Pre-Birth Assessments

1. Introduction

Some prospective parents may need additional support during pregnancy and help with the care of their baby. In some circumstances it may be anticipated that the unborn baby is likely be at risk of Significant Harm.

A pre-birth assessment enables professionals to analyse and identify the potential risks to a new born baby, the capacity of the parent(s) and carer(s) to change to meet the new born child's needs and the support that they will need to do so. Pre-birth assessments should be undertaken early in the pregnancy to allow sufficient time for whatever actions need to be taken in order to ensure a safe home environment after the baby is born.

The London Safeguarding Children Proceduresoutline under what circumstances a pre-birth assessment should be undertaken and whether a strategy meeting is appropriate. All pre-birth referrals should be recorded as a referral.

The agreed framework in Lewisham is Signs of Safety and all assessments should be compliant using the Signs of Safety guidance.

2. The Referral Pathway

When agencies or individuals suspect that prospective parents may need support services to care for their baby or that the unborn baby may have suffered, or be likely to suffer significant harm, a referral to Children’s Social Care (MASH) must be made as soon as the concerns are identified. These concerns should be addressed as early as possible before the birth, so that a full assessment can be undertaken, and support offered to enable the parents wherever possible to provide safe care.

The following circumstances are examples of where mothers, fathers or partners or any other member of the household, or regular visitor may pose a risk and therefore assessment of an unborn baby may be required.

• Where they are involved in activities such as substance misuse, including drugs and alcohol;
• Have perinatal/mental illness or support needs that may present a risk to the unborn baby or indicate their needs may not be met;
• Where they are victims or perpetrators of domestic abuse;
• Where the parents or other member of the household have been identified as presenting a risk, or potential risk, to children, such as having committed a crime against children;
• Where they have a history of violent behaviours;
• Where there are significant concerns about parental ability to self-care and / or to care for the child e.g., unsupported, young or learning disabled parents and in some circumstances severe physical or mental disability;
• Where a sibling in the household is subject of a child protection plan;
• Where a sibling has previously been removed from the household either temporarily or by court order;
• Where there have been historical concerns such as previous neglect;
• Where any other concern exists that the baby may have suffered, or is likely to suffer, significant harm including a parent previously suspected of fabricating or inducing illness in a child or harming a child;
• Where the adults are known because of parental involvement as a child or adult with social care;
• Where the parent is a looked after child or care leaver;
• Are living in poor home conditions, homelessness or temporary housing.

Children under the age of 16 who are pregnant will always be subject to enhanced checks by MASH. Children under the age of 13 who are pregnant should always be subject to S47 enquiries.

Where potential risks to unborn babies of Looked after Children or Care Leavers are identified, the unborn baby must be referred to the MASH. MASH will evaluate the referral information, and if the criterion for assessment is met, will assign the Unborn baby to the Referral and Assessment Service or Family Support and Safeguarding for a pre-birth assessment.

As an overriding principle, there must be liaison, effective communication and information sharing between the allocated social worker or personal assistant for the Looked After Child or Care Leaver, and the allocated social worker for the unborn baby, which should include involvement in the pre-birth assessment at the earliest stage.

The young person's worker should be invited to all meetings regarding the unborn baby, such as Child Protection Conferences, Child In Need review meetings, Legal Gateway/Planning Meetings etc. The needs of the unborn baby should be paramount for both services, while also maintaining sensitive and appropriate support for the unborn child’s parent/s.

3. Risks to the Unborn Baby

If, following the assessment, safeguarding issues are identified, the social worker and her/his manager must ensure that a pre-birth child protection conference is held as soon as practical and at least ten weeks before the expected date of delivery. This will ensure appropriate multi-agency planning can take place within correct time-scales.

If, following the assessment, no further action is required the social worker should notify the professional network, in writing, outlining the need to re-refer should circumstances change.

For guidance on when to convene a Strategy Meeting in relation to an Unborn child, see London Safeguarding Children Procedures.

For guidance on undertaking a pre-birth section 47 enquiries and assessment, see London Safeguarding Children Procedures. For guidance on the procedures in relation to pre-birth child protection conferences, see London Safeguarding Children Procedures.

Where a social worker is concerned that a child may be born at home, they should refer to the London Safeguarding Children Proceduresfollowing the required timescales.

In principle pre-birth assessments should be completed using the principles laid out in the assessment procedure but with due regard to the good practice steps below.

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 social care services are aware at a relatively early stage of the pregnancy.

In respect of assessment, these good practice steps were:

• A risk assessment of the parent(s) should 'commence immediately upon the social workers being made aware of the mother's pregnancy';
• Any assessment should be completed at least 4 weeks before the mother's expected delivery date;
• 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;
• The assessment should be disclosed upon initial completion to the parents and, if instructed, to their solicitor to give them the opportunity to challenge the Care Plan and risk assessment;
• Pre-birth 'Good Practice Steps' see also one-minute guide to pre-birth assessments. Please see London Safeguarding Children Procedures.

In principle pre-birth assessments should be completed using the principles laid out in this guidance but with due regard to the good practice steps below.

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 social care services are aware at a relatively early stage of the pregnancy.

In respect of assessment, these good practice steps were:

• A risk assessment of the parent(s) should 'commence immediately upon the social workers being made aware of the mother's pregnancy';
• Any assessment should be completed at least 4 weeks before the mother's expected delivery date;
• 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.

The assessment should be disclosed upon initial completion to the parents and, if instructed, to their solicitor to give them the opportunity to challenge it.