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Multi-agency Pre-Birth Protocol

This chapter was added to the manual in August 2016.


Contents

  1. Purpose
  2. Scope
  3. Identification of Issues or Concerns in Pregnancy
  4. Timescales Regarding Assessment and Planning where there is a need to refer to Children's Social Care for a Multi-Agency Pre-Birth Assessment
  5. Children Looked After who are Placed in Cumbria by Another Responsible Local Authority

    Appendix 1: Examples of Pre-Birth Risk and Protective Factors


1. Purpose

The purpose of this protocol is to ensure that a clear system is in place to develop robust plans which address the need for early support and services and identify any risks to unborn children.

Antenatal assessment is a valuable opportunity to develop a proactive multi- agency approach to families where there is an identified risk of harm.


2. Scope

This joint protocol applies particularly to staff working within Children’s Social Care, Health and the Police, but is of relevance to all agencies that work with parents, children and their families.


3. Identification of Issues or Concerns in Pregnancy

At the point of completing the Ante Natal Risk Assessment if there is a need for coordinated multi-agency support in order to promote the welfare and meet the additional needs of an unborn child, then an Early Help Assessment should be considered (see Cumbria LSCB website - Early Help). Or if at any stage in the relationship between midwife and parent an emerging additional need is identified an assessment should be in itiated then. Families need to agree to this process – however if they do not consent the implications of this should be considered – and consideration given to the need to refer to Childrens Social Care. If the family consent, the initial part of the Early Help form should be completed with them and a Team Around the Family convened to include any agencies already involved or any who could address needs identified e.g. Adult Mental Health, Drug and Alcohol Service, and Domestic Abuse Services, Health Visitor, Nursery or schools. These services can input to the assessment by adding their own information reflecting their knowledge of the family. Alternatively the first TAC could be small – with midwife parent(s) and one other agency – building as the additional needs are identified.

A referral to Children's Social Care for a pre-birth assessment should be considered when it is believed that there may be complicating risk factors which will impact on the unborn child. For guidance please refer to the Multi-agency Thresholds Guidance (including Referrals) Procedure.

A referral to Children's Social Care, via the Safeguarding hub, utilising the single contact form, for a Pre-Birth Assessment must always be completed if there is reasonable cause to suspect that the unborn baby is likely to suffer significant harm before, during or after birth, as defined in Cumbria Safeguarding Children Procedures.

Examples of when a Multi-Agency pre-birth assessment, led by Children's Social Care, should be considered (please note, this list is not exhaustive):-

  • There are concerns that parent /their partner/potential carer may pose a risk to children (examples may include previous neglect or physical abuse of children, or sexual offences – see Appendix 1: Examples of Pre-Birth Risk and Protective Factors);
  • There are concerns regarding parent/their partner/potential carer in terms of their parenting capacity. Such concerns may include mental health problems, learning disability or inability to parent or protect children from harm. See Appendix 1: Examples of Pre-Birth Risk and Protective Factors;
  • Parent/their partner/potential carer has children that have been made subject to a Child Protection Plan, or Care or Supervision Order at any time in the past (or if proceedings are ongoing);
  • One or both of the parents is in care or has previously been in care to a Local Authority and the parents view as to how this has affected them;
  • There are concerns with regards to domestic abuse. These could relate to any person who may be involved with the unborn baby;
  •  There are concerns regarding drug/alcohol misuse of parent/their partner/potential carer:
  • There are significant concerns about the lifestyle of parent/their partner/potential carer which would impact on their ability to parent or protect children (examples may include a concealed pregnancy, failure to access appropriate ante-natal care – see Appendix 1: Examples of Pre-Birth Risk and Protective Factors);
  • One or both of the parents have had previous children removed due to concerns about the care given to that child/ren.

See Appendix 1: Examples of Pre-Birth Risk and Protective Factors for additional guidance and for a link to risk assessment guidance.

When undertaking a pre-birth assessment the needs of other children in the household should also be considered.


4. Timescales Regarding Assessment and Planning where there is a need to refer to Children's Social Care for a Multi-Agency Pre-Birth Assessment

  • In general referrals to Children’s Social Care for a multi-agency pre-birth assessment should be made no earlier than at 16 weeks gestation. (1.) In exceptional circumstances, there may be a need to refer high risk cases before 16 weeks (for example, previous children removed, or children currently subject to Child Protection Plans). In such cases, advice should be sought from the duty social worker (see Responding to Abuse and Neglect Procedure, Making a Contact/Referral. If the referrer has not received an acknowledgement within 3 working days, the referrer should contact Children's Social Care again.

    (1.) Referrals must be accompanied by the EHA and TAC minutes if they are available
  • During the process of completing a pre-birth assessment, a meeting of all professionals involved must be convened as per multi-agency child and family assessment. All professionals should give high priority to attendance at child and family assessment planning meetings if requested. If attendance is not possible, they should ensure that their report is taken to the meeting by another appropriately briefed professional from their agency.

At the end of the assessment the outcome will be one of the following;

  • No further action is required;
  • A referral for early help is required;
  • An unborn baby Child Protection Conference is required;
  • Where a pre-birth Initial Child Protection Conference is required it will be convened no later than 30 weeks gestation (2.) If the unborn baby is made subject to a Child Protection Plan at that Conference, the first Core Group meeting will be held within 10 working days to agree the plan for the baby and the baby's discharge from hospital;
  • If the unborn baby is not made subject to a Child Protection Plan, a Child in Need Plan will be considered. If statutory intervention is not felt to be appropriate, a Team Around the Child (TAC) meeting should be considered.

All professionals should give high priority to attendance at Child Protection Conferences if requested. If attendance is not possible, they should ensure that their report is taken to the Conference by another appropriately briefed professional from their agency. The Conference may not be viable or quorate if professionals are not present. Child Protection Conference Reports should be shared with parents prior to the meeting. See Child Protection Conferences Procedure.

(2.) In exceptional circumstances this may not be possible (e.g. concealed pregnancy or late presentation)

  • The midwife (or representative for midwifery services) will ensure that the pre- birth plan is filed in the maternity records within 2 working days of its completion. A copy will also be sent by the social worker to the Emergency Duty Team/Care Connect;
  • Maternity unit staff will inform Children’s Social Care of the baby’s birth immediately. (If out of hours, then the Emergency Duty Team/Care Connect.);
  • The named Social Worker will organise the pre-discharge planning meeting prior to the baby's discharge from hospital. This meeting will confirm the baby’s placement after discharge and multi-agency professional interventions will be agreed, recorded and distributed;
  • The Review Child Protection Conference must be held within 4 weeks of the birth of the child, or sooner if legal action is being considered.


5. Children Looked After who are Placed in Cumbria by Another Responsible Local Authority

  • There should already be a record of the child in Cumbria as the placing Local Authority should have informed Cumbria that the child is now living in the area;
  • As soon as the child’s allocated Social Worker becomes aware that the child is pregnant they should convene a meeting with the young person and the manager of the unit/placement to discuss if the placement is able to accommodate a mother and baby. If not - if it is more appropriate for the young person to be moved back to a more suitable placement in the home authority?
  • If it is established that the child WILL remain in Cumbria up to the birth of the baby the allocated Social Worker should then make a referral for an assessment via the Cumbria Safeguarding HUB;
  • A Cumbria Social Worker will be allocated to the unborn child;
  • A joint pre-birth assessment will be necessary and a meeting should be held between the Team Manager in the placing Local Authority and Cumbria to agree who will be responsible for:
    1. Assessing the parents - which should be the allocated Social Worker for the parent/s;
    2. Assessing the needs of the unborn child - which should be the allocated Cumbria Social Worker for the unborn child.
  • If it assessed that the unborn child should be made subject to a pre-birth Child Protection Conference the Cumbria procedures should be followed: See Child Protection Conferences Procedure.


Appendix 1: Examples of Pre-Birth Risk and Protective Factors

Examples of Pre-Birth Risk Factors

Unborn Baby

  • Unwanted pregnancy;
  • Concealed pregnancy;
  • Premature birth;
  • Lack of or inconsistent ante-natal care;
  • Additional/complex health needs (e.g. disability or substance withdrawal).

Parenting Capacity

  • Lack of positive parenting role model;
  • One or both parents were Looked After Children;
  • Lack of recognition of impact of own behaviour on others
  • Lack of awareness of unborn baby's health needs;
  • Lack of preparation for new born baby Unrealistic expectations of new born baby Drug/alcohol misuse;
  • Abuse/neglect of previous child(ren);
  • Age – very young (teenage) parents/immature Mental ill health that could impact on ability to parent;
  • Learning difficulties that could impact on ability to parent;
  • Physical disabilities/ill health that could impact on ability to parent Lack of engagement with professionals;
  • Lack of self-care skills;
  • Domestic abuse.

Family/Household/Environmental

  • Domestic abuse;
  • Inappropriate social networks
  • Poor home conditions;
  • Significant debt;
  • Frequent moves of house/homelessness;
  • Relationship difficulties;
  • Multiple relationships;
  • Lack of community or family support;
  • Poor engagement with professional services;
  • Isolation (physical and social);
  • Anti-social behaviour issues/criminal activity Dangerous pets.

Examples of Pre-birth Protective factors

Unborn Baby

  • Wanted pregnancy;
  • Consistent ante-natal care;
  • No special health needs or known disabilities.

Parenting Capacity

  • Positive experiences of parental role models;
  • Previous positive experience of being a parent;
  • Parent with good physical and mental health Controlled/monitored use of substances;
  • No misuse of substances;
  • Appropriate preparation for baby;
  • Realistic expectations of new born baby;
  • Positive attitude to education
  • Positive family support;
  • Good attendance at health checks and other appointments;
  • Shared parental responsibility;
  • Parent with no additional needs.

Family/Household/Environmental

  • Stable relationships;
  • Positive social networks and support Positive contact with absent parent Stable and well managed income Employed;
  • Stable neighbourhood/ community links;
  • Secure tenancy or owned occupier Acceptable housing standards Positive acceptance of unborn child;
  • Willing to engage with professionals if needed.

End.