IN PRACTICE

Assessment

What we know:

  • The level of a parent's intellectual ability bears little relationship to their parenting ability
  • How mothers manage their parenting role is influenced by their mental maturity and stability - having a positive and realistic picture of oneself, feeling valued as an individual, and feeling that one is an asset to one's children
  • Parental capacity assessments play a big part in what happens for families, particularly families in which a parent or parents have an intellectual disability
  • Generally requested for two reasons - to inform and to justify intervention - assessment outcomes however, can be problematic. This is because what is being assessed - parenting and family life, are essentially subjective and dynamic, and therefore open to many variables
  • There are multiple limitations inherent in current parenting capacity assessments:
    * An absence of any clear definitions as to "what is parenting?" and "what is good enough parenting?"
    * An inappropriate use of assessment tools
    * An over-reliance on IQ testing
    * A preoccupation with the parent's intellectual disability as the reason for any difficulty in parenting, over and above other factors such as poverty, emotional distress, social isolation and harassment
    * An undertaking of assessments in inappropriate contexts and circumstances rather than in the family's own home and environment
    * A lack of predictive validity
    * A failure to link assessment findings to intervention
  • For parents with intellectual disability, the conditions under which they are assessed will have a significant bearing on their performance such that their usual parenting behaviour may not be truly represented. This is particularly the case when the stakes are high eg., in cases where assessment findings will determine whether children will stay at home or be placed in care

What we can do:

The most appropriate way for workers to determine just who are parents with intellectual disability is to use an approach that is not just deficit and diagnosis-focused, but which also formally recognizes the parent's intellectual disability and acknowledges their resource and support needs. This involves:

  • Using acceptable standardized tests of intelligent quotient and adaptive behaviours;
  • Assessing a person's strengths and weaknesses across four dimensions: intellectual functioning and adaptive skills, psychological/emotional considerations, physical/health/aetiology considerations, and environmental considerations (living situation, work, education); and
  • Assessing those areas in which the person is thought to need support (eg., personal resources, other people, technology and services) and the intensity of support required (intermittent, limited, extensive and pervasive).

Assessments need to be undertaken under the following conditions:

  • Both the referrer and the assessor need to clarify and be clear about what is wanted from the assessment
  • An independent professional who does not have divided loyalties or biases that will influence assessment results should conduct the assessment
  • Parents should be informed about what the assessment will entail and what is expected of them. The process should be inclusive and collaborative. It is also important that the views of all family members and those involved with the family are canvassed

Assessments need to use the following methods:

  • Conducted in the family's home and community
  • Conducted across time and family routine. The assessment must take more than a snapshot of the family. It needs to be conducted over multiple visits, preferably at different points in the family routine
  • Be multidisciplinary. Regard should be given for the expertise that a range of professionals, including workers who provide in-home support and are involved with the family on a regular basis, can contribute to the assessment process
  • Because different tools focus on specific aspects of parenting, professionals need to be au faux with what tools are available; be able to access them; be proficient in administering them; and use them in a combination that appropriately covers all areas of parenting

Assessments also need to have the following scope:

  • Multi-dimensional/ecological approach. The assessment approach needs to take account of the interplay between the multi-systems that impact on the family
  • Functional/performance base. Assess what parents understand, do and are capable of doing in terms of their care responsibilities. McGaw's Parent Assessment Model provides a useful tool that investigates different functional dimensions of parenting
  • Beyond a typical constellation of parenting skills. Service workers need to look beyond the parents' cognitive limitations and look at the parent as a whole: the mother's way of perceiving things, her judgement, her reflection, her interaction as well as her role in caring for the health and safety of her child
  • Resources and Constraints. In addition to deficits the assessment needs to identify strengths and potential resources and supports that are found in the family's environment
  • Linked to therapeutic intervention and support. Assessment findings need to be translated into intervention strategies and inform individualized support planning
  • Specific limitations reported in findings. Assessors need to be clear about what can and cannot be concluded from their assessments. Given the current limitations of assessment tools and the lack of consensus regarding minimal parenting standards, assessment findings should be interpreted and reported conservatively

Based on the Wisconsin Council's Developmental Disabilities Supported Parenting Project, below is a comprehensive model of four key assessment areas:

  1. Family Environment - housing, basic physical needs, household organization, neighbourhood, social and other support networks
  2. Family Structure and Function - family roles, current status of the family, relationships within the family, generational and current family traditions
  3. Parent/adult - parental childhood experiences; health status; self image; capabilities; skills/knowledge; learning abilities; what parents already know, how this was learnt and how they learn best
  4. Child - pregnancy/birth/developmental history, health status, behaviour/emotional status, school history

This type of interactional approach to assessment acknowledges the complexity of families and parenting, and helps in identifying parental, child and environmental factors that individually and together may affect parenting capacity.

Want to know more? Check out these publications:

Spencer, M. (2001) Proceed with Caution: The Limitations of Current Parenting Capacity Assessments Developing Practice, Winter, 16 - 24.

Llewellyn, G. (1997) Support and Services for Parents with Intellectual Disability: What? When? How? By Whom? Report prepared for the Australian Family and Disability Studies Research Centre, School of Occupational Therapy, Faculty of Health Sciences, University of Sydney.

Llewellyn, G. (1997)Parents with Intellectual Disability: Learning to Parent: The Role of Experience and Informal Learning International Journal of Disability, Development and Education, 44 (3), 243 - 261.

Llewellyn, G. (1995) "First Hand Experience" - Parents with Learning Difficulties. Disability, Pregnancy & Parenthood International, 11 (July), 10 - 12.

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