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1.2.11 Pre-Birth Assessment Procedure


Contents

  1. Context
  2. Purpose
  3. Principles
  4. Initial Contact Stage
  5. Initial Assessment Stage
  6. Child in Need Route
  7. Child Protection Route
  8. Public Law Outline
  9. Birth Planning Meeting
  10. Birth and Discharge of a Newborn Baby
  11. Pregnancy of Young People in Care
  12. Allocation and Case Transfer
  13. General Guidelines for Conducting Pre-birth Assessments

    Appendix A: Pre Birth Assessment Tool


1. Context

This guidance is intended to inform managers and practitioners involved in work with families prior to birth. It should be read by all social care staff including those who are working with young pregnant mothers in the Adolescent and After Care Service. It is of particular relevance to staff members involved in conducting pre-birth assessments.

The guidance is intended to inform a sustained approach to assessment in which parents are engaged and supported throughout the ante-natal period rather than a ‘stop start’ approach where there are long periods of time where no work is being undertaken. Identifying the needs of and potential risks to the unborn child at the earliest possible stage reduces the likelihood of last minute activity around the time of birth and the consequent distress to the family.

This guidance should be read in conjunction with the London Child Protection Procedures (which can be accessed via the button on the left hand side of the page) and the Southwark Protocols for Information Sharing between Agencies Working with Children, Young People and Families; Joint Working with Mental Health, Substance Misuse, Disabilities and Domestic Violence and Abuse (which are accessible on the Southwark Safeguarding Children Board website.


2. Purpose

The main purpose of a pre-birth assessment is to identify:

  • What the needs of and risks to the newborn child may be;
  • Whether the parent/s are capable of recognising these and working with;
  • Professionals so that the needs can be met and the risks reduced;
  • What supports the parents may need;
  • Plans to ensure the needs are meet and risks addressed.

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

  • Will the newborn 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 about the above a pre-birth assessment is indicated.


3. Principles

  • Pre-birth assessments should be undertaken within a multi-agency approach;
  • Early referrals should be encouraged in order to ensure the following:
    • Sufficient time is allowed in order to undertake a detailed assessment including the preparation of a detailed Chronology;
    • There is sufficient time to make effective care/protection plans;
    • Parents have time to contribute to any assessment and to increase the likelihood of a positive outcome to the assessment;
    • Parents are not being approached in the latter stages of pregnancy which is a stressful time in any event;
    • Support services can be provided in a timely fashion;
    • Late referrals receive the highest level of priority.


4. Initial Contact Stage

The  MASH Team will be responsible for screening all pre-birth referrals coming to the  Assessment and Intervention Service. These will be undertaken within 24 hours of receipt in order to ensure a consistent approach to the process. If there is insufficient information to establish whether the grounds are met for undertaking the assessment, the MASH Manager will liaise with the referring agency e.g. midwifery.

The MASH team  and the all the partner agencies in MASH will be actively involved in the screening process and will offer early consultation on cases where there is a mental health or other  components.

If it is considered that there are insufficient grounds for a Single Assessment to be undertaken, consideration should always be given to signposting the case to other appropriate agencies such as EH, Solace, SFFT and Children’s Centres etc.

It is important that the expected date of delivery (EDD) is ascertained from the Referrer at the point of referral and recorded on Mosaic. If this is not established at the point of referral this will be a priority task for the allocated social worker.

The details of the father of the child and/or the male partner of the mother should also be obtained and recorded on Mosaic.

There must be consultation with the health specialist in the MASH Service at this stage if there are any difficulties in establishing relevant health information, locating health visitors etc.


5. Initial Assessment Stage.

Pre-birth Single Assessments must be undertaken on all pre-birth referrals where the following factors are present:

  • There has been a previous unexplained death of a child whilst in the care of either parent;
  • A parent or other adult in the household, or regular visitor, has been identified as posing a risk to children;
  • A sibling is the subject of a Child Protection Plan;
  • The parent is a Looked After child;
  • A sibling has previously been Looked After voluntarily or via a Court Order/ Police Protection;
  • Domestic violence and abuse is known to have occurred;
  • The degree of parental substance misuse is likely to have a significant impact on the baby’s safety or development;
  • The degree of parental mental illness/impairment is likely to have a significant impact on the baby’s safety or development;
  • There are concerns about parental maturity and ability to self care and look after a child e.g. an unsupported young mother;
  • The degree of parental learning disability is likely to have a significant impact on the baby’s safety;
  • There are concerns about a parent’s capacity to adequately care for their baby because of the parent’s physical disability;
  • A child under 13 is found to be pregnant;
  • Any other concern exists that the baby may be likely to suffer Significant Harm including a parent previously suspected of fabricated or inducing illness in a child.


6. Child in Need Route

At the completion of the initial stages of the Single Assessment a decision may be made to undertake a more comprehensive Pre-birth Assessment. It is very important that this assessment involves relevant multi-agency professionals directly.

The Single Assessment should commence with a multi-agency network meeting to which the family and all relevant professionals should be invited.

It is crucial to involve midwifes and health visitors in the assessments. If the relevant health visitor cannot be identified, the health specialist's assistance should be sought. There should be at least one joint visit made with the health visitor and midwife during the course of the assessment and other joint visits with the health specialist and relevant agencies as appropriate. Where the parent is under 19 yrs of age, see 'Protocol for Joint Working between Social Care and the Family Nurse Partnership where the Mother or Expected Child may be a Child in Need or Looked After'.


7. Child Protection Route

7.1 Strategy Meetings

It is important that the potential risks to the unborn child are flagged up as early as possible to inform effective planning and in order to gather information at an early stage including relevant Police checks.

If it is evident at the point of referral or the completion of a Single Assessment that there are reasonable grounds to believe that the unborn child may be likely to suffer Significant Harm, a multi-agency Strategy Meeting must be held within 72 hours. Clearly it may become evident at any stage of the assessment that there are grounds to believe a child is likely to suffer Significant Harm, a Strategy Meeting should be held accordingly. This is particularly urgent where the referral has been received after 24 weeks’ gestation or where there has been an attempt by the mother to conceal the pregnancy (see 7.2 Late Bookings and Concealed Pregnancy).

Strategy Meetings should not be delayed purely in order to trigger a Child Protection Conference at a later stage.

These meetings must be held at the hospital in which the pregnant woman has been booked in line with the London Child Protection Procedures. Social workers and managers should refer to the London Child Protection Procedures in relation to the purpose and agenda for Strategy Meetings.

In cases where previous children have been removed by a Local Authority and continue to be Looked After, the allocated CLA social worker must be invited to the Strategy Meeting in order to provide relevant background information and history.

In cases where Care Proceedings had been conducted in Southwark, the Referral and Assessment worker should contact the Legal Department to request a copy of the legal file.

The CLA pre-birth liaison Senior Practitioner should be invited to attend Strategy Meetings in cases where there have been previous Care Proceedings. Their role will be:

  • To advise on areas of assessment;
  • To work to ensure that full historical information is made available within 7 days of the Strategy Meeting; and
  • To become involved in joint assessment work as appropriate.

The Strategy Meeting should consider the circulation of London-wide alerts if it is thought that the baby may be born outside St Thomas or King’s College Hospitals.

Hospital alerts should be authorised by the Pre-Birth Managers and sent to LSAadmin@london.nhs.uk.

Copies should also be sent to the Safeguarding Matrons for King’s College and St Thomas Hospitals and to the Quality Assurance Unit for circulation nationwide.

7.2 Late Bookings and Concealed Pregnancy

For the purposes of this guidance, late booking is defined as relating to women who present to maternity services after 24 weeks of pregnancy.

There are many reasons why women may not engage with ante-natal services or conceal their pregnancy, some of or a combination of which will result in heightened risk to the child.

Some of the indicators of risk and vulnerability are as follows:

  • Previous concealed pregnancy;
  • Previous children removed from the mother’s care;
  • Fear that the baby will be taken away;
  • History of substance misuse;
  • Mental health difficulties;
  • Learning disability;
  • Domestic violence and abuse and interpersonal relationship problems;
  • Previous childhood experiences/poor parenting/sexual abuse;
  • Poor relationships with health professionals/ not registering with a GP.

N.B. This list is not exhaustive.

In cases where there are issues of late booking and concealed pregnancy, it is extremely important that careful consideration is given to the reason for concealment, assessing the potential risks to the child and convening a Strategy Meeting as a matter of urgency.

The Strategy Meeting should take place at the hospital where the pregnant woman is or should have been ‘booked’ to deliver her baby.

Any plan arising from a Strategy Meeting should decide on the following:

The allocated social worker must contact the Midwifery Service and set up an immediate home visit within 3 working days to meet with the pregnant woman. Any home visit should set out clear expectations of engagement under a written parental agreement.

7.3 Parental Non-Engagement

There are many reasons why expectant mothers may fail to engage with the assessment, some of which relate to the factors outlined above. For example, a parent suffering from mental health problems may be reluctant to attend appointments or be compliant with medication. It is extremely important 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.

7.4 Pre-birth Child Protection Conferences

If it is decided that a pre-birth Child Protection Conference should be held it should take place as early as is practical and never later than 10 weeks before the due date of delivery, so as to allow as much time as possible for planning support to the baby and family. Where there is a known likelihood of a premature birth, the Conference should be held earlier. N.B. Drug using pregnant women are more likely to give birth prematurely, therefore early conferencing in such cases is vital.

7.5 Child Protection Plan

If a decision is made that the baby needs to be the subject of a Child Protection Plan, the plan must be outlined to commence prior to the birth of the baby.

The Core Group must be identified and should meet prior to the birth and prior to the baby’s discharge home after a hospital birth to make detailed plans at both stages.

7.6 Pre-birth Review Child Protection Conference.

The first Review Conference should take place within one month of the child’s birth or within three months of the date of the Pre-birth Conference whichever is sooner.


8. Public Law Outline

In cases where it has been agreed at Legal Planning Meeting that work should be undertaken under the Public Law Outline framework, there should be as little delay as possible in sending out Letters before Proceedings and holding Pre Proceedings meetings. This is in order to avoid such approaches to the pregnant woman in the late stages of pregnancy and to work with the family to explore all options in order to preferably avoid initiating Care Proceedings. There is also an opportunity to commission specialist assessments at this stage. For further details, see Legal Planning Meetings and Care Proceedings in Southwark: Practice Guidance Procedure.

In cases where there is a recommendation to initiate Care Proceedings at birth, cases should be booked into the monthly Legal Planning Meeting at the earliest possible date prior to the birth. The Single Assessment and full Chronology must be available at the Legal Planning Meeting and there should have been a referral for a Family Group Conference.

In the case of late referrals meeting the threshold for legal planning, the Head of Service can be requested to convene an emergency Legal Planning Meeting rather than waiting until the next Legal Planning Meeting. (For your information, LPM are held every Tuesday).

See also Care and Supervision Proceedings and the Public Law Outline Procedure, Pre-birth Planning and Proceedings.


9. Birth Planning Meeting

If the decision of the Legal Planning Meeting is that the unborn baby should be the subject of Care Proceedings, a Birth Planning Meeting must take place at the hospital. This is a professionals meeting which should be chaired by a Hospital Safeguarding Lead for Maternity Services. If the Safeguarding Lead Manager is unable to chair this meeting the line manager for the allocated social worker must undertake this task.

This meeting must take place at the most 7 working days after the legal planning decision. The decisions of this meeting should be recorded on the patient’s records by the lead midwife who will ensure that the midwives are fully appraised of the plan for the child.

The purpose of the meeting is to make a detailed plan for the baby’s protection and welfare around the time of birth so that all members of the hospital team are aware of the plans.

The agenda for this meeting should address the following:

  • How long the baby will stay in hospital (a minimum of 7 days is usually recommended to monitor for withdrawal symptoms for babies born to substance using mothers);
  • How long the hospital will keep the mother on the ward;
  • The arrangements for the immediate protection of the baby if it is considered that there are serious risks posed to the e.g. parental substance misuse; mental;
  • Health; domestic violence and abuse. Consideration should be given to the use of hospital security; informing the Police etc.;
  • The risk of potential abduction of the baby from the hospital particularly where it is planned to remove the baby at birth;
  • The plan for contact between mother, father, extended family and the baby whilst in hospital. Consideration to be given to the supervision of Contact - for example whether Contact supervisors need to be employed;
  • Consideration of any risks to the baby in relation to breastfeeding e.g. HIV status of the mother; medication being taken by the mother which is contraindicated in relation to breastfeeding;
  • The plan for the baby upon discharge that will be under the auspices of Care Proceedings, e.g. discharge to parent/extended family members; mother and baby foster placement; foster care, supported accommodation;
  • Where there are concerns about an unborn of a pregnant woman who intends to have a home birth, the Ambulance Service Lead should be invited to the Birth Planning Meeting;
  • Contingency plans should also be in place in the event of a sudden change in circumstances;
  • Hospital staff should be given clear instructions regarding any birth that is likely to occur over a weekend or Bank Holiday;
  • The Children’s Out of Hours Service should also be notified of the birth and plans for the baby.


10. Birth and Discharge of a Newborn Baby

The hospital midwives need to inform the allocated social worker of the birth of the baby and there should be close communication between all agencies around the time of labour and birth.

In cases where legal action is proposed or where the unborn child has been the subject of a Child Protection Plan, the allocated Lead Social Worker should visit the hospital on the next working day following the birth. The Lead Social Worker should meet with the maternity staff prior to meeting with the mother and baby to gather information and consider whether there are any changes needed to the discharge and protection plan. The social worker should record a brief note of their visit on the child’s medical notes, which should include the time, key points of the discussion, agreements and social work contact details. The Lead Social Worker should keep in daily contact with the ward staff and visit the baby and the parents on the ward on alternate days to meet with the parents.

If the baby is the subject of a Child Protection Plan, a Core Group Discharge Meeting should be held to draw up a detailed plan prior to the baby’s discharge home If this is not possible, the Core Group should meet within 7 days of the baby’s birth.

If a decision has been made to initiate Care Proceedings in respect of the baby, the Lead Social Worker must keep the hospital up-dated about the timing of any application to the Courts. The lead midwife should be informed immediately of the outcome of any application and placement for the baby. A copy of any Orders obtained should be forwarded immediately to the hospital.


11. Pregnancy of Young People in Care

When it is established that a young person in Care or a supported care leaver is pregnant, the referrer must ring for a consultation with the Pre-Birth Team. A decision can then be reached about the assessment process between both the referring team and the Referral and Assessment Service.

It should not be an automatic decision to complete a pre-birth assessment in relation to the pregnancies of all care leavers unless the thresholds are met as outlined above. Also see 'Protocol for Joint Working between Social Care and the Family Nurse Partnership where the Mother or Expected Child may be a Child in Need or Looked After'.

If the Section 47 threshold is met and a Strategy Meeting convened, a manager from the Adolescent and After Care (AAC) Service should be included. The AAC Service should provide a full written history and chronology of the young person either at the Strategy Meeting, or within 14 days following it. The meeting should consider the Care Plan for the young person and any additional resources needed to support the young person throughout the pregnancy. N.B. If a young person is looked after by another Local Authority and living in Southwark then the allocated social worker from that Local Authority should be invited to the Strategy Meeting.

If the young person’s placement is out of borough the CLA service must refer case of the unborn to the relevant Referral and Assessment Service. The London Child Protection Procedures clearly state that ‘where a child is a mother/expectant mother and is accommodated or subject to leaving care arrangements (potentially up to 25 years), and is placed by the originating authority in another borough, the authority in which the mother is living is responsible for the baby.’ However, in practice this is an area where there can sometimes be disputes regarding case responsibility. It is therefore important that case responsibility is negotiated at an early stage by managers. The Quality Assurance Service can also be consulted in terms of agreeing Child Protection Conference arrangements in such cases.


12. Allocation and Case Transfer

The   MASH Manager will be responsible for the initial screening of all pre-birth cases referred to the  Assessment and Intervention Service. A decision about allocation will be made within 24 hours of receipt of the referral. If the case cannot be allocated within the Pre-Birth Team, the case will be passed to the relevant  Assessment and Intervention Team on duty for allocation.

Cases where siblings of unborn children are already open to other Services or in Care Proceedings will continue to be allocated within those Services with the exception of the Adolescent and After Care Service. Cases of unborn children continue to be allocated in the CLA 0-12 Service if there are current Care Proceedings in progress in respect of the siblings. In cases where the court proceedings have concluded, the pre-birth assessment will be referred to the Assessment and Intervention service.

In order for work to be done with the family during the pregnancy appropriate cases should transfer to the Safeguarding and Family Support Services as soon as the Single Assessment has been completed. N.B. The transfer process should not necessarily be delayed until an Initial Child Protection Conference can be convened.


13. General Guidelines for Conducting Pre-birth Assessments

The importance of conducting pre-birth assessments has been highlighted by numerous research studies and Serious Case Reviews which have shown that children are most at risk of fatal and severe assaults in the first year of life, usually inflicted by their carers.

Pre-Birth Assessment is a sensitive and complex area of work. Parents may feel anxious about their child being removed from them at birth. Referring professionals may be reluctant to refer Adults at Risk and be anxious about the prospective parents losing trust in them.

It is important to undertake the assessment during early pregnancy so that the parents are given the opportunity to show that they can change. If the outcome of the assessment suggests that the baby would not be safe with the parents then there is an opportunity to make clear and structured plans for the baby’s future together with support for the parents.

Social Workers undertaking the assessments should seek the support and advice of the Pre-Birth Team who will be able to advise them on a range of issues. Access to appropriate resources, liaison with key professionals and undertaking joint assessment visits can be requested. The CLA Senior Practitioner working within the Pre-Birth Team can offer specialist advice on matters such as the meaning of history in relation to assessments where there have been previous Care Proceedings. The Health Specialist can also offer advice and consultation on a range of health related topics.

It is important that social workers do not conduct assessments in isolation. Working closely with relevant professionals such as midwives and health visitors is essential. Liaising with relevant substance misuse, mental health and learning disability professionals is also crucial. The liaison mental health worker will also offer advice on cases with a mental health component and become involved in liaison with mental health professionals.

The importance of compiling a full chronology and family history is particularly important in assessing the risks and likely outcome for the child. Where there have been previous children in the family removed, the previous Court documents such as copies of Final Court Judgements and assessment reports should be accessed at an early stage. If there have been Social Workers involved from the CLA service, they should be consulted and invited to relevant meetings.

Workers should try to compile a clear history from the parents about their own previous experiences in order to find out whether they have any unresolved conflicts, for example that may impact on their parenting of the child. It is important to find out their feelings towards the newborn baby and the meaning that the child may have for them. For example, the pregnancy may have coincided with a major crisis in the parent’s life, which will affect their feelings towards the child.

It is also important to find out the parents’ views about any previous children who have been removed from their care and whether they have demonstrated sufficient insight and capacity to change in this respect.

It is crucial to seek information about fathers/partners whilst conducting assessments and involve them in the process. Background Police and other checks should be made at an early stage on relevant cases to ascertain any potential risk factors.

Working with extended families is also crucial to the assessment process and achieving positive outcomes for unborn children. Consideration should always be given to convening Family Group Conferences in any cases where there is a possibility that the mother may be unable to meet the needs of the unborn child.

Family Group Conferences can enable the families to be brought together to make alternative plans for the care of the child thus avoiding the need for Care Proceedings in some cases. Parallel assessment of alternative family carers can prevent delays in Care Planning for the child. The CLA Senior Practitioner can advise on standards and practice in this area.

A pre-birth assessment tool is attached to this guidance to help social workers consider the key questions to address when undertaking assessments. It is important to provide an analysis of the likely impact of parental issues on the unborn child rather than just providing a description. For example, the likely impact of parental substance misuse on both the unborn and the newborn child needs to be spelled out explicitly.


Appendix A: Pre Birth Assessment Tool

Click here to view Appendix A: Pre Birth Assessment Tool.

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