Multi-Agency Pre-Birth Protocol

Research and experience indicate that very young babies are extremely vulnerable, and that work carried out in the antenatal period to assess risk and to plan intervention will help to minimise harm.

A number of learning reviews have been undertaken in respect of babies who became subject to child protection plans prior to birth, or in which the pregnancy was initially concealed. These have highlighted the importance of all agencies acting as early in the pregnancy as they can to assess and intervene to keep the unborn baby safe and increase the likelihood of the birth parents being able to provide safe care.

The NCMD Child Death Review Data Release 2024, identified that infants <1 year are at the highest risk of death, due to violence and maltreatment, than any other age group. Infants <1 are also consistently identified as an at risk group in local and national reviews.

The transition to parenthood is challenging and this is heightened when there are additional vulnerabilities identified, e.g poor mental health, domestic abuse, drug/alcohol use. The NCMD report states that risk of death, as a result of violence and maltreatment, is two times higher for children living in the most deprived areas.

It is possible to identify vulnerability and predict the potential for harm, providing support for parents who are struggling as early as possible and keep children safe.

A referral/request for support to Children’s Social Care for a Pre-Birth Assessment must always be completed if there is a reasonable cause to suspect that the unborn baby is likely to suffer significant harm before, during or after birth. Further information can be found in the Recognising Abuse and Neglect Procedure.

Information about an unborn child and their parents can only be shared with the informed consent of the parents. This is important, both to comply with legislation and to help families feel that services are working with them and not doing things to them. Only in exceptional circumstances can the need for consent be overridden and then it remains good practice to discuss the referral/request for support with them. Further information can be found in the Information Sharing Protocol. Gaining consent is good practice, but is not a barrier to making a referral under S47 i.e L4. Lack of consent can be overridden, proportionate to the level of risk.

Examples of concerns/risks about an unborn baby and their parents that may indicate that a multi-agency pre-birth assessment, led by Children’s Social Care, should be considered are included in Section 3. These should be balanced with the strengths that are also listed.

Professionals should not lose sight of any safeguarding concerns for the parents (either as children or adults) and these should be acted on accordingly.

Risk factors which could indicate that an unborn child may be likely to suffer significant harm and, therefore, should be considered for a pre-birth assessment may include:

• Involvement in risk activities such as substance misuse, including drugs and alcohol
• Perinatal/mental illness or support needs that may present a risk to the unborn baby or indicate that their needs may not be met
• Victims or perpetrators of domestic abuse
• Identified as presenting a risk, or potential risk, to children, such as having committed a crime against children
• Trafficked women
• Modern Slavery
• Needs of women and families who are seeking asylum
• A history of violent behaviours
• May not be able to meet the unborn baby's needs e.g. significant learning difficulties and in some circumstances severe physical or mental disability
• Are known because of historical concerns such as previous neglect, other children subject to a child protection plan, subject to legal proceedings or have been removed from parental care
• Currently 'Cared For ' themselves or were Cared For as a child or young person (care experienced)
• A history of abuse/trauma in childhood or as an adult
• Are teenage/young parents and are vulnerable
• Recent family break up and social isolation/lack of social support
• Unknown and unassessed males in the household
• Any other circumstances or issues that give rise to concern

The list is not exhaustive and, if there are a number of risk factors present, then the cumulative impact may well mean an increased risk of significant harm to the child. If in doubt, professionals should seek advice about making a referral. Referrals for pre-birth assessments were there has been care proceedings in the last 2 years, and where the pregnancy has not reached 28 weeks gestation, will need to be considered on a case-by-case basis. However, in most cases it is likely that, following assessment, the unborn will require statutory services at level 4 s17 / s47 threshold due to the recent history that resulted in care proceedings.

Where pre-birth involvement is a result of the parents learning difficulties/disabilities causing uncertainty as to the parents’ ability to meet the needs of the child once born, the Court of Appeal in D (A Child) [2021] EWCA Civ 787 stressed the importance of effective planning during the pregnancy for the baby’s arrival, and of taking adequate steps to ensure that the mother understands what is happening and is able to present her case. Further information can be found in the Parents with Learning Disabilities Procedure.

Family Help and Early Intervention is our Early Help approach to working with children and their families and networks. Family Help is everyone’s responsibility. Effective early intervention enables children and families to build on their strengths and skills to become more independent and resilient to the challenges that they face, ensuring meaningful conversations with a family and their network about their strengths and challenges, working out what is needed, and pulling in the right people to support change.

Where an expecting parent/s are identified as having additional support needs, and they are not open to children services or have an existing safety or wellbeing plan, the Family Help pathways can be accessed, and an Early Help Assessment and plan initiated. This will ensure that children and their parent/s have their needs assessed and that a safety or wellbeing plan offers support in preparations for parenthood and any pre-birth assessment processes. 

An Early Help assessment can be undertaken in relation to the unborn child. If the mother is under 18, they should also be offered an Early Help Assessment. If the parent consents to the Early Help Assessment, then this can start ahead of a pregnancy being confirmed at the dating ultrasound scan.

We know that early assessment, intervention, and support work carried out during the antenatal period can help minimise any potential risk of harm, and the Early Help pathway will support the right help at the right time and prevent any unnecessary escalation of risk or harm.

When it is established that a young person in care or a care leaver is pregnant or going to become a parent, the referrer must contact the responsible Local Authority in order to identify the young person’s allocated social worker or personal advisor. A decision can then be reached about whether a referral for the unborn child should be made. It should not be an automatic decision to make or accept a referral in relation to the pregnancies of all cared for children and care experienced, unless the thresholds are met.

Referrals/requests for support to Children’s Social Care for a multi-agency pre-birth assessment should be made as soon as concerns for the safety of the unborn child become apparent in the pregnancy.

A request for support should be made at point of booking or when a pregnancy is known.

Where there is any doubt as to the appropriateness or timing of a referral/ request for support, advice should be sought from the Safeguarding Hub.

Once a referral/request for support is received, screening will take place to identify the level of need, in line with Cumbria's Multi-Agency Threshold Guidance.

In cases of late presentation and concealed or denied pregnancy, referrals/requests for support should be made as soon as is possible and the subsequent process expedited as far as is possible to meet the needs of the unborn baby.

Referrals/requests for support about unborn babies should be made by whichever agency identifies the concerns. There should not be an assumption that a single agency is responsible for this. Multi-agency information sharing, with consent, prior to the referral/ request for support will enable more informed decision making e.g. probation may have concerns about criminality in household members, which midwifery can balance with strengths of which they are aware. If there are emerging concerns identified, professionals should seek to share information and build a picture of relationships and family dynamics under the Early Help/Family Help Framework. If, once information has been shared, there is a concern that unborn baby is at risk of significant harm, then a referral can be made to Children’s Social Care for more specialist support.

When a brother or sister or other child within the household is already subject to a Child in Need or Child Protection Plan, a referral/request for support for the unborn child should be made as soon as the referrer becomes aware of the pregnancy. This should be a robust, transparent, trauma informed pre-birth assessment.

The pre-birth assessment will gather information from all involved agencies for mother and father to understand the history and any known risks, historic or current, e.g. General Practitioners, Midwifery, Health Visitors, Police etc. It is critical that information is shared promptly and fully to allow for timely decision making.

During the process of completing a pre-birth assessment, a meeting of all professionals involved may be convened, as per multi-agency procedures. This could be a strategy meeting (see Section 47 Enquiries) or a multi-agency meeting, including the family, held with their informed consent. All professionals should give high priority to attendance at pre-birth assessment meetings, if they are requested to attend. If attendance is not possible, they should ensure that their report is taken to the meeting by another appropriately briefed professional from their agency.

A pre-birth assessment should only be carried out whereby the referral is received owing to the pregnancy. Therefore, if a referral is received from a family group, and one of the referred children is an unborn child, a Child and Family Assessment should be undertaken to consider the needs of the children and family holistically and there is not a need for a separate pre-birth assessment to be completed.

The pre-birth assessment will lead to one of a number of outcomes, including a step down to universal or early help services, a child in need plan or child protection plan. Children’s social care will ensure that the outcome of the assessment is explained to the parents and involved professionals. Professionals should raise any concerns that they have with the outcome of the assessment. Further information can be found in the Escalation Policy.

Where a pre-birth Initial Child Protection Conference is required, it will be convened as early as is required to meet the family’s needs, but not later than 30 weeks’ gestation. If the unborn baby is made subject to a Child Protection Plan at that Conference, the first Core Group meeting to agree the Child Protection Plan will be held within ten working days. Core groups will continue to be held at a minimum of four weekly intervals prior to, and after, the baby’s birth. If the unborn baby is not made subject to a Child Protection Plan, Child in Need and early help plans will be considered, with the first meeting for either also held within ten working days.

All professionals should give high priority to attendance at Child Protection Conferences, if they are requested to attend. 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 Case Conference Reports should be shared with parents prior to the meeting.

A detailed pre-birth assessment can provide an early opportunity to develop a good working relationship with parents during the pregnancy, especially where there are concerns. It can mean that vulnerable parents can be offered support early on, allowing them the best opportunity to parent their child safely and effectively. Importantly, it helps identify babies who may be likely to suffer significant harm, and can be used to develop plans to safeguard them.

There are some potential issues that can arise. The involvement of Children's Social Care (especially if there is a decision to remove the baby at birth) can result in the parents going missing or the woman not attending hospital at the time of birth.

It may have an adverse effect on the parents' mental or physical health or heighten the risks that had raised the concerns in the first place. The fear of losing the baby may undermine the attachment and bonding process between the parent and child. There is a danger that the woman may end up harming herself or her unborn baby or seeking to terminate her pregnancy.

It is vital that there is good communication with the pregnant woman, the birth father and, if different, her current partner in order to reduce the chance of such issues arising.

When it is agree by professionals that an alert is proportionate due to a risk of flight or evasion of services, maternity safeguarding colleagues will initiate this. Maternity services will complete their Trust specific proforma and send to other maternity units in their region, as was as North West Ambulance Service. These alerts will include demographics, outline the known risks, and identify the professionals who should be informed if the person presents. Consideration should also be given to whether the ICB should be informed, and they may support in the dissemination of these alerts.

If a professional does not agree with the decision making, they should follow the Escalation Policy.

What does the research tell us?

The number of new born babies in Care Proceedings in England and Wales has increased over the past decade. With this, Nuffield Family Justice Observatory conducted research and published 'Born into Care' which highlighted that further national guidance is needed to address many unresolved ethical and practical dilemmas that arise when the Local Authority intervenes at birth. The study explored the pre-birth process including the referral, assessment and support, the maternity setting including in the maternity ward and the first court hearing, and support given to parents following the return home, without baby and often alone. The research provides a number of key findings that identify challenges to best practice, which influence change to address these challenges and introduce more sensitive and humane practice when a Local Authority has to intervene at birth. This research has been used to inform Cumbria’s practice guidance throughout this document.

A summary of the findings can be found here and the full report can be read here.

What does this mean for your practice?

Whilst the research highlights many challenges to best practice in how we support parents during the pre-birth period and beyond, this is an exciting time in practice, as there are many changes that we are making to address these challenges and introduce more sensitive and humane practice when a Local Authority has to intervene. The best practice guidelines from the research can be found here. Within your practice, this means being aware of procedures to ensure timely support and stability in support, collaboratively working with professionals and the family, focusing on the child and the parents, having an in depth understanding of trauma, timeliness and planning support, continuity of care and support offered by Social Workers and professionals supporting the family, utilising the family network to offer support, supporting families sensitively and with respect, and providing them with transparency and choice.

Good Practice around Care Planning

• Care planning should be based on each child and family's individual needs. Do not be tempted to copy and paste a known plan – think about each individual family's needs and risks;
• There should be a clear thread between the assessment, analysis, and plan for a child;
• Parents and professionals should co-define needs and goals and work collaboratively to identify and build on strengths throughout the pregnancy;
• Professionals should work proactively with parents and the family and friend network to provide support matched to identified needs and concerns that may place the baby at risk of significant harm during pregnancy and after birth;
• Processes should be initiated in a timely manner to facilitate careful and planned decision making;
• Professionals’ concerns and plans should be shared with parents at every step of the way, including any plan to initiate care proceedings at birth; the understanding of parents is continually checked;
• Professionals should support parents to access robust, comprehensive and expert legal advice;
• The birth arrangements and plan for the baby after birth should be shared at a timely point. The birth arrangements contain sufficient detail of the management of risk. Choice and control should be offered to parents wherever possible;
• We must understand the risks and consider if and how we could mitigate them. For example, giving careful consideration to who can be on the ward, what would the risk be and what would excluding people mean?
• Don’t be afraid of being creative – what plan does this child need?
• Think about family time with both parents, what about wider family members? Brothers and sisters?

Professional Curiosity

Being professionally curious is vital in any assessment. During pre-birth assessment, it is our role to have a clear and in depth understanding of the unborn child's needs pre-birth and once born, and the parents' ability to meet those needs. This requires us to be brave and sometimes ask uncomfortable questions. If you are curious about something, ask. If you are unsure how, or whether to ask, please seek the support and advice of your colleagues or manager. If you walk away from a visit or meeting and, on reflection, realise something didn’t feel right or there is information you want to follow up on, don’t be afraid to go back and do that.

• Identify and take action to explore more deeply what is happening for an individual using proactive questioning;
• Make connections and have the confidence to respectfully challenge when appropriate;
• Don’t be judgemental – find out the facts;
• Encourage multi-agency partners to be curious and share information.

It is important that parents understand professionals’ concerns and the plans of how this will be supported to ensure they have the opportunity and specialist support to address the concerns and make positive changes before decisions need to be made about their baby's future. The parents' strengths and wider family support also needs to be considered within the Child Protection process.

It is recognised that the Child Protection process can be difficult for parents, so professionals need to ensure they have prepared and supported parents through this process by:

• Meeting with parents to explain reasons for the decision to progressing to Child protection and explaining the process of this;
• Discussing with parent's support needed to attend the meeting including translator, venue, transport, support from family members and/ or an advocate;
• Ensuring that the social worker's and other professionals conference report is shared with parents before the conference and that it is in a format they can understand;
• IRO's will contact parents prior to the conference to introduce themselves and the parent consultation document is discussed. On the day of the meeting the IRO will ensure that parents are supported to understand and participate in the meeting;
• Review Child Protection Conference is to be held by 30 weeks gestation and should have agreed/clear expected plans for parents and baby. These need to be discussed with parents prior to the conference being held.

When an unborn child is made subject to a child protection plan

A plan for the baby’s birth and subsequent discharge from hospital will be agreed by all professionals and the family/care givers at the first core group meeting and reviewed in all subsequent meetings (occasionally this may be agreed at a later meeting, when the initial child protection conference has been early in the pregnancy). Parents/care givers communication and learning needs should be carefully considered when formulating the birth plan.

The plan should address the following:

• Consideration of parental choice and plans, ie should a homebirth be deemed clinically safe;
• How long the mother and baby will stay in hospital will be dependent on clinical need of mother and baby;
• The multi-disciplinary team must acknowledge that changes to the plan may need to be considered if further concerns are identified or if service needs change which may put the baby at risk of harm;
• Parents should be given the maximum opportunity to parent their baby wherever safe and, in the baby’s best interests, holding in mind the possibility of discharge home/reunification;
• The arrangements for the immediate protection of the baby if it is considered that there are serious risks posed from parental alcohol consumption, substance misuse; mental ill health and/or domestic violence. Consideration should be given to the use of hospital security, and informing the Police;
• The risk of potential removal of the baby from the hospital prior to a safe discharge plan;
• The plan for contact between mother, father, extended family and the baby whilst in hospital. Consideration to be given to the supervision of contact – for example whether contact supervisors need to be employed;
• Consideration of any risks to the baby in relation to breastfeeding e.g. HIV status of the mother; medication being taken by the mother which is contraindicated in relation to breastfeeding;
• The plan for the baby upon discharge that will be under the auspices of Care Proceedings, e.g. discharge to parent/ extended family members; mother and baby foster placement; foster care, supported accommodation;
• Consideration should be given to whether or not Northwest Ambulance Service NHS Trust should be notified to facilitate safe transfer to hospital and effective communication with partner agencies. Information sharing should include an assessment of risk including violence and aggression and Children’s Services safeguarding arrangements;
• Contingency plans should also be in place in the event of a sudden change in circumstances;
• Who to contact should the baby be born out of hours;
• The midwife (or representative for midwifery services) will ensure that the pre-birth plan is recorded in the maternity records within two working days of its completion;
• A copy will also be sent by the Social Worker to the Emergency Duty Team;
• Maternity unit staff will inform Children’s Social Care of the baby’s birth immediately (if out of hours, then the Emergency Duty Team). A children’s social care representative will subsequently notify other members of the core group within one working day;
• A children’s social care representative 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. (Responsibility for chairing the meeting, recording and distributing a record of the meeting will be determined at the meeting. It is a multi-agency responsibility.)
• Where there is already a clear discharge plan in place, which has been agreed and discussed at a recent core group, and from which there have been no changes, a baby may be discharged without a pre-discharge planning meeting. The potential to discharge without a planning meeting should be agreed at the core group meeting prior to birth and telephone contact should be made with all core group members prior to discharge. Women should receive support that is responsive to their specific needs before, during and after separation from the baby. Discharge in these circumstances should only occur when it meets safeguarding needs and is in the interests of the baby and parents;
• However, if there are any new concerns identified, these will need to be discussed with Children's Social Care / EDT to ascertain whether a discharge planning meeting is required;
• The existence of a child protection plan does not remove the parents’ choice for the birth to be at home or in another location. In these circumstances, the core group will still agree post birth arrangements including for a discharge planning meeting, which may be in hospital or at another venue;
• Where separation is likely or planned, the mother is told in advance, in writing and in person, wherever possible;
• A children’s social care representative will undertake a home visit within 48 hours of the baby’s discharge from hospital;
• The Child Protection Review Conference must be held within four weeks of the birth of the child, or sooner if legal action is being considered.

Babies separated from their parents

For a small number of babies, a decision will be taken prior to their birth that their parents will not be able to safely care for them, irrespective of the levels of support with which they are provided. In these circumstances, the baby will be placed with extended family members who have been assessed as able to provide safe care, foster carers, or prospective adoptive parents shortly after birth.

The following steps should be applied in these circumstances (which would also apply where the decision was made shortly after birth):

• Children’s social care should seek legal advice as soon as the possibility arises that the baby may not be able to remain in the parents’ care;
• Decision making, once alternatives to keep the family together have been exhausted, should be as early in the pregnancy as possible in order to provide the parents with clarity and to begin planning for the baby’s longer-term care;
• The parents should continue to be involved in multi-agency planning for the birth and fully understand what to expect following the birth;
• In exceptional circumstances, where children’s social care are not able to secure a court order, consideration may be given to the use of police powers of protection;
• The parents should be provided with the opportunity to spend time with their baby following birth and to have a HOPE box for themselves and their baby;
• The social worker should consider how the baby’s first few days should be captured. for future life story work and include this in both HOPE boxes;
• The parents should continue to be offered multi-agency support, including from the midwife, health visitor and social worker. Particular consideration should be given to supporting the parents’ mental health and emotional wellbeing;
• The parents should be supported in attending Court hearings either face to face, or virtually;
• A referral to the Reproductive Trauma service (RTS) should be considered at 4 weeks post-partum to reduce any further trauma;
• Consider referral to Breathing Space to support with future family planning;
• Parents must have clear information about their baby’s placement and family time (contact) arrangements prior to discharge. This must be discussed at the discharge planning meeting and documented on the discharge information;
• A plan of post-natal visits for mother and baby must be formulated at the discharge meeting. Visits should be continued up to 28 days post-natal for the mother, so that she is fully involved in the planning and timing of these visits and can utilise the support available;
• If a baby is to be discharged out of area, the social worker will be required to contact the midwifery safeguarding team in the area where the baby is placed. If this is a mother and baby home, midwifery will liaise with the safeguarding midwives in the area where they are placed;
• Professionals must check the immediate basic and emotional support needs of the parents prior to them leaving the hospital and consideration must be given to their practical needs, such as transport home from hospital;
• Multi-agency professionals should continue to work together to plan for the baby’s future through children looked after reviews. Existing child protection (or child in need) plans will cease;
• Parents should be helped to give their babies the best start in life through retaining or regaining care of their baby, where possible.

Public Law Outline

Best practice tells us that we need to ensure careful consideration is given to escalation from child protection to the public law outline (PLO) process before the baby’s birth to ensure parents are given sufficient time in pre-proceedings to seek and receive legal advice. It is important that we consider how we support parents throughout this process:

• The PLO process needs to be started at the earliest opportunity to support parents and give them to best opportunity for their baby to remain in their care. Case management and legal planning meetings to be considered at 20 weeks gestation and first pre proceedings meeting to be considered at 24 weeks. If the baby is under 20 weeks gestation at the point of ICPC, the family would be transferred to Family Safeguarding who would take to pre proceedings at 24 weeks. If the baby is over 20 weeks gestation at the point of ICPC, duty and assessment would take to pre proceedings and the handover would be at pre proceedings rather than at the ICPC;
• When parents receive a letter before proceedings, consideration is to be given to the language used and areas of concerns are balanced with strengths of the family;
• Parents to be given independent legal advice throughout the process and an advocate if required. Where possible, parents to be offered continuity of legal representation from formal pre-proceedings meetings to care proceedings. This may be particularly important for parents with learning difficulties, who may need longer to process complex information;
• If the local authority intends to issue care proceedings following birth, an estimated timeline is produced with parents explaining when and where key actions are likely to take place;
• If placement with alternative care givers is part of the proposed plan for the baby following hospital discharge, parents are offered an opportunity to consider the detail of the separation arrangements and their own support needs post discharge;
• Consideration needs to be given to arrangements for first court hearing and discussion held with parents around the support they require to attend.

Wider Family Networks

Family strengths and resilience needs to be recognised and it is important key people within parents’ networks who can offer support are identified at an early point. The timing of child protection and public law outline processes needs to allow adequate space for parents to prepare emotionally and practically for a possible separation following the birth and to consider alternative carers for their baby within their family and friend networks.

Assessment of any potential carers begins at the earliest possible point to give the best chance for the baby to remain safely within their own family network. The dual role members of the family and friend network may play in offering support to parents to give them the best opportunity to keep their baby in their care, while also being assessed as alternative carers to the baby, needs to be carefully considered.

Support needs to be offered to help parents and the family and friend network navigate this difficult terrain and ensure relationships are preserved.

Professionals and family and friend networks need to work together to ensure consistent and clear messages are given to parents regarding the local authority’s decisions concerning the plan for the baby after the birth.

Family Group Conference

Parents are to be offered a Family Group Conference at the earliest opportunity, when a plan has been agreed. The referral is to be made by the team who will be supporting the family long term.

A review family group conference is also to be considered in the second and third trimesters of pregnancy to consider progress and any remaining concerns that could impact the health and well-being of the unborn baby. If the plan for the baby following discharge from hospital is likely to include placement with alternative care givers, then at the family group conference, the family and friend network is asked to consider possible alternative caregivers for the baby.

If a parent declines the offer of a family group conference initially, discussions continue, and the offer is revisited at a future point.

A discharge planning meeting should be held to plan the discharge of the baby to parents care/ to move to a foster family/ to live with family members.

Life Story Work

Life story work is a way to help care experienced children to make sense of their past and understand the journey of their identity. Life story work is not a one-off piece of work with a child and is built on throughout a child's life, the information we gather and record for children at the early stages of pre and post birth are extremely important.

Make recording about decision making clear – one of the biggest questions children often have, is about why decisions were made about their lives.

Below are some things to think about during the early involvement with a family where a child may go into foster care in relation to life story work:

• Gather information about both parents and their history. If you are twin tracking and completing a CPR, familiarise yourself with the form as this will help prompt questions about family history that will be crucial for completing the CPR at a later stage and, more importantly, for the child to know;
• Think about and collect memory box items e.g. Hospital bands (mums and dads may want a hospital band, see if the hospital can provide more than one so parents can have one as well as baby);
• Take photos – of the hospital, of baby – with parents if possible - this can be useful, but should be done with sensitivity;
• Write a letter/begin to write a later life letter. The adult child is likely to have questions about the day, what happened and why. Note them down to add to your letter. Think about things like what they were wearing, who was there/who had visited. It's ok to write that parents were sad;
• Consider items from the hope box (see section below) and any other items to be kept for memory boxes. Have a discussion with the foster carer around creating a memory box and keeping the items for baby, and what they can do to support with life story work – don’t just assume they will do it.

Hope Boxes

When separation is confirmed, all agencies should be aware that HOPE boxes may be being used. The Hope Boxes are an intervention designed to minimise the trauma experienced by the mother and baby by supporting them in different ways and at different points through their journey from the postnatal ward through care proceedings and beyond.

If Hope Boxes are being used, midwives should share this from the first point of use.

All agencies should encourage and empower families to use them in a way that works for them, promoting life story work and maintaining a form of connection.

Legislation, Statutory and Government Non-Statutory, Guidance

• The Myth of Invisible Men: Safeguarding Children Under 1 Year Old From Non-accidental Injury

Good Practice Guidance

• Born into Care: Best Practice Guidelines;
• Working Together to Safeguarding Children;
• NSPCC Learning Infants: Learning from Case Reviews;
• Promoting Safer Sleeping for Babies in England (University of Oxford, Department of Social Policy and Intervention - recommends that open conversations between parents and professionals could be used to support safer sleep for babies who have a social worker;
• Co-sleeping and SIDS - a Guide for Health Professionals (UNICEF);
• Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance - NICE guidelines [CG192];
• Birth Companions - Birth Charter for women with involvement from children’s social care.