Case study
All names have been changed

SITUATION: Maureen Davies, 29, has learning difficulties and is mother to two children, Simon, four, and Nina, three. She had been supported by social services to keep her children at home. Her family, however, do not approve of her having children and have not supported her since they were born. 

PROBLEM: Maureen's partner and father of the children, Nathan Clarke, subjected Maureen to physical, verbal and emotional abuse during their relationship. He also drank heavily. About two years ago as the physical violence escalated, social services were concerned about Clarke's treatment of Maureen and the children, and Maureen's deteriorating parenting skills. They applied to the court to have the children removed and were granted permission to do so. The children were placed together with foster carers and have since been adopted. Soon afterwards Clarke left the relationship and the house.

For the past four months Maureen has been in a new relationship with Michael Morgan, who also has learning difficulties. They met at a day service that Maureen was attending once a week. Michael moved in with Maureen a month ago, with the grudging consent of his parents, with whom he had always lived. Maureen has just contacted her social worker to say that she is pregnant again and although she accepts that she cannot have the other two children back, she wants to keep the new baby.

Practice panel: Learning Difficulties team, Bath and North East Somerset
Andrew Luff - Clinical Lead Nurse ; Linda Walz - Clinical Psychologist, Avon & Wiltshire MH Trust ; Mike MacCallum - Joint Commissioning Manager, Banes learning difficulties service ; Kirsten Ashman - Social Worker, Bridges learning difficulties team ; Dawn Gillard - Social Worker, Bridges community learning difficulties team

Panel Responses
Andrew Luff
The principal responsibility of local health and social care services is to provide support and education to Maureen and Michael that will maximise their parenting ability. The white paper Valuing People highlights the increasing evidence that people with learning difficulties can be successful parents and can provide their children with a good start in life. It is also important to acknowledge that some parents are likely to require some additional support and assistance with the parenting tasks.

Good services to parents with learning difficulties are best developed in close partnership with children's services and the parents. Safeguarding the child's welfare should be paramount. By working together from a common approach, the rights of parents will be recognised in decisions made.

For example, we have developed a joint policy between social services and the primary care trust to clarify our respective roles and responsibilities, underpinned by person-centred and family-centred values.

Maureen's circumstances have changed significantly since her relationship with Nathan Clarke started. However, it would be important to consider the necessity of a pre-birth assessment under the assessment framework. A core assessment evaluating Maureen and Michael's parenting capacity, family and home environment, and potential risks to the child's development will help to determine the level of support needed.

The community learning difficulties team (CLDT) would have a central role in evaluating Maureen and Michael's parenting capacity and facilitating their participation in the assessment and planning process. The team would also be well placed to provide any additional training, tailored to their individual needs and delivered at an early stage.

The most successful support packages are based on a shared understanding of what is "good enough" parenting and offer the parents intensive and continuous training in parenting and domestic tasks. Groupwork tailored for people with special needs is often a successful catalyst of change, particularly when combined with individual teaching and coaching in the home. Ultimately, Maureen and Michael need to feel respected as prospective parents, and for services to value them as people first.

Linda Walz
Generally, pregnancy is a cause for celebration. Unfortunately, when the parents have learning difficulties, the service response is often cautious or even negative. Maureen and Michael should be allowed to feel happy about their news.

When it is clear that Maureen is pregnant, she should be offered support from a nurse from the CLDT. It should not be assumed that, as this is her third pregnancy, she will not need information.

The most important protective factor in successful parenting is a supportive partner and social network. Maureen and Michael have not been together long and he has already coped with one major life change when he left the parental home. He should be able to explore his feelings about the pregnancy and the relationship and be helped to adjust to his life changes.

Michael's parents should be encouraged to feel positive about the baby as this will increase the chances of success. Maureen may want support to try to re-establish positive contact with her parents.

Maureen has already been the victim of an abusive partner. Any underlying issues of, for example, low self-esteem or previous abuse could be worked on with the CLDT psychologist to minimise the chances of her being targeted again. She may also be worried that Michael will become like Nathan after the baby is born. Joint work with the couple to discuss any fears could be helpful.

Their daily living skills (as a couple) should be assessed by the CLDT occupational therapist so that any necessary skill-building or support can be put in place before the baby is born. They should be given accessible information about what to expect and ways of coping with a new baby. We do not know what the problems were with Maureen's parenting but services should work with her to address these.

Recommendations from assessments should be specific with clear goals for the parents and services, and an acceptance that they may not be able to meet all their baby's needs themselves. Informal social support from other parents in their community can be as helpful as formal support and should be encouraged.

User View
I thought social services said they were supporting Maureen, writes Daniel Hardy. I don't think that it is very supportive to take her children away. If they were so concerned about her parenting skills, they could have helped find a new house for her and the children safely away from Nathan Clarke. He sounds rubbish as a boyfriend and as a father.

It wasn't the fault of Maureen or the children that Nathan behaved the way he did and they should have had lots of help to either leave him or get him out. The police do not like people who commit domestic violence and will always take action when they can.  

My job is to ensure that people with learning difficulties have fair access to the criminal justice system. This has not always happened in the past -  or even now - but it is improving. I know that the police would have helped Maureen to resolve this. She could have gone to court to make Nathan leave the house, so removing the source of distress. Social services could have given Maureen lots of help at home and groups such as Sure Start and Home Start could have too.

It sounds to me like Maureen needs someone to be on her side. Has anybody said she could be helped by an advocate? If they haven't then they should, and groups such as People First are good at this. People First is a group of advocacy groups run locally by and for people with learning difficulties (visit www.peoplefirst.org.uk).

It's not fair that people with learning difficulties do not receive support when they need it and people believe that, because we have learning difficulties, we will not be good parents. Even the people who say they are on our side sometimes say one thing and do another. 

I am not saying that all people with learning difficulties will be brilliant parents. But then that's just the same for other groups of people. But some of us need more support.

Michael sounds nice but I worry that if he has lived with his parents all his life he will be unable to help around the house properly or help look after a baby. Maureen and Michael are going to need lots of help.

I want Maureen and Michael to have a chance together and receive the right support. If Michael turns out to be a bad man like Nathan then Maureen can be helped to sort things out for herself and the baby. But he might also turn out to be brilliant. Give them support and give them a chance.

Daniel Hardy is equal access to justice project worker at Voice UK, a national learning difficulties charity