Pre-birth policy: identifying and supporting vulnerable families - roles and responsibilities of health staff

To meet their duty of care responsibilities for a child as soon as it is born, nurses, midwives and medical staff should be enabled to adopt a proactive approach to child protection from the time the pregnancy is confirmed (Hidden Harm and Hidden Harm next Steps Scottish Executive 2006). In Scottish legislation, guided by European law, an unborn child does not have the same rights as the newborn child (ECHR 2004) and decisions about the course of the pregnancy need to take account of the physical and mental health of the woman and any existing children (Abortion Act 1967, Human Fertilisation and Embryology Act 2008).

The national policy directive (Best Start, Scottish Government 2017) also highlights the need for women to experience real continuity of care and carer, across the whole maternity journey, with vulnerable families being offered any additional tailored support they may require

This policy applies to staff providing services for pregnant women and their families. The content of the Policy does not preclude any practitioner from seeking advice at any time if they are concerned about the safety or wellbeing of an unborn child.

This policy provides information about the process for early identification of family vulnerability during the antenatal period that may result in the child being considered a child at risk or in need. These concerns can be based on factors presenting at the midwifery booking assessment or as the result of prior knowledge held by a practitioner or information shared when a pregnant woman moves from another Health Board area.

The aims of the policy are to:

• Ensure early assessment of potential risk and identify early intervention strategies when concerns exist 
• Identify the pathway for referral to promote multi-agency information sharing, assessment of risk and/or need and care planning
• Ensure a multi-agency response to child protection to achieve the best possible outcomes for the child and family.
• Ensure that there is a clear plan both for the family and professionals

The Children (Scotland) Act 1995 defines a child as being “in need” because:

• he/she is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development;
• his/her health or development is likely to be significantly impaired, or further impaired, if services are not provided;
• he/she is disabled; or
• he/she is affected adversely by the disability of any other person in his family.

The categories identified below should guide practitioner thinking in relation to the need for support but is not an exhaustive list. As this policy refers to the Unborn Child consideration should be given to the possibility that the child will be in need after birth. A child in need could, using this definition, be a child of a household where one or more of the following are a feature:

• Poor economic, material and social circumstances prevail
• Domestic violence
• Previous child care/ child protection issues
• Drug and alcohol use of adults in the home
• Parental/carer mental health problems
• Learning disabilities of parent/caregiver
• Physical disabilities of parent/caregiver
• Young mother under the age of 16-years
• Families with many changes of address and relationships
• Homeless

Using the Getting It Right For Every Child questions and Risk Questions will assist the midwife in their decision making re the pathway of support required (see Appendix 1).

Getting It Right For Every Child questions:

• What is getting in the way of this woman’s wellbeing?
• Do I have all the information I need to help this woman?
• What can I do now to help this woman?
• What can my agency do to help this woman?
• What additional help - if any - may be needed from others?

Risk questions:

• What has been happening?
• What is happening now?
• What might happen?
• How likely is it?
• How serious would it be?

Where vulnerability/risks are identified consider contacting the Child Protection/Looked After Children’s Nurses at the Public Protection Unit for advice/consultation and to check if there is any relevant background information about the family.

Where vulnerability and the need for support is identified the ‘Supporting Families Pre-Birth Pathway’ should be followed (see Appendix 1).

Information will be recorded on BadgerNet as part of the woman’s maternal record.

If there is reasonable concern that a child may be at risk of harm this will always override a professional requirement to keep information confidential. This includes sharing information prior to the birth of a child to ensure protective plans are in place from the moment of birth.

Staff should involve women/partner in decisions about the sharing of information unless this would increase the risk to the unborn child, woman or staff.

Staff should always seek advice if unsure and never refuse to provide information without considering the risks of not sharing.

Information can be shared cross border where a family either move from Scotland or arrive late in pregnancy, unknown to the service.

If concerns are identified the Midwife or Family Nurse should consider taking the following action:

• If there is immediate concern about the safety of the woman follow the Scottish Borders Adult Protection Procedures.
• If there is concern about the safety and identified significant risk to the unborn child follow the Scottish Borders Child Protection Procedures.
• If the level of vulnerability can be managed by the midwife/family nurse consider holding a Pre-Birth Universal Plus (where health only are involved) or a Pre-Birth Meeting Around the Child (MAC) (when there are two or more agencies involved).

See the Scottish Borders Child’s Planning Manual and GIRFEC documentation for further information.

Where possible the 1st meeting should take place before 24 weeks of pregnancy to enable a timely response for future planning.

If child protection concerns are identified at any point referral should be made to the Children & Families Social Work Duty Team (tel: 01896 662787).

A Confirmation of Referral Form must be sent to the Children & Families Social Work Duty Team.

CFSWDuty@scotborders.gov.uk
CPU@scotborders.gov.uk
childprotectionadv@borders.scot.nhs.uk

If a Pre-Birth Child Protection Case Conference is required, where possible, this must take place by the 28th week of pregnancy.

All minutes from pre-birth Universal Plus or pre-birth MAC and Child Protection Case Conferences should be copied to the Lead Consultant Paediatrician for Child Protection and uploaded to Badgernet and EMIS web.

If a social worker is involved with other children in the family then this is the point of contact for any wellbeing concerns.

If the woman is a Looked After Child (up to the age of 25 years) or receiving Continuing Care then they may still be involved with a social worker/Through Care After Care worker; in this case contact them to discuss the appropriate support and referral.

If no social worker is involved and there are wellbeing concerns that require further assessment and the specific support from social work, a referral should be made to the Children and Families Social Work Team (please complete Social Work Referral Form and ensure a chronology is completed) The use of the Scottish Borders Keeping Children Safe and Well Tool (currently being updated) will help provide guidance on evidencing your concerns and identifying the need for social work support

All staff (antenatal, labour ward, ward 17, community midwives, FNP, health visitors) have responsibility to share and record information about concerns/risks/plan on the appropriate patient information systems.

The ‘Notification of unborn baby on Child Protection Register’ must be completed and shared by midwifery staff (see Appendix 2).

A blue BGH record should be made up by the midwifery team as soon as possible after birth for all babies where there has been a Pre-Birth Child Protection Case Conference.

If staff are unhappy with the multiagency response and/or support provided for the family they have a responsibility to escalate their concerns using the Escalation Policy in the Scottish Borders Child Protection Procedures.

Notification of unborn baby on child protection register form: PDF