pre-birth assessment

Posted on Sunday, 30th Aug, 2015 at 09:14:53 PM
The main purpose of a pre-birth assessment is to identify:

What the needs of and risks to the newborn child may be;

Whether the parent/s are capable of recognising these and working with;

Professionals so that the needs can be met and the risks reduced;
What supports the parents may need;

Plans to ensure the needs are meet and risks addressed.

Will the newborn baby be safe in the care of these parents/carer?

Is there a realistic prospect of these parents/carers being able to provide adequate care throughout childhood?

Where there is reason for doubt about the above a pre-birth assessment is indicated.

Pre-birth assessments should be undertaken within a multi-agency approach;

Early referrals should be encouraged in order to ensure the following:
Sufficient time is allowed in order to undertake a detailed assessment including the preparation of a detailed Chronology;

There is sufficient time to make effective care/protection plans;

Parents have time to contribute to any assessment and to increase the likelihood of a positive outcome to the assessment;

Parents are not being approached in the latter stages of pregnancy which is a stressful time in any event;

Support services can be provided in a timely fashion;

Late referrals receive the highest level of priority.

The Pre-birth Team will be responsible for screening all pre-birth referrals coming to the Referral and Assessment Service. These will be undertaken within 24 hours of receipt in order to ensure a consistent approach to the process. If there is insufficient information to establish whether the grounds are met for undertaking the assessment, the Pre-birth Team Manager will liaise with the referring agency e.g. midwifery.

The Adult Mental Health Safeguarding Lead will be actively involved in the screening process and will offer early consultation on cases where there is a mental health component.

If it is considered that there are insufficient grounds for an Single Assessment to be undertaken, consideration should always be given to signposting the case to other appropriate agencies.

It is important that the expected date of delivery (EDD) is ascertained from the Referrer at the point of referral and recorded on CareFirst. If this is not established at the point of referral this will be a priority task for the allocated social worker.

The details of the father of the child and/or the male partner of the mother should also be obtained and recorded on CareFirst.

There must be consultation with the health specialist in the Referral and Assessment Service at this stage if there are any difficulties in establishing relevant health information, locating health visitors etc.
Pre-birth Single Assessments must be undertaken on all pre-birth referrals where the following factors are present:

There has been a previous unexplained death of a child whilst in the care of either parent;

A parent or other adult in the household, or regular visitor, has been identified as posing a risk to children;

A sibling is the subject of a Child Protection Plan;

The parent is a Looked After child;

A sibling has previously been Looked After voluntarily or via a Court Order/ Police Protection;

Domestic violence and abuse is known to have occurred;

The degree of parental substance misuse is likely to have a significant impact on the babies safety or development;

The degree of parental mental illness/impairment is likely to have a significant impact on the babies safety or development;

There are concerns about parental maturity and ability to self care and look after a child e.g. an unsupported young mother;

The degree of parental learning disability is likely to have a significant impact on the babies safety;

There are concerns about a parents capacity to adequately care for their baby because of the parents physical disability;

A child under 13 is found to be pregnant;

Any other concern exists that the baby may be likely to suffer Significant Harm including a parent previously suspected of fabricated or inducing illness in a child.


If it is decided that a pre-birth Child Protection Conference should be held it should take place as early as is practical and never later than 10 weeks before the due date of delivery, so as to allow as much time as possible for planning support to the baby and family. Where there is a known likelihood of a premature birth, the Conference should be held earlier. N.B. Drug using pregnant women are more likely to give birth prematurely, therefore early conferencing in such cases is vital.
If a decision is made that the baby needs to be the subject of a Child Protection Plan, the plan must be outlined to commence prior to the birth of the baby.

The Core Group must be identified and should meet prior to the birth and prior to the babies discharge home after a hospital birth to make detailed plans at both stages.

The importance of conducting pre-birth assessments has been highlighted by numerous research studies and Serious Case Reviews which have shown that children are most at risk of fatal and severe assaults in the first year of life, usually inflicted by their carers.
Pre-Birth Assessment is a sensitive and complex area of work.

Parents may feel anxious about their child being removed from them at birth. Referring professionals may be reluctant to refer Adults at Risk and be anxious about the prospective parents losing trust in them.

It is important to undertake the assessment during early pregnancy so that the parents are given the opportunity to show that they can change. If the outcome of the assessment suggests that the baby would not be safe with the parents then there is an opportunity to make clear and structured plans for the babies future together with support for the parents.

Social Workers undertaking the assessments should seek the support and advice of the Pre-Birth Team who will be able to advise them on a range of issues. Access to appropriate resources, liaison with key professionals and undertaking joint assessment visits can be requested. The CLA Senior Practitioner working within the Pre-Birth Team can offer specialist advice on matters such as the meaning of history in relation to assessments where there have been previous Care Proceedings. The Health Specialist can also offer advice and consultation on a range of health related topics.

It is important that social workers do not conduct assessments in isolation. Working closely with relevant professionals such as midwives and health visitors is essential. Liaising with relevant substance misuse, mental health and learning disability professionals is also crucial. The liaison mental health worker will also offer advice on cases with a mental health component and become involved in liaison with mental health professionals.

The importance of compiling a full chronology and family history is particularly important in assessing the risks and likely outcome for the child. Where there have been previous children in the family removed, the previous Court documents such as copies of Final Court Judgements and assessment reports should be accessed at an early stage. If there have been Social Workers involved from the CLA service, they should be consulted and invited to relevant meetings.
Workers should try to compile a clear history from the parents about their own previous experiences in order to find out whether they have any unresolved conflicts, for example that may impact on their parenting of the child. It is important to find out their feelings towards the newborn baby and the meaning that the child may have for them.

For example, the pregnancy may have coincided with a major crisis in the parents life, which will affect their feelings towards the child.
It is also important to find out the parents views about any previous children who have been removed from their care and whether they have demonstrated sufficient insight and capacity to change in this respect.

It is crucial to seek information about fathers/partners whilst conducting assessments and involve them in the process. Background Police and other checks should be made at an early stage on relevant cases to ascertain any potential risk factors.

Working with extended families is also crucial to the assessment process and achieving positive outcomes for unborn children. Consideration should always be given to convening Family Group Conferences in any cases where there is a possibility that the mother may be unable to meet the needs of the unborn child.

Family Group Conferences can enable the families to be brought together to make alternative plans for the care of the child thus avoiding the need for Care Proceedings in some cases. Parallel assessment of alternative family carers can prevent delays in Care Planning for the child. The CLA Senior Practitioner can advise on standards and practice in this area.

The Assessment Tool

Family Structure

Names, addresses, ages etc.

Extended family and potential support should be included.
Assessment issues

Are there any aspects of any of the following items that seem likely to have a significant negative impact on the child? If so, what, and how?

Partner support?

Family structure and support available (or potentially available or not available)?

Whether pregnancy planned or unplanned?

Feelings of mother about being pregnant?

Feelings of partner / putative father about the pregnancy?

Dietary intake - and related issues?

Medicines or drugs - whether or not prescribed - taken before or during pregnancy?

Alcohol consumption?

Smoking?

Previous obstetric history?

Current health status of other children?

Miscarriages and terminations?

Chronic or acute medical conditions or surgical history?

Psychiatric history - especially depression and self-harming?

Relationships

History of relationships of adults?

Current status?

Positives and negatives?

Violence?

Who will be main carer for the baby?

What are the expectations of the parents re each other re parenting?

Is there anything regarding "relationships" that seems likely to have a significant negative impact on the child? If so, what?


Abilities

Physical?

Emotional? (including self control);

Intellectual?

Knowledge and understanding re children and child care?

Knowledge and understanding of concerns / this assessment?

Is there anything regarding "abilities" that seems likely to have a significant negative impact on the child? If so, what?

Social history

Experience of being parented?

Experiences as a child? And as an adolescent?

Education?

Employment?

Is there anything regarding "social history" that seems likely to have a significant negative impact on the child? If so, what?

Behaviour

Violence to partner?

Violence to others?

Violence to any child?

Drug misuse?

Alcohol misuse?

Criminal convictions?

Chaotic (or inappropriate) life style?

Is there anything regarding "behaviour" that seems likely to have a significant negative impact on the child? If so, what?

If drugs or alcohol are a significant issue, more detailed assessment should be sought from professionals with relevant expertise.

Circumstances

Unemployment / employment?

Debt?

Inadequate housing / homelessness?

Criminality?

Court Orders?

Social isolation?

Is there anything regarding "circumstances" that seems likely to have a significant negative impact on the child? If so, what?

Home conditions

Chaotic?

Health risks / insanitary / dangerous?

Over-crowded?

Is there anything regarding "home conditions" that seems likely to have a significant negative impact on the child? If so, what?

Mental Health

Mental illness?

Personality disorder?


Any other emotional/behavioural issues?

Is there anything regarding "mental health" that seems likely to have a significant negative impact on the child? If so, what?

If mental health is likely to be a significant issue, more detailed assessment should be sought from professionals with relevant expertise.

Learning Disability

Is there anything regarding "learning disability" that seems likely to have a significant negative impact on the child? If so, what?

If learning disability is likely to be a significant issue, more detailed assessment should be sought from professionals with relevant expertise.

Support

From extended family?

From friends?

From professionals?

From other sources?

Is there anything regarding "support" that seems likely to have a significant negative impact on the child? If so, what?

Is support likely to be available over a meaningful time-scale?
Is it likely to enable change?

Will it effectively address any immediate concerns?

History of being responsible for children

Convictions re offences against children?

CP Registration?

CP concerns - and previous assessments?

Court findings?

Care proceedings? Children removed?

Is there anything regarding "history of being responsible for children" that seems likely to have a significant negative impact on the child? If so, what?

If so also consider the following:
Category and level of abuse;
Ages and genders of children;
What happened?
Why did it happen?
Is responsibility appropriately accepted?

What do previous risk assessments say? Take a fresh look at these - including assessments re non-abusing parents;

What is the parent's understanding of the impact of their behaviour on the child?

What is different about now?

History of abuse as a child

Convictions - especially of members of extended family?
CP Registration?
CP concerns
Court findings?
Previous assessments?

Is there anything regarding "history of abuse" that seems likely to have a significant negative impact on the child? If so, what?

Attitude to professional involvement.
Previously - in any context?
Currently - regarding this assessment?
Currently - regarding any other professionals?

Is there anything re "attitudes to professional involvement" that seems likely to have a significant negative impact on the child? If so, what?

Attitudes and beliefs re convictions or findings (or suspicions or allegations)

Understood and accepted?
Issues addressed?
Responsibility accepted?

Is there anything regarding "attitudes and beliefs" that seems likely to have a significant negative impact on the child? If so, what?

It may be appropriate to consult with the Police or other professionals with appropriate expertise.

Dependency on partner
Choice between partner and child?
Role of child in parent's relationship?
Level and appropriateness of dependency?

Is there anything regarding "dependency on partner" that seems likely to have a significant negative impact on the child? If so, what?

Ability to identify and appropriately respond to risks?

Is there anything regarding this that seems likely to have a significant negative impact on the child? If so, what?

Ability and willingness to address issues identified in this assessment
Violent behaviour?

Drug misuse?
Alcohol misuse?
Mental health problems?
Reluctance to work with professionals?
Poor skills or lack of knowledge?
Criminality?
Poor family relationships?
Issues from childhood?
Poor personal Care?
Chaotic lifestyle?

Is there anything regarding "ability and willingness to address issues" that seems likely to have a significant negative impact on the child? If so, what?

It is good practice to draw up a working agreement between Children's Social Work Services and the parents.

The agreement should outline the reason for the assessment, its purpose and aims, and how the assessment will be carried out:
Dates, times, venues of sessions and who will attend each session;

Areas to be covered in the assessment;

How the assessment will be shared and who with;
Expectations of those participating in the assessment.
Parents should be seen individually and as a couple.
Extended family members may need to be contacted.
Assessment sessions will normally take place at the family home and local area office. One of the sessions in the family home should assess the home environment and preparations made for the baby's arrival.

The main focus of the meeting to share the working agreement is to clarify expectations, identify tasks and clarify boundaries.

Any anxieties there might be around the assessment can be dealt with and openness encouraged.

It should be clearly stated that part of the process will be to liaise with other agencies.

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