MULTI-AGENCY PRE-BIRTH PROTOCOL
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 1
BRACKNELL FOREST AREA CHILD PROTECTION COMMITTEE
MULTI-AGENCY PRE-BIRTH PROTOCOL
INTRODUCTION
Research and experience indicate that very young babies are extremely vulnerable to
abuse and that work carried out in the antenatal period to assess risk and to plan
intervention will help to minimise harm. Antenatal assessment is a valuable opportunity to
develop a proactive multi-agency approach to families where there is an identified risk of
harm. The aim is to provide support for families, to identify and protect vulnerable children
and to plan effective care programmes, recognising the long-term benefits of early
intervention for the welfare of the child.
This protocol is written with the objective of having a shared understanding of what causes
harm to young babies and a consistent approach to assessment in the antenatal and early
postnatal stages (see Appendix A).
The protocol applies the principle of flexible thresholds both for seeking advice from other
agencies/professionals and for collaborative work between agencies once it has been
identified that there is a likelihood of harm. There needs to be good consistent dialogue
between professionals and recognition of the strengths and expertise that individual
practitioners bring to the process.
EARLY IDENTIFICATION AND ASSESSMENT
Women who are pregnant may present initially via a number of different professionals, for
example GP, hospital antenatal services, community midwifery services, health visitor, or
housing officer. Additionally, other health professionals or professionals from another
agency may become aware of a pregnancy prior to a formal referral to the
obstetric/midwifery services. It is important that all professionals are aware of assessment
needs and of routes of referral in order to facilitate engagement care and intervention.
All professionals should be aware of indicators that may suggest a child could be at risk of
harm either before or following birth, or that the family will require a high level of support in
order to parent the child safely and to promote their welfare. It is vital that assessments
are begun in the early antenatal period and the information passed appropriately to
relevant professionals. Prior to referral to Children and Families Social Care, a
consultation needs to take place between professionals already involved (i.e. midwife, GP,
health visitor, etc) to ensure that planning for the babys arrival can be comprehensive and
the referral made at an appropriate time. All professionals who have contact with the
parents or who provide specialist services should be aware that they may be asked to
assist in the assessment and analysis of need or risk.
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 2
Any assessment in the early antenatal period should take into account family and social
history as well as obstetric history and details of the parents. The assessment should
include details, where possible, regarding the mothers partner and their wider family and
environment. The depth of an assessment will depend on the individual circumstances
surrounding the woman and her family and is a matter of professional judgement of those
involved with the client.
Note: This protocol does not apply to mothers who want their baby adopted, where there
are no concerns about their potential care. These women should be referred later in
pregnancy.
Pregnancy in young person under the age of 18
All professionals, particularly health and education staff who have most contact with
pregnant teenagers, have a responsibility to consider the welfare of both the prospective
parents and the baby.
The young age of a parent should not automatically be seen as an indicator of child
protection. However, all parents under the age of 18 will automatically receive a targeted
health visiting service. Young people under the age of 18 can and do parent children
appropriately. There are occasions when the parent (the young person) may themselves
have needs which may require an assessment under children in need or child protection
procedures. In this situation both would-be parents should be assessed and any ongoing
issues that relate to the young person rather than the baby should be seen as part of
individual but parallel planning.
Any assessment of need should address what support systems exist for the young
person/couple and their families. If abuse is suspected a referral needs to be made to
Children and Families Social Care and Police.
RECOMMENDED PROCEDURE
This protocol describes routine contact and two levels of concern following initial contact.
The levels are defined below but at any stage during the antenatal process, information
may be gathered that may indicate a need to re-define the situation as a higher or lower
level of need/concern and in these circumstances appropriate action must be taken.
ROUTINE ANTENATAL CONTACT
The assessment by health professionals identifies that the family will only require core
child care/health visiting/midwifery services at this stage. Services will be determined
according to need.
See Appendices A, B and C
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 3
LOW LEVEL OF CONCERN:
The assessment identifies that the family will require targeted child care/health
visiting/midwifery services with limited extra intervention from other agencies.
See Appendices A, B and D
Initial contact made by Midwifery Services/GP
If the initial assessment by a health professional indicates some level of concern, family
should be informed of the concern and the need to refer to other professionals/agencies.
The only reason for not informing the family of the concerns would be when it is felt that to
do so would put the child/unborn baby at a higher level of risk (e.g. because parents may
disappear out of the area). Any discussion with other professionals should include
information regarding whether the family have been informed and what their response to
the concerns have been. The midwife will discuss with the health visitor, GP and other
professionals involved with the family as and when appropriate. However, a referral to the
health visiting service should be made preferably by 24 weeks gestation. The health
visitor will make contact with the family as soon as possible following 24 weeks gestation.
The midwife and health visitor should work together to complete an assessment, including
other professionals as appropriate. The scope of the assessment will be determined by
the health visitor, midwife and other professionals involved with the family. Concerns must
be monitored and evaluated and additional advice taken if necessary. At any stage
professionals may wish to consult with the Children and Families Social Care referral team
as to whether it would be appropriate to make a referral to the department. The
assessment should identify concerns and plan interventions to reduce risk to the unborn
baby. The health visitor will maintain contact with both family and professionals and take a
lead role in continuing the assessment and intervention. Services will be determined
according to need.
Initial contact made via another professional/agency
If the pregnant woman presents to a professional who is not a midwife and/or a GP (for
example a housing or probation officer) and a low level of concern is identified, the
midwifery services should be contacted and the scope of further assessment agreed.
Following this the process described above should be adhered to.
MEDIUM/HIGH LEVEL OF CONCERN:
Initial contact made by professionals working predominantly with adult family members
Medium/high level of concern exists when there is reason to believe that an unborn baby
may be a child in need, or in need of protection, and is unlikely to achieve and maintain a
reasonable standard of health and development without high level intervention from a
number of different services. When initial contact is made by professionals working
predominantly with adult family members (e.g. probation, police, housing officer, voluntary
agency) which raises medium or high level concerns, the unborn baby will need to be
referred to Children and Families Social Care referral team. Professionals can consult
beforehand with the children and families referral team who will offer advice.
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 4
However, Children and Families Social Care Services will normally expect to see referrals
in the following circumstances: Schedule one offender, substance misusing parents,
previous child removed, parent with serious mental health problems, parent with
disabilities that have a significant impact on the parents capacity to live independently
without ongoing support, repeated or severe domestic violence. See Appendix A for
additional significant issues. In general there tend to be higher levels of concern where
multiple risk factors are present.
Any professional who has identified a medium/high level of concern before 24 weeks
pregnancy, should attempt to liaise with the relevant health professionals if known and
ensure they are informed of all relevant information. However, if they are unaware of
whom this is, then they should contact the Children and Families Social Care referral team
who will take appropriate action and ensure relevant health professionals are aware.
Early consultation with Children and Families Social Care Services is recommended if high
risk/complex issues are identified. In these exceptional circumstances it may be
appropriate to refer to Child and Families Social Care Services at 20 to 22 weeks.
See Appendix B for further details.
Initial contact made by Health professionals who give support to families
In the early antenatal period the midwife must inform the named midwife for child
protection within her area, health visitor, GP and other relevant professionals regarding the
outcome of her initial assessment and the analysis of risk. Family should be informed of
the concern and the need to consult/refer to other professionals/agencies. The only
reason for not informing the family of the concerns would be when it is felt that to do so
would put the child/unborn baby at a higher level of risk. Any discussion with other
professionals should include information regarding whether the family have been informed
and what their response to the concerns have been. An early consultation with Children
and Families Social Care will be necessary in order to take advice regarding
referral/intervention. Whilst all professionals should work to the principle of early referral,
the timing of the referral should be agreed between the health professional and Children
and Families Social Care to maximise information gathering and best meet the needs of
the unborn child. Early consultation with Children and Families Social Care Services is
recommended if high risk/complex issues are identified. In these exceptional
circumstances it may be appropriate to refer to Child and Families Social Care Services at
20 to 22 weeks.
The acceptance of the referral by any professional to the Children and Families Social
Care Service will begin the process of completing an initial assessment. This may require
a multi-agency planning meeting to plan the assessment and future short-term intervention
including whether a strategy meeting/discussion and/or core assessment is necessary.
Professionals involved with the family will need to make an assessment as to whether to
involve/inform the family of the meeting at this stage. The initial assessment will involve
information and analysis from other agencies/professionals, but may require a more indepth
analysis of risk. The assessment, whether under Section 17 or 47 of the Children
Act, must be conducted in accordance with the Framework for the Assessment of Children
in Need and their Families.
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 5
Strategy Discussion/Meeting/Planning Meeting
If following consultation with Children and Families Social Care it is agreed that the child is
likely to suffer significant harm, a strategy discussion should take place between children
and Families Social Care, the Police, Health (including Midwifery and Health Visiting) and
any other relevant agency. Legal advice should be considered if appropriate. The timing of
the strategy discussion is a matter of professional judgement and should be agreed by all
involved with the family. The purpose of the discussion is to agree whether Section 47
inquiries are required and, if so, to complete these. A decision will be made at the strategy
discussion/planning meeting as to whether a family support or child protection conference
should be convened. If the family is not aware at this stage of the referral, the strategy
discussion must consider how and when the family will be informed. A strategy
discussion/planning meeting will further discuss the details of the core assessment which
must be completed within 35 working days
Child Protection Conference
If it is agreed that a child protection conference is necessary this should take place within
15 working days following the final strategy discussion, which should take place at the
conclusion of the core assessment. Normally the pre-birth initial child protection
conference should be held 8-10 weeks prior to the expected delivery date, but may be held
earlier if appropriate (e.g. risk of premature birth, concerns mother may leave the area).
The aim of the child protection conference is to enable professionals with particular
expertise (even if they are not currently involved with the family), those most involved with
the family, and the family itself to assess all relevant information and plan how to
safeguard the child and promote his or her welfare. There must be representation from
the midwifery services, health visiting and other professionals as appropriate.
Child Protection Plan
The child protection plan must particularly focus on the immediate safety of the child once
it is delivered. A plan should be formulated to ensure risk to the child in either the
antenatal or postnatal stage is minimised. Hospital staff and the named midwife should be
involved with the development of this plan. Liaison between hospital, midwifery and
community services should be agreed and a nominated member of staff from the health
services should ensure that hospital midwifery staff are aware of the detail of the plan.
There may be a need to consider the steps necessary to secure the immediate safety of
the child, for example the use of the police or legal options, following legal advice. In the
majority of cases parents will have been involved from the outset and will be aware of the
level of concern. However there will be a minority of cases where it is assessed that to
inform the parents of the involvement of child protection professionals or the plan to
remove their child, may put the child at a higher level of risk either before or immediately
following birth. Staff at the hospital where the baby is likely to be delivered should be kept
informed of the plan and any assessed risk to either the baby or staff. The Emergency
Duty Team should also be alerted to the child protection plan to cover situations that may
arise out of office hours.
Planning Meeting for Child-in-Need
A decision may be made to convene a planning meeting, to include family and all relevant
professionals. A planning meeting should be held if it is assessed that:
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 6
a) there are concerns; but
b) the concerns are not sufficient to lead to the likelihood of significant harm; and
c) there is meaningful family co-operation and agreement regarding concerns and the
way forward.
Planning meetings take place within the same timescales as a child protection
conferences and the child in need care plan must ensure that the child and family receive
the necessary support.
At any stage during the initial or core assessment if concerns increase it may be
necessary to convene a child protection or a planning meeting. It is vital that
professionals exchange information that is relevant to the safeguarding of the unborn
baby.
DOCUMENTATION
All contacts and assessments must be documented in a way that is accessible to
colleagues who may be covering for the lead worker. The detail of the assessment and
the outcome in terms of the action plans must be readily available. Children and Families
Social Care needs to ensure its computer database holds current and complete
information about the family.
Formal reports completed for a Pre-Birth Child Protection Conference may be submitted to
Court and so professionals completing such reports need to ensure they are prepared in
ways that support this process, in the event it is needed. Where possible, if a parent has
difficulty understanding the standard report (e.g. parent with literacy problems, learning
disabilities, etc) professionals should consider providing reports in alternative formats in
addition to the standard format.
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 7
Appendix A
Model for Assessment
The assessment should, as well as having components from the individual disciplines, be
based upon the Assessment Framework and should include all dimensions of the three
domains, including strengths and risk factors.
Antenatal assessment should include both parents and the wider family and environmental
factors.
RISK FACTORS TO BE CONSIDERED WHEN UNDERTAKING A
PRE-BIRTH ASSESSMENT OF RISK
Unborn Baby
Unwanted/concealed pregnancy Perceptions different/abnormal
Lack of awareness of babys needs Inability to prioritise babys needs
Unattached to unborn baby Poor antenatal care
Unreal expectations No plans
Exhibit inappropriate parenting plans Special/extra needs
Premature birth Stressful gender issue
Parenting Capacity
Negative childhood experiences; Age very young parent/immature
abuse in childhood Mental disorders or illness
denial of past abuse Learning difficulties
multiple carers Physical disabilities/ill health
Drug/alcohol misuse Inability to work with professionals
Violence/abuse of others Postnatal depression
Abuse/neglect of previous child(ren)
Previous care proceedings Past antenatal/postnatal neglect
Family/Household/Environmental
Domestic violence Relationship disharmony/instability
Violent or deviant network Multiple relationships
Poor impulse control Not working together
Unsupportive of each other Lack of community support
Frequent moves of house Poor engagement with professional services
No commitment to parenting
CHILD
Safeguarding
and
Promoting
Welfare
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 8
STRENGTHS/PROTECTIVE FACTORS TO BE CONSIDERED WHEN UNDERTAKING
A PRE-BIRTH ASSESSMENT OF RISK
Unborn Baby
No special or expected needs. Appropriate preparation.
Acceptance of Difference Understanding or awareness of babys needs.
Realistic expectations. Unborn babys needs prioritised.
Perception of unborn child normal
Parenting Capacity
Positive childhood
Recognition and change in previous violent
Willingness and demonstrated capacity and ability
for change.
pattern.
Acknowledges seriousness and responsibility
Presence of another safe non-abusing parent.
Compliance with professionals.
without deflection of blame onto others.
Full understanding and clear explanation of the
Abuse of previous child accepted and addressed
in treatment (past/present).
circumstances in which the abuse occurred.
Maturity
Expresses concern and interest about the effects
of the abuse on the child.
Family/Household/Environmental
Supportive spouse/partner. Supportive community
Supportive of each other. Optimistic outlook by family and friends.
Stable, non-violent. Equality in relationship.
Protective and supportive extended family. Commitment to equality in parenting.
Optimistic outlook.
Previous efforts to address problem. E.g.
attendance at relate, have secured positive and
significant changes (e.g. no violence, drugs etc).
Non-abusive parent
Accepts the risk posed by their partner and
expresses a willingness to protect.
Willingness to resolve problems and concerns.
Accepts the seriousness of the risk and the
consequences of failing to protect.
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 9
Appendix B
Multi-Agency Pre-Birth Protocol
Midwifery Assessment
(booking-in)
ROUTINE LOW LEVEL OF CONCERN
MEDIUM/HIGH
LEVEL OF
CONCERN
Routine midwifery
and obstetric
services
On going
midwifery
assessment.
Information passed
to health visitor
Health visitor
contacts family
28-34 weeks
gestation
Plan agreed with
parents and
midwife
Ongoing midwifery
assessment.
Inform GP, health
visitor & other
professionals
Communication and
consultation with all
professionals
involved with the
family. Joint
assessment
between health
visitor and midwife
plus appropriate
others
Information gathered at any stage of the
assessment may indicate a need to re-define as
a higher or lower level of need/concern
Discussion with
other professionals
involved including
GP. Early referral
from midwife to
health visitor.
Consult with
childrens social
care service
Communication and consultation
with all professionals involved
with the family. Early health
visitor contact (24+ weeks). Joint
assessment between health
visitor and midwife. Refer to
childrens social care services
asap following 24 weeks.
Multi -professional/
multi agency meeting to plan
assessment and intervention.
Initiation of Section 47 inquiries
Liaison with all
professionals
involved with family.
Intervention as
planned
Joint assessment including
all professionals involved
with family. Intervention as
planned (strategy, family
support/child protection
conference). Liaison with
hospital
New birth visit by health visitor and
handover from midwife to health visitor.
Follow up as planned. Services will be
determined according to need
1st trimester
0-14 weeks
2nd trimester
14-28 weeks
3rd trimester
28 weeks - birth
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 10
Appendix C
ROUTINE
The assessment identified that the family will require core child care/health
visiting/midwifery services
Midwifery Assessment
(booking in)
Routine midwifery
and obstetric
services
1st trimester
0-14 weeks
On going midwifery
assessment.
Information passed
to health visitor
2nd trimester
14-28 weeks
Health visitor
contacts family
28-34 weeks
gestation
Plan agreed with
parents and
midwife
3rd trimester
28 weeks - birth
Initial assessment by midwifery/obstetric
services indicate no concerns
Health visitor informed regarding
pregnancy and outcome of early
assessment by midwife
Health visitor contact with family as soon as
possible after 24 weeks gestation. Health
visitor assessment to include social history
of mother, father and extended family. Plan
and on-going contact agreed with family
and midwife
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 11
Appendix D
LOW LEVEL OF CONCERN
The assessment identified that the family will require core child care/health
visiting/midwifery services with limited extra intervention
Midwifery Assessment
(booking in)
1st trimester
0-14 weeks
2nd trimester
14-28 weeks
3rd trimester
28 weeks - birth
Ongoing midwifery
assessment. Inform GP,
health visitor and other
professionals
Midwifery/health visiting assessment
identifies that the family will require
core child care/health
visiting/midwifery services with limited
extra intervention from other agencies
Midwife to discuss with health visitor, GP
and other professionals involved with
family, or as appropriate
Communication and
consultation with all
professionals involved with
the family. Joint assessment
between health visitor and
midwife plus appropriate
others
All professionals involved with the family
who have an input into the assessment
should be kept informed of the current
information and stage of assessment.
Health visitor to make contact with family as
soon as possible following 24 weeks
gestation. Joint assessment with midwife
plus other professionals as appropriate. It
may be necessary at this point to consult
with Childrens Social Care Services.
Concerns must be monitored and evaluated
and additional advice taken if necessary.
Assessment should identify concerns and
plan intervention to reduce risk
Liaison with all
professionals involved
with family.
Intervention as planned
Health visitor should maintain contact with
family and professionals, and take lead role
in continuing assessment and intervention.
Services will be determined according to
need
Bracknell Forest ACPC Multi-agency Pre-birth Protocol Final Document July 2005 12
Appendix E
MEDIUM/HIGH LEVEL OF CONCERN
The assessment indicates that this may be a child in need, or at risk of significant
harm, who is unlikely to achieve and maintain a reasonable standard of health and
development without high level intervention from a number of different services.
There is an indication that there is a likelihood of impairment of health and
development.
Midwifery Assessment
(booking in)
1st trimester
0-14 weeks
2nd trimester
14-28 weeks
3rd trimester
28 weeks - birth
Discussion with other
professionals involved,
including GP. Early referral
(GP or MW)l to health visitor.
Consult with/refer to
Childrens Social Care Service
During the early antenatal period the midwife
must inform health visitor, GP and other
relevant professionals about the outcome of
her initial assessment and the analysis of risk.
An early consultation with the childrens social
care service may be appropriate to take advice
regarding referral/intervention.
Communication and consultation
with all professionals involved
with the family. Early health
visitor contact (24+ weeks).
Joint assessment between health
visitor and midwife. Refer to
social services. Multiprofessional/
multi agency
meeting to plan assessment and
intervention. Initiation of Section
47 inquiries
All professionals involved with the family who
have an input into the assessment should be kept
informed of current information and stage of
assessment. Health visitor must make contact
with the family soon as possible after 24 weeks
gestation and on-going assessments must be
made jointly between midwife and health visitor
and include consideration of further consultation
with or referral to the childrens social care
service. If a referral is necessary the contact must
be made with childrens social care service at the
earliest opportunity following 24 weeks gestation
to enable an early planning meeting to look at the
detail of the multi-agency assessment. Earlier
consultation/referral (e.g. 20-22 weeks) should be
made to childrens social care services if
appropriate. A strategy meeting should be
convened and a child protection/planning meeting
arranged if necessary.
Joint assessment including all
professionals involved with
family. Intervention as
planned (strategy, planning
meeting/core assessment,
child protection conference).
Liaison with hospital
Ongoing assessment and intervention as planned.
Midwife and health visitor to ensure there is close
liaison with hospital regarding assessed risk, plan
for delivery and perinatal period. If a child
protection conference is necessary, it should be
held at a time that will optimise the planning for
assessment and ongoing intervention with the
parents/family
www.bracknell-forest.gov.uk/prebirth-protocol-july-2005.pdf
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