Special Parenting and the Combined Skills Model

Special Parenting and the Combined SkillsModelSadie Young* and Tim Hawkins�

*Honeylands Children’s Centre, Exeter, UK, �The Young People’s Centre, Mount Gould Hospital, Plymouth, UK

Accepted for publication 29 July 2005

Background The Child and Special Parenting Service pro-

vides flexible assessment, long-term domiciliary support

and home-based teaching to intellectually disabled par-

ents. It provides key coordination between the Learning

Disability Service and the Children’s Service with

focussed parenting assessments, where issues of child

care and protection proceedings arise.

Method Semi-structured interviews and questionnaires

were designed to evaluate user satisfaction for both

recipients of the service and professionals referring to

the service.

Results A high level of consumer satisfaction was found

and assessment reports were highly rated. The service is

seen to help prevent family breakdown, to meet user

needs and to be supportive and non-threatening by the

parents.

Conclusions The combined skills model proposes a small,

specialized service that acts as a linchpin for complex

cases that require skills from both child and learning

disability workers. The Child and Special Parenting Ser-

vice receives an increasing demand for assessment. It is

highly valued by the users and works strongly from an

inter-agency standpoint, coordinating complex packages

of domiciliary assessment and support, and is a good

practice model.

Keywords: combined, disabilities, evaluation, flexible,

intellectual, learning, model, parenting, special

Introduction

In the wake of the normalization movement and amidst

the implementation of the Children Act (1989), care and

support was to be delivered to clients in the community

and the progressive philosophy of normalization empha-

sized that people with intellectual disability should be

afforded the same rights, responsibilities and opportunit-

ies available to others. In conjunction with care in the

community, the Children Act (1989) gave prominence to

the enduring nature of parental responsibility, focussed

on the primacy of children’s developmental welfare and

shifted the emphasis from solely child care to a combined

caring and a protective role. These significant changes in

policy meant a steady growth in the number of adults

with intellectual disability who chose to exercise their

right to become a parent. Alongside these emergent num-

bers, there has been a growing demand for assessment

and support services and a welcome diversity of research

including interest in social support, child outcomes,

interventions beyond child-care training and the views of

the parents themselves (Murphy & Feldman 2002).

The government White Paper, ‘Valuing People: A

New Strategy for the 21st Century’ (2001) states that,

‘the number of people with learning disabilities who are

forming relationships and having children has steadily

increased over the last 20 years’. It further states that

‘people with learning disability can be good enough

parents and provide their children with a good start in

life, but may require considerable help to do so’. In one

UK study, it was found that approximately one-third of

all referrals to a community learning disability speciality

were for parenting assessments and that this reflects a

national pattern (Toft et al. 2000). Whatever the actual

figure, it is generally accepted that there is an increasing

number of parents with intellectual disability.

One characteristic shared by this group is that they

are amongst the most socially and economically disad-

vantaged of the general population and are over-repre-

sented in the child protection process (Feldman et al.

2002; Green & Vetere 2002). It is becoming clear from

the number of families involved in Child Protection Pro-

ceedings that the demands of parenting can present a

difficult challenge to them. However, whilst quality of

Journal of Applied Research in Intellectual Disabilities 2006, 19, 346–355

� 2006 BILD Publications 10.1111/j.1468-3148.2005.00276.x

parenting is a central component of most child care

developmental theories, it is a very difficult construct to

measure. A clear definition of what constitutes good

parenting has yet to be agreed (Booth and Booth, 1996)

and concerns are frequently based on professional sub-

jective judgments. In approaching parenting by people

with intellectual disabilities, level of attainment is not

based on a standardized measure, rather there is a ‘pre-

sumption of incompetence’ (Booth and Booth 1996) and

consistently the focus is upon inadequacy rather than

adequacy (Goodinge 2000).

Intellectual disability in itself does not prevent an

individual from being a good parent, but the nature of

the difference or deficit undoubtedly affects the way an

individual copes with the various aspects of parenting.

Dowdney & Skuse (1993) claim that, ‘IQ does not relate

in any systematic way to parenting competence until it

falls below 55–60’. Other factors such as those relating

to social intelligence can be of equal or greater import-

ance and the parent–child dynamics is worth special

consideration. For example, whether the parent has diffi-

culty in understanding the motives or behaviour of

other people has implications for clear boundary setting

and can also prevent the parents from adequately pro-

tecting their child from potential perpetrators of abuse.

Similarly, poor communication skills of a parent can

result in an impoverished linguistic environment which

in turn can affect the language development of a child.

In addition, children of intellectually disabled parents

may be intellectually disabled themselves and add a fur-

ther dimension to the situation. Furthermore, the issue

of developmental delay in children is quite complex as

both genetic and environmental factors can play a part.

Studies suggest that the risk of developmental delay in

a child is increased when the parent has intellectual

disability (Haavik & Menninger, 1981) and that if both

parents have intellectual disability the risk is patently

higher (Abramson et al., 1988); but there is also evidence

that when children of parents with intellectual disability

are considered in large samples, their average IQ shows

a regression towards the mean (Gath 1988). For non-

delayed children, issues such as the child ‘outgrowing’

the parent and adopting a care role themselves arise. In

conclusion, parents with intellectual disabilities have

special needs with parenting and these needs can have

serious consequences for their children’s well-being and

development if they do not receive the level of support

they need.

Several studies have examined the provision that is

both needed and available to parents with intellectual

disability. To date, there has been a central focus on the

parenting of mothers as opposed to fathers and in an

attempt to redress this imbalance, Booth & Booth (2002)

explored the role of men in the lives of mothers with

intellectual disability. They found that the majority were

in long-term relationships and the main input of the

father was not as a breadwinner but in terms of knowl-

edge and skills. The outcome of the former study is sup-

ported by Llewellyn (1995), who found that partners of

mothers with intellectual disabilities were an important

source of reciprocal support.

Additionally, McGaw (2000) suggests that while indi-

vidual factors are important, the role of family support

and helping agencies are paramount when assessing

parental competence. In a UK study using a sample of

15 mothers, Stenfert Kroese et al. (2002) found that signi-

ficant associations existed between the number of repor-

ted social contacts and reported burdens of parenting.

Few family members were part of the support networks

and only half of all contacts were viewed as helpful.

This limited social contact was also identified in an ear-

lier study carried out by Llewellyn (1995) who found

that friendships were rare and eight of 10 parents had

no friends at all. Confounded with this social isolation

is low socioeconomic status and the stress associated

with it.

In a Canadian study, Feldman et al. (1997) adminis-

tered the Parenting Stress Index (Abidin 1990) to 82

mothers with intellectual disability and found very high

levels of overall stress, stress related to child characteris-

tics, and stress related to other life experiences when

compared with a normative test group. Furthermore, in

an unpublished UK study by Hodgetts & Power (2002),

the ‘Breadline Britain Index’ was used to identify need.

They found that of 44 families where a parent had a

learning disability, 30 lived in the 13 most-deprived

neighbourhoods of the inner city Plymouth. They also

suggested that ‘the problems experienced by families

with learning disabilities come not only from their dis-

ability, but also from stresses shared with hundreds of

families in these neighbourhoods through the impact of

poverty and social disorganisation’. As a way forward

they recommended that given the relatively low number

of parents with learning disability when compared with

the number of other families, it should be possible to

consider re-housing to less stressful neighbourhoods.

However, the comprehensive support necessary to

enable this client group to successfully address their

needs appears to be lacking. Issues such as not qualify-

ing for a service due to strict selection criteria are a

common occurrence. In a ‘Report of the Task Force on

Supporting Disabled Adults in their Parenting Role’

Journal of Applied Research in Intellectual Disabilities 347

� 2006 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 19, 346–355

Morris (2003) expresses particular concerns about the

adults who do not fit the eligibility criteria of adult

learning disability support services. She notes that a

response from social services may only be forthcoming

when their children are identified as ‘at risk’. As Good-

inge (2000) states, ‘there were services to meet their per-

sonal needs and services for their children but there was

a lack of flexibility, to bring these all together to support

them in undertaking their parental role’.

In summary, it is clear from the available evidence

that a key factor for the success of parents with intellec-

tual disability is the amount of support they receive. It

is therefore the aim of this paper, first to describe a flex-

ible model of practice that provides assessment and sup-

port by using a multi-agency approach and second, to

describe the process and outcome of an evaluation study

that considered the views of the consumers in relation

to this model.

At this juncture, it is useful to consider the prime

division between adult and child health and social care

provision, and the problems that can arise as a conse-

quence of this type of family work. Child and adult ser-

vices are quite distinct in that they are delivered by

different groups of professionals, with different training

and experience, and access to separate funding. In the

majority of cases, this distinction is entirely correct and

promotes a high standard of expertise with the respect-

ive client group. But, when child protection issues occur

where expertise is required to meet the needs of both

the parent and child, problems can arise. Social workers

appointed to manage and assess such a case are usually

from a children’s service and skilled in child protection

matters, but their understanding of the needs of people

with intellectual disabilities is often limited. From the

perspective of the social worker, other child workers

involved, and the parents concerned, communication

can be problematic. The skills necessary to meet every-

one’s needs in a cohesive and co-ordinated way are

lacking. A frequent response to this situation is to

attempt to recruit a token worker from the adult learn-

ing disabilities service in order to facilitate the process

and support the parents. However, a parent with bor-

derline intellectual disabilities is unlikely to receive

input from the adult learning disabilities service for rea-

sons outlined below. In practice, this means that those

parents whose intellectual functioning is within the bor-

derline range of ability, but who still require specialist

input, may have to look elsewhere for help. Conse-

quently, there are limitations in meeting the complex

needs of an entire family because provision is often

delivered on an ad hoc basis with little sense of total

co-ordination across the essential services. This situation

is metaphorically described by one parent as, ‘trying to

adapt services…to support me as a parent is like doing

a jigsaw where you can almost see the picture, but

where the pieces just don’t seem to fit together’ (Good-

inge 2000).

The Combined Skills Model

At some stage during parenting, the majority of parents

with intellectual disability will experience involvement

from both health and social service professionals but

each professional is likely to have his/her particular

focus. As noted by Goodinge (2000) there are services

for parents and for children but the services are not

brought together in a flexible and co-ordinated way to

support the whole family, rather they either support the

parent or the child. The Combined Skills Model offers

an example of practice that brings together child and

learning disability professionals who are co-ordinated

by the Child and Special Parenting Service acting as a

linchpin to provide flexibility and to address the needs

of all family members (see Figure 1). It should be made

clear from the outset that the Combined Skills Model is

provided through a stand-alone specialist service that

serves as a central focus for any family with an intellec-

tually disabled parent and is currently located in a

National Health Service (NHS) Trust. So, where con-

cerns arise for a family, the professionals working in

either the child or learning disability services may initi-

ate assessment.

It has been established that an individual’s potential

to parent together with the type of support he/she

receives are the key factors for success in keeping his/

her family together. It is the experience of the authors

Children’sservices

Adultlearningdisabilityservice

Child andspecialparentingservice

Figure 1 Combined Skills Model.

348 Journal of Applied Research in Intellectual Disabilities


that if parents with intellectual disability are to be given

a reasonable opportunity to succeed in parenting, they

need two clear components of provision. First, appropri-

ate, coordinated assessment to identify the need and

potential within a family, and second, the long-term

domiciliary support that should be available, where

necessary, throughout the child’s development. It is fur-

ther suggested that the overarching skills needed to

accomplish this level of support is best provided by a

stand-alone Child and Special Parenting Service that

combines expertise in child, family and intellectual dis-

ability work.

The Child and Special Parenting Service

The Exeter Child and Special Parenting Service evolved

in the late 1980s from the collective needs of parents

with intellectual disabilities, their children and the com-

plex child protection issues that can arise.

The strict criteria used by many learning disability

services frequently have a cut-off point of an IQ of £70.

Using such stringent criteria for entry to a parenting ser-

vice, in the experience of the authors, creates difficulties

in that it excludes a significant number of the more

needy families. Problems arise when intellectual func-

tioning falls within the borderline range, yet parents

needing support are unable to access and benefit fully

from the mainstream adult and child services. For this

reason, the qualifying criteria for provision used in this

service is an IQ of £85. This extended range is compen-

sated for by people whose intellectual functioning is in

the severe learning disabilities range in that they have

limited social skills and although this does not exclude

them, in many cases it prevents them from forming par-

ental relationships.

The designated service personnel in the Child and

Special Parenting Service (CASPS) are a consultant clin-

ical psychologist and a specialist family support worker

who have child, special parenting and learning disabil-

ity experience, and provide the co-ordination and conti-

nuity necessary for a flexible package of support. Other

personnel who become involved in support programmes

are professionals from social services, primary care or

learning disability who come together in response to the

needs of particular families.

There are two main components of provision. First,

the service provides domiciliary care to families within

their own homes. This long-term input helps to prevent

developmental delay and family breakdown. It includes

assessment and help with daily organizational tasks,

developmental goals, practical child-care, and offers

support to parents when attending appointments con-

cerning the child/children. It offers parenting advice

and support that is aimed at preventing child protection

proceedings.

Second, the service provides assessment and interven-

tion where child protection issues arise. Most often

assessment is requested where little is known about the

mother or father’s parenting skills, or where there are

clear child protection concerns. In these cases, the ser-

vice co-ordinates all the professionals concerned with

the assessment and support programme. Although

Social Services remain the lead agency, the CASPS has a

pivotal role given the specialist expertise it can provide,

and helps in bridging the gap between learning disabil-

ity and children’s service. If legal proceedings are initi-

ated, the professionals involved are co-ordinated into

the assessment or support package by the consultant

clinical psychologist. This creates a flexible situation that

efficiently utilizes the skills from two distinct services

and draws them together to meet the individual needs

of the family.

The two components of the service are not mutually

exclusive; there may be a change in the type of provi-

sion if child protection issues arise for a family who are

already receiving domiciliary care. Likewise, a domicili-

ary support package for a family as directed by the legal

process may be required. One unique characteristic of

the service is that it provides long-term support to fam-

ilies for as long as necessary and this may mean until

the child/children reach adulthood. It is noteworthy

that, in all cases where a family has received long-term

input from this service, the children have remained with

their parents.

Each family should be assessed according to its own

individual need; there is no convenient assessment

package that meets the needs of all. Flexibility and a

comprehensive approach are essential. Many of the

issues that arise for parents with intellectual disabilities

are to be found in generic family work, but some issues

are more likely to occur than others for this client

group, and these issues are associated with limited

intellectual ability, socioeconomic status and social vul-

nerability.

If child protection matters arise for a family where

one or both parents have intellectual disabilities, a

detailed assessment of their situation becomes neces-

sary. There is an obvious need to know, for all con-

cerned, whether the parents can meet their child’s needs

not only at that particular point in time, but also whe-

ther they will be able to maintain adequate care in the

future as the child grows and the needs change. Various



factors affect the type and nature of the assessment that

can be carried out and they also need to be taken into

consideration. For example, should the family remain at

its own home for assessment or should it be placed in a

residential unit? Alternatively, if the client is a single

parent with a baby should they enter a mother and baby

unit or a foster placement for assessment? Or, if the chil-

dren were already under care, would assessment in a

neutral environment be more appropriate in order to

meet the needs of the child? There are many existing

options for gathering the necessary information and the

decision should never be dependent upon finances but

rather on the circumstances of each individual case.

From the outset, it is suggested that specialist input is

essential to ensure that the parent fully comprehends

the child protection process and the possible outcomes

for both themselves and their children. This can only be

achieved by providing a service that understands and is

capable of responding to the needs of both the parent

and child. The present study evaluated the Child and

Special Parenting Service by examining the views of the

recipient parents and the professionals who had referred

to the service.

Method

Participants

Two groups of participants took part in the overall ser-

vice evaluation: 23 parents who used the service and 39

professionals who referred to the service (see below for

details).

The first group consisted of 23 parent consumers

(mothers) who were receiving a domiciliary service. The

characteristics of these families are provided in Table 1.

This shows the age, sex and marital status of the parent,

together with the number and ages of their children liv-

ing at home with them at the time of the study. All of

the parent participants were receiving support from the

CASPS at the time of evaluation.

All the participants who agreed to take part were

mothers and their age range was from 27 to 53 years,

with a mean age of 35 years. None of the participants

were in paid employment and all but one of them resi-

ded in areas of social and economic need as defined

by the Government’s Sure Start programme. This is a

Government initiative that is designed to tackle child

poverty and social exclusion. The resources are concen-

trated in neighbourhoods where a high proportion of

children live in poverty and where Sure Start local pro-

grammes can help them succeed by pioneering ways

of working to improve services (DfES, 2004). However,

it is interesting to note that none of the families

involved in this study received individual support

from the Sure Start scheme although they had the

opportunity to attend local family support centres if

they wished. All participants were in receipt of finan-

cial benefits but in the 16 cases (60%) where partners

existed, seven were in full-time employment. Four of

the 16 partners (of the 23 mothers) also had intellectual

disabilities. Forty per cent of the families had children

under 5 years of age and in 11 families (48%) one child

had been identified with intellectual disability and one

family had two children with intellectual disability

(Table 1).

The range of the number of children living at home at

the time of the study was 1–5 with an average of 1.65.

Forty-four per cent confirmed that there had been child

protection concerns about their children. Forty per cent

said that their children were or had been on the child

protection register. Twenty-two per cent of respondents

had had children removed into care prior to their

involvement with the Child and Special Parenting Ser-

vice. Of those respondents who had experienced the

removal of children, 40% had one child removed, 40%

had three children removed and 20% had five children

removed.

The second group of participants in this evaluation

consisted of 39 professionals who had made at least one

referral to the service during the previous 2 years. They

included, social workers, solicitors, guardians, midwives

and general practitioners.

Measures: semi-structured interview with parent

participants

The questions posed in the interview schedule were

devised by a clinical psychologist working with this

client group and a research psychologist. Letters invi-

ting clients to participate in the evaluation were deliv-

ered by hand to their homes by the study researcher.

The family support worker known to each participant

introduced the researcher to the family and time was

spent explaining the content of the invitation letter to

the parents and their agreement to take part was then

sought. They were informed that they were under no

obligation to take part and if they wished to withdraw

from the study at any time they were free to do so. Of

the 24 families receiving this service, parents from 23

families agreed to participate. All participants received

a verbal summary account of the outcome of the

study.



Semi-structured interviews were conducted with all

clients who agreed to participate. The questions were of

both the open and closed type. The themes of the inter-

view can be divided into two: (i) about the client;

(ii) about the service.

The questions were aimed at providing demographic

details of the family and a measure of the views of the

clients receiving a domiciliary service. There were a total

of 21 questions of which 15 were closed and six were

open. The questions included topics such as, the number

and ages of children who were currently living at home,

whether there had ever been child protection concerns,

and the number of children who had previously been

removed into care. Questions relating to the amount

and usefulness of support the mothers received from all

sources were also included.

Measures: questionnaire for professionals

A postal questionnaire was sent to the group of profes-

sionals defined above. The questionnaire consisted of

eight questions; six were closed and the other two were

open. The questions were aimed at eliciting details

about the professionals’ views of the service.

Procedure

The research psychologist conducted all the interviews

with the parents. A measure of cross-validation was pro-

vided by a separate interview being carried out with the

Family Support Worker who gave her perception of each

of the client’s circumstances. The responses she gave clo-

sely matched those of the participant in each case.

Table 1 Characteristics of participants

and their children

Participant Gender

Marital

status

Age of

parents

(years)

No. of

children

Age range of

children

(years)

Diagnosis of

learning

disability

1 F M 31 1 <5 No

1 5–12 Yes

2 F M 32 1 <5 No

3 F Co-hab 33 1 <5 No

4 F S 43 1 5–12 Yes

5 F M 28 2 <5 No

6 F Co-hab 35 1 <5 No

1 5–12 No

7 F S 33 1 5–12 No

8 F S 31 2 5–12 No

9 F M 40 1 <5 Yes

1 <5 No

10 F S 53 1 12–18 Yes

11 F S 36 1 5–12 No

12 F M 38 3 5–12 No

1 5–12 Yes

13 F M 34 1 <5 Yes

1 5–12 Yes

3 5–12 No

14 F Co-hab 35 1 5–12 Yes

15 F M 27 2 <5 No

16 F M 29 1 5–12 No

1 5–12 Yes

17 F M 29 1 5–12 No

18 F Co-hab 38 1 5–12 Yes

19 F Co-hab 31 1 5–12 Yes

20 F Co-hab 30 1 <5 No

21 F Co-hab 37 1 5–12 No

22 F S 38 1 12–18 Yes

23 F S 40 2 12–18 No

Gender: F, female; marital status: M, married, S, single, Co-hab, co-habiting.



Data coding

A content analysis of the open-ended questions was

completed. Participants’ responses to open questions

were placed in categories that had been identified and

agreed by one of the authors and the research psycholo-

gist. Table 2 below shows examples of the comments

made by the participants to the question: ‘What has the

Child and Special Parenting Service helped you with?’

Data analysis of postal questionnaire

In the postal questionnaire for professionals, a series of

questions were asked about the assessment and the

ongoing support provided by the service. The response

to a question was rated from 1 (minimum) to 7 (maxi-

mum). A content analysis was used for open responses

and the data were allocated to a category according to

consensus between the authors.

Results

Parent interviews

Frequency and type of support

All the respondents reported that they received regular

home visits. Figure 2 shows the response to the ques-

tion, ‘How long have you been getting visits from the

CASPS?’ Thirteen per cent had received input from the

CASPS for 10 years or more. It should be noted that the

cases accepted into the domiciliary service tend to

remain as long term and with the current increasing

demand for assessment it is predicted that the number

of long-term cases will increase and require expansion

of the service.

Figure 3 shows the responses to the question: ‘How

often do you see someone from the CASPS?’ Thirty-nine

per cent received weekly visits, 43% fortnightly and the

remainder monthly. As children enter and move

through the school system, the intensity of the support

and intervention required decreases.

Table 2 Examples of responses made by participants to the question, ‘What has the Child and Special Parenting Service helped

you with?’

Getting this house, bills, physio with my child, shopping

Given me confidence, came to Child Protection Meeting with me

Everything – mostly forms

Helped when intervention service went wrong recently, helped with disability team management

Helped to get children off Child Protection Register. I have nothing to do with Social Services anymore.

They give me advice on how to cope with my children. There is someone there to talk to.

Forms, letters, going to hospital appointments

Advice, forms, activities for my child

Helped when my child was ill, helped with forms. They give support when I’m down

Forms, liaising with child’s school

Letters to council for me

Generally being there when I need her

Preparing for the new baby. When the baby was born showing me what to do. Someone to ask when I have questions about what

to do with my baby

They take me and my child out for trips

Lots of things, school reviews, medical appointments, someone to talk to when things get on my nerves

Support – help when my husband was very ill

Talking and letting off steam

Helped to get my child back. Helps me with letters and everything I need

0

5

10

15

20

25

Per

cen

tag

e o

f re

po

nd

ents

<1 1 2 3 4 6 7 8 9 10 15

Years

Figure 2 Length of support by the CASPS.



The respondents were asked ‘What help do you get

from the Child and Special Parenting Service?’ The

responses were grouped by category as defined above

and are displayed in Figure 4. As a separate issue, direct

questions were asked about help received. Approxi-

mately one half (48%) of the respondents reported that

they got help with school reviews, and 22% with med-

ical appointments. Clients most valued help with bud-

geting, administration (90% got help with letters and

forms), support and empowerment, and all of them

received home visits.

Other sources of help

Sixty-three per cent received help from family members,

21% from other professionals, 10% from the voluntary

sector and 6% from family centres.

A qualitative analysis of the satisfaction with support

from CASPS

Clients were asked to comment on the usefulness of the

service. All replied that they found the service useful

and 78% found it very useful. General comments

expressed an overall appreciation of the support, good

service and reliability. The service was perceived as

acceptable, non-threatening and an alternative to social

services involvement.

In response to the question, ‘What is missing from the

service?’ three comments were made concerning

resource issues. In particular, the need for babysitting,

more staff and more information about financial grants

was raised. However, these are resource issues for com-

ponents of care beyond the current remit of this Service.

Professional user questionnaires

Questionnaires were sent to professionals who had

referred to the service during the previous 2 years.

There were 39 respondents, yielding a response rate of

72%. Both a qualitative and quantitative analysis was

carried out on the data.

The professional users found that the Service offered

good support to their clients and highly rated the

assessment reports that were found to be useful, bal-

anced and answered the questions raised. The Service

was also seen as preventative to family breakdown but

under-resourced and would benefit from further expan-

sion and access to residential facilities.

A content analysis was carried out on responses to

open questions. These responses were then categorized

by the authors as shown in Table 3. Other data not

shown in Table 3 relate to the frequency of use. The

respondents had used the service on average 2.8 times.

Excluding two missing values, 100% of the respondents

stated that they would recommend the service to their

colleagues.

The respondents who replied ‘yes’ to recommending

the service were asked to comment on why. The 51

0

5

10

15

20

25

30

35

40

45

Per

cen

tag

e o

f re

spo

nd

ents

1 2 4Number of visits per month

Figure 3 Frequency of visits.

Budgetting/administration

41%

Quality of life5%

Support with accessto medical

appointments16%

Support withmeetings

3%

Counselling/empowering

32%

School liaison3%

Figure 4 Type of help received from CASPS.

Table 3 Professional user satisfaction (maximum score ¼ 7)

Question Mean score

How useful was the assessment? 6.2

Was the assessment balanced? 6.1

Did the assessment address your question(s)? 6.0

How useful is ongoing support provided? 6.4



comments were grouped into categories agreed by the

authors as in Table 4. Single responses were not inclu-

ded as separate categories and they account for the

remaining 7.3% of the total responses.

Discussion

The results described above show that the support pro-

vided by the Child and Special Parenting Service is val-

ued by both the recipients and the referring agents. It is

suggested that the nature and flexibility of the model

used allows for long-term continuous support and adap-

tation to family need. This presents an alternative model

to the jigsaw of services described by Goodinge (2000)

where the focus is either on the parent or the child. It

offers an example of practice that brings together child

and learning disability professionals from disparate ser-

vices by using key personnel with specialist knowledge

of this client group.

This study indicates a gradual increase in the number

of families who are supported by CASPS, the majority

having entered the system during the last 5 years and

this is commensurate with other literature (McGaw

2000; Department of Health 2001). A total of 56.4% had

been receiving visits for <5 years and 46.6% had been

receiving visits for up to 10 years. It will be interesting

to repeat this evaluation in a few years time to confirm

the growth patterns and needs.

The over-representation in Child Protection Proceed-

ings reported by Feldman et al. (2002) is also reflected in

this study. A significant number (44%) of the partici-

pants had been involved in Child Protection Proceed-

ings and 40% of the children of these families had been

on the Child Protection Register. This signals the high

risk factors associated with this population but it also

reflects the anxieties and uncertainties for the profes-

sionals who work with them. It is suggested that the tra-

ditional model where child and learning disability

services work in parallel must be reviewed if the needs

of these families are to be met. It should be remembered

that the participants in this study are all successful par-

ents in the sense that none of their children have been

removed into care since they have received support

from the CASPS. This would therefore suggest that pre-

vious concerns which had resulted in children being

removed from families may have been avoided, at least

in some cases, if the appropriate support and a com-

bined skills approach had been available to them at the

time.

It has been reported elsewhere that parents with intel-

lectual disabilities have fewer support contacts than

those who do not have intellectual disability and that

they experience an absence of friendships (Llewellyn

et al. 1999; Stenfert Kroese et al. 2002). It is suggested

that the Specialist Family Support Worker for CASPS

maintains a professional role but is perceived by many

of the parents as having a similar function to that of

friend. It is important to this model that the Special

Family Support Worker provides a continuity of support

and remains involved in a facilitation role until the chil-

dren become adults.

The long-term nature of the relationship allows the

development of invaluable knowledge and trust, and

where problems arise they are promptly dealt with. This

flexibility is essential to this practice where appoint-

ments are not timetabled but are negotiated at each visit

according to need. If the parent has to attend a meeting

concerning his/her child or has housing or financial

issues to deal with, the Special Family Support Worker

will be there for them if they so wish, thus providing

examples of ‘competence promoting’ support as des-

cribed by Tucker & Johnson (1989) and support in crisis

(Hashima & Amato 1994), consequently, alleviating

stress factors that might arise for the parent (Stenfert

Kroese et al. 2002). The nature of this support contrasts

significantly with a short-term response that is often

used where family support workers from children’s ser-

vices are sent to work with the family for limited peri-

ods of time, knowing little or nothing about intellectual

disability and ultimately withdrawing their service

through lack of engagement. Additionally, much of the

emphasis of this limited support is focused on families

with pre-school children and where no Child Protection

concerns exist, the support is usually withdrawn at the

time the children reach school age, leaving the families

to receive future services on an ad hoc basis.

Table 4 Professional comments about the CASPS

Category of response Number Percent of total

Specialist/expertise 18 32.7

Supportive 9 16.4

Significant impact for families 7 12.7

Unique 3 5.5

User-friendly 3 5.5

Valuable 3 5.5

Advocacy 2 3.6

Child focussed 2 3.6

Education for other professional

(overcoming prejudice)

2 3.6

Objective 2 3.6



So what sets this model apart? The Child and Special

Parenting Service has, from its inception, proved diffi-

cult to be categorized into any administrative system of

care provision. As a consequence, it has suffered from a

lack of funding and appropriate resources in that it has

no designated budget and operates with just two full-

time staff. Yet, despite experiencing what may be the

inevitable consequences of innovative practice, it is

highly valued by the service users and goes some way

to making the jigsaw fit for the parents it supports.

It is a service that has evolved from a strong commit-

ment to respond to the needs of the client group. It is

neither a child nor an adult service but is truly a spe-

cialist family service that acts as linchpin to bring

together and co-ordinate the workers who can meet the

needs of all family members. It provides not only short-

term assessment but also domiciliary long-term support.

This evaluation has gone some way to show that it is

possible to develop a good model of care for parents

with intellectual disabilities. However, it must be recog-

nized that the needs of these families can only be met

by providing a specific service that incorporates the

experience and knowledge of both child protection and

intellectual disability. The complexity of need is such

that the provision should combine all the necessary

skills and straddle what are usually considered to be

two distinct client groups.

Correspondence

Any correspondence should be directed to Sadie Young,

Consultant Clinical Psychologist, Honeylands Children’s

Centre, Pinhoe Road, Exeter, EX4 8AD, UK (e-mail:

[email protected]).

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Documents

Special Parenting and the Combined Skills Model