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5.21 Pre-Birth Protocol

SCOPE OF THIS CHAPTER

This chapter deals with the processes and procedures for working with parents and families where there are queries as to whether the newly-born child will be safe with the parent when they are born. Where there are concerns there should be multi-agency discussions and appropriate assessments undertaken with consideration an Initial Child Protection Conference convened. The chapter details the responsibilities of agencies and the nature of the circumstances that indicate risk.

RELEVANT CHAPTER

Concealment and Denial of Pregnancy and Birth Procedure

AMENDMENT

This chapter was significantly updated in March 2016 to reflect current organizational changes and to recognize the impact of Female Genital Mutilation. An updated process Flowchart is provided.


Contents

  1. Introduction
  2. The Roles and Responsibilities of Professionals in Respect of Unborn Children
  3. Care Pathways
  4. Unborn Child Protection Conference
  5. The Plan
  6. Conclusion
  7. Framework for Assessment
  8. References
  9. Bibliography
  10. Notes

    Appendix 1: Pre-Birth Flow Chart


1. Introduction

The purpose of this protocol is to provide practitioners with a tool and a clear pathway to assist with the decision making process when undertaking pre-birth assessment.

Research and experience indicate that very young babies are extremely vulnerable and that work carried out in the antenatal period to assess risk and to plan intervention will help to minimise harm. Evidence demonstrates that early intervention and effective prevention in childhood can lay the foundation for a healthy life (DH, 2009, p33).

The Antenatal assessment provides a valuable opportunity to develop a proactive multi-agency approach to families where there are acknowledged vulnerabilities/ an identified risk of harm. The expected outcome is to:

  • Positively support families;
  • Effectively identify and protect vulnerable children;
  • Plan and implement effective care programmes;
  • Recognise the long term benefits of early intervention; and
  • Ensuring focus is on the welfare of the child;
  • Ensure registration/contact with Children’s Centre.

Hart (2010) indicates that there are two fundamental questions when deciding whether a pre-birth assessment is required:

  1. Will this new-born baby be safe in the care of these parents/carers?
  2. Is there a realistic prospect of these parents/carers being able to provide adequate care throughout childhood?

Where there is reason for doubt, a pre-birth multi-agency assessment is indicated.

This protocol supports practice as described in:

This protocol is used by all practitioners and agencies when assessing all pregnant women and determining the level of risk.

The duty to safeguard the unborn child remains a priority despite UK law not legislating for the rights of the foetus (unborn baby).

Concerns should be addressed as early as possible to maximise time for full assessment, including establishing the whereabouts of any previous children, enabling a healthy pregnancy and supporting the parents towards providing safe care.

If there is reasonable cause to suspect a child is at risk of harm before birth or following birth it is appropriate to take action to identify and address the risks.

If any child (under-18) or vulnerable adult in your care has symptoms or signs of Female Genital Mutilation (FGM), or if you have good reason to suspect they are at risk of FGM having considered their family history or other relevant factors, they must be referred using standard existing safeguarding procedures. (See Female Genital Mutilation Procedure, Appendix 1: Advice for Regulated Professionals in Lincolnshire – FGM Mandatory Reporting).

If any adult presents or discloses FGM then professionals should be aware that this may be the first time that the woman has ever discussed her FGM with anyone. Referral to the police must not be introduced as an automatic response when identifying adult women with FGM, and each case must continue to be individually assessed. The professional should seek to support women by offering referral to community groups who can provide support, and clinical intervention or other services as appropriate. The wishes of the woman must be respected at all times. If she is pregnant, the welfare of her unborn child or others in her extended family must be considered at this point, as these children are potentially at risk and appropriate safeguarding action must be taken.

For further information regarding FGM and your professional responsibilities please refer to DoH, Female Genital Mutilation Risk and Safeguarding guidance for professionals ( March 2015).

Working Together 2015 states that: -

Following Section 47 Enquiries, if concerns relate to an unborn child, consideration should be given as to whether to hold a child protection conference prior to the child's birth.

 


2. The Roles and Responsibilities of Professionals in Respect of Unborn Children

Section 11 of the Children Act 2004 requires agencies to have in place mechanisms to ensure that they are able to safeguard and promote the welfare of children.

All practitioners whether adult or children services, have a responsibility to protect and safeguard children and work collaboratively with Children’s Services and other childcare professionals in contributing to assessments and interventions.

As part of these responsibilities key professionals have been identified with specific roles which are described below.

Midwife/Obstetrician

Midwives are responsible for providing midwifery care to women (including teenage/adolescent girls) and babies during the antenatal, intrapartum and postnatal periods. They have a duty to ensure that the needs of the woman and baby are the primary focus of their practice. Throughout this time they have a responsibility to work with other professionals in order to safeguard a baby from harm.

The Midwife/Obstetrician should follow the Pre-Birth Protocol for all pregnant women and the pre-birth assessment should involve consultation with all professionals who are known to have contact with the woman/family, e.g. GP.

Please refer to Early Identification and Early Help Assessments for further role within Early Help.

Health Visitor

The role of the Health Visitor is to ensure that there is contact from the health visiting service during the antenatal period enabling a pre-birth assessment to be undertaken. This may be done by themselves or jointly with the midwives. Where there are known concerns this assessment should begin as soon as concerns are identified. A pre-birth assessment of risk should involve consultation with all professionals known to have contact with the woman/family.

School Nurse/Vulnerable Children & Young Person (VCYP) Nursing team

School Nurses and VCYP nurse have a responsibility to safeguard children and young people through professional collaboration with colleagues and the multi-agency network. Young women may present to the School Nurse/VCYP nurse as the first point of contact where pregnancy is suspected or confirmed by the young women themselves. The role of the School Nurse/VCYP nurse is to accurately assess the situation taking into consideration legal aspects and to initiate appropriate multi-agency involvement, e.g. GP, Children Services etc.

General Practitioner (GP)

The role of the GP is to be alert to factors that affect the capacity of a parent and may pose a risk to the unborn child. The GP and Primary Care staff have a responsibility to ensure that relevant assessments and referrals are undertaken in line with Organisational and LSCB safeguarding procedures, when concerns are identified regarding the safety of the unborn child.

GP’s have a responsibility to work collaboratively with the midwife, health visitor and other multi-agency colleagues, and to ensure appropriate information sharing to improve outcomes for families and to safeguard and promote the welfare of the unborn child. (See A Model for Assessment Procedure.)

Family Nurse Partnership (FNP) (Boston and Skegness only)

The Family Nurse Partnership is a voluntary programme for young women under 20 years of age, expecting her first baby, living within the Boston/Skegness area. Providing the young woman is enrolled and engaging with the FNP programme, contact between Family Nurse and young woman will be frequent and regular throughout the ante-natal period. The FNP will work alongside Midwifery services to support the young woman during her pregnancy. The Family Nurse will initiate and develop a therapeutic relationship with the client and in line with the FNP programme work in partnership with the client to address specific topics relevant to the needs of the young woman and her unborn baby.

During this time a pre-birth assessment will be undertaken at any stage of the pregnancy irrespective of existing concerns.

The Family Nurse will liaise with all relevant agencies/professionals associated with the young woman to ensure the appropriate sharing of relevant information.

If the Young woman is not eligible or declines the FNP programme her care will be handed over to the area Health Visiting team at the time of triage, irrespective of gestation to ensure that a pre-birth assessment can be made.

East Midlands Ambulance Service

The role of the ambulance service is to respond to emergency call to accidents and incidents, provide initial treatments and transport patients as necessary to hospital settings. Ambulance crews are trained in the emergency delivery of babies and care of the mother. Where the use of the service highlights safeguarding issues within the family a notification is sent to social care and the designated health professional to support information sharing. Risk taking behaviours such as alcohol and drugs and status of patient, e.g. pregnant are reported within the notification.

Mental Health, Learning Disability and Drug and Alcohol Service Practitioners

Practitioners providing the above services have a responsibility for advising, identifying, assessing and meeting the relevant needs of pregnant women who have pre-existing mental illness / mental health issues, learning disability and/or problem drug and alcohol use within the scope of commissioned services. This includes service provision for women who are at particular risk of developing mental illness / mental health issues and or problem drug and alcohol use during the antenatal, perinatal or post-natal periods.

It is part of the practitioner’s role to assess and consider risks to the unborn child/ren with particular focus on the additional needs, risks and vulnerabilities of this service user group which can impact negatively on an unborn child/young baby. Practitioners must liaise and share information with childcare professionals in the assessment, planning and review of care provision and risk management plans.

Children’s Centres

Children’s centres provide an integrated service offer for families with very young children from ante-natal through to school age and beyond. Each children’s centre will provide an offer that is unique to the needs of their local community. Every children’s centre provides a combination of child and family health services, family support, childcare and early education for children as well as care, guidance and support for parents with parenting and relationship issues, training and employability services, emotional well-being and support for emerging mental health issues as well as a range of services for particular groups such as young parents, working parents, parents for whom English is an additional language, parents with disabilities, parents of children with disabilities or parents with individual or specific additional needs.

Children’s centre staff are able to support families by direct self-referral or via TAC referrals (see Team Around the Child Supporting Documentation,) as well as supporting service offers made through Children in Need (S17) and Child Protection (S47) action plans. Children’s Centres run universal stay and play activities as well as specialist parenting courses, outreach support, employability services, health services including health visiting and speech and language support.

Early Help Consultants

The primary role of an Early Help Consultant is to offer support, advice and guidance to Lead Professionals within Team Around the Child (TAC) (see Team Around the Child Supporting Documentation,) in Lincolnshire. TAC is designed to offer a co-ordinated package of multi-agency support for children, young people and their families at the earliest opportunity. We believe that the pre-birth period is a window of opportunity to ensure Early Help succeeds in improved outcomes for children. Therefore, the Early Help Consultants will support all Lead Professionals of pre-birth TACs to ensure that assessment and planning is robust and outcome-focused. They will offer telephone or face to face advice; and Signs of Safety mapping as appropriate. They will support and challenge all agencies to ensure true family and support network participation in TAC; and ensure the wellbeing of the unborn child is promoted.

Social Care

Children’s Services: when concerns have been raised about the safety of a child, managers and social care practitioners will lead on the assessment and care planning. All children subject to a child protection plan or who are looked after must have an allocated social worker.

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 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.

Police

When the police attend Domestic Violence incidents or risk situations involving a pregnant woman, this information will be forwarded to the agreed Health Service single point of contact, (Named Safeguarding midwife).The police will take part in any associated child safeguarding process.

In line with the existing agreed information sharing arrangement, the data identifying domestic abuse victims who are pregnant, and already have children, will continue to be shared with the Customer Service Centre. (Tel: 01522 782111 – Out of Hours Tel: 01522 782333).

Where individual officers attend incidents and become aware that a person is pregnant and they have safeguarding concerns, these will be reported using the Stop Abuse internal alert system the police have and appropriate referrals will then be made by the Central Referral Unit to the agreed Health Service single point of contact (Named Safeguarding midwife) after they have been risk assessed.

Education

A young person of statutory education age is entitled to 18 weeks of maternity leave. Either side of this period there is an expectation that the young person continues to attend school or alternative provision. The educational establishment is required to make all reasonable adjustments to allow the young person to have appropriate access to the curriculum whilst they attend the establishment including timetable and learning environment adjustments. It is important that the provision participate in the Team Around the Child (see Team Around the Child Supporting Documentation,) in order for them to fully support the continued education of the young parent. Education establishments should have a clear strategy for engaging with the young person while they are away from the provision so as to limit the disruption to their education and make appropriate arrangements that work for the young person and educational establishment. Where there is robust medical evidence that indicates that the young person is unfit to attend, the educational establishment can make a referral to the pupil reintegration team on 01522 554525 who will assess and consider alternative arrangements if appropriate.

District Councils

District Council staff are most likely to come into contact with pregnant women through their Housing, Revenues and Benefits, Community Safety or Customer Service Centres. All staff will be alert to the additional needs of the mother where she declares a pregnancy and, by extension, to the needs of the unborn child, in relation to their core role e.g. completing a benefit claim or supporting access to appropriate housing. Where staff have safeguarding concerns, they will follow their organisation’s existing policy for reporting these in order that appropriate action is taken. This will almost always involve liaison with other agencies to ensure a holistic approach to the needs of mum, baby and the wider family.

Youth Offending Service

All YOS practitioners who are working with a young woman who is pregnant; or are aware of a young person that they are working with who has a partner / parent /carer /or sibling who may be pregnant; and where there are potential concerns or risks relating to the unborn baby; the YOT practitioner must  share information with the relevant medical professionals and/or Social Care in relation to the identified risks and safeguarding concerns in order to ensure the assessment, planning and review of care provision and risk management plans is effectively managed by all relevant agencies. All YOS practitioners should follow the Pre-Birth Protocol and notify their Line Manager when the Pre-Birth Protocol is initiated.

National Probation Service (NPS)

NPS is responsible for services provided to adults convicted of an offence/s that are so serious as to warrant assessment to assist sentencers pass sentence. In addition NPS is responsible for services provided to victims of an offence/s that are so serious as to attract a custodial sentence of over 12 months and the assessment and management of convicted adults assessed as presenting a high risk of harm and/or adults convicted of an offence/s which meet MAPPA criteria.

It is part of the practitioner’s role, where the information is available, to assess risks to the unborn child/ren with particular focus on ensuring concerns are passed on to relevant professionals and to continue to contribute to risk management decisions as applicable.

Humberside, Lincolnshire, North Yorkshire Community Rehabilitation Company:

Humberside, Lincolnshire, North Yorkshire Community Rehabilitation Company (HLNY CRC), as a provider of probation services, takes seriously its responsibilities in relation to safeguarding and promoting the welfare of children, including unborn children and the requirements of Section 11. 

HLNY CRC recognise that, in its core work with adult offenders, there are opportunities to focus on improving outcomes for children and young people, including unborn children.  These opportunities may relate to working directly with women who are pregnant and subject to a Court Order or licence or working with individuals who reside with or are in a relationship with a woman who is pregnant.  The opportunities include:

  • Where offenders are parents/carers; or have significant contact with a child, or are seeking significant contact with a child;
  • Where offenders receive custodial sentences;
  • With substance misusing offenders living with, or in contact with, children and/or young people;
  • In cases where there is Domestic Abuse;
  • Where offenders have mental health issues;
  • Where there are child victims of violent or sexual offending.

HLNY CRC will ensure that staff who have contact with offenders:

  • Are able to identify and respond to issues of concern regarding children in need or those subject to Neglect or abuse, including unborn children;
  • Are able to identify and respond to issues of concerns in relation to women who are victims or potential victims of domestic abuse.
  • Understand their responsibility to raise any safeguarding concerns with a manager;
  • Are aware of the Assessment framework (see Section 7, Framework for Assessment) and know how to refer a child, including unborn children about whom they have concerns to the Local Authority Children’s Services for their locality;
  • Recognise the value of signposting offenders to services that can improve their skills as parents and carers as well as reduce the likelihood of re-offending, including referrals to Parenting Courses and Women's Projects;
  • Are alert to the potential need for early help and the assessment and referral process for this provision;
  • Take account of issues of diversity in the assessment and management of offenders and in their contact with victims and families of offenders.


3. Care Pathways

Pregnancy in a Young Person under the Age of 18

The young age of a parent should not automatically be seen as an indicator of risk. However, there are occasions when the young person may themselves have needs which require a social care assessment under Child in Need or Child Protection procedures. (See Section 47 Enquiries and Social Work Assessments Procedure.)

In this situation, a full assessment needs to take place that includes both parents and focuses on strengths, current safety and concerns regarding harm, and any complicating factors that may impact upon the young parent/s and their capacity to be good enough parents to the child. This parenting capacity needs to be assessed within the social care assessment for the child.

All available information from previous records e.g. Child Health Records, GP records and other sources should contribute to the assessment to aid effective decision making.

Practitioners working with a young person under 16 years must give consideration to a consultation with/ referral to Children’s Services. See also working Together/LSCB Procedures. Sexual activity under the age of legal consent should always trigger consideration as to whether a child is suffering, or is likely to suffer, Significant Harm. On identification the case must always be discussed with a manager/nominated child protection lead within the practitioner’s organisation. Under the Sexual Offences Act 2003, penetrative sex with a child under the 13 is classified as rape. These cases will always be reported to Children’s Services and a Strategy Discussion held.

All cases must be fully documented (following record keeping guidelines for the individual organisation/LSCB), including evidence of decision making where the decision has been taken not to share information.

Please also see Safeguarding Children and Young People at risk of Sexual Exploitation Policy.

Information Sharing and Consent

Knowing when and how to share information isn't always easy, but it's important to get it right. Families need to feel reassured that their confidentiality is respected. In most cases you will only share information about them with their consent, but there may be circumstances when you need to override this.

The Seven Golden Rules for information sharing:

  1. Remember that the Data Protection Act is not a barrier to sharing information but provides a framework to ensure that personal information about living persons is shared appropriately;
  2. Be open and honest with the person (and/or their family where appropriate) from the outset about why, what, how and with whom information will, or could be shared, and seek their agreement, unless it is unsafe or inappropriate to do so;
  3. Seek advice if you are in any doubt, without disclosing the identity of the person where possible;
  4. Share with consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, that lack of consent can be overridden in the child’s/adults/public interest. You will need to base your judgement on the needs of the child/adult facts of the case;
  5. Consider safety and well-being: Base your information sharing decisions on considerations of the safety and well-being of the person and others who may be affected by their actions;
  6. Necessary, proportionate, relevant, accurate, timely and secure: Ensure that the information you share is necessary for the purpose for which you are sharing it, is shared only with those people who need to have it, is accurate and up-to-date, is shared in a timely fashion, and is shared securely;
  7. Keep a record of your decision and the reasons for it – whether it is to share information or not. If you decide to share, then record what you have shared, with whom and for what purpose.

(From: DCSF, Information Sharing: Guidance for practitioners and managers (2008.)

Points for Consideration:

  • Is there a legitimate purpose for sharing information?
  • Does the information enable a person to be identified?
  • Is the information confidential?
  • If so, do you have consent to share?
  • Is there a statutory duty or court order to share the information?
  • If consent refused/there are good reasons not to seek consent,
  • Is there sufficient public interest to share information?
  • If the decision is to share, are you sharing the right information in the right way?
  • Have you properly recorded your decision?

Seeking advice and timely sharing of information between agencies is vital to ensure the best use of the available professional expertise to facilitate decision making in the context of effective multi-agency working. It is each practitioner’s responsibility to familiarise themselves with internal mechanisms of reporting, sharing information and escalation of concerns.

Share with consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, that lack of consent can be overridden in the child’s/public interest. You will need to base your judgement on the needs of the child facts of the case.

Discussion of Concerns about an Unborn Baby’s Safety and Welfare

Professionals, who are uncertain as to whether their concerns meet the significant harm threshold, or have serious worries about an unborn child, should in the first instance discuss this with the Child Protection Named Officer within their own Organisation. This discussion must result in a written record of the decisions taken, and the reason for those decisions, in line with their agencies internal process and procedures. See also Meeting the Needs of Children Procedure.

Records of previous children who are no longer in the care of their parents should, where possible, be reviewed and assessed to consider previous parenting history and any contributing risk factors.

Risk factors may also include, for example, drug and alcohol misuse, mental ill health, learning difficulties, social isolation, domestic abuse within the relationship, and where it is evident that mother is unwilling or unable to plan for the new baby. An assessment of factors can lead to a view that support, advice, counselling or a Family Group Conference may assist. An Early Help assessment should be completed and if required a TAC meeting should be initiated in order to address the identified needs. See also www.lincolnshire.gov.uk/TAC.

Early Identification and Early Help Assessments

It is important that all practitioners working with pregnant women/women of child bearing age are aware of assessment needs and of routes of referral in order to facilitate engagement, care and intervention in accordance with their own Organisational Safeguarding Policies and Procedures and those of the LSCB.

Where it is considered that a child and/or family have additional needs (outside those provided universally) an Early Help assessment should be completed. (See Team Around the Child Supporting Documentation).

The assessment may conclude that there is a level of concern/need and the family will benefit from additional intervention from other services. If this is the case the professional working with the parent(s) should initiate a Team Around the Child (TAC) (see Team Around the Child Supporting Documentation,) to promote a multi-agency response. As per the process, parent(s)/carer(s) should be fully involved. It is important that early services are offered and delivered to assist the parents during pregnancy and in making arrangements to enable them to be prepared for the birth and for parenting. Service provision should be co-ordinated through Team Around the Child processes.

The TAC process should run through the pregnancy.

If it is agreed that the unborn child maybe a Child in Need or child at risk under the Children Act, then a referral should be made to Children’s Social Care at 20 weeks. Prior to this service provision should be co-ordinated through the TAC. Families should be informed of concerns and referrals, unless it is felt that to do so would put a child, unborn child, or other person at risk of harm. All information should be shared in accordance with best practice and the LSCB Information Sharing Protocol Team Around the Child (TAC) and LSCB Procedures. See Appendix 1: Pre-Birth Flow Chart.

A TAC plan should fully involve the parent(s), any wider family and all those agencies who can work with the family to meet identified needs and reduce risks to the unborn child. Where a TAC Plan is already in place for an older child(ren), it can be widened to meet the needs of the unborn child.

Should the unlikely circumstances arise whereby you as a professional are initially unable to gain consent of the family it is your responsibility to work with the family to nurture and gain their consent and initiate the TAC. If you or your agency does not have ongoing long term contact with that family, it is your responsibility to identify a suitable professional with which the family has an existing relationship with and who could lead the TAC.

If the family has no existing contact with any professionals then you must refer to the named midwife (with consent). The named midwife will then arrange a response from a midwife who will undertake an EHA and initiate a TAC if required.

In the unlikely circumstances that the family will not engage with the midwife, then you must inform the family that you will be making a referral to the named midwife and they will refer to Social Care at 20 weeks gestation if the circumstances meet Social Care threshold. The named midwife and community midwives will continue to engage with the family in the pursuit of undertaking an EHA and TAC.

All assessments undertaken during the antenatal period should take into account family and social history, alongside the obstetric history, detailing the family strengths (protective factors) as well as concerns (vulnerability factors).

The assessment will explore issues, such as (see Working Together to Safeguard Children (2010)).

  • Domestic abuse (pp262 5, 310-5);
  • Substance misuse, (pp270-8);
  • Mental health issues (pp265-9);
  • Multi-Agency Practice Guidelines: Female Genital Mutilation (HM Gov. 2014, pp16);
  • Learning disabilities;
  • Child Sexual Exploitation;
  • Known parenting capacity for previous children, with particular focus where parents have cautions/convictions for offences against children and/or have had children removed from the care of either parent;
  • Any other presenting issues that may impact upon the parents capacity to effectively parent the child(ren).

Fathers and/or mothers partners should be included within this assessment alongside any other family members who may have a significant role to play in caring for the child or supporting the parents.

Pre-birth cases will be managed in a number of different ways depending on the family circumstances and the nature of the assessment carried out by practitioners in contact with the family. See Appendix 1: Pre-Birth Flow Chart.

Assessments are required in a timely manner and often at short notice to meet the statutory timescale requirements. Accordingly all partner agencies have a duty to accommodate, where possible, multi-agency meetings, e.g. GP surgeries, hospital settings, children’s centres, council buildings.

Referral to Children’s Social Care

It is essential that professionals gather as much information as is available from within their agency when making a referral. A safeguarding referral form is required. The professional should contact the Customer Service Centre 01522 782111 who will clarify the details of the referral.

At the end of the discussion about an unborn child, both the referrer and Customer Service Centre should be clear about who will be taking what action, or that no further action will be taken.

The referrer should confirm the referral within writing within 24 hours repeating all relevant information and agreed actions.

The referrer will be notified of the outcome of the decision within 24 hours of making the referral.

Where Children’s Social Care decides to take no further action at this stage, feedback should be provided to the referrer, who should be told of this decision and the reasons for making it, (and TAC continued.)

The referrer should be advised of alternative options for ensuring the family can be offered support services to promote the child’s welfare. Opportunities include information and advice, referral to another agency including the Family Group Conference Service or a co-ordinated package of inter-agency support through the TAC process if not already in place. The referrer should discuss these options with the parent and young person and gain consent for the next steps. The referrer will have a key role in taking forward these options in partnership with the family and with the clear support and involvement of other professionals.

Where concerns about impairment to the child’s health and development or, the child suffering harm are substantiated which justifies a Social Care Assessment to establish whether this child is a ‘child in need’ the case will transfer to the Children's Social Work Team who will then manage the case under Child in Need or Child Protection Processes and will appoint a key worker.

Action following Assessment under Section 17 & 47

Discussion/Meeting (Section 17)

A Social Care Assessment may indicate that the unborn child is a ‘Child in Need’ as defined by Section 17 of the Children Act 1989 but there are no substantiated concerns that the child may be suffering, or is likely to suffer, Significant Harm. In these circumstances the family must be involved and agree with this decision. For both TAC plans and Child in Need Plans, the family’s involvement is crucial and should be fully encouraged and supported.

There may be sufficient information available on which to decide what services (if any) should be provided by whom according to an agreed plan. On the other hand a more in-depth assessment may be necessary in order to understand the child’s needs and circumstances.

TACs are led by a Lead Professional (e.g. midwife, Health Visitor, Family Support Worker etc) whilst Child in Need Plans are led by a Social Worker.

3.6.2 Action  following assessment resulting in concern of Significant Harm or risk of Significant Harm (Section 47).

The timing of the pre-birth Strategy Meeting is a matter of professional judgement and will be agreed within the multi-agency professional network including (as a minimum Social Care, police and health). The effective management of pre-birth cases may require that more than one strategy meeting/discussion take place. Attendance and information sharing at the strategy meetings must take high priority to facilitate effective decision making. The Strategy Meeting will be chaired by a Practice Supervisor or Team Manager from Children’s Social Care. When arranging the strategy meeting a discussion with the family GP is required to discuss the feasibility of holding the strategy meeting at the surgery and at suitable time to enable the GP attendance.

If at the strategy meeting it is agreed that the unborn baby is at risk of Significant Harm, then a Section 47 investigation will be initiated. Whilst there may, in some circumstances, be more than one strategy discussion or meeting, it is the FINAL strategy discussion or meeting will agree the section 47 investigation.

Within 15 days of a Strategy Discussion which initiated a Child Protection Investigation under S.47, an Initial Child Protection Conference will normally be called.

The Strategy Meeting should take into account the possibility of the child being born prematurely and a Contingency Plan which must include specific risk assessment and detailed safety planning.

Strategy Meetings should also take into account the welfare of any other children within the household and should consider all identified risk factors.

Strategy Meetings need to take into account any previous history, including concealed pregnancies, home births without medical involvement, or risk of flight.


4. Unborn Child Protection Conference

If a conference is to be convened, it should be held within 15 working days of the decision being made at the Strategy Meeting that initiated the S.47 investigation.

If concerns relate to an unborn child, consideration should be given as to whether to hold a Child Protection Conference prior to the child’s birth. (Working Together 2015).

The pre-birth conference should take place as soon as practicable after 30 weeks gestation, to allow as much time as possible for planning support for the baby and family and to ensure that the first review is not being undertaken whilst the child is unborn.

Risk Factors

Where there are known risk factors of the likelihood of a premature birth, the conference should be held earlier. Risk factors include:

  • Previous history of premature delivery;
  • Twin or multiple pregnancy;
  • Maternal Health Issues / Disability;
  • Domestic Abuse;
  • Problematic Drug and Alcohol Misuse;
  • Trauma.

Above is not an exhaustive list. The pre-birth conference should always ask the question of whether the pregnancy has the risk of premature delivery and record the likelihood of risk.

All professionals should give high priority to attendance at pre-birth conferences if requested. If attendance is not possible, they should ensure that another professional from their agency takes the relevant information. All professionals are expected to complete a standard report template for the Conference and the report must be shared with parents prior to the conference.

The conference will not be viable if relevant professionals are not present. (See Initial Child Protection Conferences Procedure.) Professionals not attending where timely actions are required will be notified by the conference chair, and all actions will be recorded in the minutes. Professionals identified as relevant at the conference will be formally invited to future meetings and copies of the minutes / plans already in place made available to them.

Representation

At a minimum the pre-birth conference must have representation from:

  • Midwifery Service;
  • Family Nurse Partnership – where relevant;
  • Health Visiting Service;
  • Children Centre Social Care;

Where a Child Protection Plan recommends that it is appropriate to consider entering Care Proceedings the Social Care Team will follow the process of a legal planning meeting, presentation to Support Panel and referral to CAFCASS (See Appendix 1: Pre-Birth Flow Chart).

There is an expectation that where a previous child has been removed, or a parent (including partners of pregnant women who are not the putative father) have been convicted of any offence against a child, including a caution, will be presented to Support Panel and a legal planning meeting convened.

4.5 CAFCASS PLUS is to be applied in all cases of unborn babies where there are safeguarding concerns in respect of the parent's ability to adequately safeguard the child and/or meet the holistic needs of the child.

The Social Worker and Practice Supervisor will present any such case at the Support Panel as soon as possible after the Pre Birth Care Assessment has been completed. This must be no later than a gestation period of 24 weeks.

The request to Support Panel is for the unborn babies’ case to be included in the scheme, for a legal planning meeting to be heard and for a letter before proceedings to be issued.

Support Panel (see Support Panel Procedure) will make a decision about whether the matter should be referred to CAFCASS Plus or not.

The unborn babies’ case should then be subject of a legal planning meeting.

For further details on the CAFCASS Plus Initiative.


5. The Plan

A Child Protection Plan should be made in the conference if the concerns are substantiated and there is reason to suspect that the unborn baby may be at continuing risk of Significant Harm. The plan must consider the immediate safety needs of the child once it is born as well as future needs and details of any further assessments required. This plan will also seek to promote the child(rens) welfare. The Child Protection Plan is subject to statutory review processes and will make explicit:

  • Which agencies are involved and have contributed to the plan;
  • Each agency’s role within the plan;
  • Identify the leader co-ordinator of the plan;
  • The process of changes to plan in accordance with progress;
  • The communication across agencies involved with the plan;
  • The escalation route should concerns be raised.

NB: each practitioner has a responsibility to ensure their organisational internal mechanisms are satisfied.

The Plan needs to consider the risk factors outlined in Section 7, Framework for Assessment, and outline what actions are required to mitigate the risks.


6. Conclusion

Safeguarding children and protecting them from harm is everyone's responsibility. (Working Together 2015.)

This protocol describes best practice for Professionals when working with expectant parents about whom there are concerns regarding their unborn child. All women who are pregnant should be assessed in accordance with this protocol and where there is an identified risk of harm to the unborn baby, agencies must work collaboratively alongside other agencies in the antenatal as well as postnatal periods.

Where members of staff from any agency feel concerns regarding a child are not being addressed it is expected that the Professional Resolution and Escalation Policy and Processes should be used until a satisfactory conclusion is achieved.

See Professional Resolution and Escalation Protocol.

This protocol is used by all practitioners and agencies when assessing pregnant women and determining the level of risk.


7. Framework for Assessment

Factors to be considered when undertaking a Pre-birth assessment (Must include strengths/protective factors as well as risk factors):

Unborn Baby

  • Unwanted/concealed pregnancy;
  • Awareness of baby’s needs;
  • Awareness of unborn baby’s health;
  • Parental expectations of new born baby;
  • Parenting plans;
  • Premature birth.

Parenting Capacity

  • Childhood experiences: -
    • Positive childhood;
    • Multiple carers.
  • Recognition of effects of own behaviour on others;
  • Drug/alcohol misuse;
  • Abuse/neglect of previous child(ren);
  • Age – very young parent/immature;
  • Mental disorders or illness.

Family/Household/Environmental

  • Domestic abuse and/or honour based violence;
  • Violent or deviant network;
  • Poor impulse control;
  • Unsupportive of each other;
  • Frequent moves or house/homelessness;
  • No commitment or limited to planning or preparation to parenting;
  • Perceptions;
  • Ability to prioritise baby’s needs;
  • Antenatal care;
  • Planning;
  • Special/extra needs;
  • Previous child death;
  • Multiple pregnancy;
  • Learning difficulties;
  • Physical disabilities/ill health;
  • Inability to work with professionals;
  • Cultural issues;
  • Positive mental health;
  • Child previously removed from their care, has had contact restricted or has a child voluntarily accommodated;
  • Relationship disharmony/instability;
  • Multiple relationships;
  • Not working together;
  • Lack of community support;
  • Poor engagement with professional services.

NB – this is not a definitive list of potential triggers/risks there will be other factors not included here, which the practitioners need to consider and each pre-birth assessment must be conducted on an individual basis and in a child centred manner.


8. References:

  • Department of Health (2007a) Maternity Matters: choice, access and continuity of care in a safe service; London, DH April 2007;
  • Department of Health (2007) The Family Nurse Partnership Programme; London, DN April 2007;
  • Department of Health (2009a) Healthy Child Programme; Pregnancy and the first five years of life; London, DH;
  • Department of Health (2009b) Getting it right for children and families: Maximising the contribution of the health visiting team ‘Ambition, Action, Achievement’; CPHVA, Unite; NHS, November 2009;
  • Hart, Di (2010), Assessment Before Birth’ in Howarth, Jan (Ed) (2010) ‘The Child’s World Second Edition: The Comprehensive Guide to Assessing Children In Need’, Jessica Kingsley Publishers, London, (Chapter 14);
  • HM Government (2010) Working Together to Safeguard Children: A guide to inter- agency working to safeguard and promote the welfare of children; HM Government/Department for children, schools and families, March 2010, Nottingham;
  • National Institute for Health and Clinical Excellence (2007) Antenatal and postnatal mental health, NICE clinical guideline 45, February 2007, reissued April 2007;
  • National Institute for Health and Clinical Excellence (2007) Intrapartum care: care of health women and their babies during childbirth, NICE clinical guideline 55, September 2007 www.nice.org.uk;
  • National Institute for Health and Clinical Excellence (2008) Antenatal care: routine care for the healthy pregnant woman, NICE clinical guideline 62, March 2008;
  • National Institute for Health and Clinical Excellence (2010) Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors, NICE clinical guideline 110, September 2010;
  • Department of Health (2015) Female Genital Mutilation Risk and Safeguarding Guidance for professionals.

 

9. Bibliography

Of other area Local Safeguarding Boards Multi-Agency Pre-Birth protocols reviewed and used to inform the writing of this protocol include: -

  • Cambridgeshire SCB Pre birth Multi-Agency Procedures;
  • Devon SCB Joint Protocol and Practice Guidance on Pre-birth assessments (2010);
  • Hertfordshire SCB Multi Agency Pre-Birth Protocol (2010);
  • Lancashire SCB Multi-agency Pre-birth Protocol (2009);
  • Norfolk SCB Multi-Agency pre-Birth Protocol (2008);
  • Nottingham City SCB Safeguarding Babies at birth where the risks are too great to leave them in the care of their parents – Practice Guidance Toolkit (2009);
  • Slough SCB Multi-Agency Pre-Birth Protocol (2009).


10. Notes

  1. All cases of medium to high concern should move to TAC first if under 20 weeks gestation – where concerns remain Or escalate and there is a risk of significant harm. LP refers to Social Care at 20 weeks;
  2. CAFCASS Plus Protocol in place for unborns where:
    • Either – previous children of the same parent(s) had been the subject of care proceedings;
    • Or – a parent has / a caution or a conviction in relation to any type of abuse against a child.
  3. Please note that where a family/mother is already involved in TAC/CIN or CP Planning, the Key Worker/Lead Professional should be informed of pregnancy and any further planning around unborn should be incorporated into current planning.

Appendix 1: Pre-Birth Flow Chart

Click here to view Appendix 1: Pre-Birth Flow Chart  

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