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2004 Jordan Institute
for Families

Vol. 9, No. 2
January 2004

Family-Centered Practice with Parents with Cognitive Limitations

In family-centered child welfare practice the family is the primary unit of attention. Respecting, strengthening, and supporting the family—while guaranteeing child safety—are the hallmarks of this method.

Using this approach with any parent requires resourcefulness and conscious effort. To identify and build on a parent’s strengths, child welfare workers must first believe that the parent has strengths to build on. This can be difficult when, as so often happens, there are significant cultural and socioeconomic differences between the worker and the parent. When the parent in question has cognitive limitations, workers may find the family-centered approach doubly challenging.

Attitude Matters
Believing in the potential of the parents you work with is critically important to family-centered practice. Research indicates this is especially true when parents have cognitive limitations. One study found that families whose children were removed permanently typically had only limited support, lost their support at a crucial time, or were viewed as incompetent by key figures within their support system (Espe-Sherwindt & Kerlin, 1990). Another found that the ability of parents with learning difficulties to succeed is significantly influenced by the attitude of the helping professionals, family members, and others who make up the family’s support network (Tymchuk,1990).

This suggests that child welfare workers’ values and attitudes towards parents with learning difficulties are just as important as their knowledge and skills (Booth & Booth, 1993).

Overcoming Biases
Yet believing in parents with cognitive limitations can be difficult, especially for those struggling with personal stereotypes and prejudices about people with developmental disabilities. The following discussion of research findings may make it easier to overcome these biases:

People with cognitive limitations can be good parents. Research has found that the ability of a parent to provide adequate child care is not predictable on the basis of intelligence alone (Booth & Booth, 1993; Field & Sanchez, 1999). When they succeed as parents, people with intellectual disabilities often do so on the strength of their emotional interactions with their children and—especially—on the strength of their social supports.

This is not to say that every adult with developmental delays is or can be a good parent. Like everyone else, the ability of people with learning difficulties to parent successfully depends on a wide range of factors, including environmental stresses (unemployment, housing issues, other crises), the models of parenting to which they have been exposed, and the strength of their support network.

Studies have shown that people with intellectual limitations often exhibit similar parenting deficits, such as failure to adjust parenting styles to changes in their child’s development, a lack of verbal interaction with the child (especially failure to praise), and insufficient cognitive stimulation. Critics of these studies point to their methodological flaws, most notably their failure to control for the effects of poverty (Booth & Booth, 1993).

Children can do well in these families. Many children raised by parents with cognitive limitations go on to lead healthy, normal lives, despite the fact that the environments in which they are raised are filled with difficulties (Booth & Booth, 1998a). Protective factors that make it possible for these children to succeed include personal traits (sociable, responsive to others, outgoing), family characteristics (warm, stable, and secure), and external factors such as supportive relationships outside the home and participation and involvement in the wider community (Booth & Booth, 1998b).

At the same time, research has found that children of parents with cognitive limitations are at risk for a number of negative outcomes, including developmental delay, poor school performance, and removal from their families. Though they may be due more to poverty than parental disabilities, these risks are recognized by our service delivery system. For example, having a parent with cognitive limitations is one of the risk factors that can make a young child eligible for early intervention services in North Carolina.

Parents with cognitive limitations who need improvement can often learn to be better parents. Even when people with cognitive limitations have clear deficits in their parenting skills, research suggests appropriate training can help them improve (Thompson, 1984; Feldman et al., 1989; Whitman et al., 1989). Specially designed training courses have been shown effective in teaching parents to nurture their children, to express their affection appropriately, and to learn essential parenting skills such as menu planning, grocery shopping, and techniques for managing problem child behaviors (Field & Sanchez, 1999).

Reflecting on this research, the bottom line is that people with cognitive limitations are like other people—some will be good parents, some will not. The only way to assess and support them is on an individual, person-by-person basis.

Finding Strengths
Many parents with cognitive limitations are isolated, poor, and unused to thinking of themselves and their lives in strengths-based terms. To discover family strengths social workers need to use observation and creativity.

For example, a child welfare worker could react with dismay at the sight of a mother and her children eating off a newspaper “table” on the floor. Alternatively, he could see it as a demonstration of the mother’s ability to establish a mealtime routine and to solve the problem of having no furniture. If he can see and build on small successes in a difficult situation, the social worker has the opportunity to build the parent’s self-esteem, dignity, and competence (Espe-Sherwindt & Kerlin, 1990).

In seeking to support parents with cognitive limitations, child welfare workers should actively seek out and/or try to develop benefactors for them. A benefactor is someone without learning difficulties who helps with the practical difficulties of coping with everyday problems (Edgerton, 1967). “The one feature that has consistently been shown to distinguish families where the children remained at home from families where the children were removed is the presence of another adult able to give extended daily support” (Booth & Booth, 1993).

The presence of a benefactor can be essential to the success of one of the most important family-centered strategies practiced in North Carolina—child and family team meetings.

Child and Family Team Meetings
Research and the direct experience of child welfare workers indicates that parents with cognitive limitations sometimes resist efforts to support them. “One study found that their opinions strongly diverged from the views of social workers 85% of the time” (Field & Sanchez, 1999). Child and family team meetings may be one of the best strategies for overcoming this barrier, since they allow parents to help create their own service plans.

Joan Pennell, of NC State University’s Family-Centered Meetings Project, has these suggestions for involving parents with cognitive limitations in child and family team meetings:

  1. Take time to explain and re-explain the process to the parents. Expect the preparations to be longer.
  2. Involve “benefactors”/support people (e.g., family’s pastor, trusted relative) who can help the parents understand what is happening and make sure their views are heard at the conference.
  3. Include in the plan someone from the parents’ support network to help them follow through on the action steps and get help as needed.

Janice Doyle, a family assessment worker from Alamance County DSS, has held child and family team meetings with parents with cognitive limitations. She urges caution when inviting people to meetings. Because parents with developmental disabilities typically have so many issues and can be involved with so many systems, she says, child welfare workers may be tempted to invite lots of people. “Sometimes,” she says, “that can be a mistake.”

Like other people, these parents can feel threatened when surrounded by professionals and strangers in child and family team meetings. Doyle says that one mother she worked with felt so overwhelmed that she shut down. “She stared at the ceiling without responding,” Doyle says. “People didn’t know what to think. But when I talk to her one-on-one and let her be the expert I find she’s a totally different person.”

We hope the points below, taken from the articles in this issue, will prove useful to you in your efforts to provide family-centered services to parents with cognitive limitations.

References for this and other articles in this issue

 
Key Points
  • People with cognitive limitations are like other people—some will be good parents, some won’t. Social workers should assess parents with cognitive limitations as individuals, hold them to the same standards as other parents, and provide them with educational and supportive services appropriate to their needs.

  • Individuals with cognitive limitations have a right to have and to raise children. Do not presume a parent is incompetent simply because she is cognitively limited. Approach each family with an open mind.

  • Most parents with cognitive limitations are poor. Neglect may be the result of poverty or other factors, not the parent’s mental capacity.

  • Provided the right supports and appropriate education, people with cognitive limitations who are struggling as parents can often provide effective care for their children. Agencies have a responsibility to provide the services these families need to stay together.