Llewellyn, G., McConnell, D., Honey, A., Mayes, R. & Russo, D,

2003,

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

Study Aims

This study evaluates a home-based teaching programme with parents with learning disabilities using the UCLA Parent-Child Health and Wellness Project - Home Learning Program (HLP), (Tymchuk, Groen & Dolyniuk, 2000). The aim of the research was to promote health and safety for children of preschool age in these families. Previous research has reported major difficulties for health, welfare and education systems in meeting the special learning needs of parents with learning disabilities (Feldman, 1994; McGaw, 2000), in particular in areas of home safety and emergencies (Tymchuk, Andron & Hagelstein, 1992) and decision-making (Tymchuk, Andron & Rahbar, 1988).

The HLP has been specifically designed to equip parents who have learning disabilities (who have young children under 5 years of age) with the knowledge and skills necessary for managing home dangers, accidents and childhood illness. The HLP provides 10 lessons that are delivered by a trained parent educator in a one-to-one situation in the parent's home. This involves weekly home visits of 60-90 minute duration over a 12 week period. In this study, during each visit, the parent educator worked through a set of illustrated, plain English lesson booklets designed to accommodate the parents' special learning needs. A typical weekly visit addressed one topic such as fire, electrical and cooking dangers and relevant safety precautions. Adaptations were made to the teaching programme to suit the Australian context.

Research Methodology

Using a randomised controlled trial (RCT), this research design enabled comparisons to be made between those who received the intervention (in two different 2 formats – see below) and those who did not but who received standard services. Four groups of parents were randomly allocated to these three alternative conditions on knowledge and skill acquisition (using a table of random numbers) which were:

a) Current Services Only, b) Lesson Booklets Only and c) Visits Only. The initial sample group of 63 parents had reduced to 45 parents (from 40 families) by the end of the study. Attrition occurred as a result of parents: being too busy to participate (8), having disinterest in the program (2), feeling uncomfortable with the assessments (2) experiencing pressure from male partners to withdraw (2), moving away from the area (2), losing contact with the programme (1) and death of their child (1).

Critical appraisal

RCT's are infrequently used in studies involving people with learning disabilities and therefore any attempt to adopt this rigorous methodology to research in the area of parents with learning disabilities is of value. Typical barriers to using RCT's include: a) achieving homogeneity across experimental and sample (intervention and control) groups especially when the study focuses on a heterogeneous population and b) minimising the influence of factors from the social environment across participants in the control and experimental (intervention and control) groups (Gilbert, 2003).

Despite these methodological constraints this study makes a hearty attempt to address these concerns. Each of four parent's groups received the Home Learning Program, in a staggered sequence, to which they were randomly assigned to three alternative conditions. Parent assessors were blind to those groups receiving the HLP to ensure integrity of the independent variable and to reduce the possibility of observer (selection?) bias. At onset the study narrowed down the heterogeneity of the sample group. Parents who had a diagnosed and unstable mental illness, a substance abuse disorder or who lived in a substantiated domestic violence situation were not included in the programme.

However, in terms of methodological weaknesses, there was a wide range of learning disabilities (IQ 40 to 97) included within the parent groups, with some parents functioning within the borderline to normal range. There was little discussion as to how the research addressed child protection issues arising in these families especially when they entered the non-intervention phase of the programme. Also, there was little information as to how the study controlled for treatments that ran alongside the programme.

Nevertheless, an interesting and useful piece of research, especially with regard to its standardisation of the HLP and its use of RCTs with people with learning disabilities. Overall, a well-conducted RCT but the study needs to address some of the above issues and to replicate the research on a larger sample of parents (IQ < 75), in order to increase the reliability and validity of the findings.

Key research findings

There were five outcome measures that assessed parental health and three that related to home safety. The intervention improved parents' ability to recognize home dangers, to identify precautions to deal with these dangers and resulted in a significant increase in the number of safety precautions parents implemented in their homes with all gains being maintained at 3 months post-intervention. A MANOVA with planned Orthogonal Contrasts was used to measure the effects of each of the four conditions. The analysis revealed that for those parents receiving the HLP there were significant improvements (probability range p < .001-.025) identified in: a) their ability to learn and to remember, b) to apply the knowledge and skills with regard to recognition of dangers to young children in the family home, c) to identify appropriate precautions in order to overcome these dangers and d), in their implementation of these precautions in their own home. All gains were maintained at 3 months post-intervention. The intervention was effective regardless of parental health, literacy skills, and IQ. The authors conclude that this form of home-based intervention promotes a healthy and safe environment which is a prerequisite to continuing parental custody.

Implications for practice and policy

This study has implications for practice rather than policy in terms of increasing the knowledge and skills of parents with learning disabilities in the area of physical health and domestic safety. These findings should increase practitioners' confidence in their use of the Home Learning Program and its application with vulnerable families. Further validation and standardisation of the HLP is needed before the programme has implications for professional training and practice in general.

References

Gilbert, T. (2003). Involving people with learning disabilities in research: issues and possibilities. (Unpublished DDREG Methodologies Group).

Feldman, M. (1994). Parenting education for parents with intellectual disabilities: A review of outcome studies. Research in Developmental Disabilities, 15, (4) , 299-332.

McGaw, S. (2004). What Works with Parents with Learning Disabilities. Barnardos, Illford , UK .

Tymchuk, A.J., Andron, L. & Hagelstein, M. (1992). Training mothers with mental retardation to discuss home safety and emergencies with their children. Journal of Developmental and Physical Disabilities, 4(2), 151-165.