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This is an official Northern Trust policy and should not be edited in any way

Pre Birth Risk Assessments Best Practice Guidance

Reference Number:

NHSCT/12/503

Target audience: This guidance is particularly relevant to those professionals who are involved with families about whom there are concerns in the antenatal period such as Midwives, Health Visitors, General Practitioners, Paediatric and Obstetric Medical Staff and Children’s Social Workers. The guidance is appropriate for professionals such as those from Adult Mental Health, or Learning Disability Services or Community Addiction Services who may be/have been involved with families because of particular needs which the parent/proposed carer may have.

Sources of advice in relation to this document: John Fenton, Assistant Director, Children’s Services Liz Barry, Principal Practitioner for Child Protection, Children’s Services

Replaces (if appropriate): NHSCT Best Practice Guidance in Pre-Birth Risk Assessments (Ref: NHSCT/10/312)

Type of Document: Trust Wide

Approved by: Policy, Standards and Guidelines Committee

Date Approved: 22 March 2012

Date Issued by Policy Unit: 24 April 2012

NHSCT Mission Statement To provide for all the quality of services we would expect for our families

and ourselves

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Best Practice Guidance in Pre Birth Risk Assessments

in the Northern Health and Social Care Trust

March 2012

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Contents Page

1. Introduction 3 2. Purpose of the guidance 3 3. Target Audience 3 4. Equality, Human Rights and Disability Discrimination Act 3 5. Alternative Formats 4 6 Sources of Advice in relation to this guidance 4 7 The Pre Birth Referral and Assessment Pathway 4 8. The Pre Birth Assessment and Planning Process 9 9. Completion of the Pre Birth Risk Assessment 13 Appendices Appendix 1 Pre Birth Risk Assessment (Based on Calder 2008) 15 Appendix 2 Midwife/Health Visitor Assessment 18 Appendix 3 Roles and Responsibilities of the Midwife and the Health Visitor in relation to pre birth care 20 Appendix 4 Template letter of invitation to professionals 21

Appendix 5 Template letter of invitation to parents/carers 23 Appendix 6 Pre Birth Planning Meeting Agenda 25 Figure 1 Pre Birth Assessment Pathway 8

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Best Practice Guidance in Pre Birth Risk Assessments in the Northern Health and Social Care Trust

1.0 Introduction

1.1 A Pre Birth Risk Assessment is a formal process of multi disciplinary

collation, and analysis of information regarding the circumstances of an unborn child, which will identify the potential risks to the child following the birth. Professionals should seek to ensure the involvement of the parents or those who are proposing to care for the baby in the assessment process.

1.2 Research shows that 47% of child deaths in England resulting from

child abuse in the period 2003-2005 occurred in children under 12 months (Ref. Analysing child deaths and serious injury through abuse and neglect: What can we learn? A biennial analysis of serious case reviews 2003-2005 DCSF).

1.3 Consequently the NHSCT Child Protection Panel commissioned the

development of this practice guidance, following particular recommendations from a number of Case Management Review Reports including ‘Holly and Peter’ and Child ‘C’ in the NHSCT.

2.0 Purpose of the Guidance 2.1 The guidance will provide clarity to staff in relation to the pre birth risk

assessment pathway, the assessment process and their individual and collective roles and responsibilities within the process

3.0 Target Audience 3.1 This guidance is particularly relevant to those professionals who are

involved with families about whom there are concerns in the antenatal period such as Midwives, Health Visitors, General Practitioners, Paediatric and Obstetric Medical Staff and Children’s Social Workers.

3.2 The guidance is appropriate for professionals such as those from Adult

Mental Health, or Learning Disability Services or Community Addiction Services who may be/have been involved with families because of particular needs which the parent/proposed carer may have.

4.0 Equality, Human Rights and Disability Discrimination Act 4.1 This guidance has been drawn up and reviewed in light of Section 75 of

The Northern Ireland Act (1998) which requires the Trust to have due regard to the need to promote equality of opportunity. It has been screened to identify any adverse impact on the 9 equality categories and no significant differential impact was identified. Therefore an Equality Impact Assessment is not required.

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5.0 Alternative Formats 5.1 This document can be made available on request on disc, larger font,

Braille, audio-cassette and in other minority languages to meet the needs of those who are not fluent in English.

6.0 Sources of advice in relation to this document 6.1 The Author of the guidance, responsible Assistant Director or Director

as detailed on the title page of the document should be contacted with regard to any queries on its’ content.

7.0 The Pre Birth Referral and Assessment Pathway 7.1 When to undertake a pre birth risk assessment 7.1.1 The pre birth risk assessment process aims to identify and protect

vulnerable children, and to plan effectively to safeguard children and support families.

7.1.2 There continues to be debate about when a Pre Birth Risk Assessment

should commence. However there is a view that a period of reflective work with the parent(s) can be most helpful, in circumstances where the parents/proposed carers engage in lifestyle choices which are likely to be detrimental to the development of the unborn child as well as posing risks to the baby when it is born.

The ante natal period provides an opportunity to advise and offer

appropriate support services. Early intervention also allows for early referral to services which may have waiting lists, including Family Centres.

. 7.1.3 A Pre Birth Risk Assessment should be commenced as soon as a

cause for concern has been identified, for the following reasons:

� To enable the early provision of support services, and where possible, the involvement of family and friends in order to provide the safest

home environment for the baby.

� To provide sufficient time to make adequate plans for the baby’s protection.

� To ensure adequate time for a full and informed assessment. � To reduce distress to the parent/s by ensuring that plans are in place

as early as possible into the pregnancy ,

� To enable parents to have more time to contribute their own ideas and solutions and therefore increase the likelihood of being able to successfully parent their child.

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7.1.4 The ACPC Regional Policy and Procedures does not provide specific

guidance on when to commence a Pre Birth Risk Assessment but does state that a Pre Birth Initial Child Protection Case Conference should not be held before 24 weeks gestation of the unborn child.

There is no guidance about the latest time for convening the Case

Conference but it would seem reasonable that the last two or three weeks of the pregnancy should be considered too late unless the particular circumstances require such action, e.g. if the Trust becomes aware of a concerning situation at an advanced stage of the pregnancy.

7.1.5 Within the Northern Health and Social Care Trust professional practice

is to encourage the involvement of parents/proposed carers at all stages in the multi disciplinary assessment. This will include sharing of all reports and inviting them to attend and to participate in core groups within the care planning process.

7.2 Circumstances in which to undertake a Pre Birth Risk Assessment

7.2.1 The following are the households or circumstances in which a Pre Birth Risk Assessment should be undertaken:

• Where a child in the family has previously suffered significant harm

• Where a previous child in the family has died due to unascertained causes1

• Where a child in the home is on the Child Protection Register

• Where a child is likely to suffer significant harm as a result of parenting capacity in relation to

� where the parent(s) has either a severe mental health condition or

learning disability � Where there are concerns about domestic violence in either the

present, or in the previous relationship(s) of either parent � Where one or both parents have convictions or has been the

subject of police investigation for offences of either a violent or of a sexual nature

1 * In cases of previous SUDI (“cot death”) it is important to consult with both the Consultant Paediatrician who was involved with the deceased baby, and the Named Doctor for Safeguarding Children in the Trust. The written documentation available to the Coroner’s Inquest and the decision as to the cause of death should be sought by either the social work case coordinator or the Named Doctor for Safeguarding Children.

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� Where concerns exist regarding the ability of either parent, to adequately protect the baby from identified risk provoking behaviours of the other parent/proposed carer e.g. substance misuse.

� Where alcohol or substance abuse is thought to be affecting the

health of the expected baby

7.2.2 The decision to undertake a pre birth risk assessment may be because of one significant incident, or a series of less significant incidents.

7.2.3 In situations where a number of the above factors are known to co-

exist, the pre birth assessment must consider the potential impact of the cumulative risk factors on the unborn child as well as on the baby when it is born.

7.2.4 Where the expectant mother/proposed carers are under 18 years old,

the assessment should consider their own needs in addition to their ability to meet the baby’s needs.

7.3 The Pre-Birth Referral Pathway 7.3.1 When a safeguarding concern is identified in the ante natal period by

any professional involved with the client/family a UNOCINI referral should be made to the appropriate social work team as follows:

7.3.2 Midwifery Staff All referrals for expectant mothers who are booked for delivery in

Antrim Area Hospital should be submitted to the Hospital Children’s Social Work Team.

Referrals for all other hospitals, either in or outside the Trust area,

should be sent to the appropriate Gateway Team. 7.3.3 All other professionals

All referrals for expectant mothers should be submitted to the Gateway

Team with responsibility for the area in which the client resides.

If the referrer is aware that social services are already involved with the client /family in any capacity, for example, Family Support and Intervention Team or the Team for Children with Disabilities, telephone contact should be made with the case coordinator in that team to discuss the case and decide whether a written referral is required .

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7.3.4 Members of the public A member of the public may also make a referral identifying concerns

about the safety of an unborn child. In these circumstances the initial referral should be forwarded to the appropriate Gateway Team,

7.4 The Referral and Assessment Pathway 7.4.1 When Social Services receive a referral the key steps in the process to

be followed are illustrated at Figure 1. 7.4.2 While the time lines in Figure 1 may vary in practice the Pre Birth Child

Protection Case Conference should occur around week 24 of the pregnancy.

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1st Trimester

1st Trimester (1-13 weeks)

2nd Trimester (14-26 weeks)

Week 24

3rd Trimester (27 weeks-birth)

Cause of Concern Identified

Referral & Initial UNOCINI Assessment

Pre Birth Planning Meeting

Pre - Birth Risk Assessment

No Pre Birth Risk Assessment

Pre Birth Child Protection Case

Conference

Pre Birth Review Planning Meeting

Child Protection Plan

Family Support Plan

Figure 1: - Pre- Birth Referral & Assessment Pathway in Northern Health & Social Trust

Gestational Age

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8.0 The pre birth assessment and planning process 8.1.1 When a social worker in any social work team receives a UNOCINI

referral identifying a concern in relation to the future care which an antenatal mother may give to either her unborn child and/or to her new born child, it is a social work responsibility to undertake a UNOCINI Initial Assessment. Following this initial assessment and the identification of risk factors as previously outlined in 2.2.1, the social worker will liaise with the senior social worker in order to convene a multi disciplinary/multi agency Pre Birth Planning Meeting.

8.1.2 If the UNOCINI Initial Assessment is undertaken within a Gateway Team the senior social worker will comply with current Trust policy and

liaise with the senior social worker in the ‘receiving team’ to ensure that team is alert to the need to convene a multi disciplinary/multi agency pre birth planning meeting. The senior social worker of the receiving team will ensure the Pre Birth Planning Meeting is convened.

8.1.3 The Pre Birth Planning Meeting should be convened at the earliest

opportunity. 8.2 The Pre Birth Planning Meeting 8.2.1 The meeting will:

• identify clearly the causes for concern in terms of the ante natal mother, and any potential risks for the unborn child and the new born child

1. decide whether or not a full pre birth risk assessment is

required, having considered the information known alongside the UNOCINI thresholds

2. decide whether the matter should be referred immediately to the

Pre Birth Child Protection Case Conference. The earliest date for this is 24 weeks gestation of the unborn child.

3. identify the specific areas requiring assessment, which

professional is responsible for each aspect and determine the timeframe for the assessment

4. establish the date of the next multi disciplinary meeting.

8.2.2 Where the meeting decides not to proceed to a full pre birth risk

assessment consideration should be given to developing a Family Support Plan.

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8.3 The Pre Birth Review Planning Meeting 8.3.1 A Pre Birth Review Meeting should be convened not later than 6 weeks

after the initial Pre Birth Case Planning Meeting. 8.3.2 The purpose of a Pre Birth Review Planning Meeting is to;

• review the assessment information available and

• decide whether the case should be referred for a Pre Birth Child Protection Case Conference under the ACPC Child Protection Policy and Procedures.

8.3.3 In circumstances where the meeting decides not to proceed to a Pre

Birth Child Protection Case Conference the reasons for this should be recorded on the file and consideration should be given to the development of a Family Support Plan.

8.4 Roles and responsibilities of the members of the multi disciplinary staff group in relation to the pre-birth planning meetings 8.4.1 The Children’s Social Work Team in Antrim Area Hospital When the hospital social work team receives a referral they will make

contact with the antenatal mother. The social worker will explain her role and seek the mother’s consent to contact other professionals involved with the family with a view to completing a UNOCINI Initial Assessment

Where a mother refuses to give consent for the social worker to contact

other professionals, the social worker should explain clearly that where there are child protection concerns social services have a duty to make the necessary inquiries to gather information from other agencies. The social worker should provide the mother with the details of which professional(s) she needs to contact, the purpose of the contact with the professional, and the areas to be discussed

If social services are already involved with the client/family in any

capacity, for example, a Family Support and Intervention Team, or a Learning Disability Team the onus is on the social worker in that team to liaise with the hospital social work team to agree roles and responsibilities in relation to the future management of the case.

If there is no current social work involvement the hospital social worker

will commence an initial assessment.

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Following the UNOCINI Initial Assessment the hospital team will either:

• Make a referral to the appropriate Family Support and Intervention Team for further assessment. The hospital based senior social worker will liaise with the senior social worker in the ‘receiving team’ to ensure that team is alert to the need to convene a multi disciplinary/multi agency pre birth planning meeting. It is the responsibility of the senior social worker of the receiving team to ensure the Pre Birth Planning Meeting is convened.

or

• Provide continued input from the hospital social work team in a supportive capacity for the duration of the pregnancy and for a time limited period following the birth.

8.4.2 The Senior Social Worker/Senior Practitioner The Senior Social Worker or the Senior Practitioner will usually chair

the Pre Birth Planning Meeting. In the event of the case being complex, there may be an agreement that a Social Work Service Manager will chair the Pre Birth Case Planning Meeting.

The Senior Practitioner / Social Worker will;

• identify the professionals who are involved with the expectant mother (and her partner), and liaise with them 2 Forward letter of invitation to professionals (Appendix 4)

• invite the expectant mother/parents, or those who are anticipating being considered as carers for the baby to the meeting (Appendix 5)

• act as the case coordinator unless there is a specific recorded decision to the contrary

• provide, collate and analyse relevant information. This should be shared with the client prior to the meeting. If there is a written report this should be discussed with, and given to the client at least 3 days before the Pre Birth Planning Meeting

• contribute to decision making

• act as the case co-ordinator of any family support plan developed at the meeting.

• hand deliver a copy of the written record of the meeting, including the decisions to the client and be able to discuss fully with them the professional concerns, the decisions made and the detail of the assessment to be commenced

• ensure that a written record of the meeting is placed on the client’s case file with a copy sent to each professional invited to attend the meeting

2 In those cases where a previous child of the antenatal mother or her partner, has died due

to unascertained causes the social worker should invite the Paediatrician involved. In all cases the Named Doctor for Safeguarding Children and the Consultant Paediatrician covering the Neonatal Unit should be invited to attend the Pre Birth Planning Meeting as well as any subsequent Child Protection Case Conference which may be convened.

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8.4.3 The Named Midwife/Health Visitor The Named Midwife and Health Visitor will:

• attend the Pre-Birth Planning meeting.

• collate and analyse relevant information, if possible, provide a written report detailing their involvement to the meeting and share this with the client prior to the meeting. If there is a written report this should be discussed with, and given to the client at least 3 days before the Pre Birth Case Planning Meeting

• contribute to decision making

• following a decision to undertake a pre-birth risk assessment, the Midwife and Health Visitor will agree which domains of the assessment (Appendix 2) each will undertake

The role of the midwife and health visitor in pre birth care is described in

Appendix 3. 8.4.4 Other professionals

Where other professionals are involved with the ante natal mother or other family members, for example, community addiction team members or adult mental health staff , these should be contacted by the social worker to advise them of the pre birth planning process as described above. Each professional group has similar responsibilities to those described above and should endeavour to,

• attend the Pre-Birth Case Planning meeting.

• collate, analyse relevant information and, if possible, provide a written report. Each professional should seek to make the client aware of the information prior to the meeting

• contribute to decision making regarding the need for specific pre- birth risk assessment

• following the decision to undertake a pre-birth risk assessment, the professional will undertake the assessment domains relevant to their expertise.

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8.5 The responsibility of each professional involved in the Review Pre Birth Planning Meeting

The role of each professional is to;

• provide a written assessment report to the meeting. If the professional is unable to attend then their line manager/professional advisor/colleague should attend to present the report

• participate in the discussion and decision making of the group

• fully involve the client in the assessment process and

• share with the client the report at least 3 days prior to the meeting 9.0 Completion of the Pre Birth Risk Assessment (Appendix 1) 9.1 The detail of the pre birth risk assessment described at Appendix 1 has

been developed from the work of Martin Calder and should be used to inform the appropriate domains of the UNOCINI Pathway Assessment process. Each professional identified at the Pre Birth Planning Meeting as needing to contribute to the assessment will individually collate, record and analyse information about the aspect of the family for which they have professional expertise

9.2 The UNOCINI Initial Assessment will inform the Initial Family Support

Plan, which in this context is usually developed within Family Support and Intervention Teams or by the Children’s Social Work Team in Antrim Area Hospital, the LAC Teams and the 16+ Teams. The Pre Birth Planning Meeting may decide that a case should proceed directly to Pre Birth Child Protection Case Conference, and in these circumstances, the UNOCINI Child Protection Pathway Assessment should be completed.

9 3 In circumstances where the decision of the Pre Birth Planning Meeting is

to undertake a pre birth risk assessment the domains to be assessed are recorded in the UNOCINI Family Support Pathway Assessment. The UNOCINI Review Family Support Plan is the record of the Pre Birth Review Planning Meeting.

9.4 The domains are not mutually exclusive and it will require a high level of

effective multi disciplinary communication, facilitated by the Case Co-ordinator, to ensure that the maximum amount of information is available to facilitate the pre birth planning process. This will ensure the best outcomes for the child and his parents/ carers.

9.5 Where possible, professionals may forward their completed assessments

electronically to the Social Worker/Senior Practitioner. The composite document should be returned to each contributing professional person at least 5 days prior to the meeting.

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9.6 Practitioners should ensure that their assessment is evidence based, using where possible, specialist assessment tools to inform the analysis within the UNOCINI assessment, e.g. the Parenting Assessment Manual, and The Barnardos Domestic Violence Risk Assessment Model.

9.7 It is good practice for each discipline to have shared their assessment in

full with the client prior to the meeting 9.8 The Summary and Recommendation at the end of the Pathway

Assessment will be completed by the Social Worker/Senior Practitioner to take account of all of the material provided by the professional contributors.In complex cases where a number of professionals are involved a professional meeting prior to the meeting with parents will;

• Ensure each professional has knowledge of all of the professional assessment available

and

• Discuss and agree the record of the sections ‘Summary, Conclusions and Recommendations’ to ensure each professional contributor feels their views have been appropriately recorded.

9.9 The Case Co-ordinator will share the completed, agreed document with

each participant prior to the social worker sharing it with the baby’s mother/proposed carers.

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Appendix 1

The Pre Birth Risk Assessment

Purpose of the assessment: (Include definition of the problem the purpose and scope of the assessment with a

statement of concerns).

Area Child or young person’s needs (Include the needs of the unborn child in addition to the individual needs of each of the other children in the household)

The health of the unborn baby (Growth, identified conditions, relevant family health history/health risk factors, health interventions required, parent’s ability to recognise health care needs)

Area Parents or carers capacity to meet the child’s needs Include the following specific domains in pre birth assessments Mother’s health

General physical health: elements include existing health conditions, relevant history, pre-conceptual care, nutrition, oral health, haemoglobin, infectious illnesses, rubella immunity, blood group, ability to recognise own health care needs.

Father’s health

General physical health: elements include existing health conditions, relevant family health history, ability to recognise own health care needs)

Learning needs Refers to either of the parents, siblings, family history, schools attended by each

parent, assessed learning difficulty/disability, literacy/numeracy and communication skills, current educational needs if relevant.

Emotional wellbeing (the mother: antenatal and postnatal mental health NICE Clinical Guideline 45;

the partner: past/present history, mental health diagnosis/low mood, anxiety, aggression, treatment, services, review)

Obstetric and medical information: (Include information about physical and mental health provided by Midwives, General Practitioners, Hospital Consultants and Health Visitors).

Previous obstetric history (Previous, pregnancies/outcomes. complications)

Feelings about the pregnancy

( planned / unplanned, wanted/unwanted, expectations, fears, anxieties, acceptance, ambivalence, detachment, contentment. nurturing contact with abdomen, views on infant feeding/breast feeding, circumstances of conception e.g. violence/sexual assault)

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Booking history

(date of booking, concealed pregnancy/reason for concealment, EDC, hospital/home care)

Attendance at ante natal care (type of care, accessibility, value, history, use of other health providers e.g. A&E.

attendances, extent of fathers involvement.)

Care of previous children (include children of both parents/carers, child minding, involvement in caring for younger siblings, childcare course, school curriculum child care content. Where previous children have been removed consider their present care arrangements, the current lifestyle of the adults, and what has happened in the intervening period since the previous removal of children).

Previous abuse and/or criminal convictions:

(Research written and verbal accounts of past events, if possible speak to any children who have experienced previous abuse, gain the parents explanation for and view of the abuse testing the congruence of both; the level of acceptance of responsibility for the abuse, the parents concern/understanding for the abused child; outcomes and recommendations of previous assessments).

Assessment of the non-abusing parent’s ability to protect.

(Include the following): a. The extent and source of the information they hold. b. Their position regarding the abuse or conviction – immediate and now? Their

feelings towards the children. Their position regarding responsibility for the abuse (who do they blame?)

c. The perceived options – have they sufficient resources to provide their own solutions.

d. The relationship history including level of dependency on male partners, history of violent and abusive relationships.

e. Other vulnerabilities e.g. physical, learning or sensory disabilities or mental health conditions which have the potential to isolate them.

f. The parent’s level of recognition of future risk situations and ability to manage them safely for the child.

The level of parental/proposed carers understanding needs of the unborn baby, the needs of the baby when it is born and their ability to meet those needs:

(Include the parents developing sense of attachment to the expected baby, how each of the adults build relationships and whose responsibility they feel it is, their understanding of the child’s anticipated basic needs, whether they will be able to meet them in a time scale commensurate with baby’s needs, consider attachment issues / previous trauma of the adult(s),childcare knowledge, risk-taking/lifestyle impacts on ability to prioritise the needs of the baby, preparation for parenthood: environment, equipment, parent craft, birth plan, realistic expectations, challenges, demands, ability to meet basic care needs)

Alcohol or drug using parents and anticipated health problems: (Include an examination of the consequences for the adult themselves and as a

parent(s) of an unborn child, the delivered baby, the impact on future parenting of the child of continued alcohol or drug use by the parent(s), health impact on mother/unborn child, type, frequency, use, illicit/prescribed ).

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Future plans of the parent(s) (Include the degree of realism of the parents’ plans for the future; have they considered the impact of a future child on their relationship/ lifestyle? Is it safe for the child to be placed with the parents)?

The family’s potential for and motivation to, change

(the focus needs to be in the short term time-scale, due to baby’s needs for parenting. Include an estimation of the prospects for change such as compliance, the likely response to intervention and the means through which change might be achieved).

Area Family and Environmental Factors

Full social history: (Include all details of a Social History taken in any other situation i.e. the family

composition, family profile, accommodation with detail of neighbourhood, career history. own experiences of being parented: positive/ negative experience.

What would they do differently? Extended family influence on health advice /childcare practices)

Current family structure: (Include full details of the immediate and extended family with dates of birth, full

addresses)

The parental relationship: (Include analysis of the parental relationship, the effect on a baby of the parental

relationship information on the history of this relationship, changes which have occurred within the relationship in context of current and/or previous substance misuse, domestic violence. Problems in previous relationships and the impact of these on their current relationship should be considered.)

Family Functioning:

(Include lifestyle, roles-responsibilities, consideration of how the adults envisage adapting to arrival of a new baby, family rules, identification, management and resolution of conflict, level of co-operation)

Family attitudes toward previous action/professional involvement and their ability to engage in the current intervention programme.

Receptivity/ engagement with statutory and voluntary services (Values service, takes advice on board, seeks out information)

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Appendix 2 Midwife/Health Visitor Assessment (Add analysis of each identified Risk or Resilience factor within the appropriate section)) Name of Mother: Address: Partner’s Name: Address: Mothers Health General Physical Health: (Existing health conditions, relevant family health history, preconceptual care nutrition. oral health, haemoglobin, infectious illnesses, rubella immunity, blood group. Ability to recognise own health care needs) Father’s health General physical health (Existing health conditions, relevant family health history, Ability to recognise own health care needs) The health of the unborn baby (Growth, identified conditions, relevant family health history/health risk factors, health interventions required. Ability to recognise health care needs) Learning needs (Either parent, siblings, family history, parents attended mainstream school, assessed learning difficulty/disability, literacy/numeracy skills, communication. Current educational needs if relevant) PREGNANCY; Feelings about the pregnancy (Planned/ unplanned, wanted/unwanted, expectations, fears, anxieties, acceptance, ambivalence, detachment, contentment. nurturing contact with abdomen, views on infant feeding/breast feeding. Circumstances of conception e.g. violence/sexual assault) Booking history (Date of booking, concealed pregnancy/reason for concealment, EDD, hospital/home care) Attendance at ante natal care (Type of care, accessibility, value, history, use of other health provision, for example A&E. attendances, extent of father’s involvement.)

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History of substance use/misuse before or during pregnancy (If relevant) (Type, frequency, use, illicit/prescribed, effect/health impact on mother and on the unborn child), Previous obstetric history (Previous, pregnancies/outcomes, complications) Domestic Violence (Routine enquiry, potential impact on pregnancy/unborn/newborn baby) Emotional wellbeing (Mother: antenatal and postnatal mental health NICE Clinical Guideline 45. Partner: past/present history, mental health diagnosis/low mood, anxiety, aggression, treatment, services, review,) Preparation for parenthood (Environment, equipment, parent craft, birth plan, realistic expectations) Previous experiences of providing child care/ parenting (Previous children, child minding, involvement in caring for younger siblings, partner’s children, childcare course, school curriculum child care content) Insight into the needs of the unborn baby (Knowledge, lifestyle impacts, risk-taking behaviours, challenges/demands, ability to prioritise the needs of baby, basic care needs) Receptivity/ engagement with Midwifery/ Health Visiting services (Attitude to the service, whether takes advice on board, seeks out information) Own experiences of being parented (Positive/ negative experience? What would you do differently? Insight into own parenting responsibilities. Extended family influence on health advice/child care practices)

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Appendix 3 The role and responsibilities of the Midwife and the Health Visitor in relation to pre birth care in the NHSCT Midwives, GPs and hospital based Consultants usually provide ante natal care on a basis of shared care. Care begins as soon as pregnancy is confirmed and continues until a minimum of ten days post partum and up to a maximum of 28 days. The first contact with the Midwife generally takes place at the booking clinic around 8-12 weeks of pregnancy. Following booking, the Named Midwife is responsible for the following:

• The monitoring the health and wellbeing of the mother in conjunction with other professionals,

• The identification of any concerns or interventions required and

• The planning of the care support to address these issues. Post-natal care commences in the hospital or in the home in the case of a home delivery. The Named Midwife discharges and transfers care to the Health Visitor at approximately 10-14 days following delivery. The Health Visitor will undertake a home visit in the antenatal period around 34 weeks gestation A home visit may occur earlier or earlier if required for targeted expectant mothers such as primigravida, where there are issues of lack of social support or where there are safeguarding issues. The Health Visitor will undertake a Family Health Assessment and will then also identify interventions required and plan specific programmes to address these. In order to promote co-ordinated care the Midwife and Health Visitor should agree and record the planned interventions defining the individual

responsibility for each.

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Appendix 4

Strictly Private and Confidential DATE Dear: Under noted From: (NAME) Social Work Service Manager/SSW RE: Name of Mother, Father, Partner & Unborn Baby (Name & EDC) A Pre Birth Planning meeting in respect of the above named has been arranged:

Date: Time: Venue: Name & Address

Expected duration – hours approximately Reason for Pre Birth Planning meeting is: to assess the present situation of the family and unborn baby and to agree actions and support and safeguard the child. You should provide a brief written chronology of involvement of your service with family members to the Chairperson. Please note that parents/carers may be present throughout the meeting and where possible, you should have discussed with them, information that you will be sharing on the day. If you or a deputy cannot attend the meeting, you should submit your written contribution to the Chairperson, 2 days in advance of the date. The agenda for the Pre Birth Planning Meeting is enclosed. -2-

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Re: The following people have been invited to attend: Any apologies or queries, please contact Name, address and Telephone Number of Chairperson’s Secretary. Yours sincerely _________________________ (Name) CHAIR (SSW/SWSM)

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Appendix 5

STRICTLY PRIVATE AND CONFIDENTIAL Recipient’s Name Recipient’s Address 1 Recipient’s Address 2 Recipient’s Address 3 Recipient’s Address 4 Recipient’s Postcode Insert Date Our Ref: Our Reference Dear Under noted

RE: Name and DOB of Mother, Father, Partner Unborn Baby (Name & E.D.C)

A Pre Birth Planning Meeting in respect of the above named has been arranged to discuss the present circumstances of your child/children/unborn baby. Your Social Worker will explain the process and anything which you do not understand This Meeting will take place on:

Date: Time: Venue: Name & Address

Expected duration – hours approximately

Childcare Team, Address, Telephone Number, Fax Number, Email

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-2- The following people are also invited to attend and we have asked them to share with you or information, where possible in advance, any written reports they intend to provide for the Pre Birth Meeting: Invitation List:- If you have any concerns or worries about attending the Pre Birth Meeting, please discuss these in the first instance with the Social Worker dealing with your family, or with the Chairperson, prior to the start of the meeting.

If you are unable to attend, you may send a written contribution to the Pre Birth Meeting, or you may wish to provide written authority to the meeting or arrange for a representative to attend on your behalf. You should discuss either/both with your Social Worker Yours sincerely __________________________ Name (SSW/SWSM)

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Appendix 6

Pre Birth Planning Meeting Agenda

1. Welcome, Introductions and Apologies 2. Explanation of the pre birth planning process

3. Clarification of confidentiality issues

4. Matters arising and points of accuracy from submitted reports

(if applicable)

5. The parent/ carers views of the assessments/reports

6. Overview of the current assessment

7. Summary

8. Conclusions

9. Recommendations and Decisions

Childcare Team, Address, Telephone Number, Fax Number, Email