1.3.5 Pre-Birth Assessment

1. Introduction

Young babies are particularly vulnerable to abuse, and early assessment, intervention and support work carried out during the antenatal period can help minimise any potential risk of harm. This procedure sets out how to respond to concerns for unborn babies, with an emphasis on clear and regular communication between professionals working with the woman, the father / partner and the family.

All professionals have a role in identifying and assessing families in need of additional support or where there are safeguarding concerns. In the vast majority of situations during a pregnancy, there will be no safeguarding concerns.

However, in some cases it will be clear that a co-ordinated response by agencies will be required to ensure that the appropriate support is in place during the pregnancy to best protect the baby before and following birth.

The antenatal period provides a window of opportunity for practitioners and families to work together to:

• Form relationships with a focus on the unborn baby;
• Identify risks and vulnerabilities at the earliest stage;
• Understand the impact of risk to the unborn baby when planning for their future;
• Explore and agree safety planning options;
• Assess the family's ability to adequately parent and protect the unborn baby and the baby once born;
• Identify if any assessments or referrals are required before birth; for example for Early Help involvement or other support organisations;
• Ensure effective communication, liaison and joint working with adult services that are providing on-going care, treatment and support to a parent(s);
• Plan on-going interventions and support required for the child and parent(s);
• Avoid delay for the child where a legal process is likely to be needed such as Pre-proceedings, Care or Supervision Proceedings in line with the Public Law Outline.

A joint Integrated Care Pathway (Sheffield Children Safeguarding Partnership Child Protection and Safeguarding Procedures) has been devised in Sheffield and agreed through Sheffield Safeguarding Partnership. This integrated Care Pathway lays out a clear timetable of actions required by professionals for their joint assessment and to place for the unborn baby.

Considerations should be given to if the pregnant mother is a Looked After Child or Care Leaver, and use the Pre Birth Planning for Care Leavers and Looked After Young People Procedure to ensure support is in place.

2. Risks

Risk factors which could indicate that an unborn child may be likely to suffer significant harm and therefore be subject to a pre-birth assessment may include:

• Involvement in risk activities such as substance misuse, including drugs and alcohol;
• Perinatal/mental illness or support needs that may present a risk to the unborn baby or indicate that their needs may not be met;
• Victims or perpetrators of domestic abuse;
• Identified as presenting a risk, or potential risk, to children, such as having committed a crime against children;
• A history of violent behaviours;
• May not be able to meet the unborn baby's needs e.g. significant learning difficulties and in some circumstances severe physical or mental disability;
• Are known because of historical concerns such as previous neglect, other children subject to a child protection plan, subject to legal proceedings or have been removed from parental care;
• Currently 'Looked After' themselves or were looked after as a child or young person (care leavers);
• A history of abuse in childhood;
• Are teenage/young parents and are vulnerable;
• Recent family break up and social isolation/lack of social support;
• Any other circumstances or issues that give rise to concern.

The list is not exhaustive and, if there are a number of risk factors present, then the cumulative impact may well mean an increased risk of significant harm to the child. If there is any doubt about safeguarding of the unborn child, then Social Care need to consider the need for an assessment.

3. Working with Fathers / Partners

Fathers play an important role during pregnancy and after. The National Service Framework for Children, Young People and Maternity Services (2004) states:

'The involvement of prospective and new fathers in a child's life is extremely important for maximising the life-long wellbeing and outcomes of the child regardless of whether the father is resident or not. Pregnancy and birth are the first major opportunities to engage fathers in appropriate care and upbringing of children' (NSF, 2004).

It is important that all agencies involved in pre and post-birth assessment and support, fully consider the significant role of fathers and wider family members in the care of the baby even if the parents are not living together and, where possible, involve them in the assessment. This should include the father's attitude towards the pregnancy, the mother and newborn child and his thoughts, feelings and expectations about becoming a parent.

Information should also be gathered about fathers and partners who are not the biological father at the earliest opportunity to ensure that any risk factors can be identified. A careful assessment of the role that the person has in relation to the woman and any other children in the household as well as their views about the future care of the baby should be undertaken.

A failure to do so may mean that practitioners are not able to accurately assess what mothers and other family members might be saying about the father's role, the contribution which they may make to the care of the baby and support of the mother, or the risks which they might present to them. Background police and other checks should be made at an early stage on relevant cases to ascertain any potential risk factors.

Involving fathers in a positive way is important in ensuring a comprehensive assessment can be carried out and any possible risks fully considered.

4. Pre Birth Assessment

A detailed pre-birth assessment can provide an early opportunity to develop a good working relationship with parents during the pregnancy, especially where there are concerns. It can mean that vulnerable parents can be offered support early on, allowing them the best opportunity to parent their child safely and effectively. Importantly, it helps identify babies who may be likely to suffer significant harm, and can be used to develop plans to safeguard them.

The importance of conducting pre-birth assessments has been highlighted in many different studies and Serious Case Reviews. Pre birth assessments are sensitive and complex, where parents, carers and extended family members can be anxious and feel very emotional. It is important to undertake assessments during early pregnancy so as parents are given opportunity to voice their wishes and feelings, share information and demonstrate any need for change. It ensures that clear and structured plans for the baby's future can be developed alongside the family and all professional networks.

As a key area, Social Workers should undertake assessments in collaboration with key professionals and as part of this request, undertake joint assessment visits where appropriate. It is important that Social Workers do not conduct assessments in isolation.

To assist in conducting a pre birth assessment, the Signs of Safety (SoS) model which Sheffield has adopted needs to be incorporated, e.g. what are you worried about, what is working well and what needs to happen. Social Workers need to ensure that the following areas are also considered as part of the assessment. This is not an exhaustive list but can be used as a guide of areas that should be discussed and recorded:

Family Structure / Background

Is there anything regarding family structure / background that seem likely to have a significant negative impact on the child? If so, what?

Social workers need to ensure that they consider the full family history; e.g. of domestic abuse including the perpetrator’s pattern of behaviour in previous relationships or in an adult family violence context (i.e. abuse towards a parent, sibling etc). Where there is current or past domestic abuse, social workers should use a strength based, trauma informed approach to understanding the impact of domestic abuse on the survivor.

Support: From extended family or friends, From professionals, From other sources, Nature of support available including detail around timescale, ability to enable change and effectiveness in addressing immediate concerns.

Previous or Current Professional Involvement: Chronology of professional involvement, CP concerns and previous assessments, Court findings, Care proceedings and/or children removed.

Parenting Capacity

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

Health: General physical health of prospective parents including existing health conditions, relevant family health history and ability to recognise own health care needs.

Experiences of being parented (positive/negative memories, main carer, parental relationships) Experiences as a child/adolescent (violence, abuse, neglect, care/control issues).

Current relationship status with father of unborn child:
Who will be the main carer for the baby?
What expectations do the parents have of each other with regard to parenting?

Abilities: Physical, Emotional (including self-control), Knowledge and understanding about children and child care, Knowledge and understanding of concerns and the reason for assessment.

Behaviour: Violence to partner/others or to any child, Drug or alcohol misuse, Criminal convictions, Chaotic (or inappropriate) lifestyle.

Circumstances: Education, Unemployment/employment, Finances including benefits or debts, Inadequate housing / homelessness, Criminality / court orders, Social isolation.

Dependency on father/partner: Role of father/partner in the pregnancy, Role of the father/partner for the child after birth, Role of child in adult relationship, Level and appropriateness of dependency.

Planning for the Future: Preparation for parenthood, e.g. environment, equipment or birth plan, Realistic / appropriate or unrealistic / inappropriate expectations.

Pregnancy Background

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

Parents' Feelings: Is the pregnancy planned or unplanned? Is domestic abuse an issue in the parents' relationship? Is the perception of the unborn baby different/abnormal? Are they trying to replace any previous children? Have they sought appropriate antenatal care? Are they aware of the unborn baby's needs and able to prioritise them? Do they have realistic plans in relation to the birth and care of the baby?

Obstetric and Medical Information: Obstetric history including previous pregnancies, outcomes or complications, Attendance and engagement with ante natal care / midwifery / Health Visiting services, Medicines or drugs – whether prescribed or not – taken before or during pregnancy, Dietary intake and any related issues, Alcohol consumption / smoking.

It is important to discuss with the parents/partners views and attitudes towards any previous children who may have been removed from their care, or where there have been serious concerns around safeguarding or parenting practice.

Do the parent(s) understand and acknowledge the seriousness of the abuse?
Do the parent(s) give a clear explanation and accept responsibility for their role in the abuse?
Do they blame others or the child?
What was their response to previous interventions and did they accept any treatment/counselling?
What is different now for each parent since the child was abused and/or removed?

5. Pre-birth Planning Meeting

A Pre-Birth Planning Meeting should take place at 32 weeks as outlined in the Integrated Care Pathway (Sheffield Children Safeguarding Partnership Child Protection and Safeguarding Procedures). The Pathway outlines the agenda of the meeting and that a Senior Fieldwork Manager should chair this meeting to ensure a detailed plan to safeguard the baby around the time of birth can be agreed.

All agencies attending the meeting should receive a copy of the plan as well as other relevant agencies for example the parents' GPs. The Lead Midwife should inform midwifery staff of the details of the plan.

There are other potential areas that should be considered when undertaking a pre birth assessment. This includes consideration of a parent's mental or physical health, substance misuse or domestic abuse. Please consider these areas fully when undertaking an assessment to ensure that the impact of these can be fully understood.

Further Information

Sheffield Children Safeguarding Partnership Child Protection and Safeguarding Procedures, Concealed Pregnancies Procedure

The National Service Framework for Children, Young People and Maternity Services (DHSC, 2004)

NICE guidelines [CG192] Antenatal and postnatal mental health: clinical management and service guidance