Parents with Learning Disabilities

A learning disability is a permanent life-long condition, usually identified in childhood and which has been diagnosed by a qualified health professional or a multi- disciplinary team.

A person with a learning disability might have some difficulty:

• Understanding complicated information;
• Learning some skills;
• May have care and support needs.

A learning disability is different for everyone and a full assessment is needed to identify what the person's strengths and difficulties are.

A learning disability maybe mild, moderate, severe or profound in nature. These categories are not rigid and there are no clear dividing lines between the different groups. Equally, there is no clear cut off point between people with mild learning disabilities and the general population. It is always helpful to remember that you must see the person first.

Many adults with a mild learning disability do not have a formal diagnosis or they fall just outside this definition but may often struggle with similar issues. In most cases they will need some additional support to function well in daily life. This may be provided informally by family members, or when there are higher levels of need, by agencies including health and adult social care.

It is important as practitioners we are aware of what the person's strengths and difficulties are around their learning disabilities and how this can impact on the person's ability to be a parent to a child and how these issues can be supported.

These may include:

• Communication needs including verbal reasoning;
• Literacy skills;
• Retaining information such as appointments;
• Organisation skills;
• Problem solving;
• Understanding of other people's needs;
• Ability to learn and what method works best for the person.

The Equality Act (2010) places a duty on all service providers to take steps or make reasonable adjustments this includes providing information in an accessible format. So, professionals need to think about communication, verbal and nonverbal, written information, how to explain complex and abstract concepts, and how to check for understanding.

There is a far wider group of parents who may not have a diagnosis and would not generally fit the eligibility criteria for support from a Learning Disability Adults team. However the parent may be able to receive support from another Team within Adult Social Care or a Health provision such as a specialist Multi-disciplinary Autism Spectrum service or complex needs team within Adult Social Care. Diagnosis, and support from other services can be invaluable and help everyone to work more successfully with the parents. A multi-agency approach is therefore essential when supporting parents with learning disabilities.

Parents with learning disabilities may face a wide range of barriers to bringing up their children successfully, and they may also recognise that they need support and help to enable them to learn to be the best parents possible. Adults with learning difficulties do not usually need a high level of support in day to day life but may need professionals to make adjustments to take into account issues such as literacy or communication needs.

Historically IQ testing was used as an assessment method in an attempt to categorise degrees of learning disability, however, the current multi-disciplinary assessments use a broader approach to assess strengths and needs, and should be part of a person-centred approach to care and support planning, leading to a person-centred needs assessment/ plan It is also about the parent(s) being fully involved in the assessment and consulted throughout the process.

The additional support needs of parents with learning disabilities include the ability to meet a child's development needs, as well as their own; personal care of the child; preparation of meals and drinks; attending to the child's health needs; parental involvement in indoor and outdoor play; support in education and help to identify potential risks to their child(ren).

Where a parent has a learning disability it is important not to make assumptions about their parental capacity. A full assessment should be completed with the support of other professionals. Practitioners should not make the assumption that having a learning disability does not mean that a person cannot learn new skills. Parents with learning disabilities can be 'good enough' parents when the right support is put in place in a timely way.

If services fail to coordinate effectively, parents with learning disabilities are at risk of falling through the gap between the provision of services for children and the provision of services for adults. As a result, some parents may miss out on support services that they need in order to prevent problems from arising. Early help and Family Support services should be considered at an early stage in order to prevent future harm to the child and to promote the child's welfare.

The context in which people with learning disabilities have children is one that has been dominated by the perception of risk and the assumption that their parenting will not be good enough. However, parents with learning disabilities can be 'good enough' parents when appropriate support is put in place. Adults with learning disabilities may need support to develop the understanding, resources, skills and experience to meet the needs of their children. This will be particularly necessary if they are experiencing additional difficulties such as domestic abuse, poor physical or mental health, having a disabled child, substance misuse, social isolation / discrimination, poor housing or poverty.

Neglect through acts of omission rather than commission is a frequently stated concern; ultimately it is the quality of care experienced by the child which determines whether the parenting capacity can be regarded as good enough and whether or not a referral should be made for an assessment by Children's Social Care.

Similarly, women with learning disabilities may be Adults at Risk and at risk of exploitation or targets for men who wish to gain access to children for the purpose of sexually abusing them.

Children may end up taking increasing responsibility for caring for themselves and, at times, for their siblings, parents and other family members. A referral to the local Young Carers Support Group may be appropriate.

• Does the child take on roles and responsibilities within the home that are inappropriate for the child's age?
• Does the parent/care giver neglect their own and their child's physical and emotional needs?
• Are good routines in place within the house such as meals times, bedtimes etc?
• How is safety managed for the child?
• Does the parent/care giver have any other issues which need to be addressed such as mental health issues, substance misuse, difficult childhood experiences etc?
• Does the parent/care giver's learning disability have implications for the child with school, attending health appointments etc?
• Does the parent/care giver's learning disability result in them rejecting or being emotionally unavailable to the child?
• Does the wider family understand and accept the learning disability of the parent/care giver, and the impact of this on the parent/care giver's ability to meet the child's needs?
• Is the wider family/ friendship group able and willing to support the parent/care giver so that the child's needs are met?
• Does culture, ethnicity, religion or any other factor relating to the family have implications on their understanding of the learning disability and the potential impact on the child?
• How the family functions, including conflict, potential family break up, domestic abuse issues etc.
• Is the parent/care giver vulnerable to being exploited by other people e.g. financially, providing accommodation?
• Does the parent/care giver have difficulty developing and sustaining relationships or have relationships that may present a risk to the child?
• Does the parent have a limited understanding of the child's needs and development including pregnancy, childbirth, and caring for an infant?
• Does the parent/care giver have poor parenting experiences from their own parents as a child?
• Does the parent/care giver know how to manage the child's behaviour appropriately?
• Does the parent/care giver have difficulty accessing health care and other support for themselves or the child?
• In relation to pregnant women, should a pre-birth assessment be arranged?

Professionals undertaking assessments must consider the implications for the child as they develop throughout childhood, and services will need to re-evaluate the child's circumstances. A learning disability is a lifelong condition and parents may need long-term ongoing support, which will need to change to meet the developmental needs of a child as they grow. Assessments must therefore consider the implications for the child as they develop throughout childhood and services will need to re-evaluate the child's circumstances and there should be clear plans in place on how this will be achieved.

Where a parent with learning disabilities appears not to be able to meet the needs of their child's a referral should be made to Children's Social Care in line with the Referrals Procedure.

Children's Social Care will undertake a multi-disciplinary assessment using the Assessment Framework triangle, and include input from Adult Services and other relevant agencies in a timely way.

Specialist learning disability and other assessments are essential as a means to determine whether or not the parents require additional support to enable them to care for the child or whether the level of learning disability is such that it will impair the health or development of the child. Assessments involving families affected by parental learning disability should always include specialist input concerning the impact of a parent's learning disability.

All agencies must recognise that their primary concern is to ensure the promotion of the child's welfare, including their protection. They should ensure that any information shared with the parents is accessible for them and that time is taken to prepare parents for meetings so that they understand what is being discussed and what is expected of them.

It is important that services understand who is to take the lead on assessments:

• Where there are no welfare concerns but adults need assistance with routine tasks of looking after children, Adult Learning Disability services should take the lead on assessment and care planning;
• Where parents need support in the medium to long term Adult Learning Disability and Children's Social Care will jointly co-ordinate assessment and care planning;
• Where intervention is required to prevent children suffering impairment to their health or development or significant harm, Children's Social Care will lead the assessment and planning with specialised input from Adult Learning Disability services.

It is important for support needs to be recognised at the earliest opportunity. If possible, identification of needs should start when a pregnancy is confirmed.

It is particularly important to avoid the situation where poor standards of parental care, which do not, however, meet the threshold of significant harm to a child, subsequently deteriorate because of a lack of support provided to the parent.  It is vital to recognise low levels of need, which, if unaddressed, are likely to lead to difficulties for parents and undermine children's welfare.

Where Section 47 enquiries conclude that there is no actual or likely significant harm it will be important that action is taken to prevent future problems arising.

The case of A Local Authority v G (Parent with Learning Disability) [2017] EWFC B94 highlighted the question of whether the parenting that can be offered is good enough if support is provided. However, this obligation does not extend to support that is tantamount to substituted parenting.

The case identified five key features of good practice in working with parents with learning disabilities:

• Accessible information and communication;
• Clear and co-ordinated referral and assessment procedures and processes, eligibility criteria and care pathways;
• Support designed to meet the needs of parents and children based on assessments of their needs and strengths;
• Long-term support where necessary;
• Access to independent advocacy particularly in relation to child protection cases. This should be at the earliest opportunity.

The case also highlighted the need for specialist:

Training - specialist training should be available on how to assess and support parents with a learning disability, The Good Practice Guidance on Working with Parents with a Learning Disability should be an essential part of the continuation training for all practitioners working with families (see Further Information).

Good Practice Guidance on Working with Parents with a Learning Disability (2016) (p. 50 et seq) identifies the following:

• Self-directed learning can bring about long-term improvement in parenting skills;
• Group education combined with home-based intervention is more effective than either  home-based intervention or a group education programme on its own;
• Parents with learning disabilities value both advocacy services and those which support self-advocacy;
• Good co-ordination and communication between children's and adult services is key to effective interventions;
• Preventative approaches are key to safeguarding and promoting children's welfare;
• Interventions should build on parents' strengths as well as addressing their vulnerabilities;
• Interventions should be based on performance rather than knowledge and should incorporate modelling, practice, feedback and praise;
• Tangible rewards may promote attendance at programmes, rapid acquisition of skills and short-term commitment;
• Other methods of engagement are needed long term;
• Intensive service engagement is more effective than intermittent service engagement;
• Programmes should be adapted to the actual environment in which the skills are needed in order to enable parents to generalise their learning;
• Teaching should be in the home if possible and if not, in as home-like an environment as possible;
• Factors in the family's environment which promote children's resilience should be identified and enhanced;
• The importance of family ties (for most – though not all – parents and their children) should be recognised and no actions taken that damage such ties;
• Interventions should increase the family's experience of social inclusion rather than cause or contribute to their social exclusion.

Good Practice Guidance on Working with Parents with a Learning Disability - which has been produced by the Working Together with Parents Network.

Top tips - If you think a parent has a learning difficulty or learning disability - from the Working Together with Parents Network.

A Local Authority v G (Parent with Learning Disability) [2017] EWFC B94