Should parents with disabilities be allowed to keep their kids

A ruling in the US state of Massachusetts has raised the debate on whether parents with disabilities should be allowed to keep their children. Today Parent writes about a mother who won a 2 year battle to have custody of her baby who was apprehended by child protection soon after birth. This is an important decision when considered as part of the larger discussion about how people with disabilities are treated in our society.

This mother has what is called, "mild intellectual disability." Such a person would have a number of functional strengths along with some deficits. Yet, as the article notes, the odds are heavily stacked against persons with disabilities:

An estimated 4.1 million parents have disabilities in the United States — roughly 6.2 percent of all parents with children under 18, according to the National Council on Disability. Removal rates for children whose parents have an intellectual disability can be 40 to 80 percent, the council estimates.

I am of the view that disabilities require their own form of assessment for parental capacity. Key issues that must be addressed include:

• Does the parent have the ability to see the child for who he/she is?
• Does the parent also recognize that the child has needs that will change with age?
• Can the parent identify current needs and respond?
• If there are limits to the above, what supports are in place or could be put in place that would help with the deficits?  In this case, the parents of the mother made home and support available? 
• How, in fact, does the parent manage day to day requirements for self and the child?

There are, no doubt, other questions. There is a need for an environmental scan that will put the mother and child into a context where supports can be seen. Gaps would also be seen that could then be explored for supports.

This mother's mild intellectual disability is also part of the discussion. Disability exists on a continuum from quite mild to quite severe. Disability is not a one size fits all issue. Intellectual disabilities are getting better attention when child protection issues are considered. One disability that needs better attention is Fetal Alcohol Spectrum Disorder. Despite the word spectrum, it is often thought of as one disorder that comes in one form - disastrous. But it too has a spectrum.

Too much of the FASD and other disability literature has been written about the more profound forms of disorders. Let us begin to assess each parent for what they might be able to do and how that can work well enough for the child with the right supports in place.

Certainly not every parent is going to be able to do it - but many can and should be allowed.

To borrow a social work concept, let's consider the parent ecologically - individual strengths, immediate supports, external supports (such as parent coaching) and systemic supports such as health nurses and financial supports. Very few of us manage on our own.

The other aspect of the Massachusetts case is the role of kinship care. This has become almost a mantra in child protection to find kinship supports. So let's start there when working with persons with disability. Many have been using kinship, other informal and formal supports for most of their lives. Why would we not allow that as part of entering parenting as opposed to thinking that such a parent is going to go it alone.

Good enough parenting - a concept in need of development

Child protection is faced with difficult decisions about whether or not to sustain a family unit. That might mean that children are temporarily removed from parental care or they might be sustained in the family with supports. There are times that neither option is available.

But the question that often vexes workers is what is the standard against which to judge parents. There are certainly complex factors beyond the parents such as what are the needs of the child. By looking at parenting capacity and the needs of the child, workers can then consider the fit between the two. A parent may be capable of raising a child whose demands might fall within an average range but not be able to sustain the challenge of a high needs child.

What then is the standard of parenting capacity to be considered? There is a body of research that suggests the standard is “good enough” parenting. For example, Karen Budd has suggested this in some of her writing including her recent book on assessing parents in child protection matters. For the child protection worker, there is a need to figure out what that means in the case in front of them.

The term “good enough” appears to find its origins in the work of British psychoanalyst D.W. Winnicott who raised the idea that it is not appropriate to expect that a parent should approach perfection. Such a demand was unrealistic and something less than that is enough for children.

In a recent presentation, American writer and researcher Dr. Brenee Brown noted that a good question to ask a parent what kind of adult do they foresee their child becoming and can they model that.

Hoghughi & Speight (1998) offered the idea of three notions that could be included in the concept:

1.     love, care and commitment;

2.     consistent limit setting; and

3.     facilitation of development (p. 294).

In a very thoughtful essay, Ramaekers & Suissa (2012), explore the notion. One very valuable idea that they put forward is that parenting is a lived experience (p. 74). If so, child protection may enter the fray when the parent has fallen below a good enough standards but generally be good enough. Looking at the lived experience of the parent and the child offers ways to consider the longer view as opposed to a moment in time that resulted in child protection entering the family.  Has the event represented an exception to the lived experience or not?

Later in their article, they suggest that we might also consider how parents think, wonder, worry, deliberate, interpret and reinterpret what is going on with the child and between the child and the parent. Is there any capacity to reflect and adjust the parenting activity? Or, is the parent stuck in a lived experience that is chronically damaging to the child? What is going on in the relationship between parent and child?  To draw from Bruno Bettelheim, what is their way of doing it which leads to what outcomes for the child (see Ramaekers & Suissa, p. 85).

The concept of good enough also leads to the natural corollary that there will be mistakes. If you are not perfect and just good enough, then inevitable there will be moments when things are not good enough or certainly below desired. What then does the parent do with that?

The parent also exists in a social context. Does the standard equally apply across all such contexts? Except when there are such harmful behaviors as sexual or physical abuse (to name just two) there may well be situations that are tolerated in one social context and not in another. Child protection rolls are full of examples of disadvantaged populations being over represented. Do we look for good enough with an advantaged perspective or can we adjust the lens to know that poverty or other forms of disadvantage will change what is good enough?

An example of such a challenge is whether a disabled parent can be good enough. Swain & Cameron (2003) writing about a small sample in Australia make a fascinating argument that such parents can achieve good enough. However, they also note that the mere existence of the disability can cause child protection systems to quickly judge them as below that standard.

Perhaps we need to acknowledge that we need  not agree with a parenting strategy but accept it if that strategy allows a child to develop in a context in which they are likely to be successful. Prusak (2008) has written a very challenging piece in which he looks at that argument in the context of the Amish people in the USA who may not allow their children to finish school in the public system. Are they doing harm or are they raising children within a belief system that can work and provide the child with a developmental trajectory that is at least good enough?

We have much more work to do in this area but this is an important debate that has not received sufficient attention. Child welfare workers are guided by legislation but it is understanding the concepts of things like good enough that will help them apply legislation in a way that helps children and families.

References:

Budd, K.S., Clark, J. R. & Connell, M.A. (2011). Parenting capacity assessment in child protection. New York: Oxford.

Hoghughi, M. & Speight, A.N.P. (1998). Good enough parenting for all children – a strategy for a healthier society. Archives of the Diseases of Children, 78, 293-296.

Prusak, B.G. (20-8). Not good enough parenting: What’s wrong with the child’s right to an “open future”? Social Theory and Practice, 34 (2), 271-291

Ramaekers, S. & Suissa, J. (2012). Good enough parenting? In (eds). The claims of parenting: Reasons, responsibility and society (pp. 73-97). London: Springer

Swain, P.A. & Cameron, N. (2003). ‘Good enough parenting’: Parental disability and child protection. Disability and Society, 18 (2), 165-177.