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2.2.4 Pre-Birth Planning

SCOPE OF THIS CHAPTER

This procedure is aimed at achieving timely and consistent intervention in respect of unborn children in respect of unborn children for whom there is reason for concern. It should be read in conjunction with the following:

AMENDMENT

In May 2018 this chapter was substantially revised and updated and should be re-read in full.


Contents

  1. Introduction
  2. Aim
  3. Referrals
  4. Pre-Birth Panel
  5. Timeline Guide for the Pre-Birth Process
  6. Birth Plan
  7. Child in Need


1. Introduction

Identifying children most at risk to be able to manage their protection effectively involves preventative action at the pre-birth stage. An early warning system is fundamental in ensuring the identification of these vulnerable children, consisting of an agreed multi agency commitment that ensures professionals work together in assessing and managing the risks.

Therefore a referral received about a pregnancy where there are significant concerns for the circumstances of the unborn child's parent(s) and/or extended family must be dealt with in a timely and planned way. This document sets out the practice to be followed in Cambridgeshire to ensure appropriate actions are taken at the right time in the life of the unborn child and to avoid delay in the allocation of resources or the involvement of the court, where this is considered necessary.


2. Aim

The overall aim is to bring forward Social Care involvement to the earlier point of 12 weeks into the pregnancy and then set a clear timeline for case management decisions and social work tasks to ensure effective case management.

This document incorporates guidance from Working Together to Safeguard Children, 2015 and reflects the learning from Cambridgeshire Serious Case Reviews. Partnership working with midwifery colleagues is fundamental to the process of promoting the safety of the unborn child. The process seeks to:

  • Clarify decision-making regarding thresholds of intervention;
  • Clarify the timeline of provision of resources/meetings;
  • Set a clear meeting structure;
  • Avoid delay and improve the protection of the unborn child;
  • Enable expectant parents and their families to be clear from the outset about the process that will be followed and the responsibilities of those involved;
  • Ensure that professional colleagues are clear about their roles and responsibilities and that a holistic approach is adopted from the outset.


3. Referrals

Referrals concerning early pregnancies are made by a wide range of partner agencies, for example, Health professionals, Mental Health services, Learning Disability Partnership, Substance Misuse Teams, Housing, District Early Help Teams, and Education.

Any professional who becomes aware that a woman is pregnant and has cause to be concerned that the baby, once born, might be at risk of significant harm and/or the parents would require significant levels of support to care for the child, should make a referral to the Children Services as soon as possible irrespective of the time of pregnancy via the MASH (see Contacts and Referrals Procedure).

Referrals to Social Care will normally be made using the multi-agency safeguarding referral form. If an Early Help Assessment has been completed this should be attached.

Detail is essential within the referral which should include the history of the parents, detailed reasons for concern, information about the prospective father, any history/issues around violence, drug and alcohol and relate this to the risk of harm to the unborn baby.

Professionals must inform the prospective parents of the referral and gain consent where possible. An exception to this would be if informing the parents might place the unborn baby or the mother at risk.

Unborn babies will be recorded on ICS under the name of ‘Unborn’ with mother’s family name as the surname and will be linked in the social network with mother and any other existing family members.

A case must be referred if any of the following factors are present:

  • There is significant domestic violence or escalation during pregnancy and/or honour based violence;
  • A parent has significant mental health difficulties/diagnosis. S/he may be subject to an enhanced CPA (Care Programme Approach);
  • A parent has moderate or severe learning disabilities;
  • A parent misuses substance/s that will have a significant impact on the health and development of the baby;
  • A parent has had a child previously removed from their care or has a child voluntarily accommodated;
  • A parent is a current looked after child;
  • A parent of 18 years and under where there are concerns about sexual exploitation, trafficking or abuse;
  • Parent is previously suspected of fabricated or induced illness;
  • A parent is suspected of being involved in a forced marriage;
  • A parent is suspected of being a victim of, or involved in, spirit possession or witchcraft;
  • A parent of whatever age is suspected, or known to have been, the victim of grooming and/or sexual exploitation and the putative father is unknown or known to be the person who groomed them;
  • The parent is a victim of, or involved in, honour based violence;
  • Incest is suspected;
  • If the parent is known to move authorities in an attempt to avoid professionals;
  • A parent/relative or associate is some-one who may represent a risk to children, or has previously harmed a child. (This would include issues such as a violent history; significant criminal history; sexual offences against adults or children etc.);
  • The baby once born will be living with, or having contact with, someone who may represent a risk to children (see above);
  • A sibling is subject to a Child Protection Plan;
  • There are significant concerns about the home conditions, such that the baby may suffer physical neglect;
  • One or both parents’ behaviour or circumstances during pregnancy indicates that they will be unlikely to protect or care for their baby appropriately e.g. living a chaotic lifestyle with no home base; significant emotional instability; lack of preparation for/awareness of the impact of becoming a parent;
  • Late booking for maternity care with an inadequate explanation.

This list is not exhaustive and if a professional is in doubt about making a referral, they should always seek advice, particularly in cases where parents are vulnerable.

If a pregnancy is discontinued, whether through termination or miscarriage, referral to Children’s Services should still be considered if there are any remaining safeguarding concerns relating to another child.


4. Pre-Birth Panel

The Pre-Birth Panel is a partnership approach to ensuring the safety of, and effective joint planning for, unborn babies where there is significant concern for their welfare.

The panel will include representatives from the County Council, Midwifery, Health Visiting, Coram (adoption), etc and give specific consideration to those unborn babies that have been referred to, and are open to, Social Care. It will proactively track professional involvement and intervention with the families of the unborn babies.

The unborn babies will be discussed as close as possible to 13, 21, 26, 30, 36 and 42 weeks to ensure that case progression is regularly reviewed and if the panel identifies drift or delay in professional interventions or non-compliance with practice expectations, the representatives from the agency concerned will be responsible for ensuring issues are addressed. Where the panel is not able to resolve issues, it will offer direction for the social work and health professionals to do so outside of panel. Where the panel identifies specific actions on cases, there is an expectation that this will be followed up by the relevant professional and reviewed at following panel.

The social worker must complete the Tracking Tool and submit this to the Panel nearest to 13 weeks gestation. This same document is then revised and submitted at the intervals outlined above. Individual cases are discussed at each panel, and local arrangements should be made for a manager to present groups of cases rather than the responsible worker attending on each occasion.


5. Timeline Guide for the Pre-Birth Process

Every unborn child must be newly assessed and all unborn baby referrals will be allocated and assessed to ensure objectivity. Pre-Birth Assessments must be considered as a separate piece of work from assessments that may have been written for siblings of the expected baby.

1-12 weeks – Referral to MASH:

  • A referral can be made at any point once the pregnancy is confirmed (referrals can be made before the 12 week scan);
  • If the referral concerns a baby being relinquished for adoption, this will be passed immediately to the social work unit (see Relinquished for Adoption Procedure);
  • Where a parent has had previous children removed in the last 24 months this will be passed immediately to the social work unit;
  • A Single Assessment will be commenced immediately covering aspects of any parenting assessment and written with the possibility of subsequently going to court. The social worker must seek parental consent to share the Single Assessment with midwifery colleagues as this will assist discussions around risks and analysis; 
  • To support parents’ preparation and learning, the social worker should consider Early Help family work involvement, perhaps including use of the Virtual Doll;
  • The Single Assessment should explore the potential for the development of a nurturing relationship with the unborn and look for anticipation and positive representation of the unborn baby by the parents. It will be important to explore parental understanding of secure attachment and the importance of developing this;
  • The social worker prepares the Tracking Tool and submits this to the Pre-Birth Panel at or around 13 weeks.

19/20 weeks (35 days from referral):

  • The Single Assessment must be completed by this point and once concerns have been identified and discussed with parents, a Child in Need meeting held to ensure there is a clear plan in place;
  • The Single Assessment will determine whether an Initial Child Protection Conference (ICPC) is required;
  • Where an ICPC is not required, but the family are to remain open, then Children in Need procedures will be followed and a Family Plan formulated;
  • Where the ICPC threshold is met, then a s47/Strategy Discussion will be undertaken and a clear rationale for the Conference recorded. PQA will be notified at this point so that professionals can be notified of the date of Conference at the earliest opportunity;
  • If there are no ongoing concerns then the family would close with appropriate links to other services signposted as appropriate;
  • The social worker updates the Tracking Tool for submission to the Pre-Birth Panel at or around 21 weeks.

23/24 Weeks ICPC held (where CP concerns are present):

  • If the unborn baby is to be the subject of a Child Protection Plan, the family must be made aware that care proceedings are likely if there is no significant change in the level of concern by the time the baby is born. This must be made clear, both at the ICPC and within the CP Plan. The first Review CPC will be held within three months; the next Review CPC will be held within the following three months. Subsequent conferences will normally be six monthly, though the Chair always has discretion to arrange an earlier date, particularly where there is concern about progress.;
  • The social worker must ensure a contingency plan is in place, in case the baby is born early. This must be known to parents, midwife and other professionals, as appropriate, including the Emergency Duty Team in case action is required out of hours;
  • A Safety Plan must be completed alongside the CIN/CP Plan.to ensure any eventuality is considered;
  • The social worker updates the Tracking Tool for submission to the Pre-Birth Panel at or around 26 weeks.

29/30 Weeks:

  • Where there is any suggestion that the baby will not be living with parents, potential kinship options should be identified, prioritised and viability assessments undertaken. Potential carers should be referred to the Kinship Team without delay;
  • Social worker will arrange the first Core Group meeting to review progress with the plan and preparation for the baby’s arrival;
  • With the agreement of their manager, the social worker will book a Legal Planning Meeting. This will determine whether the Public Law Outline is required (see Care and Supervision Proceedings and the Public Law Outline Procedure);
  • Where the parents have had children removed in the last two years, and they consent, the social worker will make a referral to CAFCASS Plus;
  • The social worker updates the Tracking Tool for submission to the Pre-Birth Panel at or around 30 weeks.

30/31 Weeks:

35/36 Weeks:

  • The Review Child Protection Case Conference will be held and should consider a referral to the Threshold and Resources Panel for threshold/proceedings if warranted by the level of progress with the Child Protection Plan;
  • The social worker should ensure that the contingency plan/discharge plan/safety plans are kept updated in preparation for the birth. A specific Birth Plan must be compiled (see Section 6, Birth Plan). Midwifery Services recommends that a date for the discharge planning meeting is arranged prior to the baby being born as this prevents delay in the baby being discharged and increases the likelihood of professionals being able to attend;
  • The social worker updates the Tracking Tool for submission to the Pre-Birth Panel at or around 36 weeks.

Possible Outcomes:

  • Possible outcomes when the baby is born include:
    • Baby relinquished for adoption;
    • Baby remains with Parents;
    • Baby remains with parents with close support of their extended family;
    • Section 20 agreed – child becomes Looked After;
    • Care Proceedings, with or without concurrent planning.

The social worker updates the Tracking Tool for final submission to the Pre-Birth Panel at or around 42 weeks

Concurrent planning:

The appropriateness of concurrent planning should be considered at 3 points - The conclusion of the Single Assessment, at the Initial Child Protection Case Conference and at Threshold and Resources Panel. The 30/31 weeks stage is an ideal time for a final decision on this matter.

Relinquished for adoption

Early involvement is essential as the aim of the work with the parent(s) who remain committed to relinquishing responsibility for the expected child is to place the child with an adoptive family as quickly as possible. This can be achieved within 6 months, or sooner, of the child's birth, if all necessary steps are taken early enough. What is known is that the earlier a child is placed with their permanent carers, the better the chances are that they will form secure attachments. See Relinquished for Adoption Procedure.


6. Birth Plan

If the unborn baby is the subject of a Child Protection Plan and/or PLO a Birth Plan should be written and implemented.

The purpose of the plan is to ensure the baby’s protection and welfare at and immediately after birth so that all members of the hospital team are aware of the plans and actions expected.

The plan should address:

  • How long the baby will stay in hospital;
  • How long the hospital will keep the mother on the ward;
  • The arrangements for the immediate protection of the baby if it is considered that there are serious risks, for example, parental substance misuse;
  • Any risk of abduction of the baby from the hospital, particularly where the plan is to remove the baby at birth;
  • The plan for contact between mother, father, extended family and the baby whilst in hospital and whether supervision/Contact Supervisors required.
  • Discussion with health colleagues of any risks to the baby in relation to breastfeeding e.g. HIV status of the mother; mother’s current medication;
  • To plan for the baby upon discharge, where alternative care is planned, e.g. discharge to extended family members; mother and baby foster placement; foster care, supported accommodation;
  • Contingency plans should also be in place in the event of a sudden change in circumstances and the Emergency Duty Team should also be notified of the Birth Plan.


7. Child in Need

  • The social worker should arrange the Initial Child In Need Meeting 20 to 30 days after a Single Assessment has been commenced if the family is likely to remain open. A review should be held at least every 10 weeks; The Consultant Social Worker should record the rationale to hold or to not hold a Child in Need meeting. The social worker should ensure that midwifery are invited to CIN meetings;
  • Referral for additional support / services to be completed as appropriate;
  • Hospital Discharge Plan to be written at first Child In Need Meeting and updated as appropriate;
  • Review Child In Need Meeting to be held within 2 weeks of the birth of the baby.

End