Q1 Is pre-birth assessment addressed in the procedures? Q2 If yes how much space is allocated to it?
Q3 Is paragraph 5.14 of Working Together (HM Government, 2006) reflected in the procedures?
Q4 How far does the guidance reflect paragraph 5.140 of Working Together (HM Government,2006)?
Paragraph 5.14 of Working Together states:
Procedures and timescales set out in this chapter should also be followed when there are concerns about the welfare of an unborn child. (HM Government 2008, 5.14)
Paragraph 5.140 states:
Where a core assessment under s47 of the Children Act 1989 gives rise to concerns that an unborn child may be at future risk of harm, LA children’s social care may decide to convene an initial child protection conference prior to the child’s birth. Such a conference should have the same status, and proceed in the same way as other initial child protection conferences, including decisions about a child protection plan. Child protection review conferences should also proceed in the same way. The involvement of midwifery services is vital in such cases. (HM Government 2008, 5.140)
Of the 73 sets of procedural guidance 66 (90%) contained, at the very least, a reference that indicated the procedures applied to unborn children. The depth of reference varied from a direct quote of paragraph 5.14 and 5.140, a paraphrase of paragraphs 5.14 and 5140 or a direct web link to Working Together (HM Government 2006).
I was unable to find any reference to unborn children, pre-birth assessment or pre-birth safeguarding conferences or a web link to Working Together (HM Government 2006) in seven sets of procedural guidance (10%).
With regard to the data tool question 2, the amount of space allocated, I had originally expected that I would be able to quantify a) the number of pages in each set of procedures and b) the number of pages allocated to pre-birth assessment. However, it was not possible to make like-for-like comparisons across the sets of procedures because there was little consistency in the formatting and presentation of the procedures and many differences in the content and extent of additional information that was provided. In the end, therefore, I decided to distinguish between:
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• Those sets of procedures that did not go beyond the guidance contained in Working Together (HM Government, 2006);
• Those that did offer additional guidance.
Out of the 66 sets of procedures that addressed pre-birth assessments at all, 42 sets of procedures (64% of the 66 sets) contained information that was additional to that contained in Working Together paragraphs 5.14 and 5.140 (HM Government 2006).
The following extract is an example of information I regarded as modest additional guidance:
Pre-birth core assessments may be carried out following a referral from a professional who is concerned that prospective parents may need support to care for their baby, without which they may not be able to provide for the baby’s well- being and welfare, or where there are concerns the baby may be at risk of significant harm.
The referral will usually result in an initial assessment being completed followed by a planning meeting to agree which agencies need to contribute to the core assessment and identify what specific areas of knowledge about the family they may have. It should also clarify what support can be made available, by which agency, after the birth.
Pre-birth assessments should identify any potential risk to the baby which may suggest a need for immediate action to protect the child after birth. In circumstances where a pre-birth conference has taken place and a child protection plan put in place a ‘review conference’ must be held prior to the baby’s discharge, even if that discharge is to a ‘place of safety’.
(Wigan Safeguarding Children procedures accessed online April 08)
On the other hand, five LSCBs provided guidance that spanned between six to 19 A4 pages. The type of information covered in these procedures included guidance on early identification and assessment, levels of risk and pre-birth strategy or planning meetings. With regard to early identification the type of information covered included:
Women who are pregnant may present initially via a number of different professionals, for example GP, hospital antenatal services, community midwife services, health visitor or housing officer. Additionally, other health professionals 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 other routes of referral in order to facilitate care and intervention.
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All professionals working with families need to be alert to the factors that may indicate a potential risk to the child either before or after birth. It is vital that assessments are started early and that information is shared so that the child and family have the necessary support and best start to family life thereby minimising the need for child protection intervention. (South West Safeguarding Children Procedures accessed online April 08)
The procedures which attempted to categorise levels of risk categorised ‘low level’ as identified early in pregnancy (8-12 weeks) but did not specify what ‘low level’ may be. The procedures stated that discussion should be held between the midwifery services and children services to establish if additional support would be appropriate. In relation to ‘medium’ and ‘high’ levels of concern the following statements were made:
Medium/high level concern exist 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 services. (Bracknell Forrest Safeguarding Children Procedures accessed online April 08)
This [medium /high] level of concern relates to when there are concerns that an unborn baby may be ‘in need’ (section 17) or ‘in need of protection’ (section 47) which means that their basic physical and/or psychological need will not be met and is likely to impair the child’s health or development. (South West Safeguarding Children Procedures accessed online April 08)
Although there was some recognition of varying levels of concern or categories of risk there were no explanations or examples of what may constitute ‘reasonable’ standards of health and development. In the second example there was also an assumption that anyone reading the procedures knew the differences between the sections of the Children Act 1989 to which reference was made.
Information regarding pre-birth strategy or planning meetings included comments such as:
This discussion should be in the form of a meeting chaired by a Children’s social care line manager and involve:
• Community midwife
• Maternity services manager • G.P
• Health Visitor • Police
• Social Worker
• Other professionals as appropriate, eg. obstetricians, mental health services, probation
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The purpose of the meeting is the same as that of other strategy discussion and should determine:
• Particular requirements of the pre-birth core assessment • Whether a S.47 enquiry is to be initiated
• Role and responsibilities of agencies in the assessment
• Role and responsibility of agencies to provide support before and after the birth
(Sussex Safeguarding Children Procedures accessed online April 08)
In the above example the circumstances when a strategy discussion/meeting should be held would be any situation that may constitute ‘significant harm’ and required a referral being made to the LA children’s services department. It seems interesting that a meeting which brought together the group of professionals identified in the above quote would be held prior to a core assessment being undertaken as the resource implication would be quite significant and may not be proportionate to the ‘significant concern’. For example, a significant concern for a child could involve parents who were willing to co-operate with a support package but who had physical, mental or learning difficulties which necessitated additional support being provided. Notably, the above list of people to be invited to the meeting did not include the parent(s), family members or voluntary agencies.
The above procedures were not alone in holding a planning meeting prior to the assessment process:
An initial multi-disciplinary planning meeting is to be held to plan the pre-birth assessment. A pre-birth assessment must be based on a robust assessment model, such as that given in Section Two.
The meeting, to be convened by Children's Social Care, is to be held during the 19th or 20th week of pregnancy.
Agencies/professionals who should be invited include:
• Children's Social Care Team Manager and Social Worker • Identified Midwife
• The likely Health Visitor • The family GP
• A representative of any local family centre or equivalent, where appropriate. • Any other professional involved with the family.
Relevant information held by the Police and by the Named Nurse/Senior Nurse for Child Protection should be obtained.
Parents should throughout be involved in planning as far as possible.
A date should be set for a further multi-disciplinary planning meeting (which is to take the form of a child protection strategy meeting if the assessment outcome indicates the baby is likely to be at risk of significant harm).
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Whilst the above quote does make it clear that parental involvement should occur there appeared to be no procedural guidance to direct professionals to invite them to the meeting. Interestingly, 12 sets of procedures were based on the same web based system called ‘Tri-X’. Although the 12 LSCBs were from around England and represented different demographic factors and local needs, in relation to unborn children, the procedures were exactly the same. In each of these 12 sets of procedures additional reference to unborn children was only made in relation to safeguarding conferences, comprising one and a half A4 pages of information focussed only on the timing and administrative process of such conferences. There was therefore, emphasis on child protection as opposed to working with children in need.