Pre-Birth Assessment Procedure and Guidance

1. Introduction

Research and experience indicate that very young babies are extremely vulnerable to abuse and that work carried out in the ante-natal period to assess risk and to plan intervention will help to minimise harm. A pre-birth assessment is a proactive means of analysing the potential risk to a newborn baby when there are concerns about a pregnant woman and where appropriate, her partner and immediate family.

Pre-birth assessments are a source of anxiety not only for parents, who may fear that a decision will be made to remove their child at birth, but also for professionals who may feel that they are not giving parents a chance. However, the Children Act 1989 is clear that there are grounds for intervention if there is a likelihood of Significant Harm and that the needs of the child (in these situations the unborn child) are paramount.

It is important that the reasons for the assessment are made clear to the parents at the outset and that there is clarity of understanding between professionals as to the purpose of the pre-birth assessment process.

2. Purpose of Pre-Birth Assessment

The purpose of a pre-birth assessment is to identify any potential risks to the new born child, assess whether the parent(s) are capable of changing so that the identified risks can be reduced and if so, what supports they will need. The pre-birth assessment must be of sufficient depth to inform future care planning. It must take into account family strengths as well as the risk factors to ensure that the new born baby receives the necessary level of support to achieve their full potential and be protected from immediate and future harm.

The undertaking of a pre-birth assessment is a multi-agency task led by Children's Social Care in collaboration with parents/carers which "should help us move from a reactive, crisis-led response to a more considered, proactive, and needs led response" (Calder 2003).

The aim of this procedure is to:

• Inform practitioners and managers as they undertake pre-birth work with families;
• To clarify what is meant by pre-birth assessments, their purpose and circumstances of use;
• To provide the basis for consistent and sustained approach to pre-birth assessment when the focus is on engaging and supporting parents throughout the ante-natal period;
• To evidence why time is needed to identify the needs and potential risks to the unborn child and to avoid the possibility of last minute emergency response at the time of the birth and increasing the likelihood of causing distress to the family at what is an emotional time.

Care must be given to working collaboratively with parents as a means of drawing together a balanced assessment with due consideration of parental strengths and capacity to change as well as areas of concern. However, it is critical that the needs of the unborn child remain at the centre of the assessment as opposed to those of the parent/s. There needs to be good consistent dialogue between professionals, recognition of the strengths and expertise that individual practitioners bring to the process and constant focus that the needs of the unborn child are paramount.

3. Involving Children and Families

Hart (2000) states that the positives of undertaking a pre-birth assessment is that it provides an opportunity to:

• Identify and safeguard the babies most likely to suffer future significant harm;
• Ensure that vulnerable parents are offered support at the start of their parenting career rather than when difficulties have arisen;
• Establish a working partnership with parents before the baby is born;
• Assist parents with any problems that may impair their parenting capacity.

The potential disadvantages include:-

• Parent/s may disappear or a mother may not come to hospital to deliver the baby. The stress may have an adverse effect on the parents' mental health or physical health;
• A risk that a mother could feel pressurised into harming herself and the unborn baby or terminating;
• Fear of losing the baby may jeopardise the attachment process between parent and child.

Hart (2000) indicates that there are two fundamental questions when deciding whether a pre-birth assessment is required:

• Will the new born baby be safe in the care of these parents/carer?
• Is there a realistic prospect of these parents/carers being able to provide adequate care throughout childhood?

Where there is reason for doubt an assessment should be completed.

Some parents will be aware of possible problems in caring for their child and may seek help from various agencies while others may be referred because of concerns identified by others. These may include:

• Where previous children in the family have been removed because they have suffered harm;
• Where a person posing a risk to children or someone found by an Initial Child Protection Conference to have harmed a child or has joined a family;
• Where concerns exist regarding the mother's ability to protect;
• Where there are acute professional concerns regarding parenting capacity, particularly where the parents have either severe mental health problems or learning disabilities;
• Where alcohol or substance abuse is thought to be affecting the health of the expected baby;
• Where there are concerns about domestic abuse;
• Where the expected parent is very young and a dual assessment of their own needs as well as their ability to meet the baby's needs is required. (If the expectant mother is a child/young person, or an open case to Children's Social Care they must have an allocated Social Worker in their own right);
• Where the expectant mother is not engaging in ante-natal care;
• Where the expectant mother is cared for or is a care leaver and does not engage with services.

4. Procedures for Pre-Birth Assessment

4.1 Referral to Children's Social Care

Any professionals or agencies who anticipate that prospective parents may need intensive support services to care for their baby or the baby will be at risk of significant harm, a discussion should be held with Children's Social Care. It is best practice to undertake the assessment during early pregnancy from 20 weeks; this provides parents with sufficient opportunity to show evidence of change. The pre-birth assessment is critical to inform practice and progression of the plan. This will enable the identification and completion of specialist assessments (where appropriate) to be undertaken and ensure that the assessment is robust and holistic prior to the birth of baby.

CSC will receive referrals in respect of unborn babies where deemed they may be a child in need or at risk at the 20 week stage of pregnancy (See above).

It is essential when making a referral to gather as much information as possible within their agency. Pre-birth referrals will be screened by the Referral and Advice Team. This will be reviewed within 24 hours and decision made as to whether the grounds/threshold have been met for undertaking an assessment. At the point of referral the following information should be sought from the referrer:

• The estimated due date (EDD) of the baby;
• Details of the father and/or partner should be ascertained;
• The presenting concerns such as mental health, substance misuse or learning difficulties;
• Any other pertinent health information.

Decisions will be based on the presenting evidence and threshold criteria. If the decision is that no assessment is required but that the parent/s would benefit from universal services support then information should be provided and sign posted accordingly. Consent should always be sought and referrers should ensure that that they have discussed the referral with parent/s and seek consent unless there are concerns that would place the unborn child at risk. If the referrer is not satisfied with the response from Children's Social Care they should raise their concerns with their Designated Person for Child Protection.

The young age of a parent should not automatically be seen as an indicator of risk, but there are occasions where the young person themselves has needs which requires assessment under either Child in Need or Child Protection Process.

The Local Authority will determine the way forward in relation to the agencies response. Where the decision made is that no further action should be taken at this stage the referrer should be informed of the decision and rationale and be advised of alternatives where appropriate. i.e. EIP Children's Centre's.

The development of TAC/EIP assessment and plan should follow the same principles of active multi-agency collaboration planning and review as advocated in this policy. The plan may form the evidential basis for future intervention so the process needs to be clear and robust.

4.2 Assessment Stage

Practitioners need to take a holistic child approach to practice (See Child and Family Assessment Procedure for further guidance), where the focus is on determining the level of support needed to parent safely. Pre-birth assessments should be undertaken within a multi-agency approach. Social Workers need to work closely with relevant professionals such as midwives, health visitors, mental health, substance misuse, learning disabilities.

When undertaking a risk assessment, there should always be an explicit agreement as to how the views of children and parents are to be obtained and how they will be represented, either within the context of a report or at a child protection meeting, such as a child protection conference. Involving parents where there are child protection concerns should lead to improved family assessments, more focused interventions and better outcomes for children. The assessment process should also be fully shared with parents to encourage and support their understanding of service interventions and their potential participation.

Pre-birth cases will be managed in a number of different ways, depending on family circumstances and outcome of the assessment.

4.3 Child in Need

A Multi-Agency CIN Planning Meeting should be convened if there are concerns; but the concerns are not sufficient to lead to the likelihood of significant harm and there is meaningful family co-operation and agreement regarding concerns and the way forward. The focus of the Child In Need plan will be dependent on the stage of the pregnancy. It will either plan the completion of the pre-birth assessment and a support package to the parent/s prior to the birth or it will focus on the provision of support once the baby is born. Family Group Conferences can also be held prior to birth to help identify whether there is realistic support available from family and friend network and identify alternative plans.

4.4 Child Protection

It is imperative that any potential risks are highlighted early on to inform effective planning and gather information at an early stage. If there are reasonable grounds at the point of referral or following/during completion of assessment then a multi-agency strategy meeting should be convened within 72 hours. This is particularly important where a referral is made post 24 weeks or it is a concealed pregnancy. The decision will need to be made whether to enter the Public Law Outline process or initiate Care Proceedings.

If it is agreed that a Child Protection Conference is necessary this should take place within 15 working days following the initial strategy discussion. The social worker will be responsible for implementing the subsequent pre-birth child and family assessment which is the basis of the Child Protection Conference Report.

This will draw together the professional concerns and should include information from the pre-birth assessment report, if this has been completed as part of an earlier child in need intervention and any common assessment framework assessment and plan. It will also contain relevant information gained from midwifery services, background information from the prospective health visitor, GP and other relevant agencies.  The aim of the child protection conference is to enable professionals with particular expertise (even if they are not currently involved with the family), those most involved with the family, and the family itself to assess all relevant information and plan how to safeguard the unborn child and promote his or her welfare. There must be representation from the midwifery services, health visiting and other professionals as appropriate.

4.5 Parental Non-Engagement

There are many reasons why expectant mothers and fathers may fail to engage with the assessment process. What is important is that parental non-engagement does not become the reason for delaying the assessment and making multi-agency plans and contingency plans for the birth of the baby.

4.6 Pre-Birth Child Protection Initial Conference

The decision is made to hold a Pre-Birth Child Protection Conference no later than 10 weeks before birth of the child to allow as much time as possible for putting the plan of support to the family and baby once born. There is also the need to factor in premature birth. Where there is potential for this, then the conference should be held earlier, for example, with drug using women or where they are expecting twins.

If it is agreed that a Child Protection Conference is necessary this should take place within 15 working days following the initial strategy discussion. The social worker will be responsible for completing the subsequent pre-birth child and family assessment which is the basis of the Child Protection Conference Report and should draw together the professional concerns.

4.7 Child Protection Plan

The outline Child Protection Plan will be available within 48 hours and emailed to attendees. The minutes of the conference should be available within 15 days of the conference being held.

The point within the pregnancy is likely to determine the focus of the plan i.e. completion of the pre-birth assessment and the minimisation of risk to the unborn child during the antenatal period, or the planning for the immediate safety of the child once delivered and the management of risk during the post natal period.

If decisions are made that the baby needs to be subject to a child protection plan, the plan must be in place prior to the birth of the baby. The Core Group members identified should meet prior to the birth and prior to the baby's discharge home to ensure appropriate plans are in place. Hospital staff and the lead midwife responsible for the patients care should be involved with the development of the child protection plan as well as any other professional identified within the child protection case conference.

There should be a clear communication pathway within each service to ensure the professionals involved e.g. midwife/health visitor are fully up to date with the plan and core group meeting dates. The child protection plan may need to consider any steps necessary to secure the immediate safety of the child when born. A pre-birth planning meeting will need to be considered together with the use of the police or legal options, following legal advice. In the majority of cases parents will have been involved from the outset and be aware of the level of concern. Staff at the hospital where the baby is likely to be delivered should be kept informed of the plan and any assessed risk to either the baby or staff. The Emergency Duty Team and Police should also be alerted to the child protection plan to cover situations that may arise out of office hours.

4.8 Pre-birth Review Protection Conference

The first review should be held within one month of the child's birth or within three months of the date of the Pre-birth Conference whichever is sooner.

4.9 Public Law Outline (PLO)

See Public Law Outline Toolkit - to follow.

Where there are significant concerns the PLO can be initiated prior to the baby's birth. Where a Legal Planning Meeting (LPM) (see Legal Gateway/Planning Meetings Procedure) has been held and the decision is that the Public Law Outline framework should be initiated then as per guidance the Letter before Proceedings and Pre-Proceedings Meetings should be held as per guidance timescales. This is an opportunity to engage parent/s in work that will prevent the need to initiate care proceedings and there is also the opportunity to commission specialist assessments at this stage. Where the decision is made to initiate care proceedings at birth, then an LPM should be convened at the earliest opportunity prior to the birth of the child.

4.10 Birth Planning Meeting

If the decision of the Legal Planning Meeting is for the unborn baby to become subject of Care Proceedings then a Birth Planning Meeting should be convened at the hospital the expectant mother is booked into. This is a professionals meeting and should be chaired by the senior midwife. The meeting should be held within ten working days of the Legal Planning Meeting. The meeting should result in a detailed plan to protect the child at birth, ensuring that all parties are aware of the plan which is confirmed in writing. The plan should address the following:

• How long the baby will stay on the ward;
• How long mother with remain on the hospital ward;
• Whether hospital security and police should be notified;
• If there are serious risks i.e. abduction of the baby the arrangement to immediately protect the child;
• The plan for contact with parents and extended family members and whether it needs to be supervised;
• The plan for baby upon discharge from the hospital;
• Clear instructions regarding birth if it takes place out of work hours;
• Contingency plan in the event of a change of circumstances;
• EDT 'out of hours' service to be informed of plans.

5. Birth and Discharge of New Baby

For the hospital midwife to inform the allocated social worker once the baby is born and close communication should be maintained around the time of labour and birth.

If the unborn child has been subject to a Child Protection Plan the allocated social worker should visit on the day following the birth. The social worker should meet with maternity staff prior to seeing mother and baby to gather information and determine whether there are any changes needed to the discharge and protection plan.

If the baby is subject to Child Protection Plan, a Core Group Discharge Meeting should be held to draw up detailed plan prior to baby's discharge home. If it is not possible for a Core Group Discharge Meeting to be held then the core group should meet within seven days of the baby's birth.

If the decision is made to initiate Care Proceedings in respect of the baby then the social worker should keep the hospital informed of the timeline for the court application being made and informed of the outcome of any application and placement for the baby. A copy of the Order once obtained should be shared with the hospital.

Appendix 1: Pre-birth Process for Pre/Care Proceedings Cases and Transfer Points

Click here to view Appendix 1: Pre-birth Process for Pre/Care Proceedings Cases and Transfer Points.