This baby is for keeps

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