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Pre-Birth Assessment

SCOPE OF THIS CHAPTER

This chapter contains guidance on Pre-Birth Assessments, including when a Pre-Birth Assessment should be considered, who should contribute and what areas it should cover. The role of the Pre-Birth Multi-Agency Planning Meeting is also covered.

This guidance was added to the online procedures in October 2020.

RELEVANT GUIDANCE

Hull Safeguarding Children's Partnership Procedures, Unborn Procedures and Guidance (Pre-birth Pathway).

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.

2. Receipt of an Accepted Referral for a Pre-Birth Assessment

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.

The Pre-Birth Assessment Request Letter must be sent to parent(s) upon receipt of the referral. The Pre-Birth Assessment will commence on receipt of the referral and in line with the social care assessment timeframes.

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 children's social work 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.

Thought should be given to the location and time of the Pre-Birth Multi-Agency Planning Meeting, with preference given to a venue close to the family home. If this is not possible the family, if they wish to attend, should be provided with assistance to attend. Consideration also needs to be given to work commitments; child-minding; pre-arranged appointments; etc., in addition to any requirements that the family may have, disabled access, translator etc.

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.

If parent(s) are comfortable in speaking to the group, they should be encouraged to share their understanding of the reason(s) for a Pre-Birth Assessment being undertaken. Dependent on the account given by parent(s), it may be necessary to recap on the reasons, and again check parent(s) understanding of this.

In turn, those present at the meeting should share their information within the meeting addressing the following:

  • What is working well? Although still very early in the process it is likely that strengths will be present, or changes implemented, however small;
  • What are we worried about? What is the likely consequence of not addressing these worries?
  • Are there any complicating factors?

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. Pre-Birth Assessment

The Pre-Birth Assessment should commence at the point of referral, and be completed within 45 days of being initiated.

The Social Worker must offer a clear statement of their initial concerns (including the origin i.e. Midwifery), the process and content of the assessment and what the expected baby needs to be protected from. They also need to advise about the potential consequences of non-co-operation. During the course of an assessment, further concerns may become evident and should again be shared with the parent(s).

A Pre-Birth Assessment will be carried out by either the Assessment Team or a Locality Team determined via the multi-agency pre-birth panel held weekly.

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's Social Care Assessment and the structure of the Assessment Triangle. However, unlike the Children's Social Care Assessment, 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.

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.

Important – when carrying out the Pre-Birth Assessment, any sessions that are recorded on paper, such as an exercise from the 'Tool Kit', or paper recordings from a session, must be scanned into LiquidLogic on the unborn child's file. These may be required to inform a court application at a later date.

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.

1. Relationships

  • History of relationships of adults?
  • Current status?
  • Positives and negatives?
  • Violence?
  • Who will be main carer for the baby?
  • What are the expectations of the parents re each other re parenting?

Is there anything regarding "relationships" that seems likely to have a significant negative impact on the child? If so, what?

2. Abilities

  • Physical?
  • Emotional? (including self-control);
  • Intellectual?
  • Knowledge and understanding re children and child care?
  • Knowledge and understanding of concerns / this assessment?

Is there anything regarding "abilities" that seems likely to have a significant negative impact on the child? If so, what?

3. Social history

  • Experience of being parented?
  • Experiences as a child? And as an adolescent?
  • Education?
  • Employment?

Is there anything regarding "social history" that seems likely to have a significant negative impact on the child? If so, what?

4. Behaviour

  • Violence to partner?
  • Violence to others?
  • Violence to any child?
  • Drug misuse?
  • Alcohol misuse?
  • Criminal convictions?
  • Chaotic (or inappropriate) life style?

Is there anything regarding "behaviour" that seems likely to have a significant negative impact on the child? If so, what?
If drugs or alcohol are a significant issue, more detailed assessment should be sought from professionals with relevant expertise.

5. Circumstances

  • Unemployment / employment?
  • Debt?
  • Inadequate housing / homelessness?
  • Criminality?
  • Court Orders?
  • Social isolation?

Is there anything regarding "circumstances" that seems likely to have a significant negative impact on the child? If so, what?

6. Home conditions

  • Chaotic?
  • Health risks / insanitary / dangerous?
  • Over-crowded?

Is there anything regarding "home conditions" that seems likely to have a significant negative impact on the child? If so, what?

7. Mental Health

  • Mental illness?
  • Personality disorder?
  • Any other emotional/behavioural issues?

Is there anything regarding "mental health" that seems likely to have a significant negative impact on the child? If so, what?
If mental health is likely to be a significant issue, more detailed assessment should be sought from professionals with relevant expertise.

8. Learning Disability
Is there anything regarding "learning disability" that seems likely to have a significant negative impact on the child? If so, what?
If learning disability is likely to be a significant issue, more detailed assessment should be sought from professionals with relevant expertise.

9. Communication

  • English not spoken or understood?
  • Deafness?
  • Visual impairment?
  • Speech impairment?

Is there anything regarding "communication" that seems likely to have a significant negative impact on the child? If so, what?
If communication is likely to be a significant issue, more detailed assessment should be sought from professionals with relevant expertise.

10. Support

  • From extended family?
  • From friends?
  • From professionals?
  • From other sources?

Is there anything regarding "support" that seems likely to have a significant negative impact on the child? If so, what?
Is support likely to be available over a meaningful time-scale?
Is it likely to enable change?
Will it effectively address any immediate concerns?

11. History of being responsible for children

  • Convictions re offences against children?
  • CP Registration?
  • CP concerns - and previous assessments?
  • Court findings?
  • Care proceedings? Children removed?

Is there anything regarding "history of being responsible for children" that seems likely to have a significant negative impact on the child? If so, what?
If so also consider the following:

  • Category and level of abuse;
  • Ages and genders of children;
  • What happened?
  • Why did it happen?
  • Is responsibility appropriately accepted?
  • What do previous risk assessments say? Take a fresh look at these - including assessments re non-abusing parents;
  • What is the parent's understanding of the impact of their behaviour on the child?
  • What is different about now?

12. History of abuse as a child

  • Convictions - especially of members of extended family?
  • CP Registration?
  • CP concerns
  • Court findings?
  • Previous assessments?

Is there anything regarding "history of abuse" that seems likely to have a significant negative impact on the child? If so, what?

13. Attitude to professional involvement.

  • Previously - in any context?
  • Currently - regarding this assessment?
  • Currently - regarding any other professionals?

Is there anything re "attitudes to professional involvement" that seems likely to have a significant negative impact on the child? If so, what?

14. Attitudes and beliefs re convictions or findings (or suspicions or allegations)

  • Understood and accepted?
  • Issues addressed?
  • Responsibility accepted?

Is there anything regarding "attitudes and beliefs" that seems likely to have a significant negative impact on the child? If so, what?
It may be appropriate to consult with the Police or other professionals with appropriate expertise.

15. Attitudes to child

  • In general?
  • Re specific issues?

Is there anything regarding "attitudes to child" that seems likely to have a significant negative impact on the child? If so, what?

16. Dependency on partner

  • Choice between partner and child?
  • Role of child in parent's relationship?
  • Level and appropriateness of dependency?

Is there anything regarding "dependency on partner" that seems likely to have a significant negative impact on the child? If so, what?

17. Ability to identify and appropriately respond to risks?
Is there anything regarding this that seems likely to have a significant negative impact on the child? If so, what?

18. Ability to understand and meet needs of baby
Is there anything regarding this that seems likely to have a significant negative impact on the child? If so, what?
It may be appropriate to consult with Health professionals re this section.

19. Ability to understand and meet needs throughout childhood
Is there anything regarding this that seems likely to have a significant negative impact on the child? If so, what?
It will usually be appropriate to consult with relevant Health professionals re this section.

20. Ability and willingness to address issues identified in this assessment

  • Violent behaviour?
  • Drug misuse?
  • Alcohol misuse?
  • Mental health problems?
  • Reluctance to work with professionals?
  • Poor skills or lack of knowledge?
  • Criminality?
  • Poor family relationships?
  • Issues from childhood?
  • Poor personal care?
  • Chaotic lifestyle?

Is there anything regarding "ability and willingness to address issues" that seems likely to have a significant negative impact on the child? If so, what?
It will usually be appropriate to consult with other professionals re this section.

21. Any other issues that have potential to adversely affect or benefit the child.
E.g. one or more parent aged under 16? Context and circumstances of conception?

22. Planning for the future

  • Realistic and appropriate?

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.

Factor Elevated Risk Lowered Risk
The abusing parent
  • Negative childhood experiences, inc. abuse in childhood; denial of past abuse;
  • Violence abuse of others;
  • Abuse and/or neglect of previous child;
  • Parental separation from previous children;
  • No clear explanation
  • No full understanding of abuse situation;
  • No acceptance of responsibility for the abuse;
  • Antenatal/post natal neglect;
  • Age: very young/immature;
  • Mental disorders or illness;
  • Learning difficulties;
  • Non-compliance;
  • Lack of interest or concern for the child.
  • Positive childhood;
  • Recognition and change in previous violent pattern;
  • Acknowledges seriousness and responsibility without deflection of blame onto others;
  • Full understanding and clear explanation of the circumstances in which the abuse occurred;
  • Maturity;
  • Willingness and demonstrated capacity and ability for change;
  • Presence of another safe non-abusing parent;
  • Compliance with professionals;
  • Abuse of previous child accepted and addressed in treatment (past/present);
  • Expresses concern and interest about the effects of the abuse on the child.
Non-abusing parent
  • No acceptance of responsibility for the abuse by their partner;
  • Blaming others or the child.
  • Accepts the risk posed by their partner and expresses a willingness to protect;
  • Accepts the seriousness of the risk and the consequences of failing to protect;
  • Willingness to resolve problems and concerns.
Family issues (marital partnership and the wider family)
  • Relationship disharmony/instability;
  • Poor impulse control;
  • Mental health problems;
  • Violent or deviant network, involving kin, friends and associates (including drugs, paedophile or criminal networks);
  • Lack of support for primary carer /unsupportive of each other;
  • Not working together;
  • No commitment to equality in parenting;
  • Isolated environment;
  • Ostracised by the community;
  • No relative or friends available;
  • Family violence (e.g. Spouse);
  • Frequent relationship breakdown/multiple relationships;
  • Drug or alcohol abuse.
  • Supportive spouse/partner;
  • Supportive of each other;
  • Stable, or violent;
  • Protective and supportive extended family;
  • Optimistic outlook by family and friends;
  • Equality in relationship;
  • Commitment to equality in parenting.
Expected child
  • Special or expected needs;
  • Perceived as different;
  • Stressful gender issues.
  • Easy baby;
  • Acceptance of difference.
Parent-baby relationships
  • Unrealistic expectations;
  • Concerning perception of baby's needs;
  • Inability to prioritise baby's needs above own;
  • Foetal abuse or neglect, including alcohol or drug abuse;
  • No ante-natal care;
  • Concealed pregnancy;
  • Unwanted pregnancy identified disability (non-acceptance);
  • Unattached to foetus;
  • Gender issues which cause stress;
  • Differences between parents towards unborn child;
  • Rigid views of parenting.
  • Realistic expectations;
  • Perception of unborn child normal;
  • Appropriate preparation;
  • Understanding or awareness of baby's needs;
  • Unborn baby's needs prioritised;
  • Co-operation with antenatal care;
  • Sought early medical care;
  • Appropriate and regular ante-natal care;
  • Accepted/planned pregnancy;
  • Attachment to unborn foetus;
  • Treatment of addiction;
  • Acceptance of difference-gender/disability;
  • Parents agree about parenting.
Social
  • Poverty;
  • Inadequate housing;
  • No support network;
  • Delinquent area.
Future plans
  • Unrealistic plans;
  • No plans;
  • Exhibit inappropriate parenting plans;
  • Uncertainty or resistance to change;
  • No recognition of changes needed in lifestyle;
  • No recognition of a problem or a need to change;
  • Refuse to co-operate;
  • Disinterested and resistant;
  • Only one parent co-operating.
  • Realistic plans;
  • Exhibit appropriate parenting expectations and plans;
  • Appropriate expectation of change;
  • Willingness and ability to work in partnership;
  • Willingness to resolve problems and concerns;
  • Parents co-operating equally.

When analysing the information gathered in the assessment, full consideration must be given to all aspects of the parents' capacity including: danger/risks; safety; strengths; complicating factors; and grey areas.

Analysis must be clear. For example if there is risk identified, then a clear recording must include the nature of the risk; who is identified with the risk; in what circumstances will the risk increase / decrease. If strengths have been identified, are these in association to reducing risk, in what time scale, by whom.

5. Assessment Outcome

The assessment outcome will determine which path will be required to be followed next.

If following the Pre-Birth assessment, the threshold for input from the Children and Family Service is not met then the case will either be referred to Targeted Early Help Support (with consent from parent(s)), or be managed via the signposting of parent(s) to additional support, it will be up to parents as to whether they access any services that they are signposted to.

If following the Pre-Birth Assessment, there is a need for further input from the Children's and Family Service then this will take the form of one of the following pathways:

5.1 Child in Need

Where the Pre-Birth Assessment has identified a need under Section 17 of the children's Act 1989, the case will remain open to the children and Family Service. The initial step that will be required is for a Child in Need Planning Meeting to be convened. The Child in Need Planning Meeting must be held within 15 days of the Pre-Birth Assessment being completed. For guidance on convening a Child in Need Planning Meeting and subsequent reviews please see Child in Need Plans and Reviews Procedure. The focus of the child in Need Plan will be dependent on the stage of the pregnancy, it will either have an initial focus on support to parent(s) prior to the birth, or it will focus on the provision of support once the baby is born.

5.2 Child Protection

Where during the course of completing the Pre-Birth Assessment or on completion of the Pre-Birth Assessment it is judged that there is a likely risk of suffering significant harm the process for convening an Initial Child Protection Meeting must be followed. Please see: Section 47 Enquiries Procedure.

5.3 Public Law Outline (PLO)

Where it is identified that there are significant concerns for a child from the point of birth, which cannot be managed through Child Protection procedures it will be necessary to initiate the Public Law Outline (PLO). Please see: Care and Supervision Proceedings and the Public Law Outline Procedure.

6. Birth Planning Meeting

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 (details for this are on the bottom of the form), no later than 32 weeks gestation.

6.1 Universal Services

If following the completion of the pre-birth assessment the outcome is to close the case then a birth planning meeting is not required. The outcome of the assessment should be conveyed to the referrer for their records, and the outcome shared with the family.

6.2 Targeted Early Help/ Child in Need / Child Protection

If following the completion of the pre-birth assessment the outcome is Targeted Early Help, Child in Need or Child Protection a Birth Planning Meeting must be held by 32 weeks gestation. It is the assessing Social Worker's responsibility to arrange this meeting. This is an opportunity for the family and all professionals involved with the family to form a clear plan as to any expectations of both the family and professionals, and also how these will be recognised as been achieved. In addition to this the meeting will also address the plan for contingency should the family struggle to or be unable to secure the safely of the child.

Once the child is born, the monitoring of the open case will follow the guidelines of the specific Case Status.

6.3 Care Proceedings

If during the course of the Pre-Birth Assessment it was deemed necessary to attend the Legal Gateway Panel in respect of initiating the Public Law Outline, and the outcome of the meeting was to progress to Care Proceedings, then the Birth Planning Meeting will need to be convened at the hospital that the expectant mother is booked in to and this will take.

It is the responsibility of the Social Worker to advise the Safeguarding Midwife of the need to arrange this meeting, following attendance at Legal Gateway Panel. It will not necessarily be the Social Worker's responsibility to arrange the meeting, discussion around who will arrange the meeting can take place between the Social Worker and Safeguarding Midwife.

NOTE - If attendance at Legal Gateway Panel exceeded 34 weeks gestation due to concealed pregnancy or some other reason, the Birth Planning Meeting should be held at the earliest opportunity (not exceeding 10 working days) so as to have a Birth Plan in place by 32 weeks gestation.

This meeting should result in a detailed plan to protect the child at birth. The 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.

7. 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.

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.

Trix procedures

Only valid for 48hrs