Abstract
Children of parents with intellectual disabilities (ID) are at risk for neglectful care due to parenting skill deficiencies. This article describes the development, use, and evaluation of self-directed learning (via self-instructional audiovisual child-care materials) to teach basic child-care, health, and safety skills to parents with ID. We developed the materials based on input from pediatric health care professionals and research on how to present visual materials to persons with low literacy skills. The parents quickly learned how to use the pictorial manuals and accompanying audiocassette. Controlled field studies with 33 parents with ID (30 mothers, 3 fathers) found that 96% of the self-trained skills rapidly reached the same level seen in competent parents and maintained as long as 3.5 years. Consumer satisfaction ratings were uniformly high. Percentage correct performance was significantly related to the parents' reading abilities and initial acceptance of the materials. Overall, the results of these studies indicate that many parents with ID may improve their parenting skills with low cost, low tech, self-directed learning. Future research should evaluate the effects of mass dissemination of the self-instructional materials on the incidence of child neglect related to parental incompetence.
CHILDREN of parents with intellectual disabilities (ID)* are at risk for neglectful care that leads to health, developmental, and behavioural problems (Feldman, 1997, 2002a; Feldman & Walton-Allen, 1997). Most of these problems can be traced to parenting skill deficiencies, rather than purposeful abuse or neglect. Many of these parents (who come to the attention of social service and child protection agencies) lack critical knowledge and skills in providing adequate instrumental child-care (Feldman, 1998b; Feldman, Case, & Sparks, 1992), a safe home environment (Barone, Greene, & Lutzker, 1986; Feldman & Case, 1999; Tymchuk, Hamada, Andron, & Anderson, 1990b; Watson-Perczel, Lutzker, Greene, & McGimpsey, 1988), proper nutrition (Feldman, Garrick, & Case, 1997; Sarber, Halasz, Messmer, Bickett, & Lutzker, 1983), and nurturing interactions (Feldman, Sparks, & Case, 1993; Slater, 1986; Tymchuk & Andron, l992). Parents with ID also have difficulties in problem-solving (Tymchuk, Yokota, & Rahbar, 1990), recognizing and treating medical emergencies (Feldman & Case, 1999; Tymchuk, Hamada, Andron, & Anderson, 1990a), and understanding basic child development information (Tymchuk, Andron, & Tymchuk, 1990).
Fortunately, many of these problems can be rectified through parent education and supports (Feldman, 1994). Effective parent training typically involves frequent (eg, weekly) instruction in the home (or a home-like setting) by specially trained parent educators. Skills are trained individually by direct instruction methods including task analysis, illustrations, prompting, modelling, feedback, and reinforcement (Feldman, 1998b). This training enhances child health and development and dramatically decreases the need for child custody intervention (Feldman et al., 1992, 1993, 1997).
Despite the existence of an evidence-based parent educational technology for this population, few specialized programs exist. Many family support and early intervention programs are not equipped to commit to the intensive and long-lasting supports these families require. Workers often do not have the unique (broad) set of knowledge and skills needed to effectively function as parent educators. These competencies comprise knowledge of child development, health, safety, and nutrition, as well as effective teaching methods for adults with cognitive and literacy limitations. In addition, a parent educator should be unbiased, nonjudgmental, empathic, and offer competency-enhancing support (Espe-Scherwindt & Kerlin, 1990; Feldman, 2002b; Tucker & Johnson, 1989).