Feldman, M.A,

1994,

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

Methodology

This review compares and contrasts outcome data from 20 published studies that report on parenting education interventions for parents with learning disabilities. The author refers to the literature that profiles these families as being the most complex and time-consuming cases presenting to social service workers; yet specialised services remain under-developed. The author's intention is to provide a critical review of the parent training literature to determine, if, in fact, parents with learning disabilities and their children do benefit from parent education efforts. Also, the author sets out to offer evidence-based research in a format that would promote fair and well-informed decision-making in matters relating to parental competency and child custody by child welfare agencies and the Courts.

In many respects the paper does successfully provide such information, although the visual inspection' method by which the different interventions were compared may be difficult to follow at times. Regardless, this systematic meta-analysis is the only one of its kind produced in the area of parents with learning disabilities. Its valuable contribution to the empirical research therefore provides a bedrock for intervention outcome data which has been reported over the past decade.

The review involved a thorough literature search that involved computerised and index searches of English language journals and books published since 1983. Studies prior to this date were excluded from the review on the grounds of their insufficient reporting of outcome data with regard to the efficacy of interventions.

The inclusion criteria was appropriate and involved the author excluding studies that presented as a) descriptive with no or inadequate outcome data, b) interventions for low income at-risk families which did not identify or report on parents IQ as < 80 and c), child-focused out-of-home interventions that did not provide formal training and evaluation of parenting skills.

Across the 20 published studies identified from the search, the final sample group included 190 parents (188 mothers & 2 fathers) with IQs ranging from 50 to 79. Parenting skills training included basic child-care, safety, nutrition, problem solving, positive parent-child interactions, and child behaviour management.

Critical appraisal

Data were extracted, in 16 out of 20 of the studies, by drawing on an overall impression of the effectiveness of parenting training which involved summarising outcomes in terms of the percentage of demonstrated improvements in trained skills. Improvement scores are based on visual inspection both by the author and an experienced research associate of each single-subject figure provided in the original articles. An in-depth analysis and rationale for using visual inspection and how it was applied to evaluate the effectiveness of interventions from baseline to available treatment, generalization and follow-up conditions was provided. In view of the complexity of this task with this parent population it was not surprising to find that comparability was not possible in some instances, because of the inconsistency in chosen methodologies across some of the studies (with the inclusion of high baseline scores, differences reported in follow-up periods and variation of programme settings when addressing the issue of generalization). However, overall, a good account was provided of how the author managed to compare and contrast these studies which varied in terms of their design, methodology and outcome data. Inter-rater reliability appeared satisfactory with the two reviewers agreeing on 87.6% (range 60% to 100%) of decisions about improvement opportunities in the studies.

Key findings

• The most common instructional approach was behavioural (e.g. task analysis, modelling, feedback, reinforcement).
• Overall, initial training, follow-up and social validity results are encouraging.
• Generalization and child outcome data are weak.
• Further research is needed to a) identify variables associated with responsiveness to intervention and b), develop and compare innovative programmes that teach parents with cognitive disabilities the necessary generalized skills to demonstrate long-term beneficial effects on their children.

Social work practice implications

Social workers will find this paper extremely useful in guiding them in their choice of teaching programmes from an empirical perspective. However, they need to be aware of the limitations of the analysis in terms of the differing methodologies and outcome data reported across some of the studies. There paper deserves to be revisited over time and updated as new studies emerge.

Policy implications