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
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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.
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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.
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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:
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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.
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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
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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.
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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
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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
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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