A learning disability is a permanent life-long condition, which is defined by the Department of Health as:
- A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence);
- A reduced ability to cope independently (impaired social functioning), which started before adulthood, with a lasting effect on development.
However, some people who have a diagnosed learning disability prefer to use the term 'learning difficulty'. They may feel that the term 'learning disability' implies that they cannot learn at all.
There is a far wider group of parents with learning difficulties, who do not have a diagnosis and would not generally fit the eligibility criteria for support services in their own right. These parents often recognise that they need practical support and help to enable them to learn to be the best parents possible.
There is no direct link between IQ and parenting ability above the IQ level of 0. A person's IQ is less important than their functional ability to manage basic parenting tasks. Parents with learning difficulties face a wide range of barriers to bringing up their children successfully.
The needs of parents with learning disabilities include the ability to meet a child's physical and emotional/psychological 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; parental ability to provide age appropriate supervision and a safe environment; support in education. It is important to assess the capacity parents with learning disabilities may have to respond to their child's changing needs as they grow and develop.
- Does the child take on roles and responsibilities within the home that are inappropriate?
- Does the parent/carer neglect their own and their child's physical and emotional needs?
- Does the learning disability result in chaotic structures within the home with regard to meal and bedtimes, etc.?
- Is there a lack of the recognition of safety for the child?
- Does the parent/carer misuse alcohol or other substances?
- Does the parent/carer's learning disability have implications for the child within school, attending health appointments etc?
- Does the parent/carer's learning disability result in them rejecting or being emotionally unavailable to the child?
- 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 wider family able and willing to support the parent/carer 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 etc.
- Is the parent/carer vulnerable to being exploited by other people e.g. financially, providing accommodation?
- Does the parent/carer 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/carer have poor parenting experiences from their own parents as a child?
- Does the parent/carer have difficulty accessing health care and other support for themselves or the child?
- In relation to pregnant women, should a prebirth assessment be arranged?
Professionals undertaking assessments must recognise that a learning disability is a lifelong condition. Assessments must therefore consider the implications for the child as they develop throughout childhood and will need to re-evaluate the child's circumstances from time to time. Children may exceed their parent's intellectual and social functioning at a relatively young age.
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, if the services fail to coordinate effectively. 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 risks 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 parenting will not be good enough. 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, poor physical or mental health, having a disabled child, substance misuse, social isolation, 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 sufficient 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 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.
The Care Act 2014 provides new national eligibility criteria for Adult Social Care support. An adult's needs are eligible where they meet all 3 of the following conditions:
- The adult's needs arise from or are related to a physical or mental impairment or illness;
- As a result of the needs, the adult is unable to achieve two or more specified outcomes. The specified outcomes include carrying out any caring responsibilities the adult has for a child; maintaining personal hygiene; maintaining a habitable home environment;
- As a consequence, there is a significant impact on the adult's wellbeing.
Adult Social Care teams have a duty to carry out an assessment if this is requested and cannot make any decision about eligibility until after they have made a needs assessment. A person can be considered unable to achieve an outcome if:
- They are unable to achieve it without assistance;
- They are able to achieve it without assistance but doing so causes the person significant distress, anxiety or pain;
- They are able to achieve it without assistance but doing so endangers or is likely to endanger the health or safety of the person or others;
- They are able to achieve it without assistance but it takes significantly longer than would normally be expected.
There is a duty under the Care Act to consider the impact of a person's needs on family members. No child should be expected to offer their parent/carer inappropriate or excessive care.
4. Protection and Action to be Taken
Where a parent with learning disabilities appears not to be able to meet her/his child's needs, a referral should be made to Children's social care in line with the Referrals Procedure, and they have a responsibility to assess need and where necessary, offer supportive or protective services.
Children's social care, Adult Services and other agencies must undertake a multi-disciplinary assessment using the Assessment Framework triangle, including specialist learning disability and other assessments including Care Act assessments, to determine whether or not the parents with learning disabilities require 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 for an adult with learning disabilities to be the primary carer.
Key elements of this whole family approach mean agencies and services must work together, clarifying responsibilities between teams; make a plan that works for everyone; continue to review the plan together to make sure it works for the whole family.
All agencies must recognise that their primary concern is to ensure the promotion of the child's welfare, including their protection.
Parents with learning difficulties may need long-term support, which will need to change and adapt as the developmental needs of a child changes as they grow.
Resources will need to be adapted to work with parents may find it difficult to use written information. They may face a multiplicity of other difficulties and there is the potential for a wide range of professionals to be involved in their lives. Professionals should enable a person to participate in decisions and support them to communicate their needs.
It is important to assess whether a learning disabled person has capacity to make a particular decision at a particular time. This means assessing whether they can understand relevant information, retain that information, use or weigh that information and communicate their decision. The 2005 Mental Capacity Act makes it clear that the test of someone's capacity can only be made in relation to a particular decision that needs to be made at a particular time. It recognises that someone may be able to make some decisions but not others.
The safeguarding system can appear very daunting for parents with learning difficulty, and consideration should therefore be given to supporting them throughout this process, including the use of an advocate. Oxfordshire County Council has commissioned Oxfordshire Advocacy to provide support for vulnerable adults and young people over 16 years. This service can provide advocates for people with a learning disability or with learning difficulties.