Feldman, M.A. & Case, L,

1999,

Reviewed by Dr Susan McGaw,
Cornwall Partnership (NHS) Trust

Study aims

The author evaluated the effectiveness of self-instructional audiovisual child-care manuals across 10 parents. Current research indicates that parents with learning disabilities do have the ability to learn parenting skills and to provide acceptable child-care if they are given appropriate training and support. The author cites a range of teaching methodologies such as task analysis, instructions, modelling, feedback, and tangible reinforcement, which parent educators have taught parents with intellectual disabilities on a wide-range of important child-care skills which protect and promote children's welfare. Such programmes are known to have promoted improvements in child health and child development, and led to a greatly decreased rate of child apprehension by child protection.

Research previously conducted on the general parenting population has reported the efficacy of self-learning. Whilst child-care training manuals have been developed as part of multi-component parent education packages, specifically for use by parents with learning disabilities, few studies have evaluated the effectiveness of these bespoke programmes. Only two studies appear to have been conducted so far in this area, both reporting successful outcomes (Feldman & Case, 1997; McGaw, 1994). This study provides further evidence to support the use of self-instructional teaching packages as a low cost, non-technical and re-usable resource for families with learning disabilities.

Methodology

A multiple baseline design was used in the study across subjects, alongside a time-series replication design, which involved the introduction of the intervention (the self-learning material) at staggered intervals across subjects.

The sample group comprised 10 parents (nine mothers and one father) all of whom were diagnosed as having mild learning disabilities and were eligible for specialist services. Six out of the nine parents were under court-ordered supervision of a child protection agency. Eligibility criteria included: a) the parents were either expecting a child or were currently caring full-time for their own child < 2 years of age, b) the parents required training on at least one child-care skill for which self-instructional materials could be provided and c), the parents were not receiving such training elsewhere at the time of the study.

The manuals included illustrated picture books from birth to two years of age on 25 child-care skills. These were validated by a paediatric health care professional. The manuals are now available in a 230 page parenting handbook, including 70 child-care checklists covering areas such as newborn care, feeding and nutrition, health and safety, handling emergencies, positive parent-child interactions and promoting appropriate behaviour in older children (Case & Feldman, 1993). The pictures are presented in a line-tracing format and the text has a Reading Ease equivalency of Grade 3 Level. The parent's reading ability was measured using the Wide Range Achievement Test-Revised.

Audiotapes were used alongside the manual during which directions were given to the listener to look at a picture whilst the accompanying text as read out.

The dependent measure was the parent's observed performance on the actual skill level recorded on child-care skill checklists. Each step or skill corresponded to a picture and accompanying text in the manual. Task-analysed skills (making up bottles, nappy changing) were assessed step-by-step, with a correct score recorded when the skill was performed without the assistance of the trainer (either verbally or physically).

The training criterion was set at 80% for mean rate of learning over 3 consecutive weeks. Inter-rater reliability was high and reported to be 95.0% across 12% of the sessions sampled.

During training, parents were shown how to use a portable tape recorder and asked to listen to the audiotape that came with the manual she/he had just read. Thereafter, the parent was asked to continue to use the materials to prompt them in remembering how to complete the child-care skill. Over a four week period no further reminders or training were given to the parent. Weekly checks were carried out by the trainer, during which observations were made regarding the targeted child-care skills.

Critical appraisal

This is a robust and thoroughly executed study conducted - albeit across a very small sample of parents. The authors report that a total of 23 parents with intellectual disabilities (across two studies) benefited from this self-instructional teaching approach. The authors also note that the multiple-design is one frequently used when evaluating interventions with small populations of subjects with complex needs. In this study such an approach usefully demonstrates individual progress within and across subjects, although establishing a stable baseline before the introduction of the manual and audiotape appears to have been problematic in some instances. Overall, this was a well-conducted piece of research that deserves attention from practitioners as it demonstrates the level of learning that needs to take place in order to achieve acquisition of task-analysed skills with many parents with learning disabilities.

Key research findings

• Self-instruction was effective with 9 out of 10 parents with 11 of 12 skills being attained.
• Skills reached percentage correct levels seen in parents without intellectual disabilities.
• Increased skills were maintained up to 6.5 months after training, during which time observations of the trained skills were reduced.
• Only one parent required full training.
• User satisfaction ratings were uniformly high.
• Overall, the results indicate that many parents with intellectual disabilities may improve their parenting skills with low cost, low tech, self-instructional materials.

Social work practice implications

Although the study may appear intricate, it is a good example of an evaluation with a complex parent population that social workers could use directly, or in supervision with others. A useful study for trainee social workers to cut their teeth on, in terms of learning about evidence-based practice and evaluating innovative interventions.

Implications for practice and policy

Currently, the study is on too small a scale to impact policy and practice nationally. Replication is needed on a larger sample group, using a between-group controlled experimental design with long-term follow-ups. Nevertheless, this is a robust piece of research which many practitioners will find informative. McGaw, S. (1994). Raising the Parental Competency of Parents with Learning Disabilities. (PhD Dissertation). Exeter University .