Multi-Agency Pre-Birth Protocol

The purpose of this protocol is to ensure that a clear system is in place to develop robust plans which address the need for early support and services and identify any risks to unborn children.

Antenatal assessment is a valuable opportunity to develop a proactive multi-agency approach to families where there is an identified risk of harm.

This joint protocol applies particularly to staff working within Children’s Social Care, Health and the Police, but is of relevance to all agencies that work with parents, children and their families.

At the point of completing the Ante Natal Risk Assessment if there is a need for coordinated multi-agency support in order to promote the welfare and meet the additional needs of an unborn child, then an Early Help Assessment should be considered (see Cumbria SCP website - Early Help). Or if at any stage in the relationship between midwife and parent an emerging additional need is identified an assessment should be initiated then. Families need to agree to this process – however if they do not consent the implications of this should be considered – and consideration given to the need to refer to Children's Social Care. If the family consent, the initial part of the Early Help form should be completed with them and a Team Around the Family convened to include any agencies already involved or any who could address needs identified e.g. Adult Mental Health, Drug and Alcohol Service, and Domestic Abuse Services, Health Visitor, Nursery or schools. These services can input to the assessment by adding their own information reflecting their knowledge of the family. Alternatively, the first TAF could be small – with midwife parent(s) and one other agency – building as the additional needs are identified.

A referral to Children's Social Care for a pre-birth assessment should be considered when it is believed that there may be complicating risk factors which will impact on the unborn child. For guidance please refer to the Cumbria Multi-Agency Thresholds Guidance and the supporting document Cumbria Understanding The Level of Need and Practice Response which can be used alongside the Threshold Guidance

A referral to Children's Social Care, via the Safeguarding hub, utilising the single contact form, (or STRATA) for a Pre-Birth Assessment must always be completed if there is reasonable cause to suspect that the unborn baby is likely to suffer significant harm before, during or after birth, as defined in Cumbria Safeguarding Children Procedures.

Examples of when a Multi-Agency pre-birth assessment, led by Children's Social Care, should be considered (please note, this list is not exhaustive):-

• There are concerns that parent /their partner/potential carer may pose a risk to children (examples may include previous neglect or physical abuse of children, or sexual offences – see Appendix 1: Examples of Pre-Birth Risk and Protective Factors);
• There are concerns regarding parent/their partner/potential carer in terms of their parenting capacity. Such concerns may include mental health problems, learning disability or inability to parent or protect children from harm. See Appendix 1: Examples of Pre-Birth Risk and Protective Factors;
• Parent/their partner/potential carer has children that have been made subject to a Child Protection Plan, or Care or Supervision Order at any time in the past (or if proceedings are ongoing);
• One or both of the parents is in care or has previously been in care to a Local Authority and the parents view as to how this has affected them;
• There are concerns with regards to domestic abuse. These could relate to any person who may be involved with the unborn baby;
•  There are concerns regarding drug/alcohol misuse of parent/their partner/potential carer:
• There are significant concerns about the lifestyle of parent/their partner/potential carer which would impact on their ability to parent or protect children (examples may include a concealed pregnancy, failure to access appropriate ante-natal care – see Appendix 1: Examples of Pre-Birth Risk and Protective Factors);
• One or both of the parents have had previous children removed due to concerns about the care given to that child/ren;
• There are concerns that pregnant women has been trafficked / is the victim of modern slavery (see Guidance for professionals working with women and children who have been trafficked / are victims of modern slavery and who are pregnant).

See Appendix 1: Examples of Pre-Birth Risk and Protective Factors for additional guidance and for a link to risk assessment guidance.

• Referrals to Children’s Social Care should be made at the earliest opportunity after there has been confirmation of the pregnancy by scan. It is anticipated that this will be at the earliest following the 12 week scan. It is recognised that each case will need to be reviewed individually depending on the family circumstances but it is anticipated that high risk cases are referred as early as possible following the 12 week scan, for example cases where children have previously been removed. If the referrer has not received an acknowledgement within 3 working days, the referrer should Contact Children’s Social Care again.
  
  Referrals must be accompanied by the EHA and TAC minutes if they are available;

• During the process of completing a pre-birth assessment, a meeting of all professionals involved must be convened as per multi-agency child and family assessment. All professionals should give high priority to attendance at child and family assessment planning meetings if requested. If attendance is not possible, they should ensure that their report is taken to the meeting by another appropriately briefed professional from their agency.

At the end of the assessment the outcome will be one of the following;

• No further action is required;
• Early help is recommended;
• A child in need plan is recommended;
• An unborn baby Child Protection Conference is required;
• Where a pre-birth Initial Child Protection Conference is required it will be convened no later than 30 weeks gestation (2.) If the unborn baby is made subject to a Child Protection Plan at that Conference, the first Core Group meeting will be held within 10 working days to agree the plan for the baby and the baby's discharge from hospital;
• If the unborn baby is not made subject to a Child Protection Plan, a Child in Need Plan will be considered. If statutory intervention is not felt to be appropriate, a Team Around the Family (TAF) meeting should be considered.

All professionals should give high priority to attendance at Child Protection Conferences if requested. If attendance is not possible, they should ensure that their report is taken to the Conference by another appropriately briefed professional from their agency. The Conference may not be viable or quorate if professionals are not present. Child Protection Conference Reports should be shared with parents prior to the meeting. See Child Protection Conferences Procedure.

2. In exceptional circumstances this may not be possible (e.g. concealed pregnancy or late presentation):

• The midwife (or representative for midwifery services) will ensure that the pre- birth plan is filed in the maternity records within 2 working days of its completion. A copy will also be sent by the social worker to the Emergency Duty Team/Care Connect;
• Maternity unit staff will inform Children’s Social Care of the baby’s birth immediately (if out of hours, then the Emergency Duty Team);
• The named Social Worker will organise the pre-discharge planning meeting prior to the baby's discharge from hospital. This meeting will confirm the baby’s placement after discharge and multi-agency professional interventions will be agreed, recorded and distributed;
• The Review Child Protection Conference must be held within 4 weeks of the birth of the child, or sooner if legal action is being considered.

Safe Sleeping

Sudden Infant Death Syndrome (SIDS), which was formerly called 'cot death', is the sudden and unexplained death of a baby where no cause is found. Although SIDS is rare, it still accounts for a small but significant percentage of deaths among infants across the UK every year. Every one of these deaths is a tragic and unexpected loss for a family. Research has shown that co-sleeping is a significant factor in SIDS.

Although there is no clear cause or explanation for why SIDS happens, research has identified a simple set of key messages for parents and carers that may help reduce the risk of it happening to their baby. Please see Safer Sleep For Babies: A Guide For Professionals (lullabytrust).

Open in-depth conversations between professionals and the mother and father/partner of the unborn baby should be held around safe sleeping with the baby once it is born; this might involve planning around reducing any risks, as well as avoiding risks to the baby. During these conversations, information should be provided around safe sleeping practices to protect babies. Discussions should also include exploration around peer and support networks for parents to reinforce the information and provide practical advice.

• There should already be a record of the child in Cumbria as the placing Local Authority should have informed Cumbria that the child is now living in the area;
• As soon as the child’s allocated Social Worker becomes aware that the child is pregnant they should convene a meeting with the young person and the manager of the unit/placement to discuss if the placement is able to accommodate a mother and baby. If not - if it is more appropriate for the young person to be moved back to a more suitable placement in the home authority?
• If it is established that the child WILL remain in Cumbria up to the birth of the baby the allocated Social Worker should then make a referral for an assessment via the Cumberland Safeguarding Hub or Westmorland and Furness Safeguarding Hub;
• A Cumbria Social Worker will be allocated to the unborn child;
• A joint pre-birth assessment will be necessary and a meeting should be held between the Team Manager in the placing Local Authority and Cumbria to agree who will be responsible for:
  1. Assessing the parents - this should be the allocated Social Worker for the parent/s;
  2. Assessing the needs of the unborn child - this should be the allocated Cumbria Social Worker for the unborn child.
• If it assessed that the unborn child should be made subject to a pre-birth Child Protection Conference the Cumbria procedures should be followed: See Child Protection Conferences Procedure.

Good Practice Guidance

NICE guidelines [CG192] Antenatal and postnatal mental health: clinical management and service guidance