Full care order for young child with special needs, mother has a mild intellectual disability – 2020vol2#23

A District Court in a provincial city granted a full care order in the case of a preschool age child whose mother had a mild intellectual disability. The court heard the child, A, the youngest of three children, came into foster care at six months due to failure to thrive and had since been diagnosed with global developmental delay. The mother lived with her parents and one of the older siblings had developmental delay. The father of the older children provided some support for the older children.

The Child and Family Agency (CFA) social worker, the guardian ad litem (GAL), a Barnardos’ family support worker, a paediatrician, a psychologist and the mother all gave evidence. The psychologist gave her evidence by video link due to COVID-19 public health guidance. The mother was legally represented. The CFA had been unable to locate the father of the child who had played no role in the child’s life.

The CFA solicitor said the mother had been diagnosed with a mild developmental disability in 2002 and he was very conscious she was a vulnerable person and he was not going to make things more difficult. The witnesses would be focusing on what A needed, he said. He told the court the case was not about wilful neglect, but the child had high needs and it was the view of the CFA and the GAL that this would be difficult for any parent as the child needed a team of professionals into the future.

A had been diagnosed with global developmental delay and was under the care of a consultant paediatrician. He was referred to the early intervention team where he attended speech and language therapy, a dietitian, a dentist and an ophthalmologist. “Unfortunately, [A’s] best chance to reach his potential is in the care of the CFA and not in the care of his mother, who unfortunately lacks capacity,” he told the court. The court heard the foster carers whom the child had been with since he was six months old were his approved long-term foster carers.

The mother’s barrister said the Irish state had ratified article 23 of the Convention on the Rights for Persons with Disabilities which meant the state had an obligation to respect the family and home life of persons with a disability and to take this into account when providing support structures. She told the court the mother would consent to a one-year care order and to increased access to two hours twice a week to allow the mother to attend counselling. She said she should have been notified in advance that A needed lifelong intervention, and this was the first time she had heard this.

The CFA solicitor said A should not have to wait for his mother to improve and the mother had supports going in five days a week for A’s first six months and Barnardos were also involved and the CFA had tried everything but to no positive effect.

Failure to thrive

The consultant paediatrician gave evidence that A was in intensive care at birth to get his feeding established before being discharged home. When she examined A as an outpatient, he was very wasted and did not have muscle bulk. He was not gaining enough weight for his normal development, to be able to sit up, she said.

Paediatrician: “What the mother reported sounded like plenty calories, [it] didn’t add up. A was in hospital for observation. The mother was not deliberately unaware of how much the baby was getting.”

The mother became upset on hearing the paediatric evidence and the judge allowed a short break. On resumption the CFA solicitor acknowledged the situation was upsetting for the mother and told the court he would take this into account.

The paediatrician told the court the mother felt the baby’s weight loss was due to feeding problems with formula milk and vomiting. The paediatrician disagreed with this and said the weight loss was caused by feeding mismanagement and lack of calories and she had considered medical malabsorption and chronic disease before coming to this conclusion.

She told the court she saw a difference in A’s growth gain and other areas of interaction in the first six months in care. There had been a big improvement and she agreed with the CFA solicitor that this had been impacted by the foster carer.

The CFA social worker told the court during the first six months there was high level input to support A at home which took the mother’s difficulties into account. This involved family support workers going into the house to help twice daily with feeding and sleeping arrangements. The court heard this did not work in terms of A thriving and the CFA called a child protection conference where it was decided it was in the best interests of A to bring a care order application. The social worker said it was decided to try a different environment where A would thrive, and he was placed with the present foster family. The court heard they were experienced foster carers, they had their own adult children and were committed to A.

The social worker told the court she believed the child’s progress would regress if returned to his mother’s care. She told the court reunification had been explored and a signs of safety framework had been followed, but she was advised no other person outside the family was able to step up to support the mother. The social worker told the court the mother’s parents were a huge support but from her conversations with the family she had been advised there was poor communication between the mother and her parents.

The social worker disagreed with the mother’s barrister that the mother could parent A with the right supports which she was entitled to on a statutory footing and with the encouragement of the CFA and professionals.

She agreed with the CFA solicitor A was part of the foster carers family unit. “[It] comes across as a very warm home, all looking to and aware of A’s needs. They go slower in the evening, less noise, tuned in and very aware,” she told the court. She said the foster carers were aware of A’s needs and the need for consistency and structure.

When asked by the CFA solicitor the consultant paediatrician said: “It would be very difficult for a parent with a limited capacity to have to be constantly watching and to keep at this day after day.”

The paediatrician agreed with the mother’s barrister that the professional supports would remain if A returned to his mother’s care.

Mother’s barrister: “Would it ease your mind with two [other] adults in the home?”

Consultant paediatrician: “A’s basic needs were not met in the home. This would make me very concerned.”

The mother’s barrister asked the paediatrician whether a consultant psychologist could come up with the right tools to support a parent with a mild intellectual disability to understand the right amount of formula.

Mother’s barrister: “[Could] it be possible with the right supports and two parents watching out and the support of an up to date psychological assessment she could be reunified in a manner that is reasonable?”

Paediatrician: “I don’t accept, I presume these things have been tried and haven’t given a result at this point.”

The mother, who was tearful during evidence, agreed with her barrister that she would like A to return home and she wanted 12 months to undergo counselling and get her house sorted. She told the judge she also found it hard to manage A in the current buggy and would need a bigger buggy.


Global developmental delay

The court heard A had global developmental delay and had been referred to the early intervention team where he attended speech and language therapy, a psychologist, an ophthalmologist and more recently a dentist. He would need supports going forward and into adulthood, the paediatrician said. A had sensory and behavioural issues and the paediatrician commended the foster carer on how she followed through at home on the advice of the different professionals and this meant continuing input on a daily basis at home.

Parenting programme

The court heard the CFA social worker referred the mother to a Barnardos parenting programme. The parenting support worker told the court the course specifically took account of the mother’s disability by simplifying concepts, using visual aids, and modelling how the parent should respond through understanding the child’s feelings and the parent’s response. The course was one on one.

There were 31 appointments of which the mother kept 15 over 14 weeks the court heard. The course was designed to help the mother with her two older children, but the same principles applied to A also, the parenting support worker said. The gaps in attendance caused difficulty in terms of recapping and maintaining consistency. The support worker agreed with the mother’s barrister that the mother had usually cancelled appointments and let the service know when the children were sick or she was having to attend access and there was always a valid reason.


Parenting capacity assessment

A psychologist who completed a parental capacity assessment (PCA) regarding the mother gave evidence over video link. She told the court she modified assessments for parents with an intellectual disability by not using complex sentence and metaphors. She said she used language in accordance with the mother’s own understanding.

The court heard the mother consented to the PCA and attended the first appointment with her social worker. The psychologist said the mother’s disrespect, anger and rage towards the social worker was difficult to watch and was most concerning. The mother calmed down once the social worker left, she said.

CFA solicitor: “It is fair to say [this was because] the mother had a learning difficulty.”

Psychologist: “Maybe.”

The psychologist said there was a gap of four months between the first and second appointment meeting when the mother lost her phone, and the client did not contact the psychologist through her social worker. The court heard the appointments took place in social work offices and psychometric vector intelligence scales were used and the mother answered questions regarding an adult attachment interview.

The mother understood her son was in care due to being underweight and getting sick on a specific formula which was changed when he went into foster care, the psychologist said. She also considered the mother would need an advocate in court as she said she might not understand what was being said in court. There was some disagreement in court between the CFA and the mother’s barrister as to whether the mother refused the advocacy service or whether the advocacy service closed her case.

The psychologist told the court she also observed the mother at a home access for A. She said the mother focused on A and when she asked the mother to turn off the TV and play with A, this was not well received. She said A was quite avoidant in his attachment and the mother was not rushing to him. Although there was no welcoming of A by the mother, the psychologist said before the end of access she did play with him.

The psychologist told the court she suggested to the mother she should attend therapy in relation to earlier trauma and the distress shown in her relationship with social workers. She said, “It is very difficult to open your heart and to embrace thinking of your children [when you have] a lot of trauma repressed [and] sadly a lot of historical trauma.”

The psychologist disagreed with the mother’s barrister that the maternal grandparents in the home fulltime would provide enough support. “The return of A would cause a lot of stress and I was not aware the grandfather was at home; I know he was supporting appointments with B and C. Both parents when [there was] significant emotional dysregulation at the meeting [with the mother] said, ‘now you know what we have to put up with’,” The psychologist told the court.

The mother’s barrister told the court the father of B and C and the grandfather now supported the mother with appointments.

Mother’s barrister: “If they were informed of appointments and the mother underwent therapy could you see reunification in 12 months?”

Psychologist: “No. A has special needs. The mother was offered an opportunity to make contact with national counselling.”

Mother’s barrister: “Is it in someone’s interest to start or should they move at their own pace?”

Psychologist: ”All I can do is point the way forward.”


The GAL told the court a meeting needed to be held with the mother to review access which was happening once a week. She said the access worked better when it was structured and when unstructured the mother missed a lot of what A was trying to tell her. She said access needed to be looked at in terms of A’s therapeutic and developmental needs and his ability to receive support from his caregiver. She supported access being at the discretion of the CFA if an order was made to allow flexibility and the use of a playground.

Long term care order

The judge said this was a sad case and A was taken into care for most of his life and he remembered the initial concern in the case was A not thriving and concerns about his mother’s ability and coping.

Judge: “In all her dealings [the mother is] a lovely person who wants the best interests of her children and is to be commended, and, as pointed out by counsel she is entitled to benefit from legitimate statutory obligations and to rely on that legislation or convention. I’m glad to say the mother has been very well represented by her legal team today. I am going to make an order under section 18(1)(c) on the sheer weight of evidence. I am not going to go through the evidence”

The judge said A was a full-time job in all areas of his development, he had no safety awareness and needed significant help into adulthood. Initially he said the CFA was looking towards reunification and six-month intensive support was put in place. He said the social work bottom line was if A returned home, he would regress but he wanted to acknowledge this had been explored.

He said he heard the psychologist evidence the mother had issues and about how this impacted on her ability to look after A who needed a stable environment and who did not do well in a non-structured environment. Because of A’s needs, he said caring for him was a full-time job and challenging for anyone.

The judge said: “The mother has always attended court regarding this matter and always attended access and prioritised access with A over everything. She strikes me as a very decent and well-intentioned person and a very good mother within the parameters of her ability and I have no doubt she can look after A better than anyone else.

“It is only natural she has a difficult relationship with the social workers and in particular the current social worker bore the brunt of her frustrations. Sometimes people have to make difficult decisions and hopefully she will understand any person who sees the CFA take their child, as they see it, may not have more articulate avenues open to them. “

The judge said he was of the view that it was absolutely in A’s best interest to make a care order under section 18 and directed the GAL to remain involved and put the matter in for review in 12 months. He said if the mother were not satisfied at that point that she did not have sufficient access he would have no hesitation in making a direction.

The judge wished everyone well.