1.4.33 Parents with Learning Disabilities/Difficulties
SCOPE OF THIS CHAPTER
This chapter provides guidance for practitioners on identifying and supporting parents / carers with learning disabilities. It emphasises that parents with learning difficulties may face a wide range of barriers to bringing up their children successfully, but when they are provided with timely and appropriate practical support, they can be good parents and care for their children safely.
AMENDMENTThis chapter was refreshed in December 2022.
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. It affects the way a person understands information and how they communicate. This means they can have difficulty:
- Understanding new or complex information;
- Learning new skills; and
- Coping independently.
A learning disability is different for everyone and a full assessment is needed to identify what the person's strengths and difficulties are.
Please note a learning disability and learning difficulty are different.
A learning difficulty is a problem that the individual faces in learning such as ADHD, dyspraxia and dyscalculia and does not affect an individual's intellect.
Parents with mild learning difficulties, who do not have a diagnosis will not generally fit the eligibility criteria for support services in their own right. In these circumstances Early Help / Early Support / Early Intervention approaches should be implemented.
For further information, please see the Mencap website which explains further.
Parents who do not have a diagnosis 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 work more successfully with the parent(s). A multi-agency approach is therefore essential when supporting parents with learning disabilities.
A learning disability will not necessarily have an adverse impact on a parent (or carer's) ability to care for and safeguard their child(ren) but it is essential to assess the implications of this for the child, including whether or not they are suffering or likely to suffer significant harm. Assessments should be undertaken jointly with services supporting the parents / carers so that the needs of all members of the family and the impact of these on other family members are considered and appropriately supported in a co-ordinated way.
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.
Where a parent/carer has a learning disability it is likely there will be a number of practitioners involved from a range of services. It is important that all practitioners work together within enquiries and assessments to identify any links between the parent's learning disability, their parenting, and the impact on the child - as well as avoiding duplication. Any assessment should be holistic and include an understanding of the needs of the family and children and an identification of the services required to meet these needs.
2. Implications of Parent/Carer Learning Disability
Parents with learning disabilities may need support in meeting a child's developmental needs, as well as their own. This could include help with the following:
- Personal care of the child;
- Preparation of meals and drinks;
- Attending to the child's health needs;
- Involvement in indoor and outdoor play; and
- 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. Parents with learning disabilities can make good parents especially when appropriate and timely support is put in place.
To determine how a parent/carer's learning disability may impact on their parenting ability and the child's development an Early Help / Early Support or Single Assessment should be commenced (dependent on the level of concern). The Assessment should look to identify the strengths of the family, as well as the needs and difficulties, and seek to understand what life is like for the child(ren) living as part of that family. Issues to consider include:
- Does the parent / carer understand and accept professional concerns?
- Does the parent / carer have support from another adult ? (e.g. partner / grand parent / family friend);
- Does the parent engage well with services?
- Is the child attending school / early years setting?
- Does the child take on roles and responsibilities within the home that are inappropriate?
- Does the learning disability result in chaotic structures within the home? (e.g. at meal times and bedtimes, etc.);
- How well does the family function?
- Does the parent/carer have any other issues which need to be addressed such as mental health issues, substance misuse, difficult childhood experiences etc.
- Does the child witness acts of violence or is the child subject to violence?
- Does the wider family understand the learning disability of the parent/carer, and the impact of this on the parent/carer's ability to meet the child's needs?
- Is the parent/carer vulnerable to being exploited by other people e.g. sexually, financially, providing accommodation?
- Does the parent have a limited understanding of the child's needs and development including pregnancy, childbirth, and caring for an infant?; and
- Does the parent/carer have poor parenting experiences from their own parents as a child?
Assessments should acknowledge that a learning disability is a lifelong condition and that parents may need long term ongoing support which will need to change and adapt as the developmental needs of a child changes as they grow. Assessments must therefore consider the continued implications for the child as they develop throughout childhood, including the possibility that they may become a young carer. Children may exceed their parent's intellectual and social functioning at a relatively young age. Early identification and support are therefore essential.
Practitioners should challenge their own negative attitudes and stereotypes (and those of others) towards people with a learning disability and their ability to be parents. Parents with learning difficulties can be good parents when provided with the ongoing emotional and practical support they need.
Information about parenting which is given routinely to new parents must be adapted in order to make it accessible to parents with learning disabilities.
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 or escalating. Early Help / Early Intervention / Early Support 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 parents especially 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 violence and abuse, poor physical or mental health, having a disabled child, misuse substances, or are experiencing social isolation / discrimination, poor housing or poverty. Concerns usually centre on any perceived risk of neglect, both as the result of the parents' intellectual impairments, and the impact of the social and economic deprivation commonly faced by adults with learning difficulties.
Neglect through acts of omission rather than commission is a common 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 Services.
Parents with learning disabilities may be Adults at Risk and targets for others who wish to exploit either them or exploit and / or abuse their children.
Children may take 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.
4. Protection and Action to be Taken
Where possible an Early Help / Early Intervention / Early Support approach should be adopted, working in partnership with the family to support them to meet the needs of the child(ren). However if there is a concern that a child is at risk of or is suffering significant harm, a referral to the local authority Children's Social Care Services should ne made.
Where, as a result of a referral, Children's Social Care Services have concerns that a child of a parent with a learning disability is suffering or likely to suffer significant harm, a Strategy Discussion/Meeting will be held and consideration should be given to undertaking a Section 47 Enquiry.
Children's Social Care Services will undertake a multi-disciplinary assessment using the Assessment Framework triangle, and include input from Adult Services and other relevant agencies, 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 may 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 learning disability.
All agencies must recognise that their primary concern is to ensure the promotion of the child's welfare, including their protection.
It is important that services understand who is to take the lead on assessments:
- Where there are no welfare concerns but the parents / carers need assistance with routine tasks of looking after children, Adult Learning Disability services should take the lead on assessment and care planning;
- Where parents / carers need support in the medium to long term, Adult Learning Disability and Children's Social Care Services 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 Services will lead assessment and planning with specialised input from Adult Learning Disability services.
It is important for support needs to be identified as early as possible in the parenting experience; ideally when a pregnancy is confirmed. A referral for a Pre Birth Assessment should be made if there concerns about the welfare of an unborn baby or that additional support may be required once the baby is born. Where pre-birth involvement is a result of the mother's learning difficulties causing uncertainty as to her ability to meet the needs of the child once born, the Court of Appeal in D (A Child)  EWCA Civ 787 stressed the importance of effective planning during the pregnancy for the baby's arrival, and of taking adequate steps to ensure that the mother understands what is happening and is able to present her case.
It is particularly important to avoid a situation where poor standards of parental care, which do not place the child at risk of significant harm, subsequently deteriorates because of a lack of timely and appropriate support provided to the parent. It is vital to recognise low levels of need, which, if unaddressed, may 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 support is provided to prevent problems arising again in the future.
5. Guidelines for Joint Working
It is essential that staff working in Adult Learning Disability Services and children's / family services work together in a holistic, approach to ensure the safety of the child and, support the parent / carers to care for their child.
Joint work will include learning disability workers providing any information in relation to the parent/carer's:
- Cognitive ability and functioning;
- Ability to attain and sustain change.
Professionals working with children must assess the individual needs of each child and within this incorporate information provided by adult learning disability workers.
Methods of assessment and intervention with regard to parenting must take into consideration the parent/carer's learning disability and be informed by learning disability professionals.
It is important that professionals consider / take advice on the following:
- How written information is presented (including checking the if the parent can read);
- The learning style of the parent;
- Whether the parent understands the assessment process and what is being asked, the use of pictorial aids (etc.);
- Whether the parent / carer would benefit from the support of an independent advocate.
Adult learning disability professionals must attend and provide information to any meeting concerning the implications of the parent/carer's learning disability on the child. These will include:
- Pre-Birth Assessment Planning Meetings;
- Strategy Meetings;
- Initial and Review Child Protection Conferences;
- Core Group Meetings.
Where appropriate and requested to do so, the child's social worker or lead practitioner should attend meetings related to the management of the parent/carer's learning disability and / or provide information as appropriate.
All plans for a child including Child Protection Plans will identify the roles and responsibilities of adult learning disability and other professionals. Plans will also identify the process of communication and liaison between professionals. All professionals should work in accordance with their own agency procedures/ guidelines and seek advice and guidance from line management when necessary.
6. Contingency Planning
Social workers and lead practitioners should consider carefully the implications for children when closing their involvement / withdrawing support from a family where there is a parent(s) with a learning disability. Other professionals who will remain working with the family should be informed of the change so that the impact on the child or the family as a whole can be monitored and re-referred to Children's Social Care Services or Early Help / Early Intervention / Early Support services at a future date if needed.
7. Best Practice when Working with Parents with Learning Disabilities
The case of A Local Authority v G (Parent with Learning Disability)  EWFC B94) highlighted issues around whether parenting can be 'good enough' if support is provided. Parents with learning disabilities should be offered appropriate levels of support (as long as this support is not tantamount to substituted parenting).
The case identified areas of best practice for practitioners in relation to communicating with parents and providing accessible information.
Communication – communicating with parents in a way they understand.
This may include:
- Taking more time to explain things, and any written information should be provided in an accessible form for the parent;
- Telling parents things more than once and checking their understanding of what has been said;
- Considering in advance how best to prepare for meetings, and discussing with parents whether they would like an independent advocate to support them to prepare for the meeting and take part in it;
- Hands-on approaches, such as role-play, modelling, and filming tasks being completed;
- Step by step pictures showing how to undertake a task;
- Repeating tasks regularly and providing opportunities for frequent practice;
- Use of 'props', for example, containers which will hold the right amount of milk.
Specialist Support from a Speech and Language therapist, Occupational therapist, and /or psychologist who can advise on the parent’s needs and how best information can be given. They can also advice on suitable learning strategies which may enhance the parent’s ability to learn.
Parents should be told, in plain language, what any assessment is, what it is for, what it will involve, and what will happen afterwards. This information should be provided in an accessible format and may need to be repeated if there are any memory or cognitive issues.
The Family Court in XX, YY and Child H (Rev1)  EWFC 10 stated that, in cases where a parent has a learning disability:
- There should be timely referrals to adult social care for a parent with learning difficulties, without a very lengthy gap after a referral;
- Parents with learning difficulties involved with children’s social care where a child is on a child protection plan should have their own advocate as a priority. A referral for that service should be made as soon as is practicable; and
- The support available to a parent with learning difficulties should be distilled into a simple document identifying what is available, how often it is available, timescales for its availability and who is responsible for its delivery. Such a document should be shared with children’s social care (if involved) and discussed with a parent in the presence of their advocate.
Information about universal services made available to parents and prospective parents should be in formats suitable for people with learning disabilities. This may include:
- Easy Read versions of leaflets, avoiding the use of jargon;
- Audio and/or visual information on CD/DVD/MP3;
- Fully accessible websites;
- Creating opportunities to tell people with learning disabilities, face-to-face, about services for parents and parents-to-be;
- 'Word banks' of words that parents can read and understand, to be used in written communications with the parents.
8. Findings from Research
Good Practice Guidance on Working with Parents with a Learning Disability should be an essential part of the continuation training for social workers and managers. This Guidance 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.