I was personally motivated to establish this parenting group as a direct result of my clinical work with these parents. I felt strongly that the lack of service provision in South Gloucestershire was directly contributing to their involvement with child protection agencies. At its worst, I felt the lack of service provision was contributing to child removal into care.
I was able to create this group by taking a consultative role between the children’s and adult’s services. Service managers welcomed my involvement, as they were keen to meet some of the recommendations made by the Social Services Inspectorate
(Goodinge, 2000), with respect to interventions for parents with learning disabilities. I was therefore able to capitalize on a degree of good will which existed within the management team, towards initiatives such as parenting skills groups for this population.
In effect, the Social Services Inspectorate recommendations gave permission for the normally bureaucratic and functionally separate ALDT and CFSC to join together for the purposes of this group.
Pooling our resources and manpower lead to a solid piece of inter-professional work. Rawson (1997) points out that such collaboration challenges professionals to rethink their purpose and establish the most effective means of practice, which can reduce duplication and waste by expensive teams. As a service for parents with learning disabilities, we were able to provide coherent assessment and intervention, moving away from the previous method of duplicating both within the ALDT and CFSC.
Using the social systems (Mercer, 1973) as opposed to the medical definition of learning disability allowed us greater flexibility in identifying the population of
parents with learning disabilities. However, in doing so, our group may have included mothers whose IQ would have fallen in the borderline or low average range (IQ 70- 89), although their adaptive behaviour skills may still have been limited. As such it might be argued that some of the mothers who took part in this group did not have a
38
learning disability as defined by DSM-IV (American Psychiatric Association, 1999). Nonetheless, using the social systems definition of learning disability is in keeping with the wider research in his area. Indeed, Feldman et al. (1986) and Feldman et al. (1992) included mothers with IQ up to 85 in their studies.
The group was successful in retaining the commitment of its members; which many parenting programs find difficult to achieve (Heinz and Grant, 2003). Yet it is possible our mothers may have felt compelled to join and to attend the group (even though participation was voluntary), as each of their children were being monitored under child protection plans. Hence not doing so may have harmed their position with social services. In this respect, mothers included in this group may not be seen as representative of parents with learning disabilities as a whole, as not all children will be subject to child protection.
The group fulfilled its first aim of teaching parenting skills identified at assessment, thereby enhancing parenting competence. The outcomes of this group were therefore in keeping with previous research, which has demonstrated parents with learning disabilities are able to improve child-care skills through intervention (Feldman et al., 1992; Feldman et al., 1989).
However, during the process of the group it was noted that mothers displayed more competent parenting skills in most areas than would have been predicted from
assessment. This finding was surprising. One reason for this might be that the group setting energised these mothers in a way that being in their own home would not. Yet this seemed an insufficient explanation, as their parenting skills deficits had been of concern to social services over a period of time, so much so their children were considered at risk of neglect.
Alternatively, this discrepancy might be explained by two other factors. First, it was possible that professionals were taking an over cautious approach to assessment of these mothers due to parental learning disability, an issue noted in the wider literature (Booth, 2000). Second, it might suggest that mothers’ competence in basic parenting skills was intermittent, leaving professionals unclear as to their actual ability. Such inconsistency in care-giving might indicate an underlying attachment problem
39
between mother and child that was not the focus of either the assessment or the intervention with these mothers. As Howe (2005) describes, neglectful care-giving is often characterised by passive and unresponsive behaviour in the mother. It is
possible that professionals interpret this fragile care-giving as due to parental learning disability and ignorance as to what is required of them. However, the real cause of the difficulty might lie in the mothers own dysfunctional history of being parented, which has left them unable to provide the conditions necessary for their child to form a secure attachment. In such cases successful mother-child interaction may be observed as intermittent. If this is the case, interventions designed to address attachment may be an important precursor to parent skills training. This issue was noted and considered important to take forward with regards to future parenting assessments with these mothers.
Nonetheless, during the group program, it was also the case that parenting
competence tended to be stronger on practical skills (such as bottle feeding and nappy changing) and weaker on emotional skills (such as why babies cry). This may have indicated that mothers easily understood concrete information as opposed to their baby’s more abstract needs – such as to be soothed when crying. Mothers did clearly indicate knowledge deficits in terms of child development (such as when a child should be potty trained), as well on achieving appropriate food and nutrition for themselves and their child on a limited budget. These issues were noted for greater inclusion in future parenting skills groups.
The group fulfilled its second aim of creating an environment in which mothers felt emotionally supported by us and by each other. This enabled them to grow in confidence and to reduce their sense of social isolation. Some of the mothers also indicated a desire to continue with their friendship once the group had come to an end. Heinz and Grant (2003) report a similar experience with their parenting program. They found that the opportunity to socialise with and receive support from peers was the main reason mothers continued to attend their parenting group. Reducing social isolation is a valuable intervention provided by parenting projects. As Feldman et al. (2002) demonstrate, a satisfactory social support network can not only mitigate the effects of parenting related stress, but have a positive benefit of parent-child interaction.
40
In fact, feedback from the group members themselves indicated that emotional support was the most valued component of the program. During the group all of the mothers had drawn attention to their limited social support networks, and how simple things such as the lack of money for a bus fare could restrict their ability to stay in contact with their friends and families. This highlighted the potential for a parenting group such as ours to act as an important support for these isolated mothers,
particularly as they were able to access funding for transport to attend it via social services.
Feedback from the mothers also drew attention to difficulties they have to negotiate when attending child protection conferences. Group members benefitted from being able to discuss these experiences with one another, which prior to the group none had been able to do with a peer. Mothers also highlighted the need for information to be made accessible to them within such meetings, in order that they can fully engage in the processes by which decisions are made about their children. Indeed, this is echoed in the document Good Practice Guidance on Working with a Parent with a Learning
Disability (Department of Health, 2007), which advises that information at child
protection conferences should be delivered in a format which parents with learning disabilities can understand.
As a result of the group intervention, mothers improved their parenting skills with respect to menu planning, safety in the home, bottle feeding, nappy changing and playing with their child. However, professionals’ observations of parenting skills were used as the baseline and outcome measure in this intervention. Although this is in keeping with other similar studies (Feldman et al., 1986; Feldman et al., 1992) the inclusion of a standardised measure, or feedback from significant others involved in mothers’ daily lives, would have provided more robust data in this regard. Such assessment might be particularly important if professionals’ concerns about parental learning disability, and/or child attachment issues are clouding the picture with regards to an accurate assessment of skills competence.
Throughout the twelve weeks I supervised my co-facilitators on an ongoing basis. One of the themes of supervision was the balance we had to strike between providing a safe, supportive environment for mothers, whilst observing our child protection
41
responsibilities and ongoing relationships with child social workers. Such tensions between policing and enabling roles for professionals involved with these families are reflected in the literature (Booth, 2000). These conflicting responsibilities were managed within our parenting group by being clear with mothers and social workers what our processes were in this regard, right from the start of the program. In keeping with this, the child protection concern I responded to in session 8 was first discussed with the mother before the information was passed to social services. Although distressing, having been clear about the procedure I needed to follow enabled this incident to be addressed effectively and with minimum disruption to the group as a whole.
During supervision I frequently drew on a psychoanalytic model to make sense of underlying dynamics within the group. It was notable that in the transference we often felt cast as the parents. We were mindful of this and made efforts to draw group members’ attention to this dynamic when it was taking place. In the counter-
transference we were able to re-enforce the mothers ‘parent-self’ and foster confidence in their ability.
The supervision process also enabled us to recognise our inherent bias towards either mother or child needs, depending on whether we worked for the child or adult
services. Through supervision we were able to prevent splitting within the team of facilitators. Goodinge’s (2000) report illustrates the importance of managing this dynamic, as professional bias’ towards children or adults in this way have been found to compromise the success of interventions.
As a counselling psychologist I brought a broad set of skills to developing this group. It is a pity therefore that learning disabilities has held a Cinderella status within the field of counselling psychology. To some extent this might be understood as reflective of a historical lack of emphasis on the emotional lives of people with learning disabilities, by both services and society as a whole (Bender, 1993). However, with increasing numbers of counselling psychologists working within the field of learning disabilities, training courses should look to include the needs of this population within their syllabus.
42
In conclusion, this pilot parenting skills group was successful in its aims to: promote parenting competence
provide emotional support for mothers with cognitive limitations
As a result of the success of this group, I was able to secure agreement from both adult and child services that a parenting skills group would be offered on an ongoing basis in South Gloucestershire. This is in line with good practice guidance from the Social Services Inspectorate (Goodinge, 2000) and the Department of Health (2007).
In terms of service agenda, it was considered that directing resources at such early intervention strategies may (in the long-term) have some moderating influence on the numbers of children removed into care for reasons of neglect by omission in this locality.