Developmental Psychology. A Second Level course.

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Parenting, being a vulnerable adult and
communication needs an audit of service demand
and delivery. Jois Stansfield, Manchester
Metropolitan University Alison Matthews, Oldham
Community Health Service

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Issue

• Increase in referrals of adults with LD who are
  parents
• Social policy
• Every Child Matters (2003)
• Mental Capacity Act (2005).
• Valuing People (2001/ 2009)

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Principles the needs of a child must take
precedence over the rights of parents health
and social care services should provide parents
with LD with the support they need to care
adequately for their children parents with IQs
below 60 are unlikely to be able to parent
adequately unless they receive effective support
(McGaw, 20003) parents with learning
disabilities often receive attention from too
many, rather than too few professionals and are
often over- rather than under-assessed families
respond best to services which provide
predictable, consistent support, rather than
crisis intervention. McGaw (2000)
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Background

• Period book-ended by service delivery issues.
• Feb- April 2007 severe understaffing
• May 2007 root and branch re-organisation of
  service delivery by the authority
• November 2008 present 3 SLT maternity leaves
  and another on the way!!

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Speech and Language Therapy Generic Care Pathway
(after Malcomess, 2005)
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Triage Process Request referral form from SLT
service - paper/electronic. Complete form in
consultation with service user and carers as
appropriate Book appointment for triage session
at SLT service. This needs to be a key
member of staff and manager if possible. Sessions
held weekly on different days. If urgent
priority, telephone referrals accepted
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Assessment Process Therapist will assess
individuals Understanding of spoken language
Capacity to express self through any means
Communication environment Communication
partners Referrer will receive Assessment
report Communication support specification
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Database date of referral therapist
responsible date of triage assessments type of
intervention date of report
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• Method
• Data base
• establish the number of referrals over the 2 year
  period from Feb 07-Jan 09
• Case files
• reviewed to identify
• type of referrals
• source of referrals
• degree of urgency
• subsequent care pathway
• clinical outcome to date.
• Vulnerable adults reviewed
• Parents
• triage, assessment and intervention approaches
  logged.

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Results 122 referrals for assessment (others are
referred for updates of passports or
dictionaries) 3 sets of partners
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• Referrals
• from the vulnerable adult service, plus a
  range of other sources
• clients involved with a wide range of
  professionals, multiple interventions and case
  conferences
• each client normally assigned a social worker to
  support them, while the child/ren have a
  different social worker representing their
  interests
• identified urgency was related to the imminence
  of court cases, and potential level of risk to
  which children were exposed.

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Professional involvement with Gerry
N.B. This service user was in the throes of court
action intended to protect her child through
removing it and offering it for adoption.
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Statements about service user Pauline
BUT this person has long standing communication
difficulties, states that no-one (ie
professionals) will listen to her or give her
time to work out what they mean, and she doesnt
like being bossed about. She liked her last
social worker who has been moved on to another
role. Her child is in care .
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Communication skills and needs of parents with
learning disabilities Typically ability to
understand simple concrete concepts,
difficulties with low frequency vocabulary
complex and abstract sentences time
concepts non-literal language. All these
are issues in child care, especially court
cases Parents seen as non-compliant partly as
a result of lack of communication skills.
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Assessment issues Only one client-group-specifi
c UK based assessment (van der Gaag 2009) Other
assessments are either standardised on typically
developing children, or adults who have acquired
communication difficulties following a life of
normal communication. Appropriateness of using
child age norms? Usually not, but May help to
reduce length and complexity of utterance Courts
find this over-simplification helpful.
Clinical psychologists are using IQ tests after
a generation when these have not been seen to be
appropriate, as these too are useful in helping
courts to decide on the level of support needed
by parents.
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SLT intervention to act as communication
advocate in meetings reduce complexity of
language, slow the pace of communication down
ensure that the parent service user understands
what is being said producing accessible
information, e.g. visual timetables and memory
support for essential and desirable activities,
working to support the service users
understanding of key health and well-being
messages which must be complied with if parents
and children are to be allowed to remain as a
family unit.
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Robert Crisis referral. SLT assessment request
to establish Roberts ability to understand court
proceedings Non accidental injuries to child.
Process of investigation. Child taken into
care Police investigation Core Assessment / Risks
/ Needs of Child Core Assessment / Parenting
Capacity
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Robert Lives with fiancee. Sad their child is
not with them. Reports he has a bus spotting
company exchanging photos of busses with
customers. Travels to bus conventions around the
UK when he has the money. Care Aim 1
assessment and report for court Care Aim 2
onward referral (clinical psychology) Care aim
3individual intervention planned (accessible
information)
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Robert SLT assessment outcome High level
language and communication difficulties which he
was skilled at hiding.   Non-literal language
(e.g. metaphors) understood, but could not
inference.   The combination of unusual interest,
inappropriate social interaction and focus on
small details rather than a larger picture, were
typical of autistic spectrum behaviours.
Detailed report for court. He is likely to be
able to respond best to verbal input reinforced
by visual (picture, photo, or written)
support. No criminal charges were laid, and his
child was put forward for adoption. He and his
partner did not contest this. Individual
intervention not accepted by Robert. NB
too late.
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Noreen Predictable, consistent support Prior to
SLT referral Query non accidental injury to
child. Process of investigation. Support from
childrens services Joint Investigation with
Police Initial Assessment / Decision
Making Core Assessment / Risks / Needs of
Child Core Assessment / Parenting
Capacity Criminal Proceedings / Decision
Making Health Visitor involved to support
parenting Learning Disability Nursing team to
support personal healthy living, including
management of epilepsy during subsequent pregnancy
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Noreen referral to SLT Increase in demand on
Ns communication due to child protection
procedure Risk - foreseeable psychological/emoti
onal harm due to process and distinct possibility
of removal of child/ren Care Aim 1
stabilisation/ maintenance (e.g visual
timetable) Care Aim 2 assessment (joint
recommendations with psychology) Care Aim 3
anticipatory
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Noreen SLT assessment outcome Difficulties with
understanding verbal language AND does not
always say she hasnt understood. Visual memory
stronger than auditory memory Limited literacy
skills Some opting out, due to word finding
difficulties and embarrassment about speech
dyspraxia
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Recommendations from SLT and psychology
assessments Work with visual skills Show Noreen
what to do Keep it simple and slow Dont
presume Repetition Prompts Encouragement and
praise Work with the Core Group
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Care Aim 3 anticipatory Joint staff training
with psychology Accessible information Adaptatio
ns to processes eg supporting core group members
to simplify language, check back understanding
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Reasons we are worried
Why you need to do this
Things you need to do now
House is untidy and needs to be cleaned
Keep the house clean and tidy- use the timetables
to help you remember all the jobs
Some visitors dont care about the children and
might get hurt. Smoking in front of the children
will make them poorly
People visiting the house too much drinking and
smoking
No smoking
Make sure the children are safe
Safety of children in the house
If the house isnt safe the children might get
really hurt- they might have to go to hospital
If the children dont have a routine they will be
sad They might miss meals and drinks They might
be dirty
Not enough routine for children
Take your son to nursery
Money needs to be saved for important things like
food, gas electric.
If there isnt enough money the children will be
hungry and cold
Think about how you spend your money. Make sure
you have enough for food,gas, electric
What will happen if you dont do this? The
children wont be able to live with you.
What will happen if you do this the children
will be able to stay with you
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• Factors Contributing to successful outcome and
  subsequent changes
• TEAMWORK!
• Motivation of Noreen and her Mum to work with
  Core Group (key professionals)
• Support role of her mum
• Multi-agency communication and collective
  decision making
• Timely referrals (not waiting for another crisis)
• Changes to working practice especially around
  meetings
• Self advocacy encouraged
• Focus on positives as well as concerns in
  meetings

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Recently Noreen took part in a presentation to
1st year Speech and Language Therapy Students
about Accessible Information
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Summary Communication is one aspect of not
complying with advice Children need to be
safe, and parents need to be enabled to be good
enough parents Service users at present need
to be seen to be able to bring up their
children NB the level of communication required
in order to understand child care requirements
and proceedings
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References

• Malcomess,K 2005  Care pathways in C Anderson
  and A van der Gaag (eds).Speech and language
  therapy issues in professional practice London
  Whurr.
• DoH 2009 Valuing people now . Norwich
  Stationery Office.
• Department for education and Skills 2003 Every
  Child matters. www.everychildmatters.gov.uk
  accessed 10.12.08.
• Mental Capacity Act 2005 www.opsi.gov.uk accessed
  19.2.09.
• McGaw,S 2000 What works for parents with
  learning disabilities? Basildon Barnardoes.
• van der Gaag, A. 2009 Communication assessment
  and screening process. www.speechprofiles.co.uk.
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