5.1.24 Pre Birth / Pre Placement

Pre-Birth Assessment: A Guide to Good Practice
Pre-Placement Assessment: A Guide to Good Practice

1. Pre-Birth Assessment: A Guide to Good Practice

Pre-birth procedures aim to predict the potential for future harm to the baby at birth and thereafter. A Phase Two Social Work Assessment should always be commissioned when there appears to be a risk of significant harm to an unborn baby. The pre-birth assessment detailed in this document is essentially a Phase Two Social Work Assessment. However, it is inevitably the case that the actual birth of a child will result in a change of circumstances which will need to be reassessed. Therefore, an updated Phase Two Social Work Assessment will need to be completed following the birth of the child to ensure that the assessment takes into account the changed circumstances.

This document aims to provide guidance in promoting good practice in prebirth assessment and planning. The guidelines act as a step by-step guide in planning, completing and concluding pre-birth assessments. The information is organised as follows:

The purpose of pre-birth assessments;
When to undertake a pre-birth assessment;
How to plan the pre-birth assessment;
What information to put into the pre-birth assessment;
Concluding the pre-birth assessment;
The outcomes of the pre-birth assessment.

2. Pre-Placement Assessment: A Guide to Good Practice

The guidance and procedure outlined below focuses on the assessment to be completed prior to the birth of the child. It will not be possible in all cases to complete such an assessment for a range of reasons such as late disclosure of pregnancy or 'unexpected' births. The same standards of assessment and schedule of issues should be addressed as soon as is practical, before the parent and baby are placed together in a foster home or as soon as possible thereafter. No separate guidance and procedure will be issued as the requirements for effective assessment will be the same, but time constraints will be greater. When the text below refers to pre-birth please simply substitute pre-placement, making allowances for the fact that the child has now been born and gathering information retrospectively if need be.

2.1 The purpose of the pre-birth assessment

Before embarking upon any assessment it is worth thinking about the purpose, scope and timescale of the task. Phase Two Social Work Assessments should be completed in 35 working days thus it is essential that the timing of any pre-birth assessment is given adequate thought - both in terms of preparation and function. Generally the purpose of undertaking a pre-birth assessment is to predict the level of care a child is likely to be afforded when there are significant concerns associated with the parent(s). It is important, when assessing the needs of an unborn baby, that the specific concerns are clearly outlined so that shared understanding can be reached about the purpose of the assessment. Cooperation should always be sought from the families themselves as their participation will assist in the completion of the assessment. The consequences of non-co-operation should be made clear at the outset of the assessment process.

2.2 When to undertake a pre-birth assessment

Once a pregnancy has been confirmed by an appropriately trained medical professional, antenatal care should begin. Ideally a 'booking interview' is undertaken by the community midwife between 8 and 12 weeks gestation. The booking interview provides the pregnant woman and the midwife the opportunity to plan the care of the pregnancy. During this process the midwife will seek to collate information to assess the health and social needs of the family in order to consider their individual and collective support needs. The central issue is whether there is anything in the medical or obstetric history that may have a significant negative impact on the child - and if so, what? Thus the relevant health professionals should, in the course of their general duties, gain the following information:

Name, age, date of birth, and address of parent;
Next of Kin;
Marital Status;
Partner Support;
Family Structure and potential support;
Planned or unplanned pregnancy;
Feelings of parent about pregnancy;
Feelings of father/ partner about pregnancy;
Dietary issues;
Medication/ drug issues - prescribed or not - taken before or during pregnancy;
Alcohol consumption;
Smoking;
Obstetric history;
Current health status of any other children;
Miscarriages and terminations;
Chronic or acute medical conditions and surgical history;
Psychiatric history - particularly depression and self-harming.

Pre-birth (core) assessments should be considered when there are concerns in respect of either parent, or a potential carer, or a partner of the mother, in terms of:

Psychiatric illness;
Personality disorder;
Substance (drug and alcohol) misuse;
Significant learning difficulty;
Responsibility for children about whom there have been previous child protection concerns or who have been subject to Care Proceedings;
The prospective parent being a child themselves;
Domestic violence;
Criminality - particularly offences against children;
Either parent is 'looked after' by the Local Authority.

The pre-birth assessment affords potential proactive protection planning for when the child is born. In most circumstances the earlier plans can be made to do this the better.

London Child Protection Procedures state that a pre-birth child protection conference should take place as soon as practical and at least 10 weeks before the due date of delivery, so as to allow as much time as possible for planning support for he baby and family.

2.3 How to plan the pre-birth assessment

Any assessment should be carefully planned, with clarity about who is doing what and when. The planning process and decisions about the timing of the different assessment activities should be undertaken in collaboration with all those involved with the family.

It may be useful to convene an initial planning meeting to share information about what is known about the family and agree tasks, roles, responsibilities and timescales involved with completing the assessment. Such a forum affords a good opportunity to consider the need for any specific assessments. An initial (pre-birth) child protection conference may provide the appropriate arena for such multi-agency discussion.

The decision about when to embark upon the pre-birth assessment and if/ when to initiate child protection procedures will vary in accordance with the individual factors/ characteristics of the family concerned thus professional judgement must be exercised in determining the appropriate course of action.

2.4 What information to put into the pre-birth assessment

Pregnancy has a significant impact on people's lives and can affect behaviour and relationships. It is important that professionals are aware of the additional stresses and pressures that can occur during pregnancy as well as the changes in the woman's emotional and physiological health as any combination of these issues may impact on the behaviour of the woman and/ or her partner. Family structure should always be noted for consideration. This should, where possible, include the names, ages and addresses of all (extended) family members, the nature of their relationships and the level of potential support available.

Those working with children should be informed by a developmental perspective which recognises that, as the child grows, their needs change in accordance with their developing skills and abilities. Each stage, from infancy through middle years to adolescence, lays the foundations for more complex development. Throughout the assessment it is appropriate to consider the ability of a parent to safely care for the newborn baby and to consider their likely ability to parent satisfactorily throughout childhood.

In undertaking any assessment to consider the well-being of the unborn child it is essential that relevant information is obtained from the appropriate health professional(s) involved. In addition to this information, the social worker will need to consider how the 'family' functions in order to fully assess the potential risks to the child. The social worker may need to draw on the assistance of other professionals in order to collate and consider all relevant information.

The assessment information should be organised in accordance with the Framework for the assessment of Children in Need and their Families. In addition to the Department of Health Guidance it is useful to consider the following tool, designed to assist professionals in carefully considering and analysing issues that may have a significant impact on a child.

The following areas should be explored:

Relationships

Is there anything regarding the parental relationships that may have a negative impact on the child - and if so, what?

History of adult relationships;
Current status of relationship;
Positives and negatives associated with existing relationship;
Violence;
Who will be the main carer for the baby;
What are the expectations of the parents regarding themselves and each other?

Abilities

Is there anything about the parental abilities that may have a significant negative impact on the child - and if so, what?

Physical;
Emotional;
Intellectual;
Knowledge about children and child care;
Understanding about the reasons why the assessment is being undertaken.

N.B. if there is an issue relating to a parent(s) learning, mental health problems or drug and alcohol related problems a specific detailed assessment may need to be sought. This should be linked to specialist resources (learning disability/mental health/or drug and alcohol services) or guidance from any experts instructed in legal proceedings. The value of cognitive assessments and the need for expert advice when learning is known or suspected is critical. Assessments will turn on such expertise and the failure to obtain may well undermine the value of the placement completely. It may be that continued expert input may be needed to inform decision making and evidence.

Social History

Is there anything about the social history of the parent(s) that may have a significant negative impact on the child - and if so, what?

Experience of being parented;
Experiences as a child - including any history of abuse;
Education;
Employment;
History of being responsible children - including previous care proceedings, CP registration and assessments;
What happened, when and why;
Ages & gender of the children involved;
Category and level of abuse;
What is the parent's understanding of the impact of their behaviour on the child?
Is responsibility appropriately accepted?
What is different about now?

Behaviour

Is there anything about the parental behaviour that may have a significant negative impact on the child - and if so, what?

Violence to partner;
Violence to others;
Violence to any child;
Drug misuse;
Alcohol misuse;
Criminality and convictions;
Chaotic or anti-social lifestyle.

If drugs or alcohol are a significant issue a specific, detailed assessment (DAAT/adult services) should be sought as this will affect analysis of risk, plans for addressing physical needs or treatment, and the increased likelihood of placement breakdown.

Current circumstances

Is there anything relating to the parent(s) circumstances that may have a significant negative impact on the child - and if so, what?

Employment/unemployment;
Debt;
Inadequate housing/homelessness;
Home conditions;
Court orders;
Social isolation;
Mental illness.

If mental illness is a significant issue a specific, detailed assessment must be sought.

Communication

Is there anything relating to parental communication that may have a significant negative impact on the child - and if so, what?

English not spoken or understood;
Hearing impairment;
Visual impairment;
Speech impairment;
Literacy.

In order to properly analyse the information available, the social worker will need to consider:

Religious and cultural needs may also need to be identified and considered.

Support

Is there support available from extended families, friends, professionals;
Is support likely to be available over a meaningful time-scale;
Is it likely to address any immediate concerns;
Is it likely to enable change.

Attitude to professional involvement

Previously - in context;
Currently - regarding this assessment;
Currently - regarding any other professionals.

Dependency on partner

Choice between partner and child - who is the priority?
Role of child in parent's relationship;
Level and appropriateness of dependency;
Access to accommodation and basic income;
Dependency on extended family.

The social worker will need to comment on the parent(s) ability to understand and meet the needs of the baby and their ability or willingness to respond adequately to any identified risks - as highlighted by the assessment.

Particular care should be taken when assessing risks to babies whose parents are themselves children. In such circumstances attention should be given to (a) evaluating the quality and quantity of support that will be available within the family, (b) the needs of the parent(s) and how these will be met, (c) the context and circumstances in which the baby was conceived, and (d) the wishes and feelings of the child who is to be a parent.

2.5 Concluding the pre-birth assessment

The social worker should be mindful that the completed assessment will inform future planning about the child thus it is imperative that information is properly collated and fully explored with the relevant people involved. The conclusions of the assessment should take account of the identified issues that may have a significant negative impact on the child, alongside any identified family strengths or protective factors. The social worker may need to estimate the parent(s) likely response to intervention through which change might be achieved and the timescale by which change could be effected in relation to the short timescale demanded by the baby's changing developmental needs.

2.6 The outcomes of the pre-birth assessment

The outcome of the pre-birth assessment will inform any intervention necessary to promote the child's healthy development. In considering what intervention to implement in order to safeguard the child's welfare it is essential that careful thought is given to: (a) the parent(s) level of understanding, acknowledgement and responsibility for the concerns; (b) the level of co-operation with professionals demonstrated by the parent(s); and, (c) the level of support available to the parent(s). Generally the parent(s) motivation for change will be on a continuum between - accepting the identified concerns and wanting to take responsibility to address them in order to provide adequate care to the child - and - not accepting the concerns, not wanting to address them but recognising the coercive powers of the Local Authority thus 'going along' with any proposed plan. In the broadest sense, an evaluation must be made as to the likelihood that this process is worthwhile, how risk, progress/regression or success will be monitored and what the key factors will be in bringing a placement to an end.

It should be recognised that when a child is born (s)he has no cognitive capacity to understand the world. Instead the newborn baby has the innate ability to be aroused in an agitated or anxious way. In order to contain the child's anxiety the parent(s) need to be available to respond to the child's demands with consistency and routine. Such a patterned response creates safety for the child. It is through this process that attachment is developed. The social worker needs to be aware of attachment theory when considering any plan of intervention for the child. Attachment theory explains that it is from the position of safety or 'secure base' the child develops the confidence to explore the uncertainty of their environment, gradually making sense of the world - physically and emotionally.

The factors highlighted in Section 2.4, What information to put into the pre-birth assessment will impact on a parent(s) availability to respond to the needs of the child. Any disruptions to the care that the child receives - physically, emotionally, sexually or through a lack of availability (i.e. neglect of care) will impact on the child's development - in terms of how they think, how they feel, and how they behave - both in respect of themselves and others. Cognitive, behavioural and psychodynamic theories will assist the social worker in making sense of this.

Furthermore much research has been undertaken about the impact of drug taking, alcohol abuse, mental illness and domestic violence on the parent(s) capacity (availability and ability) to meet the child's needs as well as the effects on the child's development. It is useful to consider any relevant research when determining what is useful in terms of intervention. This material will be helpful to the social worker when considering how best to safeguard and promote the child's well being.

There are five possible outcomes of the assessment:

The child's well being is best safeguarded by placement alone in foster care while the parent(s) work with professionals to address the factors limiting their availability to provide safe care for the child and developing their parenting ability. This should be clearly evidenced by evaluating the level of risk, the prospects of success, or the nature of the shortcomings;
The parent(s) would be able to provide primary care to the child but needs intensive support to develop parenting abilities and this can best be achieved by placement of the child together with the parent in foster care;
The parent(s) are able to respond to the child's needs at birth but they will need assistance in understanding and responding to the changing needs as the child develops. A parenting program may be appropriate to assist the parent(s) in developing their understanding in order to keep the child safe, and both child and parent should remain at home whilst this work is done;
The strengths within the family indicate there is no need for social work intervention at this time. There will be ongoing professional health input to monitor the situation;
There is no realistic prospect of a successful process of further assessment or intervention to provide safe care. Other options for permanent safe care should be considered. It is important that the social worker is clear about the reasons that have led to such conclusions so that the plan is formulated by an 'evidenced based' assessment that is grounded in child development and based on careful considerations of 'what works'. It is important that parent and baby foster care is not used as the default method of parenting assessment, although if a parent and baby placement is not to be used the assessment must be able to show clearly why other arrangements are more appropriate. It will be critical here to consider the question of the maintenance of the prospects for attachment as well as any actual attachment. For children who are the subject of legal proceedings, it is critical that the reasons for not choosing a parent and baby placement must be fully recorded, child centred and evidence and research based.

End