Cambridgeshire and Peterborough Pre-Birth Protocol

1. Introduction

It is critical that all Children’s services have robust procedures in place, both to identify the children most at risk and then to effectively manage their protection.

The very nature of the work dictates that the most successful preventative action is taken if these children are identified pre-birth. This early warning system can only operate in a meaningful way if there is an agreed interagency commitment to the importance of this area of Child Protection and that professionals work together to assess and manage the response to this high-risk group. The aim of this protocol is to ensure that all children born in Peterborough and Cambridgeshire are safe.

As prescribed in Working Together (2023) the key agencies in terms of identification and intervention are:

• Children’s Services
• Maternity Services
• Primary Care Services
• Adult Mental Health
• Community Drug and Alcohol Services
• Probation
• Police
• Learning Disability Services.

The Guidance should support all professionals in identifying risk factors and assist in constructing meaningful plans in partnership with parents that will protect the unborn child from harm.

Where required, advocates and or language communication interpreters should be made available to the parents throughout the process.

Almost half of Child Safeguarding Practice Reviews in all Local Authorities relate to babies under 1 year of age. A Child Safeguarding Practice Review is a multi-agency review that happens when a child dies or is seriously harmed because of abuse or neglect. Babies are entirely reliant on their parents or carers to meet all their needs, and this makes them extremely vulnerable.

Early referral (once the pregnancy has been confirmed) and intervention gives prospective parents time to either demonstrate that change has happened and that they can parent the expected child or gives them time to create any change that is needed. Pre-Birth Assessments are critically important and need to be undertaken in a thorough and timely way.

The purpose of this multi-agency protocol is to set out the processes by which agencies can agree on a clear, cogent, and proportionate plan to ensure that the child is safe and will continue to be safe when born. By week 35 of gestation (5 weeks before the Expected Due Date), the plan should have been agreed upon and shared with parents, unless doing so will increase risk to an unacceptable level.

The early identification of risk factors by Midwives at the Maternity booking appointment will form the basis of the referral to Children’s Social Care. Multi-agency working is at the heart of the Pre-Birth Assessment and the identification and management of risk.

2. The Pre-Birth Assessment

This is the same across Cambridgeshire and Peterborough.

When completing a Pre-Birth Assessment, the 2 questions to be answered are:

1. Will this new-born baby be safe in the care of these parents/carers?
2. Is there a realistic prospect of these parents/carers being able to provide good enough care throughout childhood?

Where there is reason for doubt about the above questions, a Pre-Birth Assessment is required.

A Pre-Birth assessment must be completed at the earliest possible point in the confirmed pregnancy and must be finalised no later than 45 days after commencement. Where risks are clear and substantial and a legal intervention appears possible, then it should be completed and agreed upon in a much shorter timescale. Where there are significant concerns, parents will be given the support and encouragement to make necessary changes to their circumstances, or to be able to demonstrate that they have already achieved change and that they can safely look after their baby.

Fathers of unborn babies and partners of the parents (if the birth parents are no longer in a relationship and have a new partner) are a crucial part of the Pre-Birth Assessment. A rounded and complete understanding of the circumstances of the child is vital in the understanding of risk.

Fathers should be assessed along with the mother, even if the father is not part of the household and may not have day-to-day care of the child. If the parent with whom the baby will live has a partner who is not related to the baby, that person must also be assessed. Gathering all the relevant information from both expectant parents and where relevant, their partners, requires professional curiosity and thoughtfulness. The information must be considered and analysed to establish its relevance to the current circumstances and the known risk issues.

Information shared by relatives, neighbours and anonymously, can be particularly significant in determining the likely circumstances faced by an unborn/young baby and should be carefully considered by the assessing Social Worker alongside information from colleague professionals.

Sometimes it is possible to understand the likely circumstances (of the baby) very early on in the Pre-Birth Assessment process, for example, where previous children have been removed and there is no indication of parents having made any change in their circumstances. In these situations, the assessment should be completed as soon as possible (and no later than 25 days after commencement, or sooner if the baby will be born in that timeframe), and the relevant additional safeguarding processes should be commenced to safeguard the unborn child.

The assessment should consider the prospective parent/s previous parenting, their history of being parented themselves, any history of domestic abuse, drug or alcohol misuse, mental health issues and any other relevant issues that may have a bearing on their parenting capacity and the care that will be given to the baby.

It is also important to consider the capacity of the parent/s to achieve positive change in the issues that give rise to the risk and concern. Referrals can therefore be made to the evidence-based Parenting Programmes that are provided by Targeted Support Services to support parents in their path to positive change.

A good assessment does not rely only on what the prospective parents report about their circumstances. It is very important to corroborate what they say by talking to extended family and all involved professionals, checking out information, and using professional curiosity.

3. What are the known Risk Factors which may mean that expectant parents may not be able to care for their baby?

1. There has been a previous unexpected or unexplained death of a child whilst in the care of either parent, their partner or other household member.
2. A sibling or child has previously been removed from either parent’s care during this, or any of their previous relationships by a Local Authority for safeguarding reasons, either temporarily or by court order.
3. There are concerns about the parent’s or carer’s ability to care for themselves and/or to care for the child, for example, no family support, very young parent, or prospective parent with a learning difficulty.
4. A parent, adult, relative or regular visitor to the household has been identified as posing a risk to children.
5. There are known or suspected domestic abuse issues likely to impact the baby’s safety or development.
6. The degree of parental substance misuse is likely to affect parenting capacity and baby’s safety or development.
7. The degree of parental mental illness, learning difficulty or learning disability inclusive of neurodiversity is likely to affect parenting capacity and the baby’s safety or development.
8. A sibling or child in the household is the subject of a Child in Need or Child Protection Plan.
9. A parent or carer has been previously suspected of fabricating or inducing illness in a child or harming a child.
10. A child aged 16 years or under is pregnant.
11. There are maternal risk factors, for example, denial of pregnancy, avoidance of antenatal care (failed appointments), non-cooperation with necessary services, non-compliance with treatment with potentially detrimental effects for the unborn baby.
12. Concealed pregnancy or late booking at or after 24 weeks gestation without a plausible explanation.
13. A parent has said that they want to relinquish their baby and then changes their mind.
14. Concerns that the mother and/or father of the unborn are at risk from ‘Honour Based’ Abuse.
15. Concerns that the mother has been or that the baby may be subjected to Female Genital Mutilation.
16. Parents are at risk of experiencing forced marriage.
17. Parents have been identified as being at risk of or experiencing Child Sexual Exploitation or criminal exploitation.
18. There is a family history of known or suspected incest.
19. Parents have moved to new local authority areas in an apparent effort to avoid professionals.
20. There are significant concerns regarding a parent’s home conditions which are likely to impact on the baby’s safety or development.
21. Either parent is homeless or sleeping rough.
22. Any other concern that indicates the baby may be at risk of significant harm.

This list is neither exhaustive nor prescriptive, families are complex. Professionals should always question and be curious about the family’s circumstances. The professional taking the information must exercise their professional judgement and discretion in determining the presence, extent of, or absence of concerns, and this may include undertaking risk assessment in accordance with their agency protocols at the time, to arrive at a considered view, which they will then act upon.

If a parent is 16 years or under, even where there are no apparent concerns, a referral should be made for an assessment around support needs, accommodation, and the relationship that resulted in the pregnancy. There should, however, always be a conversation with the parents around consent and that the reason the referral is being made. Consideration must also be given to whether the young parent/s need to be referred for an assessment themselves, as a Child in Need.

If the parent is aged between 17-18, then age alone should not be the basis of the referral but would need to be accompanied by some other safeguarding concerns, and this would be for Midwifery colleagues to risk-assess before making a referral. Consideration must also be given to whether the young parent/s need to be referred for an assessment themselves, as a Child/ Children in Need.

Where a prospective parent or carer has a child living with another parent or family member, professionals should be curious about how and why this came about. The arrangement may be formal or informal and may or may not have involved the local authority but is worthy of careful consideration by the Midwife when gathering information and considering whether a referral should be made, and by the Social Worker within the Pre-Birth Assessment.

Most referrals relating to unborn babies will be made by the Midwifery service, however, any professional involved with a family where a woman is pregnant, and the professional has concerns can make a referral to Children’s Social Care, and they should discuss this with the family before doing it.

4. Especially Concerning Situations

Some family circumstances are especially concerning due to the family history and the fact that the history is unalterable. Some are concerning due to the need to co-ordinate the response with Adult Social Care and tailor the involvement to be sure that parents understand what is happening and why.

Both require a very swift and effective response. These are:

1. Parents or carers have previously cared for a child where there has been an unexplained child death.
2. Unborn babies where the mother, father or parent’s partner, or any other adult in the household where the unborn baby would live has had a child who has been subject to care proceedings and for whom the significant harm threshold has been crossed with a child in the past. This includes where children have been subject to supervision orders and where child arrangement orders have been made to other family members.
3. Parents whose contact with other children is prohibited or supervised through a court order.
4. Where the mother, father or the mother’s partner, or any other adult or child in the household where the baby will live is a person who poses a risk to a child. They may have been convicted of an offence or suspected of having committed an offence, or they may be prone to violent and unpredictable behaviour.
5. Where children living in the unborn baby’s household are currently subject to a child protection plan.
6. Concealed or denied pregnancies. A concealed pregnancy is one where the parent has not come to the attention of Midwifery Services until 24 weeks of gestation or later.
7. Unborn babies where either mother, father, or other prospective carer has a learning difficulty or learning disability inclusive of neurodiversity, which is likely to have a significant impact on parenting capacity and/or the care that the baby could receive from the parent/s.
8. Substance misusers including those not engaging with treatment of specialist services.
9. Parents with untreated mental health difficulties with limited parenting capacity, particularly where there is inadequate family support.
10. Parents with a history of abuse and / or neglect within childhood presenting concerning behaviour/attitude towards pregnancy and support services (including those who have been or are ‘looked after’ by the Local Authority.
11. Where there are significant risks because of child sexual or criminal exploitation.
12. Unstable / chaotic households, unprepared or unsuitable for baby.
13. Young vulnerable parents who require high levels of support.
14. Vulnerable parents expecting multiple births i.e. twins / triplets.
15. Any pregnancy that has been highlighted due to domestic abuse.

Where there is a concerning family history, the circumstances of which cannot change, Pre-Birth Assessments should be completed in 25 working days (or earlier if the baby will be born in that timeframe) followed by swift decision making about next steps. Parents cannot change their past, but they can make changes to their present and future and should be given every opportunity and support to do so.

For prospective parents with a learning difficulty or learning disability inclusive of neurodiversity, there is a need to respond swiftly because the process of assessment may take longer owing to the need to co-ordinate with Adult Services, to allow for any reasonable adjustments to the assessment process to be made and for parents to take full advantage of learning opportunities which are designed to support them in their care of their baby.

Where there have been previous care proceedings, the Social Worker must request the court bundle before starting the Pre-Birth Assessment and ensure that they are familiar with the contents of it, paying particular attention to any assessments of parents undertaken in those proceedings, and to the final Judgement and Order.

5. Process

The Hospital Booking Visit Stage

At the booking appointment, the Midwife will take information from the parents and assess whether there are any risks arising to the unborn child. The Midwife will talk to the parents about these issues and will seek consent for the referral. However, if the identified risk is considered high, the midwife will inform parent/s that the referral will be made in the absence of consent and an assessment may be undertaken.

Each case should be assessed by Children’s Social Care on the available information, and if there is any doubt, a Pre-Birth Assessment should be initiated to establish the circumstances of the baby during pregnancy, and after birth. In Peterborough and Cambridgeshire these are completed using the Child and Family Assessment template on LiquidLogic. The case will be moved to another team for assessment.

The Pre-Birth Assessment Stage

All prospective parents whose unborn child is the subject of a Pre-Birth Assessment should be told about parenting groups and courses that they can attend that will help them to develop their parenting capacity, and they should be supported and encouraged to attend.

The overall aim of Child in Need, Child Protection or PLO processes is that by week 35 of gestation, there will be a clear plan about what should happen when the baby is born to ensure that the baby can be safely cared for, and that this will have been clearly communicated to parents.

Where it is thought that the significant harm threshold has been crossed, the process to convene an Initial Child Protection Case Conference must be initiated. There is no benefit to the unborn child or to the parents to delay in these circumstances. This may mean that the unborn child is subject to a Child-Protection Plan for many months before birth, with the strengths and support of multi-agency engagement, planning and independent formal review processes in place to monitor progress and consider whether any additional safeguarding measures are needed.

A completed Pre-Birth Assessment is required for an Initial Child Protection Case Conference, though not at the Strategy Discussion stage.

Where it becomes clear in the early stages of the Pre-Birth Assessment that there are some significant risks in a case then a Legal Planning Meeting may be initiated before the Pre-Birth Assessment has been concluded. An example of this may be where previous children have been removed, or there has been an unexplained death of a child.

Ideally, the completed Pre-Birth Assessment will be available by the time of the Legal Planning Meeting for consideration in the meeting. It is important to proceed on the basis of minimising delay, and it may be permissible for a Legal Planning Meeting to be held without the Pre-Birth Assessment being concluded in some circumstances, there should be a discussion with Legal colleagues about this. The Pre-Birth Assessment can then be completed during the PLO stage where threshold is met, if that is what the Legal Planning Meeting decides.

Where a Legal Planning Meeting has been agreed upon, the request for this should be made promptly to legal services. The Social Worker must make a referral to the Regional Adoption Agency Family Finding Team if the PLO process is to be initiated, to enable early family-finding considerations.

Within the PLO process, a parent has access to free legal advice and representation, and this can continue for longer than the usual 12-week period that the PLO is engaged, which means that the PLO can continue for longer than 12 weeks if necessary.

The PLO process takes place when the Local Authority is concerned about a child’s wellbeing and unless positive steps are taken to address and alleviate those concerns, the Local Authority may consider making an application to the court when the baby is born. The PLO process is therefore the last opportunity for parents to make improvements to their circumstances and parenting before care proceedings are issued. The Social Worker and parents should be mindful that the initiation of the PLO process does not mean that Care Proceedings at birth are inevitable.

The aim should be that the Pre-Proceedings process will conclude no later than week 35 of gestation, by which time a clear plan of intervention or services will have been developed and will be understood by all parties. This means that other than for concealed or denied pregnancy, the Legal Planning Meeting should have been held by week 21 of gestation, which is usually about 9 weeks after the referral. (14 weeks is allowed for this process due to the need to send letters out to parents and to allow time for parents to secure legal advice and representation.)

If an unborn child is in a Pre-Proceedings process (PLO), they should also have a Child Protection Plan, and both processes will work together to achieve positive change for the baby or to make appropriate plans if positive change is not happening.

If the Legal Planning Meeting outcome is that Pre-Proceedings are to be commenced, it is important to establish possible alternative carers for the baby. A referral must be made for a Family Group Conference at this stage (also known as Family Network Meeting), to identify any people who may be willing and able to provide permanent care for the baby. This step is vital if any subsequent court proceedings find that the parent/s cannot care for the child and an alternative permanent arrangement is needed.

When possible alternative carers have been identified, the Social Worker will conduct a Viability Assessment of them. The purpose of a Viability Assessment is to determine whether a full Fostering or Special Guardianship Assessment has any prospect of being successful.

The Child in Need, Child Protection, and Public Law Outline processes are governed by other policies and procedures in Peterborough CC and Cambridgeshire CC, and these should be referred to by the Social Worker and their Team Manager to ensure that they are being adhered to.

6. Concealed or Denied Pregnancy

A concealed pregnancy is one where the expectant parent does not have a booking visit with Midwifery Services by 24 weeks of gestation.

In the case of a concealed or denied pregnancy, the ambition of developing a clear plan by week 35 of gestation is already compromised due to the late presentation. This means that the Pre-Birth Assessment must be commenced immediately and completed within 25 working days, or sooner if the baby will be born in that timeframe. It is important to stress that even in these circumstances, corroboration of available information from agencies, relatives, partners, neighbours and any anonymous sources must still be included to ensure there is a well-rounded assessment.

There are some explanations for apparent concealment that do not necessarily indicate risk; for example, the prospective parent/s have recently arrived in the UK and do not speak English and were unaware of the need to present to Midwifery services. Professionals should be curious and thoughtful about the reasons given for delay.

Where there are concerns that the reasons given for concealment are not compelling or believed, or the parent/s circumstances or history is concerning, this will become apparent in the very early stages of the Pre-Birth Assessment and immediate consideration must be given to convening a Strategy Discussion and where agreed, Initial Child Protection Case Conference, and Legal Planning Meeting. A clear plan of service or intervention must be developed before the baby is born.

7. Prospective Parents with Care Experience

Prospective parents who are care experienced and under the age of 25 must be given every possible support by services to prepare for and care successfully for their child. If they are between the ages of 21 and 25 and are eligible for service under the Leaving Care Act 2000, they are entitled to the support of a Personal Advisor if they wish to have it. If they are under 21, they will already have an allocated Personal Advisor. Not all care experienced young people are eligible for service under the Leaving Care Act, and contact should be made with the Leaving Care Service to clarify eligibility. The Local Authority where the young person was in care is the Local Authority that is responsible for providing the Leaving Care Service, this may be different to the Local Authority where the young person now lives.

For PCC only

All expectant Care Experienced young people should be offered a Pre-Birth Assessment as some may feel that this is a supportive measure. Where there are no apparent risks, and the parent/s do not wish to be referred for an assessment, this wish should be respected.

If a Care Experienced person who is expecting a baby (whether the mother or the father) has some concerning circumstances such as those outlined above, then they should be referred for assessment by Midwifery colleagues, and they should be informed that they have been or will be referred and that there may be an assessment. Care Experienced prospective parents will have the same consideration of risks and possible referral as any other prospective parent.

In common with any other Pre-Birth Assessment, the assessment must consider the other parent and any partner as they will have a parenting role alongside the Care Experienced person.

Where the Care Experienced prospective parent is 19 or under, they should be encouraged to take advantage of the additional support given by the Family Nurse Partnership.

The outcome of a Pre-Birth assessment may be that concerns/support needs are not significant enough to warrant further intervention and therefore support should continue at a targeted and universal level for the family.

All Care Experienced prospective parents should be informed about support services such as parenting programmes and courses to support them in gaining knowledge and skills to inform their parenting. These evidence-based programmes are available via Targeted Support.

For CCC only

The following leaflet is for young care experienced parents and should be printed off and given to them, or emailed to them.