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5.25 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 or may need support with any additional needs they may have with the parent with the parent when they are born. 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. 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 or additional needs and to ensure that early help is provided to prevent escalation.

RELATED CHAPTER

Concealment and Denial of Pregnancy and Birth Procedure

AMENDMENT

This chapter was significantly reviewed in November 2020 and includes an updated protocol flow chart. The earliest date for a referral to Children's Services for unborn children is now at 14 weeks gestation. The process has also been significantly amended to enable separate pathways for Child Protection and Care Proceedings.


Contents

  1. Introduction
  2. The Roles and Responsibilities of Professionals in Respect of Unborn Children
  3. Care Pathways
  4. Conclusion
  5. References

    Appendix 1: Pre-Birth Protocol Flowchart


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. 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. When additional needs are identified before or following birth then appropriate action should also be taken to support these needs.

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).

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?

In addition practitioners must consider if there are additional needs that will require early support to prevent escalation and to provide the family support.

Where there is reason for doubt, a pre-birth multi-agency assessment is initiated, either through the early help protocol or by social care. This assessment should be carried out when there are additional needs or risk has been identified. Both these factors do not need to be present for an assessment to be completed and early support provided.

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 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).

For further information regarding FGM and your professional responsibilities please refer to Safeguarding women and girls at risk of FGM.


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

All agencies, 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. Therefore, the professional who is first made aware of the pregnancy should initiate the pre-birth protocol and complete a Child and Family Early Help Assessment, or make a referral for the unborn child to Children's Services.

All agencies are likely to come into contact with pregnant women through their duties. 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 roles. 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. All agencies should liaise with the Midwifery Service

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


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 an assessment, either through a Child and Family Early Help Assessment or by a social care assessment under Child in Need or Child Protection procedures. (See Section 47 Enquiries and Social Work Assessments Procedure.)

Practitioners working with a young person under 18 years must give consideration to a consultation with/ referral to Children’s Services. See also Working Together/LSCP 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.

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

Information Sharing and Consent

All partners must ensure that they are aware of the guidance and legislation in place regarding information sharing when there are concerns about an unborn child. For further information please see Protocol on Sharing Information in Order to Safeguard and Promote the Welfare of Children.

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 their Safeguarding Lead within their own Organisation. Safeguarding Leads should consider if a discussion with the Midwifery Safeguarding Lead is required. 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: Putting Children First (Meeting the Needs of Children and Families in Lincolnshire).

Practitioners should also consider a consultation with a social worker by calling the Customer Service Centre.

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, Family Network Meeting or a Family Group Conference may assist. An Early Help Child and Family assessment should be completed and if required a TAC meeting should be initiated in order to address the identified needs. See also Team Around the Child (Lincolnshire County Council Website).

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 LSCP.

Where it is considered that a child and/or family have additional needs (outside those provided universally) a Child and Family 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 may be a Child in Need or child at risk under the Children Act, then a referral should be made to Children’s Social Care at 14 weeks or at any point afterwards that concerns arise. 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 LSCP Information Sharing Protocol Team Around the Child (TAC) and LSCP Procedures. See Appendix 1: Pre-Birth Protocol Flowchart.

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 See Appendix 1: Pre-Birth Protocol Flowchart.

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.

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.

If Social Care is made aware of an unborn baby before 14 weeks gestation, however the history of the parent/s is known or has involved previous Child Protection or Legal action, then the Social Care team is responsible for notifying the Midwifery Safeguarding Lead. This will ensure that the Midwifery Safeguarding Lead is aware of high risk pregnancies and can liaise with the Midwifery Service and Social Care team as required.

Action following Assessment under Section 17 & 47

Social Care support will follow one of three pathways as below. The support for the unborn child and parents may step up or down between these pathways as identified by ongoing casework. The pathway followed is a decision that will be made by Social Care based upon the available evidence including any relevant past history applicable to the parents.

Action under Section 17

The Child in Need (CIN) process will be followed. A case can be stepped down to TAC at any stage where it is assessed as being relevant and suitable to meet the unborn child and the parents' needs. A case can be escalated to a strategy discussion or Support Panel at any stage where it is assessed that the potential risks to the unborn baby (or baby once born) are such that the threshold is met. These decisions will be made by Social Care with consideration to the views and information from partner agencies.

Action under Section 47

If the assessment of the available information, including that from partner agencies and consideration of both parents' history, is such that there are concerns of a significant risk of harm to the unborn baby or baby once born then the child protection policy (see Initial Child Protection Conferences Procedure) will be followed.

The strategy discussion will be held as a discussion involving Police, Children's Health and the Midwifery Safeguarding Lead. This must take place by 23 weeks gestation. In the event of late presentations or concealed pregnancies the strategy discussion must be convened as a matter of urgency.

Consideration of Legal Proceedings under the Public Law Outline (PLO)

If the assessment of the available information, including that from partner agencies and consideration of both parents' history, is such that the that legal proceedings may be required then Social Care will present the case to the Support Panel by 21 weeks gestation. At the Support Panel the information gathered, including partner agencies information, will be analysed with senior managers from Social Care.

It will be the decision of the Support Panel to initiate a Legal Planning Meeting (LPM) and to progress to Pre-Proceedings or whether to manage the case within Child Protection. If the decision is that the case can be managed at Child Protection, the steps outlined above should be followed. If agreed at a subsequent Initial Child Protection Conference, a plan will be confirmed.

If the decision is that the case should by managed under PLO then Social Care will initiate a Legal Planning Meeting. This will involve only Social Care. A strategy meeting must be held by 23 weeks gestation and must include all relevant agencies that are working with the family. This strategy meeting will be chaired by a member of the Quality and Standards Team (an IRO), as the matter is subject to PLO, consideration will be given to managing the case as CIN s17. A CIN plan will be agreed at this meeting. This is because the case will be managed under PLO and Child Protection procedures are not required.

The purpose of an Independent Chair leading the strategy meeting is to provide an independently led multi-agency forum that can facilitate the involvement of all partner agencies in the sharing of information for the purposes of safeguarding the UBB. The strategy meeting will enable all agencies to identify their roles in the delivery of support and assessment services prior to the baby's birth. The role of the IRO as Chair will also ensure consistency of practice across social care teams and ensure that social care share their plan of support for the family with relevant partner agencies. The contribution of partner agencies will enable social care to determine the safest most relevant pathway for the protection of the UBB

The LPM does not have to wait until the strategy meeting is held and this should also not delay the commencement of Pre-Proceedings Meetings (PPM). A PPM is a meeting between Social Care and their legal representatives and the family and their legal representatives.

Concurrently with the PLO process Social Care will manage the case at Child in Need s17. This will ensure that regular multi-agency meetings take place.

Post Birth

If the case has been managed under PLO then Social Care are responsible for making any applications to the Court in a timely manner.

A Discharge Planning Meeting (DPM) (see Discharge Planning from Physical Healthcare Hospitals when there are Safeguarding Concerns about a Child) must be held if the case is being managed within Child Protection or PLO. Consideration for a DPM must be given if the case is managed in CIN or TAC.

It should be noted that at any point in the different pathways then a case may escalate or step down, this includes from the PPM pathway. This change of pathway can happen at any point and the decision to do so is made by the social care team who have case management oversight.


4. Conclusion

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

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.


5. References

  • HM Government (2018) Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children, HM Government, July 2018;
  • Department of Health and Social Care (2009a) Healthy Child Programme; Pregnancy and the first five years of life; London, DH;
  • Department of Health and Social Care (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, D (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);
  • Hidden Harm: Responding to the needs of children of problem drug users. ACMD (2003);
  • Howard, L et al (2011) Antenatal domestic violence, maternal mental health and subsequent child behaviour: a cohort study BJOG: An international journal of obstetrics and gynaecology;
  • National Institute for Health and Care Excellence (2014) Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance;
  • National Institute for Health and Care Excellence (2014) Clinical guideline [CG37] Postnatal care up to 8 weeks after birth;
  • National Institute for Health and Care Excellence (2016) Maternity Matters and Better Births Public Health England;
  • 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 and Social Care (2015) Female Genital Mutilation Risk and Safeguarding Guidance for professionals;
  • NHS Long Term Plan 2019.


Appendix 1: Pre-Birth Flowchart

Click here to view Appendix 1: Pre-Birth Protocol Flowchart.

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