Pre-Birth Assessments: A Quick Guide
Numerous research studies have concluded that children are most at risk of severe and fatal assaults in the first year of life, generally inflicted by parents or carers. For this reason, Pre-Birth Assessments can be an essential tool to identify and protect vulnerable individuals.
These assessments are conducted ideally during early pregnancy, allowing parents the opportunity to change. If the assessment suggests the parents’ capacity to care for the child is negatively affected then there is a window of opportunity for parents and professionals to work together and make plans for the child and support the parents.
Safeguarding concerns may emerge for a variety of reasons. For example, a child is at increased risk if either or both parents are under 18 and especially if the mother is under 16. Similarly, if either parent has mental health problems, learning disabilities or abuses alcohol or drugs, then this assessment would be forthcoming.
Other factors taken into account could be: concerns regarding domestic violence or abuse; a denied or concealed pregnancy; when either parent is a looked-after child (or is known to children’s social care); or a child in the household is subject to a Child Protection Plan.
There may be someone in the house (or a regular visitor) who has been identified as posing a risk to children, or a sibling could have been removed by a court order or because they have suffered harm. Any evidence of a parent having harmed children in the past, or a mother’s inability to protect a child, warrants a Pre-Birth Assessment.
The first step when professionals suspect that prospective parents may need support is to undertake an Early Help Assessment (EHA). This could result in a Team Around the Child (TAC) being formed, or a multi-agency meeting to pool resources and arrange a package of care for the baby and family. A referral is made to Children’s Social Care if there is concern that the baby may be at risk of Significant Harm. The subsequent support provided will be multi-agency and could be a Child Protection Plan.
In this case, a multi-agency meeting should take place as soon as possible. In particular, initial approaches to the parents in the last stages of pregnancy should be avoided, as this is already an emotionally delicate time. It is also a good idea to allow parents time to contribute their own ideas in order to increase the possibility of a positive outcome. It makes sense to allow more time for the early provision of support services, a full and informed assessment, and adequate planning for the baby’s protection.
Sometimes child protection procedures need to be in place before the birth. This could apply when the mother’s lifestyle is putting her unborn foetus at risk, as a result of alcohol/substance misuse for example (particularly if there has been no positive response to specialist treatment services). Another factor could be when the mother has been identified as being at risk of sexual exploitation, or when particular support services are needed after the birth such as a change in accommodation.
If there are significant concerns for the safety of an unborn child then a Child Protection Conference may be convened, which will consider the need for a multi-agency child protection plan. This will normally follow the Pre-Birth Risk Assessment, and should take place when a previous child has died / been seriously injured or removed from parents due to significant harm, or when a person known to pose a risk to children lives in the household or regularly visits.
Other risk factors include the presence of other children in the household already subject to a child protection plan, and a pre-birth assessment leading to concerns that an unborn child may be at risk of significant harm.
A pre-birth conference should take place by 32-week gestation (or even earlier when there is a history of premature birth). When a decision has been made that the child will be subject to a Child Protection Plan, the Core Group (made up of the lead social worker and other multi-agency professionals) should be defined in the initial conference. They should meet before the birth, and particularly before a child’s return home after a hospital birth. There should be an initial Child Protection Review Conference within 3 months of the pre-birth conference, or within 1 month of the birth (whichever happens first).
Pre-birth assessment can be complex and stressful for parents, as they may feel worried about their child being removed from birth. Professionals may also be reluctant to lose the trust of the adults they work with. It is important for them to liaise with other professionals such health visitors, midwives, and those working with mental health or substance abuse. It is also important for them to access the full family history to see, for example, if previous children have been removed from the family. Time should also be dedicated to the prospective parents, to establish their feelings about the birth and any unresolved conflicts they may have.
In serious cases, when it is agreed in a Legal Planning Meeting that proceedings under a Public Law Outline framework will go ahead, then steps should be taken to explore all options quickly in order to avoid initiating Care Proceedings. Professionals should work with the family, minimising activity in the late stages of pregnancy.
If the baby will indeed be subject to Care Proceedings from birth, then Birth Planning Meetings should take place, at the hospital ideally. This will be the case if there are serious concerns over alcohol/substance abuse, mental health or domestic violence. The objective of this is to safeguard the newborn baby with a multi-agency plan. Professionals should take into account the need for hospital security and police intervention, as well as potential abduction of the baby from hospital. Contingency plans should also be in place for any last-minute changes.
In most cases, care proceedings can be avoided. Even when individuals have had children removed previously, it is useful to talk with them to see if they have developed any insights or capacity for change. This is often the case. It is also essential to work with extended families , and consider Family Group Conferences when it is feared that the mother may be unable to meet the needs of the unborn child.