Pre-Birth Assessment Guidance

1. Introduction

A Pre-Birth Assessment should be viewed as a preventative assessment, predicting risks in advance of a child being born. The aim of which is to ensure a child's safety post-partum, including ensuring that parents that are vulnerable and/or in difficulties, receive the kind of support and services that they require in order to be able to parent effectively and at the earliest opportunity.

A Pre-Birth Assessment must be considered in the following cases (this is not an exhaustive list):

• Previous child(ren) have been removed;
• A child in the household is subject to a Child Protection Plan;
• A person who poses a risk lives in the household or joins the family;
• There are concerns about the mother's ability to protect;
• There are acute professional concerns regarding parenting capacity, particularly in relation to mental health, learning difficulties and / or domestic abuse;
• Where alcohol/substance misuse could affect the health and wellbeing of the baby or the adult(s) caring for the baby;
• Either parent is a Child Looked After/Care Leaver or are known to Children's Social Care;
• Either or both parents are under 18 years; or
• The pregnancy is denied or concealed;
• A Pre-Birth Assessment must be undertaken if either parent is a child looked after. The assessment will be undertaken by the locality teams.

2. Receipt of an Accepted Referral for a Pre-Birth Assessment/Role of the Multi-Agency Pre-Birth Panel

Upon receipt of an appropriate referral for a Pre-Birth Assessment, the unborn child must be entered on to Liquidlogic. An unborn child is recorded using the mother's surname. If the mother's surname is Jones, then this will be recorded as 'Unborn Jones'. Within the Unborn case record all relationships must be recorded, with every effort made to gather the details of the unborn child's father. It is important that the expected date of delivery (EDD) is ascertained from the Referrer at the point of referral.

When a referral for an Unborn Baby (or a family group which includes and Unborn) is made to EHASH this will be presented at the weekly multi-agency pre-birth panel for decision making and allocation. If Threshold is met for children and family pre-birth assessment this is allocated to either the Assessment Teams or Locality Teams (dependant on the presenting concerns and level of risk). If threshold is met for strategy discussion EHASH to arrange and Assessment Team or Locality Team to attend.

Unborn's will continue to be reviewed by the multi-agency panel at 12 weeks post referral, and again 6 weeks before Unborn is due to ensure assessments are timely, plans are in place and all agencies are aware of the plan for baby post birth.

If threshold is not met for a pre-birth assessment however, it is acknowledged that the family would benefit from support and consent has been given the this will be allocated to Early Help. Were there are no identified concerns, the outcome will be no further action and the referrer will be notified of the decision within 2 working days.

NOTE - If midwifery become aware that the pregnancy is no longer viable, the midwife will inform the allocated Social Worker. The Social Worker should contact the midwife on allocation of the Pre-Birth Assessment. This is to prevent undue distress to the family should the pregnancy no longer be viable.

At the start of the Pre-Birth Assessment a Pre-Birth Multi-Agency Planning Meeting must be arranged (see Section 3, Pre-Birth Multi-Agency Planning Meeting). This will be the platform for the sharing of information between all agencies and parents. As a minimum this should be completed by day 20 of the child and family assessment.

In addition to the Pre-Birth Multi-Agency Planning Meeting there are a number of other tasks that should be commenced, if appropriate. Below are suggestions that may be applicable:

• If learning difficulties are already identified for either parent, then contact must be made with the parent to ascertain if they require an advocate. Also see: Mental Capacity;
• If English is not the first language of the parent(s), then ascertain if a translator will be required;
• Contact parents(s) to ascertain if there are any restrictions on availability for assessment sessions, such as employment, existing appointments, etc.
• Draw up an initial plan of dates for completing the assessment which can be given to parent(s), including venue. If there are two people to be assessed, then both joint and individual sessions will need to be accounted for;
• System checks carried out, including police checks and if applicable, other authority checks;
• Read any case files for existing children (if applicable) including any past legal files;
• If there have been previous pregnancies, seek any details of these; and
• Commence a Chronology on Liquidlogic if one has not already been created.

Timescales must be adhered to in order that a thorough assessment and any subsequent planning are achieved. In the case of a concealed or denied pregnancy, it may not be possible to adhere to the times scales set out above. In such cases where a referral is received, the Pre-Birth Multi-Agency Meeting and the Pre-Birth Assessment must commence without delay.

3. Pre-Birth Multi-Agency Planning Meeting

The allocated Social Worker has responsibility for arranging this meeting. Unless there is a justifiable reason as to why parents should not be invited to this meeting, the parents and any advocate identified by them should be invited, as should any professional / service that is currently working with the family.

Prior to the Pre-Birth Multi-Agency Planning Meeting being held, the Social Worker should visit the family in order to explain the purpose of the meeting, including the commencement of the Pre-Birth Assessment. Parent(s) need to be fully informed of the purpose of the assessment, the process and how the findings of the assessment will be used. In addition parents should be reminded of their right to seek independent legal advice and informed of the complaints procedure.

The following is a list of other professionals / agencies who, if involved with the parent(s) / partner(s) should be invited to the Pre-Birth Multi-Agency Planning Meeting. This is not an exhaustive list:

• Midwife;
• Health Visitor;
• Children Centre Practitioner;
• Targeted Pregnancy Support;
• ReNew Drug/Alcohol Service;
• Probation;
• Housing;
• Hull Domestic Abuse Partnership;
• Sexual Exploitation Team; and
• Family Group Conferencing.

The Pre-Birth Multi-Agency Planning Meeting, whilst being respectful of parent(s) feelings, must be frank and honest. Attendees at the meeting must be prepared to share information openly and 'own' the information that they share.

As outlined in the Introduction, a Pre-Birth Assessment includes ensuring that parent(s) receive the kind of support and services that they require in order to be able to parent effectively at the earliest opportunity, the Pre-Birth Multi-Agency Planning Meeting is the starting point for this, and offers an opportunity to:

• Enable the early provision of support services to facilitate optimum home circumstances prior to the birth;
• Provide a multi-agency approach to supporting the family;
• Provide sufficient time for a full and informed assessment.

4. Finding and Building a Support Network

Within 15-20 working days into assessment an initial family / friends network meeting is to be held to look at the family's support.

5. Harm Analysis Matrix

Using the harm matrix for pre-birth assessments will be helpful for some cases, particularly were there has been previous involvement with older children. For some pre-birth assessments it may be helpful if the parent themselves has had significant CSC involvement in their lives to complete a harm matrix – you would not need to fill in the impact on the child section, but it may just help to organise the information.

6. Pre-Birth Child and Family Assessment

All pre-birth assessments should be recorded on the Child and Family assessment document on Liquid Logic.

The child and family Pre-Birth Assessment should commence at the point of referral, and be completed within 45 days of being initiated. This fits with the ethos of early assessment and planning which provides parents with every opportunity during the pregnancy to address worrying behaviours, and make changes before baby is born.

The Assessment cannot be completed in isolation, and the Social Worker must seek input from any other services involved with the family. Midwifery will always be involved, even if this is via non-engagement. The Social Worker must not take feedback from parent(s) as factual in relation to engagement with services; clarification must be sought from the actual service. Parents should be made aware of this, and any in-discrepancies discussed with them.

A Pre-Birth Assessment utilises the format of a Children and Family Assessment. However, unlike other assessments (unless unborn is part of a sibling group) there will be no child to assess, resulting in the need to utilise a more in-depth assessment of parents and their understanding and perceived ability to parent safely.

For SOS guidance and helpful hints please refer to the SOS C&F assessment guidance.

Social workers should consider which risk assessment / need assessment tools would be helpful to their work i.e. DASH / Barnardo's DV risk matrix, neglect tool kit, SCODA tool, SDQ etc. Please refer to the risk assessment tool kit – and ensure that any paper tools / resources used are scanned onto the child's file.

Please also refer to the appendix below which is based on the work of Martin C Calder - as described in Appendix 1: Martin Calder Unborn Children - Framework for Assessment and Intervention.

6.1 Completing a Genogram/Eco Map

This is a good starting point for all assessments and can be compiled with both parents to identify who is in their family, important people, and help to identify family scripts / behaviours. Completing an eco-map will help to identify who is important in the parent's lives, friends / family members, professionals.

6.2 Assessment Details - Reason for assessment

In creating the plan for this assessment consider the following issues:

• What is the purpose / reason for the assessment? What do you want to achieve in undertaking this assessment and any subsequent plan?
• Where did the referral come from (who is worried?);
• Planning – timescale to get the work done and what is the interim safety plan for the child whilst the assessment is being done. (what is keeping the child / Unborn safe while we do our work?);
• Prioritisation (how urgent is it that we make plans to improve things for the Unborn / child/ young person?);
• To complete the assessment who needs to be involved, seen, spoken to - where, how and how often?
• Is anyone else's consent required to speak to any of the stakeholders?

6.3 Assessment domains

What are we worried about?

Harm

Harm/worry statements summarise past behaviour that is currently creating significant problems, the worker should detail the specific concerns about the behaviour of the adults in the child's / Unborn's life, how often the harmful behaviour happens, how bad the harmful behaviour is and how this has affected the child (if applicable) / Unborn. The impact for the child / Unborn is the most important factor to consider. Write the harm/worry in language the parents will understand without minimising the seriousness of the concerns. Wherever possible use the words of the parents to describe the concerns.

Complicating Factors

Actions, behaviours, circumstances and events in and around the family, child and carers, and by professionals that make it more difficult to address the safety/wellbeing concerns.

There is a tendency to record every complication, challenge and difficulty facing the family, but this will tend to overwhelm professionals and family alike. Use your best professional analysis and judgement to think carefully about the key complicating factors that will make it more difficult to address the wellbeing concerns. Complicating factors can include:

• Homelessness or poor home conditions;
• Insufficient income;
• Employment Issues;
• Problematic relationships with extended family, friends and community;
• Isolation;
• Mental Ill Health;
• Excessive drug and alcohol use;
• Bad experiences with and/or fear of professionals;
• Poor communication between professionals;
• Too many professionals involved in the case;
• Asylum status;
• Gang activity;
• Absent parent (e.g. in hospital or prison).

List any critical issues that seem directly connected to the concerns that are currently unclear.

What is Working Well?

What's Working Well is the engine room of the Signs of Safety/Wellbeing/Success approach in engaging and energising service recipients and involves detailed inquiry and careful, forensic attention being given to everything that is working in the child and family's life. Frequently, when professionals document strengths they tend to focus on professional priorities such as attending meetings and services.

While these things have some significance the strengths, resources and exceptions that have most value are the everyday actions, behaviours, people and plans that directly enhance and support the family and the child's life.

Building plans that make best sense to the family to address the past concerns depends on the professionals bringing compassionate and rigorous focus to everything that's working well in the child's / Unborn's home and broader life creating a base where the plan can be built on the foundation of what is already working.

The professionals build the detail of strengths and existing safety/ wellbeing/ success by asking as many questions as possible related directly to the concerns. Focusing on what's working not only provides the foundation for planning it also builds hope, trust and collaboration between the professionals and family members. Exploring what's working involves questioning to lead the families in thinking themselves into and through their difficulties.

This is the section that helps to identify what the family/carers are doing about the worries and who is helping them (strengths) and the times when the worry has been present, and the child / Unborn has been kept safe (safety).

Existing Strengths

People, behaviour and actions that positively contribute to a child's wellbeing, health and development and plans parents/carers/young person commit to about how the worries for the child will be addressed. Strengths are the things that are working well for the Unborn or older children in the family and could possibly be translated to future success.

Existing Wellbeing, Safety or Success

By asking questions about actions taken by parents, carers, children/young people and support people that have previously resolved or addressed the health and wellbeing worries, their safety and success can be identified.

Please utilise Assessment Best Practice Guidance.

6.4 Analysis - danger statements and safety goals

When analysing the information gathered in the assessment, full consideration must be given to all aspects of the parents' capacity to meet their baby's needs. The analysis will be detailed in the danger statements / worry statements in the assessment.

Danger and Worry Statements

The crucial problems that are believed likely to happen for the child in the future if nothing in their situation changes. Danger or Worry statements should:

• Explain who is worried;
• Summarise what has happened to make them worry (harm / behaviours that pose a risk);
• Explain how this is likely to harm/impact on the child if nothing changes (this can include theoretical / expert knowledge about what can happen to a child's health / development based on the evidence of what has happened);
• Clearly and behaviourally describe what the professionals are worried will happen in the child's future if nothing changes. The professionals should draw on and incorporate what the child/ren and parents/carers have told them, always using the child's and any parent/carer's words wherever possible;
• Be written in language understandable for the child and parent/carer, while still capturing the seriousness the professionals, parent/carer or child see in the situation;
• Be clearly informed by actual past concerns the child displays and the adult behaviour believed to be contributing to those concerns. The behavioural focus ensures professional and carers keep their worry statements behaviourally grounded rather than written out of anxious worst fears.

Safety, Success and Wellbeing Goals

The behaviours and actions that children's services need to see to be satisfied the dangers/worries for child are addressed. Goals:

• Clearly describe what the child/ carer/ professionals needs to see to know the danger/ worry will be addressed;
• Must be paired with a danger or worry statement;
• Start with a positive statement about what the professionals see that makes them believe the child, parents and carers/child can address the danger/ worries;
• Avoid saying how the danger/ worries will be addressed, wherever possible leaving this detail to carers, child and their support networks.

Safety, Success and Wellbeing Scale

A unique safety/success scale should be created, matched with each danger/ worry statement and safety/success goal. The 0 and 10 end points of the scale need to be clearly defined in line with each danger/ worry (0) and wellbeing/safety/success goal (10) so the scale clearly measures the current safety/wellbeing of the child/ren and carers in relation to the danger/ worry.

As a solution focused approach start with the definition of 10 and what everyone is aiming to achieve, before defining the 0 of what we are trying to avoid. In this way everyone has a clear way of understanding, measuring and discussing the seriousness of the problems and what progress has been made.

7. Assessment Outcome

Once a C&F pre-birth assessment has been completed there are a number of possible outcomes:

1. No further role for CSC – case closed to universal services.
   
   Letters confirming case closure to be sent to the family, along with a copy of the assessment. Letters should also be sent out to involved agencies and professionals to confirm closure;
   
   
2. Step down to Early Help – case to be presented at Early Help panel and a step down meeting convened.
   
   Please refer to Early Help procedures;
   
   
3. Child in Need plan – an initial CIN meeting will be convened within 10 – 15 working days following the completion of the assessment.
   
   The initial child in need meeting, will also be the transfer point for any case transferring from the assessment service across to the locality teams. It is good practice for a visit to be undertaken by the receiving social worker and allocated social worker prior to the meeting. The meeting should involve each agency involved or likely to have information relating to the family who may contribute to a support plan during pregnancy. Those unable to attend the meeting should be asked for their contribution in writing.
   
   This meeting will formulate the basis for a multi-agency plan, including the commencement and timeframes for any further assessments. An appropriate review point will need to be agreed at the meeting.
   
   The meeting should consider any referral to additional support services such as parenting programmes or specialist support. A review CIN meeting date will be set at the end of the initial meeting. The Social Worker should then provide minutes of the meeting to all professionals;
   
   
4. Initial Child Protection Conference.
   
   On occasions there may be sufficient, evidenced concerns regarding the risks posed to the unborn child, which may warrant the convening of an Initial Child Protection Conference, following a Strategy Discussion/Meeting.
   
   The Child Protection Conference is the appropriate multi-agency arena to share the assessment to date and using the SOS model, will consider whether the unborn baby should become subject to a Child Protection Plan.
   
   If a Child Protection Conference is assessed as necessary, the Team Manager and Social Worker must ensure that this is held well in advance of the estimated date of delivery. This should be held at approximately 20 – 24 weeks of pregnancy.
   
   If it is agreed that the Unborn will be made subject of a child protection plan, there will be core group meetings held every 20 working days. A review child protection conference will be scheduled in within 12 weeks of the initial meeting;
   
   
5. Public Law Outline – pre-proceedings and Care Proceedings.
   
   Early planning should consider the need for legal action through the formal Children's Social Care process. Although not all referrals will go on to require legal proceedings, it is important to bear in mind the timescales laid out in the guidance as they will not be met unless referrals are made at an early stage in the pregnancy (see Statutory Guidance on Court Orders and Pre Proceedings, DfE, 2014 and the Public Law Working Group amended guidance of pre-proceedings work 2021).
   
   Where an Unborn is assessed to be at risk of significant harm due to the parental behaviours consideration will be given to presenting the Unborn to legal gateway panel. This should take place between 24 and 26 weeks gestation. This provides families with every opportunity to work with the plan and PLO agreement to support change prior to baby being born. Social workers will be expected as part of the PLO period to involve the family network, complete viability assessments of connected carers to inform planning for Unborn. Consultations with the adoption team regarding Early Permanence Placements should be considered were necessary.

8. Planning: The Wellbeing/Safety/Success Plan

Children's services planning has tended to focus on sending family members to services and assuming that this will translate into improved outcomes or care for the child. It is important that Wellbeing, Safety and Success plans are created with the parents, carers and children and members of the support network.

Planning in Signs of Wellbeing, Safety or Success focuses on the everyday actions of the parents, carers, support people and the child/young person creating a detailed plan of who will do what in everyday life to ensure the worries and danger are always dealt with.

Where parents, carers or children are participating in a professional service it is vital to identify how this will actually improve and change the direct outcomes or care of the child.

8.1 Professional Bottom-lines

Professionals will almost always have bottom line requirements in Child Protection work but also often in early help and child in need case work and with looked after children, this will usually depend on the seriousness of the danger/ worry statements.

Parents, carers, and support people need to know what the bottom-line requirements are. Professionals should think through carefully the bottom lines they require, keeping these requirements to an absolute minimum by ensuring they are clearly linked to the direct care and improved outcomes/quality of life for the baby / child.

8.2 Who is Involved in the Plan?

The Signs of Safety approaches further draws on the traditional child raising wisdom that 'It takes a village to raise a child' by seeking to establish a forever network around a child to support them as they grow into adulthood and beyond in order to preserve their success past when they grow up. In child protection cases, safety networks are considered a bottom line in the safety planning process – no network, no safety. Always start with parents / network then move onto professional involvement.

8.3 Timeline - Creating the plan

A timeline is a shared plan that describes and measures a pathway to success. The timeline is a powerful means for engaging the parents, and everyone around them because it shows them clearly what is expected, what will change, when and how the work will end.

The timeline is the part of the plan that sets out the steps to achieve safety. The worker should consider how long in weeks it will take to complete the work to enable the case to be closed or for long term looked after children for the work needed to be completed. The worker then details the tasks (including Words and Pictures, safety planning sessions etc), the meetings that need to happen during those weeks and the corresponding changes to contact/network involvement in monitoring the safety plan as parents and the network demonstrate how the plan is working and increasing the safety of the child. The timeline is drafted by the worker in negotiation with the family and network. It is important that the timeline is agreed with the manager who is responsible for decision making in the case.

8.4 Plan Rules

The Plan Rules will address each concerning behaviour in turn; moving from what is working well on to stressors, and triggers for emergency events and consider who will do what when problems arise?

9. Birth Planning Meeting/Discussion and Hospital Plans

In all cases following a pre-birth assessment, the Child's Plan for Health Professionals must be completed and submitted to the Safeguarding Midwifery Team no later than 34 weeks gestation. For complex cases it may be more appropriate to have a discussion, or arrange a planning meeting with midwifery. Please refer to the HSCP document for further information.

The Birth plan will need to address the following:

• How long the baby will stay on the ward;
• How long mother will 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.

See also: Pre-Birth Template.

The plans should be sent to Midwifery and Health Visitors at these email addresses:
hyp-tr.safeguardingchildren@nhs.net
Hull.cypcommunityservices@nhs.net

10. Birth and Discharge of a New-born 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.

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.

Appendix 1: Martin Calder Unborn Children - Framework for Assessment and Intervention

The following table highlights the areas that need to be thoroughly addressed within the assessment. The table draws extensively on the work of Martin C Calder – as described in "Unborn Children: A Framework for Assessment and Intervention". In addition to the below table there is a 'Tool Kit' located within each office which can be utilised as necessary.

Note - Particular care should be taken when assessing risks to babies whose parents are themselves children. Attention should be given to a) evaluating the quality and quantity of support that will be available within the family (and extended family), b) the needs of the parent(s) and how these will be met, c) the context and circumstances in which the baby was conceived, and d) the wishes and feelings of the child who is to be the parent.

Once the Pre-Birth Assessment sessions have been completed and all information has been gathered from other agencies involved with the parent(s) / partner, this material will need analysing in order to determine the appropriate action to be taken. Below is a framework taken from an adaptation by Martin Calder in 'Unborn Children: A Framework for Assessment and Intervention' of R. Corner's 'Pre-Birth' Risk Assessment: Developing a Model of Practice', which is a useful framework to utilise for risk estimation in addition to using professional judgement.