents Plus–Parenting when Separated Program

(Sharry, Murphy, & Keating, 2013) has been developed. An outline of these programs is

provided in Table S1.

All programs include a facilitator’s manual and printed psychoeducational materials for

clients. Each program contains a DVD of vignettes illustrating skills for developing posi-

tive parent–child relationships and dealing with parent–child discipline issues in a con-

structive way. The topics covered in these DVDs were identified in collaboration with

families attending child and adolescent mental health service clinics in Ireland. The Work-

ing Things Out DVD contains short movies with illustrated graphics, animation, and

music based on personal stories of adolescents with depression or anxiety disorders who

attended mental health clinics to deal with a range of problems, including loss, trauma,

bullying, self-harm, anger management, and comorbid neurodevelopmental disorders

such as attention-deficit hyperactivity disorder.

All of these programs involve attending 6–9 small group sessions with 8–12 partici-

pants. Group sessions last about 2 hours and program s span 2–3 months. In group ses-

sions, skills are learned through psychoeducation, viewing and discussing video

vignettes, role-play, practice, and constructive feedback. In most sessions, both a positive

parent–child relationship skill and a discipline skill are covered. In the PP Parenting

when Separated Program, in addition to parent–child relationship-building and discipline

skills, participants learn skills for co-operative co-parenting, conflict management within

the co-parenting relationship, and self-care. In the Working Things Out program, the

focus is on adolescents developing self-regulation and relationship-building skills. In all

of these programs, typically each group session begins with a review of progress since the

previous session and closes with an invitation for participants to practice skills learned

during the session in the coming week as homework. Following solution-focused princi-

ples, the groups are centered on client goals and there is an emphasis on clients’

strengths and resilience and on creatively using skills in a solution-focused way.

When these programs are offered in clinical settings, additional “individual” sessions

are offered to clients which they may attend conjointly with members of their families. In

these sessions, clients are helped to implement skills learned in group sessions within

their families to achieve specific treatment goals. In the PP Children’s and Adolescents

Programs, usually two sessions for individual clients and their families are offered. Where

Fam. Proc., Vol. 56, September, 2017

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