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Kent - Pre-birth Procedures

In October 2016, this chapter was added to the manual.


Contents

  1. Introduction
  2. Early Help
  3. Referral to Specialist Children's Services
  4. Children Specialist Children's Services
  5. Pre-birth Child and Family Assessment

    Appendix A: Pre-birth Assessment Tool

    Appendix B: Pre-birth and Proposed Discharge Plan Proforma


1. Introduction

UK law does not afford legislative rights to an unborn baby. In some circumstances though, agencies or individuals are able to anticipate a likelihood of Significant Harm, potential risks and vulnerabilities with regard to the as yet unborn baby. Such concerns should be addressed as early as possible to maximise time for:

  • Forming professional relationships with family member with a focus on the unborn baby;
  • The completion of a full assessment and understanding/identification of risk;
  • Exploring the family’s ability to protect the unborn baby;
  • Enabling a healthy pregnancy;
  • Early identification of significant relative or family member who might be able to support or provide primary care;
  • Building multi agency relationships and networks around the family.


2. Early Help

Universal services seek to meet the needs of families. Health professionals in contact with pregnant women routinely assess the needs of the mother, the unborn child and their family. The midwife should refer to the health visiting service as soon as any concerns are identified for the family by the completion of a Concern and Vulnerability form.

For vulnerable families, the midwife and health visitor will work closely to ensure effective transition which may include a joint meeting with the family.

Families with additional needs are best supported by those who already work with them but where a midwife and/or health visitor requires help they can request support from Early Help and Preventative Services. Open Access services based in Children’s Centre and Youth Hubs provide additional support and/or and targeted provision.

The Kent Family Support Framework provides a clear pathway for notification, screening, assessment, planning, outcome tracking and review. Early Help Units work with children, young people and families requiring intensive support. They work in partnership with other professionals and the family to build resilience and develop solutions to problems the family may be experiencing. Using an Early Help Notification form, the midwife and/or health visitor can request support where they identify the need for intensive support. The process must not delay a referral to Specialist Children’s Services (Kent) if there is a likelihood of significant harm to the unborn baby.


3. Referral to Specialist Children's Services

Any professional working with expecting parents who has concerns in relation to the welfare of the unborn baby must discuss and analyse them with her/his line manager or supervisor or Named Nurse/Doctor.

If it appears that there is a likelihood that:

  • The unborn child has/will have higher level intensive needs,
  • The needs of the unborn child are likely to be so great that statutory specialist intervention is required to keep them safe or ensure their continued development or, the unborn child is at risk of significant harm (see Kent Thresholds / Medway Thresholds) a referral must be made to Specialist Children’s Services (Kent). At any stage professionals may wish to consult Specialist Children’s Services (Kent) about the appropriateness of a referral (see Referrals Procedure).

A GP who has concerns and is uncertain about the appropriate action should discuss the concerns with the Designated or Named Health Professionals in her/his locality.

Concerns should be shared with prospective parent/s and consent obtained to refer to Specialist Children’s Services (Kent) unless this action in itself may place the welfare of the unborn child at risk e.g. if there are concerns that the parent/s may move to avoid contact or that informing parents would compromise a Police investigation.

Timescales for Referral

When it is decided that a referral to Specialist Childrens Services is needed, the referral should be made as early in the pregnancy as possible. This enables Specialist Children’s Services to assess and plan in a timely way.

Delay must be avoided when making referrals in order to:

  • Provide sufficient time to complete assessments and make adequate plans for protection;
  • Provide sufficient time to complete assessments and make adequate pre-birth plans;
  • Avoid initial approaches to parents in the last stages of pregnancy, at what is already an emotionally charged time;
  • Enable parents to have more time to contribute their own ideas and solutions to concerns and increase the likelihood of a positive outcome to assessments;
  • Enable the early provision of support services so as to facilitate optimum home circumstances prior to the birth.

Identify significant family members who might be able to provide support and consider the use of a Family Group Conference to facilitate this.

Circumstances when Referrals must be made to Specialist Children’s Services

Referral must always be made for a pre-birth assessment in any of the following circumstances:

  • There has been a previous unexpected death of a child whilst in the care of either parent where abuse / neglect is/was suspected;
  • A parent or other adult in the household, or regular visitor is a person identified as presenting a risk, or potential risk, to children;
  • Children in the household / family currently subject to a Child Protection Plan;
  • A sibling (or a child in household of either parent) has previously been removed by a Court order;
  • There is knowledge that parental risk factors e.g. domestic abuse, mental illness / impairment or substance misuse may impact on the unborn baby or child’s safety or development;
  • There are concerns about parental ability to self care and/or to care for the child e.g. unsupported, young or learning disabled parent;
  • There are maternal risk factors e.g. denial of pregnancy, avoidance of antenatal care (failed appointments), non-co-operation with necessary services, non compliance with treatment with potentially detrimental effects for the unborn baby;
  • Any other concern exists that the baby may suffer, or be likely to suffer, Significant Harm, including a parent previously suspected of fabricating or inducing illness in a child;
  • The parent is a Child in Care to the Local Authority;
  • All pregnant girls under the age of 16 should be referred to Specialist Children’s Services (or the Police) if a risk assessment indicates a risk of sexual exploitation or risk of harm to the child in accordance with the procedures in Working with Sexually Active Young People Procedure and Safeguarding Children Abused through Sexual Exploitation Procedure;
  • A Child under the age of 13 is pregnant.

Any female child to be born to a woman who has been subjected to FGM must be considered to be at risk, as must other female children in the extended family (please see, Female Genital Mutilation Procedure).

When the concerns are about a category of parenting behaviour e.g. substance misuse, the referrer must make clear how this is likely to impact on the baby and what risks are predicted.

In some cases relevant records identifying one or more of the above risk factors may only be available to the GP e.g. if an adult has moved frequently. The GP must therefore consider an early referral when any of the above factors apply to a prospective mother, father or carer.


4.Specialist Children's Services

Specialist Children’s Services (Kent) may decide to refer the parent/s to other agencies or Early Help and Preventative Services for advice/support when after CDT assessment the concerns do not warrant the need for Specialist Children’s Services involvement.

Specialist Children’s Services (Kent) should undertake a Child and Family Assessment on all pre-birth referrals that reach the Kent Inter-Agency Threshold Criteria for Children and Young People.

A Section 47 Enquiry and Child and Family Assessment should always be undertaken when there appears to be any likelihood of Significant Harm to the unborn baby. This decision may be made at any point in the assessment process. If the Section 47 Enquiry concludes the unborn child is likely to suffer Significant Harm an Initial Child Protection Conference must be held.

In situations where the pregnancy has been concealed, when it is imperative to elicit police information in detail against parental consent or where the parents are not co-operating with the process, a Section 47 Enquiry must be initiated.

Multi-Agency Meeting or Strategy Discussion

When any of the criteria in, Circumstances when Referrals must be made to Specialist Children's Services, Specialist Children’s Services (Kent) should convene a multi-agency meeting within10 days of the referral to consider concerns in relation to the welfare of the unborn baby and to initiate a pre-birth Child and Family Assessment and any other specialist assessments. An up to date chronology and genogram must be provided by Specialist Children’s Services for this meeting.

When it is possible to work in partnership with the parents and there are no immediate issues that could put the unborn baby at risk, this multi-agency meeting should be in the form of a Child in Need Meeting under Section 17 Children Act 1989.

If it is suspected that the unborn baby may be likely to suffer Significant Harm the meeting should be in the form of a ‘Strategy Discussion’.

A Specialist Children’s Services front line manager should chair the meeting and those invited should include a:

  • Parents (if a Child in Need meeting but not invited to Strategy Discussions);
  • Identified midwife;
  • GP (if GP attendance is impossible they should send a written report detailing the any concerns);
  • Likely health visitor;
  • Police officer (if a strategy discussion);
  • Social worker;
  • Other professionals as appropriate e.g. obstetricians, mental health services, probation; drug and alcohol services;
  • When required, a legal advisor (if a strategy discussion);
  • The referrer (if a professional);
  • Any other professional who can add relevant information.

Any Legal advice should be considered, and recorded, where there have been Care Proceedings on a child in the household of either parent.

This meeting should determine whether a Section 47 Enquiry is to be initiated and to discuss:

  • What we are worried about:
    • The causes for concern and potential impact on care provided to the baby, past harm, future danger and complicating.
  • What’s working well:
    • Existing strengths, people, plans and actions.
  • What needs to happen – future safety and safety goals (see below):
    • Particular requirements of the pre-birth Child and Family Assessment, what areas need to be considered for assessment and direction of social work intervention (i.e.: important to focus on parental engagement and make use of the duration of the pregnancy to work with the family and with the professional network around them);
    • Timescales for assessments and enquiries, bearing in mind the expected date of delivery, Role and responsibilities of agencies and specialists in the assessment e.g. involvement of expert in substance misuse;
    • Role and responsibilities of agencies to provide support before and after the birth with a specific focus on the role of the midwife;
    • The actions required by adult services working with expectant parents;
    • Identity of responsible social worker to ensure planning and communication of information;
    • How and when parent/s are to be informed of the concerns (if not already informed);
    • Required action by ward staff when the baby is born by agreeing an interim multi agency pre-birth plan for an unexpected delivery.

The need for a pre-birth conference (which should be held by 20-24 weeks week gestation at the latest).

If a Strategy Discussion has been held parents should be informed as soon as possible of concerns and need for assessment, except on the rare occasions when advice suggests this may be harmful to the health of the unborn baby and/or mother.


5. Pre-birth Child and Family Assessment

The overall aim of the assessment is to identify and understand for all involved prospective parents /carers whether the family’s likely care of the child following its birth will be safe enough and what is needed to support the child remaining within its family or whether the situation is so dangerous that consideration should be given to the child being removed.

Assessment is not an exact science, but can be made as sound as possible if it includes the following three elements:

  1. What research tells us about risk factors;
  2. What practice experience tells us about how parents may respond in particular circumstances;
  3. The practitioners' professional knowledge of this particular family.

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

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 children who have been removed from the parents care, ensuring that searches are done on any new partners in the household and reviewing the parental history if they were known to social care as children, for example, previously looked after children.

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 information from all agencies and, if feasible, for them to contribute to the chronology.

See suggestion for Appendix A: Pre-birth Assessment Tool.

Pre-birth Child Protection Conference

(See, Initial Child Protection Conferences Procedure).

A pre-birth conference is an Initial Child Protection Conference concerning an unborn child. Such a conference has the same status and purpose and must be conducted in a comparable manner to an Initial Child Protection Conference.

Pre-birth conferences should be convened following Section 47 Enquiries, where there is evidence that the child is suffering or is likely to suffer Significant Harm and where there is a need to consider if a Child Protection Plan is required.

The pre-birth conference should take place at the latest between 20-24 weeks of pregnancy to allow sufficient time for an assessment of parenting ability and the preparation of a discharge plan.

Developing a Child Protection Plan

Where a decision is reached that a child needs to be the subject of a Child Protection Plan, the Conference Chair must ensure that a Child Protection Plan is outlined and clearly understood by all concerned including the parents; and the plan sets out what needs to change in order to safeguard the child.

If it is agreed that a child protection plan is to be provided for the unborn baby, a core group meeting will take place immediately after the initial conference unless there are exceptional circumstances.

This meeting must make a detailed pre-birth plan of any actions to be taken and support to be delivered before and immediately following the birth. (See Appendix B: Pre-birth and Proposed Discharge Plan Proforma).

Particular care should be taken to ensure representation of relevant agencies including maternity ward / midwifery in all cases and police / legal if the plan involves the removal of the baby at birth.

Timing of the review conference (see Child Protection Review Conferences Procedure).

Where an unborn child has been identified as requiring a Child Protection Plan at a pre-birth conference, the first Review Conference should be scheduled to take place within 4 to 6 weeks of the child’s birth. This may be extended to 2 months with the written authorisation of a Children Social Services Service Manager if information from a post-natal assessment is crucial for a well-informed review conference.

  1. An early Review Conference should be considered in the following circumstances:
    1. Where there is a further incident or allegation of Significant Harm to a child with a Child Protection Plan;
    2. If the Child Protection Plan is failing to protect the child or if there are significant difficulties in carrying out the Plan;
    3. Where there is a significant change in the circumstances of the child or family not anticipated at the previous conference and with implications for the safety of the child;
    4. Where the previous Conference was inquorate.

If a Child is not Assessed as being in Need of a Child Protection Plan

An unborn child may not be made subject of a Child Protection Plan, but he or she may nonetheless require services to promote his or her health or development. In these circumstances, the Conference, together with the family, should consider the child’s needs and what further help would assist the family in responding to them.

Subject to the family’s views and consent, it may be appropriate to continue with and complete the Child and Family Assessment of the child’s needs to help determine what support might best help promote the child’s welfare including a birth plan/discharge plan.

Where a Child in Need Plan is agreed the Conference Chair will lead this planning within the Child Protection Case Conference and the Child In Need meeting date will be set as appropriate to the needs of the child.

Where it is considered support from Early Help and Preventative Services may be appropriate either following the Child and Family Assessment or as part of the Child in Need Plan’s exit strategy, this will be discussed at the Joint Step-down Panel in the relevant district to determine the most appropriate step-down pathway.

Pre-Birth and Proposed Discharge Plan

The aim of a pre-birth and discharge plan is to ensure there is a clear and agreed plan for the mother and baby following the birth.

A Pre-Birth Proposed Discharge Plan should be made for all unborn babies who are:

  1. Subject of a Child Protection Plan;
  2. Subject of a Pre‐Birth Specialist Children’s Services Assessment;
  3. Subject of a Public Law Outline (PLO) Meeting held between Social Care and parents (i.e.: Letter Before Proceedings/Pre-Proceedings meetings).

This plan should be made during a multi-agency meeting (i.e. Child in Need Meeting, Child Protection Conference /core group meeting or as a separate multi agency meeting as part of the planning for any PLO meeting). This plan should be written in partnership with parents and made well in advance of the estimated date of delivery (at least 6 weeks in advance) unless in exceptional circumstances i.e.: concealed pregnancy.

Suggested attendance to the pre-birth planning meeting:

  • Parents (if safe to do so);
  • Social worker;
  • Community midwife;
  • Proposed health visitor;
  • Other appropriate agency i.e. Maternal and Infant Mental Health Service, Family Nurse partnership, mental health, drug and alcohol support services.

The social worker is responsible for compiling and minuting the agreed plan (using format) and copies are to be distributed within 48 hours to parents and the appropriate safeguarding team at the local hospital trust who are responsible for sharing the plan with the agreed circulation list (see Appendix B: Pre-birth and Proposed Discharge Plan Proforma).

The social worker must upload the plan onto Liberi within 24 hours in order that is accessible to Out of hours, fostering, adoption teams etc. when necessary.

Birth and Discharge of a Newborn Baby

The hospital midwives should inform Children’s Social Care of the birth of the baby as soon as possible (ideally the allocated Social Worker will be informed once the expectant mother is admitted in established labour).

The Lead Social Worker should meet/discuss via telephone with relevant maternity staff prior to meeting with the mother and baby to gather information and consider whether there are any changes needed to the pre- birth and proposed discharge plan. The midwife with access to the health records should record a brief note of the Social Worker’s visit/discussion in the medical records, which should include the time, key points of the discussion, agreements and social work contact details.

Ward staff should keep a daily record of any visitors to the child and details of any concerns that emerge whilst on the ward. This could be important information for child protection planning or evidence needed for care proceedings.

If there is a change to the discharge plan between the time of writing and the delivery, a further multi agency meeting/discussion should be convened to reconsider the plan prior to mother and baby being discharged. The initial pre-birth and discharge plan should be followed unless circumstances have altered which would lead to change of plan i.e. identification of other child protection concerns).

In cases where legal action is proposed or child protection concerns are raised by hospital staff the allocated Lead Social Worker or representative should visit the hospital on the next working day following the birth.

If a decision has been made to initiate Care Proceedings in respect of the baby, the Lead Social Worker must keep relevant maternity staff up-dated about the timing of any application to the Courts.

The lead midwife and named safeguarding nurse should be informed immediately of the outcome of any application and placement for the baby. A copy of any Orders obtained should be forwarded immediately to the hospital if they are not being discharged that same day.

PLEASE NOTE: The application to Court can only be made once the baby is born. If there are immediate child protection concerns prior to the order being granted then professionals should contact the Police. Consideration must be given to the need for supervision of parents with the child independent of hospital staff as a contingency if planned Court applications are delayed.

Public Law Outline

In cases where it has been agreed at Legal Planning Meeting that work should be undertaken under the Public Law Outline framework, there should be as little delay as possible in sending out Letters before Proceedings and holding Pre Proceedings meetings. This is in order to avoid such approaches to the pregnant woman in the late stages of pregnancy and to work with the family to explore all options in order to preferably avoid initiating Care Proceedings. There is also an opportunity to commission specialist assessments at this stage.

In cases where there is a recommendation to initiate Care Proceedings at birth, cases should be booked in for a Legal Planning Meeting at the earliest possible date prior to the birth. The Child and Family Assessment and full Chronology must be available at the Legal Planning Meeting and there should be discussion about the appropriateness of a referral for a Family Group Conference.

Unless there is a strong and achievable plan for the child to live at home within the child’s timeframe, a Permanency Planning Meeting should always be held prior to the child coming into care, which may be pre – birth, where a legal planning meeting has been called, especially when consideration of a Foster to Adopt, or a Concurrency Placement is needed.

If Family Plan to Move / has Moved

If there are significant concerns and the whereabouts of the mother are unknown, Specialist Children’s Services must inform other agencies and local authorities in accordance with procedures about missing child, adult or family in Children Missing from Home and Care Procedures.

If there are significant concerns and the case is being transferred to another local authority, procedures in the Children Moving Across Boundaries Procedures must be followed and transfer should not deter the originating authority from initiating or continuing care proceedings. Health professionals should transfer antenatal care via the designated nurse for safeguarding children in the receiving CCG.

End