Children’s Services: Pre-Birth Assessments

1. Why do A Pre-Birth Assessment?

There are a number of different circumstances in which a Social Worker would consider the need for a pre-birth assessment:

Where previous children in the family have been removed because they have suffered harm;
Where a Person Posing Risk To Children (or someone found by an Initial Child Protection Conference or a Court to have abused) has joined a family. (Note. A PPRTC (previously known as a Schedule One Offender is someone who has been convicted of an offence against a child. It is retained on their record for life);
Where concerns exist regarding the mother's ability to protect;
Where there are acute professional concerns regarding parenting capacity, particularly where the parents have either severe mental health problems or learning disabilities;
Where alcohol or substance abuse is thought to be affecting the health of the expected baby, and parents ability to respond to their child's needs and is one concern amongst others;
Where there are concerns about Domestic Abuse;
Where the expected parent is very young and a dual assessment of their own needs as well as their ability to meet the baby's needs is required;
Where the expected parent is a Child in Care or Care Leaver, active consideration to a pre-birth assessment must be given to ensure all support needs and/or risk factors are identified. The decision not to refer for a pre-birth assessment must be recorded as a Management Decision on Casenotes. Note that this applies to both parents of the child and not just the expectant mother.

A pre-birth assessment should always be undertaken:

If a previous child/young person has died unexpectedly in the care of the parents and the cause of death is a result of anything other than 'natural causes';
If a previous child has been removed via Care Proceedings due to abuse or Neglect or other Risk of Significant Harm or if they have a current child who is the subject of Care Proceedings or within a Public Law Outline (PLO) process;
If the parents have a child living with them who is currently the subject of a Child Protection Plan;
If there is a current Sec 47 investigation on the unborn that is likely to lead to an Initial Child Protection Conference or Child In Need Plan;
If for any reason (in addition to the above) it is possible that the mother and newborn will need to be separated at birth and Children's Services will be part of the planning (not including a parent's request for adoption);
A Pre-Birth assessment should be considered if the parents have a child under 8 who was the subject of a CPP within the previous 18 months.

2. Instructions for Recording on Eclipse and Workflow

Front Door for Families Initial Contact- Screening Practice Manager makes a decision about whether the referral needs Assessment.

Pods to refer to Front Door for Families immediately when a pregnancy becomes known about on an open case. Front Door for Families will create the IC and forward back to Pod Team, if the family are an open case, or if Care Proceedings have been concluded within the last year and the pod holds a good working knowledge of the case.

Under 12 weeks: If the pregnancy is under 12 weeks a CIN task will be opened and the case will be allocated to a Pod Manager pending allocation to a Social Worker in their supervision group.

At 12 weeks gestation: Case is allocated to a Social Worker to discuss with PM and agree timing of the start and duration of the Strengthening Families Assessment.

Pre-birth 'Good Practice Steps'

In a High Court judgment (Nottingham City Council v LW & Ors [2016] EWHC 11(Fam) (19 February 2016)) Keehan J set out five points of basic and fundamental good practice steps with respect to public law proceedings regarding pre-birth and newly born children and particularly where Children's Services are aware at a relatively early stage of the pregnancy.

In respect of Assessment, these were:

A risk assessment of the parent(s) should 'commence immediately upon the social workers being made aware of the mother's pregnancy';
To conclude Pod Managers will need to evidence that they have made a risk assessment and reflect this in their decision making about the start of the assessment upon the confirmation of the pregnancy at 12 weeks. There should be sufficient information in the Front Door for Families IC to inform this initial risk assessment. Where there is not sufficient information to make an initial assessment of risk or where the risk is regarded to be high, the assessment and relevant pre-birth planning processes that follow, need to begin upon notification of the pregnancy;

Any Assessment should be completed at least 4 weeks before the mother's expected delivery date.
On the timescales built into our current pre-birth process the SFA should at the very latest be completed by 30 weeks gestation. There may however be other components of the assessment process that are triggered as part of any PLO process – we need to ensure that these assessments are concluded 4 weeks prior to the birth of the baby (i.e. cognitive). Pod Managers need to allow sufficient time in the planning of the assessments to have these completed prior to 36 weeks gestation;
The Assessment should be updated to take into account relevant events pre - and post delivery where these events could affect an initial conclusion in respect of risk and care planning of the child.
Assessment is a continual process and a birth plan outlining how risk is to be managed pre/post birth should be completed for the first core group following a pre-birth ICPC in preparation for the birth and shared with health and police colleagues. Chronology's must be kept up to date and accessible on file;
The Assessment should be disclosed upon initial completion to the parents.

Caption: good practice

Good practice indicates that it is better to start the assessment earlier, rather than later, particularly when a high level of need is evident at the outset for e.g; previous children have been removed from the care of a parent; parent has a learning disability; has a history of giving birth early; Request archive files, arrange to view files in different LA and start compiling a chronology (if appropriate); Inform parent of the referral, seek consent for welfare checks and arrange a visit for as soon as possible following allocation. Inform professional network of SW involvement; Refer to Group Supervision at the earliest opportunity and prior to supervision complete Case Map regarding the level of concern and areas of focus for the pre-birth assessment. Think where your gaps in knowledge are, ask BSO to obtain previous case files from archives, undertake chronology as early as possible, organise an Family Group Conference (FGC) at the earliest opportunity to gain knowledge of networks and potential supports/alternative carers. Consider referral to the EPAP Pre-birth Group.

If late notification of pregnancy received, the case is to be immediately allocated to a Social Worker to begin assessment and decision made by Pod Manager as to necessary acceleration of the workflow pre-birth process, dependent on level of perceived risk.

It is a Social Work judgement as to most appropriate time to initiate the Strengthening Families Assessment.

All Pre-birth Strengthening Families Assessments should be concluded by 28 weeks gestation.

Undertake assessment, arrange regular visits and seek information from professional network, formulate a genogram and eco-map.

You may decide to undertake a strategy/network meeting at this stage, particularly if it is clear that there are many professionals involved.

Consider the following:

Would a Family Group Conference (FGC) be appropriate? If so, make a referral at the earliest possible point;
If potential carers are identified via an FGC have a discussion with Friends and Family Team about Initial Viability assessments (Pan Sussex Part C: Viability Assessment of Family & Friends Carer(s));
Is the mother eligible for the Family Nurse Partnership?
If substances are an issue refer to the One Stop Clinic and link in with Substance Misuse service;
Is Domestic Abuse (DA) is an issue? Is a referral to MARAC required? Consider referral to RISE, discuss case with the Advanced Practitioner for DA and make referral to Living Without Violence or other appropriate service for perpetrators;
Is the case eligible for EPAP? Make a referral if they are;
Are learning needs an issue. Consider whether parent needs a referral to the Adult Learning Disability Team, do they need an Advocate? (Speak Out/Interact);
Are mental health needs an issue? Link in with adult mental health services. May need an advocate (MIND).

Make sure that the putative father is included in the assessment (if this is agreed by expectant mother and reasons for exclusion must specifically be explored). Consider all of the above in respect of putative father to the baby.

Child Protection and Care Planning Pre Birth

25 weeks or prior- Consider the need for a Strategy Discussion/Meeting.

Is a Sec 47 Enquiry necessary? If so complete relevant checks and make a decision to progress to an Initial Child Protection Conference inside of 2-3 days of the S.47 being initiated in order to satisfy 15 working day requirement. If ICPC required then present to conference no later than 30 weeks gestation. Good practice is to progress to conference earlier than 30 weeks, if case is judged to be complex and requires legal consultation.

If the case is high risk and in your view requires legal planning, a referral will need to be made to Care Planning Panel for consultation and agreement to progress to a Legal Planning Meeting (LPM) and to scope plan post birth.

Early pregnancy notifications to be heard at Care Planning Panel no later than 28 weeks gestation, late notifications of pregnancy to be progressed to Care Planning at the earliest opportunity, if threshold is deemed to be met.

Legal Planning Meeting to be held at least 10 weeks prior to the estimated due date (30 weeks gestation). Relevant Head of Service to chair. LPM minutes will then advise on whether threshold met and if so whether there is evidence to support a care plan for separation, parent & baby or community based plan of support. If you have your evidence then LPM can happen earlier than at 30 weeks providing relevant permissions have been sought from Care Planning Panel and Head of Service (HoS).

You may decide that the case would benefit from a Child in Need plan. CiN Network Meeting to be arranged within 10 working days of the conclusion of the Strengthening Families Assessment to initiate the Child In Need plan.

Following the ICPC, to be agreed at the first Core Group:

Birth Plan to be formulated (should include a police serial number). Birth plan should:

Detail risks, strengths;
Who should hospital contact when mum admitted/in labour/baby delivered;
What happens if the baby is born out of hours;
What level of contact/care (supervised or not) can the parents have;
What is the plan in relation to breastfeeding;
Identify agreed visitors/prohibited visitors;
What are the arrangements for initial legal proceedings;
Are the parents aware of the plan and what is their attitude?
Who will be co-ordinating contraceptive advice to Mother post birth and timescales.

Copy of birth plan should be sent to Police SIU, Safeguarding Midwives and Legal (if necessary).

Letter before Action to be formulated - agreed by legal and signed by Pod Manager.

Before 32 weeks and no later (with earlier notification) - following LPM and case being heard and agreed at the CPP, schedule a Meeting Before Action.

Agree at LPM and then CPP following – Care Plan, assessments to be undertaken within PLO and any subsequent planned proceedings, frequency of contact, assessment of family members etc. Convene a Meeting Before Action.

Start to compile your evidence, update Chronology, write the Court statement, Care Plan at the earliest opportunity. Understanding that there will be pressure upon hospital colleagues to discharge at the earliest opportunity if baby and parents are fit and well post delivery.

Complete a referral to fostering and contact service (if needed).

3. Factors to Consider in the Strengthening Families Assessment

The content of a sound assessment will be formed by looking at relationships – between parents/carers, between parents/carers and the child (whether born or unborn) – looking at how previous history shapes current experiences and the context within which people are living, highlighting particular strengths and risks.

A key task in the preparation of a pre-birth assessment is to identify a fundamental baseline of acceptable parenting skills against which change can be monitored.

The vital step when planning a pre-birth assessment is to review any previous history. This will entail reading the case files on any child/ren who have been removed from the parents care, ensuring that searches are done on any new partners in the household. Look to the recommendations made in previous assessments, have parents engaged in support advised to make changes – if so are changes in evidence and have they been sustained?

It is essential to construct a chronology of key events from the previous history, as repeated serious case reviews point to failures in drawing information together, analysing it and identifying patterns that, when seen together, change the perspective of the case. It is essential to include as much information from other agencies as possible and, if feasible, ask them to contribute to the chronology. The knowledge gained from the chronology will help direct the assessment.

Previous History

Reder and Duncan (1999) propose that maltreating parents may experience "care" and/or "control" conflicts in which the parents' own experiences of adverse parenting left them with unresolved tensions that surface in their adult relationships.

Care conflicts: arise out of experiences of abandonment, neglect or rejection as a child, or feeling unloved by parents. They show in later life as excessive reliance on others and fear of being left by them; or, its counterpart, distancing themselves from others; intolerance of a partner's or child's dependency; unwillingness to prepare ante-natally for an infant's dependency needs; or declining to respond to the needs when the child is born.

Control conflicts: are based on childhood experiences of feeling helpless in the face of Sexual or Physical Abuse or Neglect, or inappropriate limit-setting. In adult life they may be enacted through: violence; low frustration tolerance; suspiciousness; threats of violence; or other attempts to assert power over others. Violence or control issues can become part of their relationship with partners, children, professionals or society in general.

Unresolved conflicts can influence the meaning that a child has for its carer. For example: the child's birth may have coincided with a major life crisis e.g. being abandoned by a partner, or a child born of incest or into a violent relationship, following which the child can become a constant reminder of the associated feelings. The child may be blamed for problems in the parent's life or expected to help resolve them.

Practitioners should attempt to build up a clear history from the parents of their previous experiences in order to ascertain whether there are any unresolved conflicts and also to identify the meaning any previous children had for them and the meaning of the new born baby.

It will be particularly important to ascertain the parent(s) views and attitudes towards any previous children who have been removed from their care, or where there have been serious concerns about parenting practices.

Is the parent able to hold the child in mind and emotionally attune to their needs?

Relevant questions would include:

Do the parent(s) understand and give a clear explanation of the circumstances in which the abuse occurred?
Do they accept responsibility for their role in the abuse?
Do they blame others?
Do they blame the child?
Do they acknowledge the seriousness of the abuse?
Did they accept any treatment/counselling?
What was their response to previous interventions? e.g. genuinely attempting to cooperate or characterised by tokenistic compliance?
What are their feelings about that child now?
What is going to be different?
What has changed for each parent since the child was abused/removed?

This list is not exhaustive. There will be particular issues for individual cases that require Social Workers and other practitioners to gather information about past history and review past risk factors.

It will be also be important to ascertain the parents' feelings towards the current pregnancy and the new baby including:

Is the pregnancy wanted or not?
Is the pregnancy planned or unplanned?
Is this child the result of sexual assault?
Is severe 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 ante-natal 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 their care of the baby?

In cases where a child has been removed from a parent's care because of sexual abuse there are some additional factors which should be considered.

These include:

The ability of the perpetrator to accept responsibility for the abuse (this should not be seen as lessening the risk for additional children);
The ability of the non-abusing parent to protect.

The fact that the child has been removed from their care suggests that there have been significant problems in these areas and pre-birth assessment will need to focus on what has changed and the prospective parent(s) current ability to protect.

Relevant questions when undertaking a pre-birth assessment when previous sexual abuse has been the issue include:

The circumstances of the abuse: e.g. was the perpetrator in the household? Was the non-abusing parent present? The severity of the abuse?
What relationship/contact does the mother have with the perpetrator?
How did the abuse come to light? e.g. did the non-abusing parent disclose or conceal? Did the child tell? Did professionals suspect?
Did the non-abusing parent believe the child? Did they need help and support to do this?
What are current attitudes towards the abuse? Do the parents blame the child/see it as her/his fault? Has the perpetrator accepted full responsibility for the abuse? How is this demonstrated? What treatment did he/she have?
Who else in the family/community network could help protect the new baby?
How did the parent(s) relate to professionals? What is their current attitude?

In circumstances where the perpetrator is the prospective father or is living in the household, where there is no acknowledgement of responsibility, where the non abusing parent blames the child and there is no prospect of effective intervention within the appropriate time-scale, then confidence in the safety of the new-born baby and subsequent child will be significantly diminished.

Circumstances where the perpetrator is convicted for posing a risk to children and is already living in a family with other children, (albeit with Social Work involvement), should not detract for the need for a pre-birth assessment.

In all assessments it is important to maintain the focus on both prospective parents, and any other adults living in the household and not to concentrate solely on the mother.

4. Other Useful Tools

Caption: Other Useful Tools

Factor	Elevated Risk	Lowered Risk
The Abusing Parent	Negative childhood experiences, inc. abuse in childhood; denial of past abuse; Violence abuse of others; Abuse and/or neglect of previous child; Parental separation from previous children; No clear explanation; No full understanding of abuse situation; No acceptance of responsibility for the abuse; Antenatal/post natal neglect; Age: very young/immature; Mental Disorders or illness; Learning Difficulties; Non compliance; Lack of interest or concern for the child.	Positive childhood; Recognition and change in previous violent pattern; Acknowledges seriousness and responsibility without deflection of blame onto others; Full understanding and clear explanation of the circumstances in which the abuse occurred; Maturity; Willingness and demonstrated capacity and ability for change; Presence of another safe non-abusing parent; Compliance with professionals; Abuse of previous child accepted and addressed in treatment(past/present); Expresses concern and interest about the effect of the abuse on the child.
Non-abusing parent	No acceptance of responsibility for the abuse by their partner; Blaming others or the child.	Accepts the risk posed by their partner and expresses a willingness to protect; Accepts the seriousness of the risk and the consequences of failing to protect; Willingness to resolve problems and concerns.
Family issues (marital partnership and the wider family	Relationship disharmony/instability; Poor impulse control; Mental health problems; Violent or deviant network involving kin, friends and associates (including drugs, paedophile or criminal networks); Lack of support for primary carer/unsupportive of each other; Not working together; No commitment to equality in parenting; Isolated environment; Ostracised by the community; No relative or friends available; Family violence (e.g. Spouse); Frequent relationship breakdown/multiple relationships; Drug or alcohol abuse.	Supportive spouse/partner; Supportive of each other; Stable or violent; Protective and supportive extended family; Optimistic outlook by family and friends; Equality in relationship; Commitment to equality in parenting.
Expected child	Special or expected needs; Perceived as different; Stressful gender issues.	Easy baby; Acceptance or difference.
Parent-baby relationship	Unrealistic expectations; Concerning perception of baby's needs; Inability to prioritise baby's needs above own; Foetal abuse or neglect including alcohol or drug abuse; No ante-natal care; Concealed pregnancy; Unwanted pregnancy; identified disability (non- acceptance); Unattached to foetus; Gender issues which cause stress; Differences between parents towards unborn child; Rigid views of parenting.	Realistic expectations; Perception of unborn child normal; Appropriate preparation; Understanding or awareness of baby's needs; Unborn baby's needs prioritised; Co-operation with ante-natal care; Sought early medical care; Appropriate and regular ante- natal care; Accepted/planned pregnancy; Attachment to unborn foetus; Treatment of addiction; Acceptance of difference- gender/disability; Parents agree about parenting.
Social	Poverty; Inadequate housing; No support network; Delinquent area.
Future Plans	Unrealistic plans; No plans; Exhibit inappropriate parenting plans; Uncertainty of resistance to change; No recognition of changes needed in lifestyle; No recognition of a problem or a need to change; Refuse to co-operate; Disinterested and resistant; Only one parent co-operating.	Realistic plans; Exhibit appropriate parenting expectations and plans; Appropriate expectation of change; Willingness and ability to work in partnership; Willingness to resolve problems and concerns; Parents co-operating equally.

4.1 The difference between the Early Parenting Assessment Programme (EPAP) and the Family Nurse Partnership (FNP)

If you need a parenting assessment you need to consider as to whether this can be completed by a Social Worker, the Clermont or alternatively EPAP;
FNP is a universal offer of intervention and support to young parents and their children it is not a programme to assess parenting skills;
Parents can be allocated to both FNP and EPAP because the services offered are different.

Caption: EPAP/FNP table

	EPAP	FNP
Offer	Parenting assessments to a small number of vulnerable parents and babies with the aim of offering parenting intervention alongside assessment to facilitate greater understanding of parents ability to meet their child's needs within the child's timescales. Pre-birth Preparation Group for expectant parents open for Social Care assessment.	Universal parenting support.
Time with Programme	6 months in total. Antenatal contact 2 – 3 hours per week. Post natal contact 8 – 10 hours per week, includes 8 hours day programme, 1 – 2 hours home visits	From pregnancy until child is 2 years Antenatal contact weekly (1 – 1.5hrs) for first 4 weeks then fortnightly until baby is born Post natal weekly visits first 6 weeks, fortnightly until baby 22 months old
Clients	Vulnerable parents where there is likelihood of parent & baby placement or removal of baby at birth	First Pregnancy. Aged 19 or under at date of last period when pregnancy is confirmed
Criteria	Previous children have been removed Vulnerable due to age, care leaver, poor parenting experiences Mental heath Learning difficulty/ disability and other vulnerabilities	All first time teenage parents whom are 19 or under. Can be 20 at birth of baby This is a voluntary preventative programme aimed at improving the health & wellbeing of the child and mother
Referral route	From Social Worker/Pod Manager to Cas Short / Gillian Luckock Practice Managers at EPAP Consultations will be provided prior to referral and referrals received by 20 weeks if possible, to allow time to consider the SW assessment although the team will consider later referrals to assess parents post birth	Via midwifery, Self Referral, professional working with client i.e. SW YOT, CASH etc. 60% of referrals need to be received by 16 weeks of pregnancy. In order to meet fidelity goals of the FNP licensed programme. No referrals can be accepted after 28 weeks of pregnancy