O'Hara, J. & Martin, H,

2003,

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

Methodology

A non-experimental retrospective study was conducted involving 54 parents with learning disabilities (mean age 33.7 years), all of whom had received services from a National Health Service team in East London over a 5 year period. The aim of the study was to evaluate service provision for two culturally different groups of parents with learning disabilities. Also, to compare these two groups on culture and gender issues.

The authors argue that there is an absence of studies of this kind in the literature and draw attention to the parenting differences in the multi-cultural and diverse parent population with whom they work. In the Tower Hamlets inner-London borough, the Community Team for People with Learning Disabilities (CTPLD) carries a caseload of 245 adults with learning disabilities. Across this group, the clinical population ranks highest on the Jarman poverty and deprivation indices for London . Adults from Bangladesh comprise 35% of the CTPLD caseload and 23% of the local population.

A key-informant methodology was used to identify potential or actual parents with learning disabilities with whom the CTLD members had previously provided services over the period 1995-2000. Clinical and demographic data were obtained through interviews with key practitioners using a semi-structured format. If service involvement had ceased, a review of case notes was conducted instead. If psychometric assessment was not available, practitioners were asked to estimate the level of disability.

Critical appraisal

• The study sets out to further our understanding of cultural and gender issues in this parent population in inner London . In that sense, it does contribute to the pool of demographic and clinical knowledge currently available within the UK . However, within the discussion, cultural comparison could have been made between this sample population and other parent populations (with learning disabilities) cited across the international literature, for which there is a proliferation of data.
• The authors acknowledge limitations regarding the sample regarding accuracy of characteristics, personal information, medical histories and diagnosis. They also recognised that their sample may have been biased towards adults who required specialist learning disability services rather than those who self-referred.
• In terms of methodology, the reliance on non-experimental descriptive analysis meant that it was difficult to compare gender and cultures across the four groups (i.e. parents who were men/women/Bangladeshi/English). Even so, the paper highlights a number of cultural and gender issues of interest to service providers, clinicians and researchers.

Key findings

• The quality of information contained within the CTPLD's electronic database and manual records was a significant issue. Consequently, identifying subjects of inclusion in the survey was problematic. Information regarding the presence or degree of a person's learning disability was sparse. Also, service information regarding therapeutic support during and after terminations, adoptions or prior experiences was limited.
• There were cultural issues identified in terms of mothers with learning disabilities. Differences were reported between the English women (n = 18) and Bangladeshi women (n = 15) regarding where they lived, the level of extended network of family supports within the home and the number of children whose names were on the Child Protection Register.
• There were cultural issues identified across fathers with learning disabilities including difference in marital status between English men and their Bangladeshi peers.
• Parents with borderline learning disabilities (IQ scores >70 – 85) were not eligible for local CTPLD services. Regardless, this group comprised a significant proportion of referrals made to the CTPLD services. Following an assessment, none were offered support or intervention from the CTPLD in the medium to longer term and generic services were inadequate in meeting their needs.
• Across genders and cultures there were similarly high referral rates for specialist psychiatric assessments, although they did differ in type and reason for their instigation.
• There were issues of emotional and physical well-being, sexuality and family planning, which were different for Bangladeshi parents than for English parents. Services need to be aware of cultural practices that could serve to strengthen social identity and permit the person with learning disabilities to adopt adulthood.

Practice implications

There is a wealth of information within the paper that will be of particular interest to social workers who work with similar families. As comparison was limited to families living within this particular inner-London borough, the generalisation of the reported findings may be limited. Nevertheless, this is still a useful and interesting study. In terms of social work practice, the paper offers insight into the diversity of parenting expectations and behaviours as a result of cultural and gender differences across this parent group.

Policy implications