Parents with Learning Disabilities

A learning disability is defined by the Department of Health and Social Care (DHSC) (2001) as:

a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with a reduced ability to cope independently (impaired social functioning), which started before adulthood.

A learning disability is different from a learning difficulty.

Learning difficulties are where a person has learning challenges in an area of their life. For example, people with dyslexia have problems with reading, writing and spelling. People with dyscalculia have difficulties with understanding numbers. A person might have a mild learning difficulty or a severe learning difficulty. A learning difficulty affects someone's learning in a specific way. It does not affect someone's general intellect. An individual may often have more than one specific learning difficulty (for example, dyslexia and dyspraxia are often encountered together), and other conditions may also be experienced alongside each other.

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, (particularly new 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 particularly in relation to parenting. This is because definitions/diagnosis of learning disability or learning difficulties can have their limitations as they tend to be deficit-based and do not specifically relate to parenting. Research indicates that a parent's learning disability or difficulty may not always be identified until court action is instigated.

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 Social Care  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.  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 as early identification and cognitive assessments are useful tools in any parenting assessment It can provide more focused support to the parents' learning needs including around communication and cognition. This can also be useful in engaging and enabling the participation of the parents.

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.

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 parent appropriately when the right support is put in place in a timely way by professionals or extended family.

When multi agency working is not effective, 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 including at the prebirth stage in order to prevent future harm to the child and to promote the child's welfare. . Consideration should also be given to wider family support that is available.

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 child with a disability, substance misuse, limited family networks which may lead to social isolation / discrimination, poor housing or poverty  or are at risk of being exploited.

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.

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.

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 clear plans should be in place on how this will be achieved.  The impact of support over time should also be measured, given the short-term nature of interventions. Consideration should be given to what will be expected to happen when support or direct involvement ends, and developing a long-term strategy to ensure the ongoing needs of children are met.

Changes in circumstances should also be assessed in terms of impact on parenting capacity. For example, a parent/carer with a learning disability may have been successfully supported to care for one child, but the assumptions cannot be made that their capabilities will automatically extend to caring for 2 (or more) children. New circumstances, in particular those which may bring new pressures, should be considered in terms of impact for the whole family.

Whilst there must be focus on the needs and wellbeing of children, it should be recognised that parents/carers with learning disabilities should have their needs appropriately responded to, to enable them to parent their children effectively. Parents/carers with learning disabilities can often be socially isolated, this can leave them open to other risks, including domestic abuse and coercive control. Consideration should also be given to support for parents or carers who have children removed from their care to enable them to manage their emotional response to what is a significant trauma.

• Child being expected to undertake roles and responsibilities, outside of what would be reasonable for a child of their age. If so, consider referral to Young Carer's services;
• Parent having limited parenting capacity or understanding of the needs of the child, including pregnancy, childbirth and caring for an infant. This includes an inability to implement age appropriate boundaries for the child;
• Child's needs being neglected, emotionally and physically. The parent or carer may also not meet their own needs, such as basic hygiene. A parent not being emotionally available would also be an  increased risk factor;
• A lack of clear and consistent routines in place within the family home, ie, regular meal times and bedtimes;
• Reduced understanding of safety, ie safety in the home and also in the community;
• Parental substance misuse, domestic abuse poor mental health, or previous trauma (including relating to their own experiences of being parented). Is the parent/carer able to protect the child from being exploited or from dangers outside the home?
• Child's basic care needs not being met, for example, inconsistent school attendance, missed health appointments and lack of stimulation;
• When the wider family does not have a realistic understanding of the parent's learning disability and the impact that this has upon their ability to parent the child;
• In the event that the families, culture, ethnicity, religion or other factors has implications on their understanding of the learning disability of the parent and therefore the impact that this would have upon the child;
• A limited support network/cognition and learning needs;
• Can the parent/carer apply learned knowledge to a different context?
• Has there been a change in circumstances which might impact on the capacity of the parent/carer? For example, another child in the family.

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 child and family assessment and include input from Adult Services and other relevant agencies in a timely way.

Specialist learning disability/cognitive 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 and cognitive abilities.

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.

Children and Adult Services have a role in supporting the parent and/or child/ren. Local Protocols may have been developed around how Children and Adult services work together. The Working With Parents programme (Research in Practice) has an example protocol that maybe of interest.

However, this is what should be considered in terms of who should take on the lead role:

• However, this is what should be considered in terms of who should take on the lead role:Where there are no welfare concerns but the parent need assistance with routine tasks of looking after children, Adult services should take the lead on assessment and care planning; (as per the Care Act eligibility criteria);
• Where parent needsongoing support such as with a child in need or early help support, Adult Social Care and Children's Social Care will jointly co-ordinate assessment and care planning;
• Wherethere are safeguarding concerns, Children's Social Care will lead the assessment and planning with input from Adult Social Care.

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, acknowledging that early intervention is key.

It is particularly important to avoid the situation where poor standards of parental care, which do not 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 identify and respond to  low levels of need which if unaddressed, are likely to lead to difficulties for parents and undermine children's welfare. Family Group conferences or family network meetings have been used successfully to encourage the wider family support network to support the parents to feel less alone. 

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;
• Person-centred support where required;
• 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 should be 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 (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 and the use of family group conferences and family network meetings (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.

(2021) Good practice guidance on working with parents with a learning disability (England)

Working Together With Parents Network - run by Research in Practice, part of the NCB family, is a free-to-join network that supports professionals working with parents with learning disabilities and learning difficulties and their children.

Working With Parents Programme - resources aimed to support local authorities when developing local policies and protocols around working with parents with a learning disability or learning difficulty. It includes an example protocol alongside other supporting documents - Underlying Core Concepts and Key Contextual issues

Tool for Assessment of People with Learning Disabilities

Babies in Care Proceedings: What do we Know about Babies in Care Proceedings: What do we Know about Parents with Learning Disabilities or Difficulties? - Nuffield Family Justice Observatory

Parents and Carers with Learning Difficulties (Anna Freud)

The role of adult social care for parents with learning disabilities when a child is no longer in their care - there are two insightful videos which look at the experience of the parent with learning disabilities when being visited by a social worker and when in court.