Contents

1. Introduction
2. When Should Pre Birth Assessments be Considered?
3. Starting the Pre Birth Core Assessment
4. Assessments Completed in Conjunction with the Pre-birth Assessment
5. Service User's Perspective
6. The Pre-Birth Assessment Report
7. Overall Risk Assessment
8. Risk Estimation Matrix

1. Introduction

There are some situations where sufficient concerns exist prior to the birth of a baby that requires multi-agency assessment, intervention and planning. The assessment and the subsequent weighing up of vulnerability factors is an important process and needs to be considered in a context that includes:

• Factors specific to the child
• Factors specific to the adults
• Adverse stress and environmental factors
• Strengths, supports and protective factors

2. When Should Pre Birth Assessments be Considered?

Pre-birth assessments must be considered in the following cases:

• Where previous child(ren) have been removed because of Significant Harm
• When a person is deemed to be a risk to children lives in the household or joins the family
• Where there are concerns about the mother's ability to protect
• Where there are acute professional concerns regarding parenting capacity, particularly in relation to parental mental health, learning disability, or domestic violence.
• Where alcohol or substance misuse could affect the health and wellbeing of the baby or the adult(s) caring for the child.
• Where the parent is young, was/is Looked After and the parent's lifestyle leads to concerns about their ability to meet the needs of a baby.

NB. This is not an exhaustive list and if in any doubt discuss with your Team Manager

3. Starting the Pre Birth Core Assessment

It is useful at the start of a pre-birth assessment to conduct the following:

• Read all documents relating to the family including the documents for any siblings subject to proceedings or Child Protection Plan Safeguarding & Specialist Provision Case Files (ESCR and paper files), other Local authority case files and reports produced by other professionals. This should include any past legal files and court judgements.
• If there is a court judgement this must form a factual starting point of any assessment
• Compile a Chronology of significant events with coherent histories and accurate recording, following up any missing information if possible
• Take an objective look at the Chronology to see if there are any overall patterns emerging
• Obtain details of all family members/significant adults living in the household including details of any name changes, previous addresses, cautions, convictions, final warnings and other significant relationships.
• Establish the date of confinement and the antenatal history relating to the unborn child. The expectant mother's ante-natal care, medical and obstetric history. This can be completed by the Midwife/Health Professional as part of the pre-birth assessment but reference to this must be included in the assessment report. The central question is whether there is anything in the medical and obstetric history that seems likely to have a significant negative impact on the child and if so, what?
• Establish details of any previous pregnancies and subsequent births.
• Determine professional responsibilities for collating relevant information and supporting the parent(s).
• Prepare and agree a written contract with the person(s) participating in the assessment specifying the dates, times and venues for any assessment sessions as well as the consequences for lack of co-operation. The contract should also specify what subjects are to be discussed. This should be reviewed and amended as the assessment progresses and made clear to the parents.
• The pre-birth assessment is usually conducted by engaging the parent(s) in a number of individual and if more than one person being assessed in joint sessions. Give consideration to joint and individual assessment sessions, especially if there is potential conflict of interest.
• Staff must take notes of the topics discussed and the information provided. Notes of each session should be dated and typed and must be kept as they may be required to be submitted to court as evidence. It is helpful to give a copy of these notes of each session to the participant so that they can add, amend or comment on the content.
• It is always advisable to also keep the hand written notes as they may also need to be submitted to court.
• Ask the parents to countersign the finalised notes indicating their agreement to the content.

4. Assessments Completed in Conjunction with the Pre-birth Assessment

In conjunction with the social worker's pre-birth assessment it may be appropriate to commission other type of assessment to be undertaken which will provide a holistic overall assessment of the parent's capacity to parent a newborn child. Such assessments should be undertaken by the relevant agency/professional if a parent(s) have:

• Suspected drug/alcohol misuse
• Learning difficulties
• Psychiatric history
• Chronic or acute medical conditions which may impact on their physical ability to care for a child

In addition, it may be appropriate to commission a practical parenting assessment from the Family Support and Assessment Service.

5. Service User's Perspective

Pre-birth assessments like any other assessments completed need to take into account the service users' perspective:

• Parents and children (where appropriate) need to be fully informed of the purpose of the assessment, the process and how findings of the assessment will be used.
• There is a constant need to check out the views of parents and children (where appropriate) with regard to the assessment.
• Do they share the concerns of the professionals or if not, why not?
• Do they share some concerns and not others?
• What are their views about the risk to the child?
• What forms of intervention, help or monitoring do they think would assist in reducing any risks?
• It is important that a completion date for the assessment is set and that the assessment outcomes and the reasons for reaching them are shared openly with parents (and children where appropriate).
• You should advise parents of their right to independent legal advice in these situations and representations under section 26 of the Children Act 1989.
• Parents are under no obligation to work with professionals. Therefore there is a need for all professionals to use skill and expertise in engaging parents along with an understanding of parents' rights.
• Encourage them to discuss issues arising out of the assessment and make them aware of services/support they could access (e.g. Health Authority Parenting Classes)

6. The Pre-Birth Assessment Report

The pre-birth assessment report should consider the following components (using the template provided which will assist you in completing the report).

1. Date assessment started
2. Dates of individual sessions completed and with whom
3. Date assessment completed
4. Sources of information
5. Agencies involved and consulted as part of the assessment
6. Reason(s) For Pre-Birth Assessment
7. Documents read as part of the assessment (e.g. legal documents from previous proceedings, documents from Safeguarding & Specialist Provision files, minutes of specific meetings)
8. Background History (attach a chronology of significant events and a Genogram as well as providing a summary)
9. Identified Causes for Concern
10. Engagement of the family in the assessment process
11. A Full Social History of Each Parent/Significant Person:  (including education, employment, health, previous relationships/children & criminal activity/convictions, ante natal, medical and obstetric history including any potential complications)
12. The Parental Relationship: (The assessment of the current  relationship  and the effects of a new baby on the relationship, who will be the main carer, previous relationship problems, impact of any previous relationships, children, Safeguarding & Specialist Provision involvement, impact of removal of any child if relevant)
13. Family Functioning And Strengths: (Including parental roles and responsibilities, styles of parenting, capacity for development, hopes and fears for the future, social and family support systems (include an ecomap) and relationship with professionals)
14. Additional Information Obtained from the Assessment Sessions
15. Previous Concerns Re: Abuse/Neglect and any relevant convictions:  (Is the account given by the person being assessed consistent with the written records, do they accept responsibility. What was the age and level of maturity of the person then and what evidence is there now of psychological development. Is there an understanding of the impact of the past abuse/neglect and how would this help them recognise the future needs of other children?)
16. How well do the Parent(s) understand the Expected Baby's Needs?
17. Assessment of Motivation and Capacity to Change (identify the positive changes, negative changes, no change in the family's circumstances as well as their capacity to change). You will need to demonstrate how the parents have/can change and in what timescale.
18. Analysis of the Pre-Birth Assessment.
19. Conclusion/Recommendation

You should state what your conclusions is and what recommendations you are making and why.

Points to note:

1. Assessment work needs to be carefully planned
2. Adequate time needs to be allocated to complete the work with targets set for completion
3. Assessments should be clearly and accurately recorded
4. Assessment reports require a recognisable structure and should demonstrate the decision making process.
5. The views of other children, family members and other professionals should be clearly identified in the report.
6. Assessment reports must always be shared with the relevant parties
7. Plans which follow the assessment need to have:
   • Clear objectives and timescales
   • Details about the proposed intervention and the services to be provided  and by whom

7. Overall Risk Assessment

Any risk assessment should include consideration of the following factors:

1. Concerns identified
2. Strengths and mitigating factors identified
3. Any risk of Significant Harm for this baby including the nature of the any risk, by whom and in what circumstances
4. Will any risks arise
   • before the baby is born,
   • at or immediately following the child's birth,
   • whilst under 1 year of age
   • as a toddler
   • as an older child
5. What changes are required to optimise the well being of child
6. What changes must be made to ensure safety and an acceptable level of care for the child 
7. How motivated are the parent(s) to change
8. How capable are the parent(s) to change

8. Risk Estimation Matrix

The matrix has been taken from an adaptation by Martin Calder in 'Unborn Children: a Framework for Assessment and Intervention' of R Corner's 'Pre-birth Risk Assessment: Developing a Model of Practice'.

This matrix is to be used as a tool and is not intended to provide a comprehensive analysis of risk.

Factor	Elevated Risk	Lowered Risk
The Abusing Parent	Negative childhood experiences, inc. abuse in childhood; denial of past abuse. Violence abuse of others Abuse and/or neglect of previous child Parental separation from previous children No clear explanation No full understanding of abuse situation No acceptance of responsibility for the abuse Antenatal/post natal neglect Age: very young/immature Mental Disorders or illness Learning Difficulties Non compliance Lack of interest or concern for the child	Positive childhood Recognition and change in previous violent pattern Acknowledges seriousness and responsibility without deflection of blame onto others Full understanding and clear explanation of the circumstances in which the abuse occurred Maturity Willingness and demonstrated capacity and ability for change Presence of another safe non-abusing parent Compliance with professionals Abuse of previous child accepted and addressed in treatment(past/present) Expresses concern and interest about the effect of the abuse on the child
Non-abusing parent	No acceptance of responsibility for the abuse by their partner Blaming others or the child	Accepts the risk posed by their partner and expresses a willingness to protect Accepts the seriousness of the risk and the consequences of failing to protect Willingness to resolve problems and concerns
Family issues (marital partnership and the wider family	Relationship disharmony/instability Poor impulse control Mental health problems Violent or deviant network involving kin, friends and associates (including drugs, paedophile or criminal networks) Lack of support for primary carer/unsupportive of each other Not working together No commitment to equality in parenting Isolated environment Ostracised by the community No relative or friends available Family violence (e.g. Spouse) Frequent relationship breakdown/multiple relationships Drug or alcohol abuse	Supportive spouse/partner Supportive of each other Stable or violent Protective and supportive extended family Optimistic outlook by family and friends Equality in relationship Commitment to equality in parenting
Expected child	Special or expected needs Perceived as different Stressful gender issues	Easy baby Acceptance or difference
Parent-baby relationship	Unrealistic expectations Concerning perception of baby's needs Inability to prioritise baby's needs above own Foetal abuse or neglect including alcohol or drug abuse No ante-natal care Concealed pregnancy Unwanted pregnancy identified disability (non- acceptance) Unattached to foetus Gender issues which cause stress Differences between parents towards unborn child Rigid views of parenting	Realistic expectations Perception of unborn child normal Appropriate preparation Understanding or awareness of baby's needs Unborn baby's needs prioritised Co-operation with ante-natal care Sought early medical care Appropriate and regular ante- natal care Accepted/planned pregnancy Attachment to unborn foetus Treatment of addiction Acceptance of difference- gender/disability Parents agree about parenting
Social	Poverty Inadequate housing No support network Delinquent area
Future Plans	Unrealistic plans No plans Exhibit inappropriate parenting plans Uncertainty of resistance to change No recognition of changes needed in lifestyle No recognition of a problem or a need to change Refuse to co-operate Disinterested and resistant Only one parent co-operating	Realistic plans Exhibit appropriate parenting expectations and plans Appropriate expectation of change Willingness and ability to work in partnership Willingness to resolve problems and concerns Parents co-operating equally

 

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