Referral and Assessment

For a record of all amendments and updates, see the Amendments & Archives.

Specific definitions of key concepts used by safeguarding practitioners are available through the Glossary.

AMENDMENT

In January 2022 the section on Pre-birth referral and Assessment was revised and updated.

1. Introduction

Caption: Referral and Assessment
   

1.1

Local authority children's social care will receive approaches from practitioners, agencies and the public which usually fall in to three categories:

  1. Requests for information from local authority children's social care;
  2. Provision of information such as notifications about a child;
  3. Requests, for services for a child, which will be in the form of a referral.

Anyone who has concerns about a child's welfare can make a referral to a local authority children's social care service. Referrals can come from the child themselves, practitioners such as teachers, early years providers, the police, probation service, GPs and health visitors as well as family members and members of the public. local authority children's social care has the responsibility to clarify with the referrer the nature of the concerns and how and why they have arisen.

1.2

When practitioners refer into local authority children's social care, they should state if there are any pre-existing assessments such as an early help assessment in respect of the child. Any information they have about the child's developmental needs and the capacity of their parents and carers to meet these within the context of their wider family and environment should be provided as a part of the referral information. Such early help assessments should identify what services the child needs and why the child and family require further support to prevent the concerns from escalating to the child needing statutory services. The interagency early help assessments should be undertaken by a Lead professional acting as a coordinator of support services and as an advocate for the child. Local arrangements should be in place to promote effective early help assessments and services.

1.3

The referrer must always have the opportunity to discuss their concerns with a qualified social worker. local authority children's social care should make clear in their local area how this should happen as local arrangements vary for receiving referrals. Most Local Authorities have arrangements in place to screen referrals via a multi agency safeguarding hub process usually referred to as the MASH.

1.4

Within one working day of a referral being received, a qualified social worker and their line manager must make a decision about the course of action to be taken. The social worker will need to make a professional judgment as to what type and level of help and support is needed, record this and feed back in writing to the referrer and the child and their family.

1.5

Where an early help assessment has been undertaken by the referring agency, it should inform the assessment to be undertaken by the social worker. All good assessments should be based on the common principles, which are set out in the three domains represented by the assessment framework[1]. This provides a systematic approach, which addresses the interactions between the three domains when considering the impact on the child and assessing their needs. The three domains are:

  1. The child's developmental needs, including whether they are suffering or likely to suffer significant harm;
  2. The parents' or carers' capacity to respond to those needs;
  3. The impact and influence on the child of wider family, community and environmental circumstances.

[1] (Working Together to Safeguard Children 2018)

1.6

Each local authority must with its partners develop and publish their own local frameworks for assessment which must be based on good analysis, timeliness, and transparency and be proportionate to the needs of the child and their family.  Principles for an assessment should include that it is:

  • Child centred and focussed on the child's best interests;
  • Rooted in child development and informed by evidence;
  • Focussed on action and outcomes for children;
  • Holistic in approach and involves all relevant agencies;
  • Timely to meet the child's needs;
  • Involved with children and their families; including the child's views and wishes;
  • Builds on strengths as well as identifies difficulties;
  • Monitored and reviewed regularly as a continuing process;
  • Transparent and open to challenge.

See Quick Referral Flowchart.

1.7

In all assessment processes, the safety of the child should always remain paramount and in all circumstances. The child must be seen alone by a qualified social worker as soon as possible following a referral. Practitioners involved with the child and family must decide on the timing of this meeting, based on their assessment of the child's needs. Age appropriate assessment tools should be used to structure the assessment of the child. The child's wishes and feelings must be considered when deciding what services to provide. It is important that the impact of what is happening to a child is clearly identified and that information is gathered, recorded and checked systematically, and discussed with the child and their parents/carers where appropriate.

1.8

Early help, assessment and intervention are important because incidents of neglect and abuse within families are on a continuum and situations where abuse is developing can, at times, be resolved by multi-agency preventative services outside the child protection procedures.

1.9

At all stages of referral and assessment, consideration must be given to issues of diversity, taking into account:

[1] If as EU / EEA nationals the family have been granted pre- settled status under the EU Settlement Scheme, establishing their status will ensure practitioners can support them to apply for settled status at the point at which they accrue 5 years' continuous residence in the UK. See GOV.UK, Switch from pre settled status to settled status.

1.10

Assessments should, as far as possible, build on rather than repeat recent assessments and specialist assessments and have a clear purpose.

1.11

All assessments should be updated and reviewed regularly for example when new information comes to light or prior to consideration of case closures.

Related assessments:

1.12

Where a local authority is assessing the needs of a disabled child, a carer of that child may also require the local authority to undertake an assessment of their ability to provide, or to continue to provide, care for the child, under the Care Act 2014. The Children and Families Act 2014 also includes duties for the assessment of young carers and parent carers of children under 18. The local authority must take account of the results of any such assessment when deciding whether to provide services to the disabled child.

1.13

Under provisions in the Counter-Terrorism and Security Act 2015, local authorities have established Channel panels, which will assess the extent to which identified individuals are vulnerable to being drawn into terrorism or extremism and arrange for support to be provided to those individuals. Local authorities and their partners should consider how best to ensure that these assessments align with assessments under the Children Act 1989.

1.14

In some cases where there are social workers employed by voluntary/charitable/private organisations undertaking assessments with children and families, they should be invited to share information in the best interest of the child to ensure that no aspects of significance are lost in safeguarding the child's welfare.

2. Referral criteria

Practitioners in all agencies have a responsibility to refer a child to local authority children's social care when it is believed or suspected that the child:

  • Has suffered significant harm (see Responding to Abuse and Neglect Procedure);
  • Is likely to suffer significant harm (see Responding to Abuse and Neglect Procedure);
  • Has a disability, developmental delay or welfare needs which are likely only to be met through provision of social work led family support services (with agreement of the child's parent) under the Children Act 1989;
  • Is a Child in Need whose development would be likely to be impaired without provision of services.

3. Local Authority Children's Social Care - Thresholds for referrals

Caption: local authority Children's Social Care - Thresholds for referrals
   

3.1

Each local authority will have local agreements in place for early help assessments. These should be based on an agreed set of principles and values and reflect the statutory guidance in Working Together to Safeguard Children 2018. The aim is to facilitate the access to appropriate services across local boundaries and different agencies.

3.2

The Threshold Document: Continuum of Help and Support aims to provide guidance to explain how Local Authority Children's Social Care apply thresholds when making decisions about how to receive and respond to referrals made to them.

3.3

Referrals to services about a child where there may be concerns typically fall in to four categories and pathways:

  • No further action, which may include information to signpost to other agencies;
  • Early help - referrals for intervention and prevention through early help services;
  • Child in Need services - assessment to be undertaken by Children's Social Care (Section 17 CA 1989);
  • Child Protection services – assessment and child protection enquiries to be undertaken by Children's Social Care (Section 47 CA 1989) with active involvement of other agencies such as the police, health practitioners and education practitioners.

3.4

Local arrangements vary for receiving referrals as some Local Authorities have arrangements in place to screen referrals against the Threshold Document: Continuum of Help and Support. Whatever the local route for a referral, it should be assessed by a qualified social worker and a decision should be made by the relevant line manager within the time scale of one working day about what should happen next.

4. Making and receiving a referral

Caption: Making and receiving a referral
   

4.1

New referrals and referrals on closed cases should be made to the local authority children's social care duty social worker. New information on open cases should be made to the allocated social worker for the case (or in their absence their manager or the duty social worker). Referrals should ideally be in writing unless a child is at immediate risk of significant harm. In these circumstances, referrals should be made by telephone without delay and the referrer should discuss their concerns with a qualified social worker.

The referrer should outline their concerns and will be asked to provide information to explain what they are concerned about and why, particularly in relation to the welfare and immediate safety of the child. See 4.4 for details of the information that might be requested. The referrer should not refrain from making a referral because they lack some of the information as the welfare of the child is the priority.

4.2

For all referrals to local authority children's social care, the child should be regarded as potentially a child in need, and the referral should be evaluated on the day of receipt. A decision must be made within one working day regarding the type of response that is required.

4.3

Local authority children's social care should ensure that the social work practitioners who are responding to referrals are supported by experienced first line managers competent in making sound evidence based decisions about what to do next.

4.4 Where a child or young person is admitted to a mental health facility, practitioners should consider whether a referral to local authority children's social care is necessary.

Checks and information gathering 

4.5

When taking a referral, local authority children's social care must establish as much of the following information as possible:

  • Full names (including aliases and spelling variations), date of birth and gender of all child/ren in the household;
  • Family address and (where relevant) school / nursery attended;
  • Identity of those with parental responsibility;
  • Names and date of birth of all household members;
  • Where available, the child's NHS number and education UPN number.
  • Ethnicity, first language and religion of children and parents;
  • Any special needs of children or parents;
  • Any significant / important recent or historical events / incidents in child or family's life;
  • Cause for concern including details of any allegations, their sources, timing and location;
  • Child's current location and emotional and physical condition;
  • Whether the child needs immediate protection;
  • Details of alleged perpetrator, if relevant;
  • Referrer's relationship and knowledge of child and parents;
  • Known involvement of other agencies / practitioners (e.g. GP);
  • Information regarding parental knowledge of, and agreement to, the referral;
  • The child's views and wishes, if known.

4.6

At the end of the referral discussion the referrer and local authority children's social care should be clear about proposed action, timescales and who will be taking it, or that no further action will be taken.

4.7

The social worker should lead on an assessment and complete it within the locally agreed time scale by:

  • Discussion with the referrer;
  • Consideration of any existing records for the child and for any other members of the household;
  • Involving other agencies as appropriate (including the police if an offence has been or is suspected to have been committed and probation, if the child is at risk of harm from an offender).

4.8

This assessment should establish:

  • The nature of the concern;
  • How and why it has arisen;
  • What the child's and the family's needs appear to be;
  • Whether the concern involves abuse or neglect; and
  • Whether there is any need for any urgent action to protect the child or any other children in the household or community.

4.9

Personal information about non-professional referrers should not be disclosed to third parties (including subject families and other agencies) without consent.

4.10

Referrals from practitioners that have been made by telephone or in person should ideally be confirmed in writing, by the referrer, within 48 hours.

4.11

If the referrer has not received an acknowledgement within three working days, they should contact local authority children's social care again.

4.12

It is not necessary to seek permission from parents before sharing information by way of making a referral to another agency. See Information Sharing - S24 onwards - WT 2018 and the Information Sharing Guidance.

4.13

Interviews with family members and, if appropriate, with the child should also be undertaken in their preferred language and where appropriate for some people by using non-verbal communication methods.

4.14

A decision to discuss the referral with, or request information from, other agencies does not require permission so long as it is to help identify, assess and respond to risks or concerns about the safety and welfare of children, whether this is when problems are first emerging, or where a child is already known to local authority children's social care (e.g. they are being supported as a child receiving early help, in need or have a child protection plan).

4.15

Local authority children's social care should make it clear to families (where appropriate) and other agencies that the information provided for this assessment will be shared with other agencies as appropriate.

4.16

This checking and information gathering stage must involve an immediate assessment of any concerns about either the child's health and development, or actual and/or potential harm, which justify further enquiries, assessments and / or interventions.

4.17

The local authority children's social care manager should be informed by a social worker of any referrals where there is reasonable cause to consider s47 enquiries and authorise the decision to initiate action. In most cases this will first involve an assessment, which may be brief when the threshold for child protection enquiries is met (see Child Protection s47 Enquiries Procedure). If the child and / or family are well known to professional agencies or the facts clearly indicate that a s47 enquiry is required, the Local Authority should initiate a strategy meeting / discussion immediately, and together with other agencies determine how to proceed.

4.18

The threshold may be met for a s47 enquiry at the time of referral, following checks and information gathering or at any point of local authority children's social care involvement.

4.19

The police must be informed at the earliest opportunity if a crime may have been committed. The police must decide whether to commence a criminal investigation and a discussion should take place to plan how parents are to be informed of concerns without jeopardising police investigations.

4.20

The Police should assist other agencies to carry out their responsibilities, where there are concerns about the child's welfare, whether or not a crime has been committed. 

Outcomes of Referrals

4.21

The immediate response to referrals may be:

  • No further action at this stage;
  • Signposting to other agencies and services;
  • Provision of services;
  • An assessment of needs with a stated timescale and plan including regular reviews;
  • Emergency action to protect a child;
  • A s47 strategy meeting / discussion.

4.22

A local authority children's social care manager must approve the decision about the type of response that is required and ensure that a record of the outcome of the referral has been commenced and/or updated.

4.23

Local authority children's social care must acknowledge all referrals within one working day. It is the responsibility of local authority children's social care to make clear to the referrer when they can expect a decision on next steps.

4.24

The social worker should inform, in writing, all the relevant agencies and the family of their decisions and, if the child is a Child in Need, about how the assessment will be carried out or of a plan for providing support.

No further action

4.25

Where there is to be no further local authority children's social care action, feedback should be provided to the child, the family and referrers about the outcome of this stage of the referral. This should include the reasons why a case may not meet the statutory threshold to be considered by local authority children's social care for assessment and suggestions for other sources of more suitable support.

4.26

In the case of referrals from members of the public, feedback must be consistent with the rights to confidentiality of the child and their family.

5. Assessment of children in need or in need of protection

Caption: Assessment of children in need or in need of protection
   

5.1

The assessment should be undertaken in accordance with the relevant local assessment protocol based on the guidance in Working Together to Safeguard Children 2018. Where an early help assessment has previously been completed, this information should be used to inform the assessment, although the information must be updated and the child must be seen.

5.2

The assessment must be completed in a timely manner as identified by the social worker and local authority children's social care manager but should not exceed 45 working days from the point of referral. Where it becomes apparent that this timescale will require extension, a local authority children's social care first line manager must review the file, record the reason for the extension and agree the new timescale. Local Authorities may have different local Assessment framework agreements in place which may contain timescales to be observed. Any timescale should be regularly reviewed.

5.3

The assessment must be led by a qualified local authority social worker who is supervised by an experienced and qualified social work manager. The social worker should, in consultation with their manager and the other agencies involved with the child and family, carefully plan the assessment actions and steps for who is doing what by when:

5.4

Personal information about non-professional referrers should not be disclosed to third parties (including subject families and other agencies) without consent.

5.5

It is not necessary to seek parents' permission before discussing a referral about them with other agencies. See Information Sharing - S24 onwards - WT 2018 and the Information Sharing Guidance.

5.6

The checks should be undertaken directly with the involved practitioners and not through messages with intermediaries for example reception staff in GP Practices.

5.7

The relevant agency should be informed of the reason for the enquiry and asked for their assessment of the child in the light of information presented.

5.8

All discussions and interviews with family members and the child should be undertaken in their preferred language and where appropriate for some people by using non-verbal communication methods.

5.9

Local authority children's social care should make it clear to families (where appropriate) and other agencies that the information provided for this assessment may be shared with other agencies.

5.10

If during the course of the assessment it is discovered that a school age child is not attending an educational establishment, the local authority education service where the child resides should be contacted to establish the reason for this. local authority education must take responsibility for ensuring that the child receives education as soon as possible.

Action must also be taken, if it is discovered that a child is not registered with a GP, to arrange registration. Depending on the age of the child the relevant community services named health professional should be contacted and action taken to arrange for the child to have access to all health services and an NHS number.

Principles for an assessment

5.11

The multi-agency assessment should be led and coordinated by a qualified social worker and must provide a rigorous analysis of the child's needs and the capacity of the child's parents to meet these needs within their family and environment. Based on this analysis the key questions to be answered are:

  • What is likely to happen if nothing changes in the child's current situation?
  • What are the likely consequences for the child?

The answers to these questions should inform decisions about what interventions are required to safeguard and promote the welfare of a child and where possible to support parents in achieving this aim.

5.12

An assessment should be planned in accordance with Local Assessment guidance / protocols in place and set out to aim to understand the child's developmental or welfare needs and circumstances and the parents' capacity to respond to those needs, including the parents' capacity to ensure that the child is safe from harm now and in the future.

5.13

The assessment must set out the timescales and the child must be seen within a timescale that is appropriate to the nature of the concerns expressed at referral.

5.14

A local authority children's social care manager must approve the assessment and ensure that:

  • There has been direct communication with the child alone and their views and wishes have been recorded and taken into account when providing services;
  • All the children in the household have been seen and their needs considered;
  • The child's home address has been visited and the child's bedroom has been seen;
  • The parent has been seen and their views and wishes have been recorded and taken into account;
  • Background history of both mother and father, or other adult carer, and their parenting skills and capacity has been considered;
  • The analysis has been completed;
  • The assessment provides clear evidence for decisions on what types of services are needed to provide good outcomes for the child and family;
  • The records and the child's chronology within the records are up-to-date;
  • The assessment will be reviewed regularly;
  •  The action points have been distributed to all participants.

Information from previous local authorities / countries

5.15

If the child and their parents have moved into the local authority children's social care area, all practitioners should seek information from their respective agencies covering previous addresses in the UK and abroad. See also guidance in Working with Foreign Authorities: Child Protection Cases and Care Orders Departmental advice for local authorities, social workers, service managers and children's services lawyers (July 2014) and Cross-border Child Protection Cases: The 1996 Hague Convention for updated information applicable from January 2021.

5.16

For information from foreign countries, see Accessing Information from Abroad Procedure. In some cases, specialist assessments and information can be undertaken or obtained through independent consultants or through specialist agencies such as International social services (ISS) and Children And Families Across Borders (CFAB).

5.17

It is never acceptable to delay immediate action required whilst information from foreign countries is accessed.

Notifying the police 

5.18

It will not necessarily be clear whether a criminal offence has been committed, which means that even initial discussions with the child should be undertaken in a way that minimises distress to them and maximises the likelihood that they will provide accurate and complete information, avoiding leading or suggestive questions.

5.19

The police must be informed at the earliest opportunity if a crime may have been committed. The police will decide whether to commence a criminal investigation and should work jointly with the Local Authority. The police should assist agencies to carry out their responsibilities, where there are concerns about a child's welfare, whether or not a crime has been committed.

Outcome of assessment 

5.20

The focus of the multi-agency assessment is to gather important information about the child and family, to analyse their needs, and the level and nature of any risk and harm, and to provide support services in order to improve the outcomes for the child. In the course of the assessment, local authority children's social care should ascertain:

  • Is this a child in need? (s17 Children Act 1989); if so, is there a need for further social work support or provision of support?
  • Is there reasonable cause to suspect that this child is suffering, or is likely to suffer, significant harm? (s47 Children Act 1989);
  • Is this a child in need of, or requesting, accommodation? (s20 or s31 Children Act 1989).

5.21

Every assessment should be focussed on outcomes, deciding which services and support to provide in order to deliver improved welfare for the child.

The possible outcomes of the assessment are:

  • No further action;
  • The development of a multi-agency child in need plan for the provision of child in need services to promote the child's health and development;
  • Specialist assessment for a more in-depth understanding of the child's needs and circumstances;
  • Undertaking a strategy meeting / discussion, a s47 child protection enquiry;
  • Emergency action to protect a child (see Child Protection s47 Enquiries Procedure, Immediate protection).

5.22

The outcome of the  assessment should be:

  • Discussed with the child and family and provided to them in written form. Exceptions to this are where this might place a child at risk of harm or jeopardise an enquiry;
  • Taking account of confidentiality, provided to professional referrers;
  • Given in writing to agencies involved in providing services to the child.

5.23

A local authority children's social care manager must have approved the outcomes of an assessment and have recorded and authorised the reasons for decisions, future actions to be taken and also that:

  • The child/ren have been seen alone or there has been a recorded management decision that this is not appropriate (e.g. a s47 enquiry and police investigation initiated which will plan method of contact with child);
  • The needs of all children in the household have been considered;
  • Records and a chronology have been completed and / or updated;
  • Written feedback has been provided to the family, other agencies and referrers about the outcome of this stage of the referral in a manner consistent with respecting the confidentiality and welfare of the child.

5.24

If the criteria for initiating s47 enquiries are met at any stage during an assessment a Strategy meeting/discussion should take place.

5.25

If the assessment is that further support is required, a child in need plan should be agreed with the family and other agencies. This plan should be monitored and reviewed regularly in line with local standards but within a maximum of six months to ensure that the outcomes for the child are met.

6. Pre-birth referral and assessment

Caption: Pre-birth referral and assessment
   

Referral

6.1

Where agencies or individuals anticipate that prospective parents may need support services to care for their baby or that the baby may have suffered, or be likely to suffer, significant harm, a referral to local authority children's social care must be made as soon as the concerns are identified. See Responding to Concerns of Abuse and Neglect Procedure, Potential risk to an unborn child.

6.2

The importance of conducting pre-birth assessments has been highlighted by numerous research studies and case / practice reviews which have shown that children are most at risk of fatal and severe assaults in the first year of life, usually inflicted by their carers. It is important to consider the circumstances of both prospective parents, not just the mother. Where possible, information should be obtained directly from each prospective parent rather than relying on a third party account [1].

[1] See The myth of invisible men: safeguarding children under 1 from non-accidental_injury caused by male carers and Hidden men: learning from case reviews - NSPCC and Serious Case Review in relation to Clare and Ann – RBKC.

6.3

The following circumstances might indicate an increased risk to an unborn child. A referral should be made to children’s social care to decide if a pre-birth assessment needs to be undertaken.

  • A child has previously sustained non accidental injuries in the care of either parent / carer (this includes the sudden, unexpected death of a child where safeguarding concerns were raised);
  • Previous children in the family have been removed from the care of the parent(s) either by a private arrangement or by a court order;
  • A child in the household is the subject of a Child in Need or Child Protection Plan or is a Looked after Child;
  • Either parent is the subject of a Child in Need or Child Protection Plan or is a Looked after Child or Care Leaver;
  • The mother is a child aged under 16 who is found to be pregnant (see Sexually Active Children Procedure and Sexual Exploitation Procedure);
  • A parent or other adult in the household, or regular visitor, has been identified as posing a risk to children (see Risk Management of Known Offenders Procedure);
  • There are concerns about the parent(s) ability to protect the baby;
  • There are concerns regarding domestic violence and abuse (see Domestic Abuse Procedure);
  • Either or both parents have mental health problems that might impact on the care of a child (see Mental Illness (Parenting Capacity) Procedure);
  • Either or both parents have a learning disability that might impact on the care of a child (see Learning Disability (Parenting Capacity) Procedure);
  • Either or both parents abuse substances; alcohol or drugs (see Parents who Misuse Substances Procedure);
  • Any other concerns exist that the baby may be at risk of Significant Harm including a parent previously suspected of fabricating or inducing illness in a child (see Fabricated or Induced Illness Procedure) or harming a child;
  • If the pregnancy is denied or concealed.

This list is not exhaustive, and professionals will need to apply their judgement.

For more information about risk factors, see “The myth of invisible men: safeguarding children under 1 from non-accidental injury caused by male carers”.

6.4

If a decision is made by the local authority not to undertake a pre-birth assessment following the referral, then this should be clearly recorded on each agency’s files together with the rationale for that decision.

6.5

If a decision is made by the local authority to delay the commencement of an assessment following a referral, then this should be clearly recorded on each agency’s files together with the rationale for that decision and a date set for that decision to be reviewed.

Sharing Concerns

6.6

Where agencies or individuals anticipate that prospective parents may need additional support to care for their baby, they should clarify what they already know about the family and seek information from other agencies. They should clearly outline strengths within the family, their concerns in terms of how the parent's circumstances and / or behaviours may impact on the baby and what risks are predicted. It is important to note that:

  • There can be a lack of patient record integration across the health service which may necessitate multiple requests for information and that some risk factors (especially those pertaining to fathers / partners) may only be known to GPs;
  • Local authority information systems may need to be searched separately for information about adults and that requests for information may need to be made to more than one local authority if one of the prospective parents resides in a different area.

Pre-birth strategy meeting / discussion

6.7

Proactive, effective information sharing is essential to identify, assess and respond to risks or concerns about the safety and welfare of children at any time and especially prior to birth. The General Data Protection Regulations (GDPR) provides a number of bases for sharing personal information including “legal obligation” and “public task”; consent is not required when seeking information nor when making a referral – see paragraph 4.11; Concerns should normally be discussed with prospective parents – see paragraph 6.10, below.

6.8

A multi-agency meeting under the local early help procedures may provide a forum for sharing information and to help identify a multi-agency package of support for the baby and family. This should take place as soon as possible but preferably not later than 18 weeks.

6.9

Compiling a full chronology and family history is particularly important in assessing the risks and likely outcome for the child. Professionals should try to compile a clear history from the parents about their own previous experiences in order to find out whether they have any unresolved issues that may impact on their parenting of the child. It is important to find out their feelings towards the new-born baby and the meaning that the child may have for them. It is also important to find out the parents’ views about any previous children who have been removed from their care and whether they have demonstrated sufficient insight and capacity to change in this respect.

6.10

Pre-Birth Assessment is a sensitive and complex area of work. Parents may feel anxious about their child being removed from them at birth. Referring professionals may be reluctant to refer vulnerable adults and be anxious about the prospective parents losing trust in them.

6.11

If there are concerns that the unborn baby may be at risk of significant harm, a referral should be made to Children’s Social Care at the earliest opportunity to:

  • Provide sufficient time for a full and informed assessment;
  • Enable the early provision of support services to facilitate optimum home circumstances prior to the birth;
  • Enable the parents to have more time to contribute their own ideas and solutions to concerns and increase the likelihood of a positive outcome to assessments;
  • Avoid initial approaches to the parents in the last stages of pregnancy, at what is already an emotionally charged time;
  • Provide sufficient time to make adequate plans for the baby's protection.

Pre-birth s47 enquiry and assessment 

6.12

Concerns should be shared with prospective parent(s) UNLESS in doing so the unborn child or a sibling will be at an increased risk of significant harm. In those cases, practitioners should liaise with their named / designated professional for safeguarding for advice and support.

6.13

If an urgent response is required if a pregnancy is concealed or denied [1], a strategy meeting should always be convened.

[1] A concealed pregnancy is where the mother is aware that she is pregnant however conceals the pregnancy from family / friends and / or health professionals. The reasons for concealment can be varied however, should always present as a potential safeguarding concern. Case / Practice Reviews tell us that lack of engagement is a risk factor for potential significant harm. A referral to children social care should be made for all concealed pregnancies and the mother should not be discharged home until the outcome of the social care referral is known. Information should be obtained from the GP and other relevant agencies. A discharge planning meeting should be convened.

6.14

If a pregnant woman fails to attend antenatal appointments and cannot be located, information should be shared with maternity services in other areas London. Should a pregnant woman present at a different hospital from that which had provided her antenatal care seeking assistance / in labour, then the originating hospital maternity services should be contacted and asked to provide relevant information about any concerns / risk that they may have identified.

6.15

If a pregnant woman disengages from maternity services and the local authority had already commenced a pre-birth assessment, then they should be notified, and consideration given to what further action should be taken. If concerns had been identified but a decision had not been undertaken to undertake a pre-birth assessment, then a further referral should be made to the local authority and that decision reviewed.

Assessment

6.16

A pre-birth assessment should always be undertaken where prospective parents may need support services to care for their baby in addition to those available through early help services or where the unborn baby may have suffered, or be likely to suffer, significant harm.

6.17

Pre-birth assessments may be undertaken as an assessment of need; they may subsequently become an assessment of risk. Consideration should be given as to when during the pregnancy the child protection procedures are invoked to ensure the appropriate support and monitoring can be put in place sufficiently early.

6.18

The pre-birth assessment should usually commence as soon as possible after a viable pregnancy has been confirmed and the mother has registered for midwifery care, but no later than 16 weeks into the pregnancy. If the initial identification of the pregnancy is delayed or concealed, it should commence as soon as the pregnancy has been identified. The assessment should identify:

  • Risk factors;
  • Family history and functioning;
  • Always include the father of the baby;
  • Strengths in the family environment;
  • Factors likely to change, reasons for this and timescales.
6.19

It is important that social workers do not conduct assessments in isolation. Working closely with relevant professionals such as midwives and health visitors is essential. Liaising with relevant substance misuse, mental health and learning disability professionals is also crucial. The liaison mental health worker will also offer advice on cases with a mental health component and become involved in liaison with mental health professionals.

6.20

It is crucial to seek information about fathers / partners whilst conducting assessments and involve them in the process. It should not be assumed that a male partner is necessarily the father of the unborn child. Research suggests that paternal attendance at pregnancy scans and at births is over 90% indicating that fathers are there to be engaged [1]. Background police and other checks should be made at an early stage in relevant cases to ascertain any potential risk factors and necessary risk assessments undertaken. This can include mental health or substance misuse, for example. The Data Protection Act 2018 and General Data Protection Regulations (GDPR) do not prevent the sharing of information for the purposes of keeping children safe. Fears about sharing information must not be allowed to stand in the way of the need to promote the welfare and protect the safety of children (WT 2018).

[1] See the Myth of Invisible Men, cited above
[1] Research suggests that infants were more likely to be killed by their father (at a rate of approximately 2:1) than their mother. See: Flynn S, Shaw J & Abel K (2013) Filicide: mental illness in those who kill their children

6.21

Where fathers / partners do not engage and / or mothers do not provide their details, then this could provide a further reason to be concerned.

6.22

Working with extended families is also crucial to the assessment process and achieving positive outcomes for unborn children. Consideration should always be given to convening Family Group Conferences in any cases where there is a possibility that the mother may be unable to meet the needs of the unborn child.

Family Group Conferences can enable the families to be brought together to make alternative plans for the care of the child thus avoiding the need for Care Proceedings in some cases. Parallel assessment of alternative family carers can prevent delays in Care Planning for the child.

6.23

The assessment should be completed within 45 days and must make recommendations regarding the need for a child in need planning meeting, a Pre-Birth Child Protection Conferences, or a legal planning meeting to consider initiating Public Law Outline prior to birth and / or initiating proceedings at birth.

6.24

Completing the pre-birth assessment at an early stage within the pregnancy, i.e. by the 24th week, provides an opportunity for the prospective parents to address any concerns identified and for the multi-agency team to review progress with the implementation of a protection plan prior to the birth of the baby.

Following Assessment

6.25

A pre-birth conference should be held in the circumstances listed below unless the pre-birth assessment has concluded that the risk no longer applies:

  • A pre-birth assessment gives rise to concerns that an unborn child may have suffered, or is likely to suffer, significant harm;
  • A previous child has died or been removed from parent/s as a result of significant harm;
  • A child is to be born into a family or household that already has children who are subject of a child protection plan;
  • An adult or child who is a risk to children resides in the household or is known to be a regular visitor.

Other risk factors which must be considered are:

  • The impact of parental risk factors such as mental ill health, learning disabilities, substance misuse and domestic abuse. See Safeguarding Practice Guidance for Guidance.
  • A mother under 18 years of age about whom there are concerns regarding her ability to self-care and / or to care for the child.

See Pre-Birth Child Protection Conferences Procedure.

6.26 The pre-birth conference should be convened prior to the 28th week of gestation, or earlier if there is a history of premature birth. If a decision is made that the unborn child will be made the subject of a child protection plan the main cause for concern should determine the category of the child protection plan. The core group must be established at the initial conference and ideally meet prior to the birth and certainly prior to the baby's return home after a hospital birth. The discharge planning meeting can also be used as a core group meeting. See Child Protection Conferences Procedure.
6.27 If it is not possible to hold a child protection conference before the birth of a baby who is considered at risk of significant harm, contact should be made with the relevant children's social care team for immediate action to protect the child, and consideration should be given to them convening an initial child protection case conference at the earliest opportunity.
6.28

Where the assessment recommends that legal action should be considered, a legal planning meeting should be held as soon as possible to consider initiating action under the Public Law Outline and / or initiating proceedings at birth. This will:

  • Avoid additional stress for the pregnant woman in the later stages of pregnancy;
  • Provide an opportunity for the prospective parent(s) to obtain legal advice;
  • Provide an opportunity to work with the family to explore what support they will be able to give;
  • Provide an opportunity to commission specialist assessments; and
  • If appropriate, to avoid the need for legal proceedings.
6.29

The Public Law Working Party (March 2021) has published “Recommendations to achieve best practice in the child protection and family justice systems”. This provides guidance on best practice in decision making at legal planning meetings, support for families prior to court proceedings and when making an application to a court in care proceedings. The report also recommends that:

  • Local authorities and NHS Trusts providing maternity services develop protocols setting out the arrangements for the birth at hospital and an agreed period for the baby to remain in hospital to allow an application to be made to court in a timely way; and
  • Local authorities and their family justice board agree protocols providing clarity of expectation and principles under the pre-proceedings phase of the Public Law Outline.

Birth Planning Meeting

6.30

Consideration should always be given to the need for a birth planning meeting. The purpose of the birth planning meeting is for professionals and parents to be clear about their roles and responsibilities and to agree a multi-agency plan to safeguard the baby once born. This plan should be shared with the parents. The social worker with case responsibility will attend this meeting which may be combined with a core group meeting or child in need meeting. The meeting should be held before 34 weeks of pregnancy, or earlier if there is a risk of premature birth. The meeting should consider:

  • Any medical/pregnancy related health issues for either mother or baby and the impact this might have on the early postnatal period;
  • The arrangements for the immediate protection of the baby if it is considered that there are serious risks posed from parental alcohol consumption, substance misuse; mental ill health and / or domestic violence or another significant safeguarding concern Consideration should be given to the use of hospital security and involving the police1 so that the baby can be police protected;
  • Consideration to the safety of baby in mothers care whilst in hospital; is constant supervision required? If so, who should provide this?
  • The risk of potential abduction of the baby from the hospital particularly where it is planned to remove the baby at birth;
  • The plan for contact between mother, father, extended family and the baby whilst in hospital. Consideration to be given to the supervision of contact – for example whether contact supervisors need to be employed;
  • How the mother intends to feed the baby;
  • Record the need for a discharge planning meeting to take place prior to discharge;
  • Consideration should be given to whether or not alerts should be circulated to other maternity units (locally, regionally or nationally) and to the ambulance service;
  • Contingency plans should also be in place in the event of a sudden change in circumstances;
  • Who to contact should the baby be born out of hours.

[1] The police do not normally attend birth planning meetings. The plan agreed at the meeting should be shared with the police by the local authority in order that they can update their records.

Birth and Discharge of a Newborn Baby

6.31

The hospital midwives should inform children’s social care of the birth of the baby as soon as possible (ideally the allocated social worker will be informed once the expectant mother is admitted in established labour).

  • It is expected that there is regular liaison between social care and the maternity unit whilst the mother and baby are in hospital;
  • Ward staff should keep a record of any concerns that emerge whilst on the ward. This could be important information for child protection planning or evidence needed for care proceedings;
  • If the baby is the subject of a child protection plan, consideration should be given to convening a core group / pre-discharge planning meeting to draw up a detailed plan prior to the baby’s discharge home. (See Child Protection Conferences Procedure). The police should also be informed so that their records can be updated – a PNC record created and flagged as a child subject to a child protection plan;
  • It is expected that, where a decision has been made to initiate care proceedings following birth, all necessary paperwork is prepared in advance of the birth to prevent any delay. The social worker must keep relevant maternity staff updated about the timing of any application to the Courts. The lead named midwife for safeguarding/ maternity safeguarding team should be informed immediately of the outcome of any application and placement for the baby. A copy of any orders obtained should be forwarded immediately to the hospital and to the police;
  • PLEASE NOTE: The application to court can only be made once the baby is born and is likely to take a few days before the case is heard. If there are immediate child protection concerns prior to the order being granted, then contact the police.

Pregnancy of Young People in Care / Care Leavers

6.32

Careful consideration should be given to the need to complete a pre-birth assessment in relation to the pregnancies of looked after children and care leavers. It should not be an automatic decision unless the thresholds are met as outlined above. The rationale for that decision should be recorded. Consideration should also be given to who should undertake the pre-birth assessment:

  • For a looked after child, the assessment should not be undertaken by their allocated social worker; the risk to the un-born child should be assessed separately from the best interests of the looked after child;
  • For a care leaver, the assessment should never be undertaken by their allocated personal advisor [1];
  • If the looked after child or care leaver is placed outside of the LA with statutory responsibility for them, then the pre-birth assessment should be undertaken by the LA in whose area they are residing.

[1] The role of the personal advisor in children’s social care is not always properly understood. Personal advisors play an important role in supporting care leavers and their ability to form helpful relationships is well evidenced. Assumptions should not be made about their role in identifying the potential risk to babies; there can be a tendency for other professionals to attribute a greater degree of responsibility for this to personal advisors than should be the case.

Moving across borough boundaries

6.33

Where an expectant mother moves between local authority areas, it is particularly important that the pre-birth assessment is undertaken in a consistent manner.

  • The authority in whose area the pregnant woman is residing at the time that the concern is first identified should retain case responsibility until the assessment is complete.
  • Where a pregnant woman presents at a hospital without having previously booked at that hospital and / or having not previously received anti-natal elsewhere, then the local authority responsible for the area in which the hospital is located will be responsible for the risk assessment.
  • If a pregnant woman is homeless, then the responsibility for undertaking the pre-birth assessment will be with the authority in who's area the concern is first identified, usually through registering for antenatal care.
  • If a concern is identified in respect of a pregnant woman who is in prison, then the responsibility for the pre-birth assessment lies with the local authority where the prison is located rather than the local authority in which the woman lived prior to her imprisonment [1].

See also Children and Families Moving Across Local Authority Boundaries Procedure.

[1] See Section 76, Care Act 2014

Missing Families

6.34 Where concerns have been identified and an expectant mother misses appointments or cannot be located, that may provide further reasons to believe that the unborn child is at risk of or has suffered significant harm. See Missing Families Procedure.

7. Multi-agency Pre-Birth Assessment Flowchart

Quick referral flowchart