For the purposes of this article we will refer to the parent as the person who is pregnant and births the child. Like any family undergoing assessment these factors should be considered given the individual circumstances of that parent including the safety of that parent and child and the need to balance any risk of harm at the time of the assessment and keep matters under review. This article is to look over the evidence and existing guidance in several areas which should be considered, and updated if or when these are available.
A common question that is asked around parenting assessments is whether it is right or acceptable to be assessing parents in the immediate pre-birth period (4-6 weeks before the expected date of delivery or EDD for short) or six-week post-natal period.
Most social workers and professionals within a family law or assessment context recognise that it is best practice not to risk continuing assessments beyond what is ethically reasonable and can agree when assessment will end and resume, but often it is important for us to re-visit why this is and offer consideration for social workers to apply to each family context alongside receiving legal advice.
Pregnancy and birth are a not only a significant physiological process but also has immense emotional, psychological and social repercussions. Ethically we know any parent undergoing the process of an assessment by Children’s Services will inevitably cause concern for them; something which again has implications for emotional health of the parent and the developing foetus.
Every situation around any pre-birth assessment will be different depending on the timing of a parents presentation in pregnancy, and timing of referrals being made and accepted for assessment based on the gestational milestone reached in the pregnancy; most local authorities will have their own ‘pre-birth’ referral and assessment protocols which should be considered locally. Broadly speaking the earlier an assessment can commence the more time is afforded to gather information and to plan and to put in place support. Earlier and more timely assessment is widely known to be best practice, having been publicised since the PLO (DFE, 2014) and original Working Together (2013) and this needs to be emphasised for pre-birth assessments more generally as well as pre-birth parenting assessments.
We know this isn’t always possible in practice with late referrals, poor information sharing between agencies and later presentation or not sharing of pregnancies. For many of the parents we work with the involvement of Children’s Services is something that is stressful and worrying at what is already a significant change in their life, as well as the inclusion of any other risk factor which may make them at higher risk of pre-term birth or health complications (substance misuse, emotional or mental health difficulties or other health conditions) If there is already a history of pre-term birth and early delivery in other pregnancies their risks are much higher and that needs to be considered to not bring additional risks them to expectant parents through early birth, and pre-term babies. Every family should be considered based on their unique and individual circumstances, risk and safety and not based on social work capacity and resources.
One of the most helpful resources for social workers to read and consider are the findings of the Nuffield report: Born into Care (2022) which comprehensively looks at both the ethical and evidential involvement of pre and post-birth involvement, recognising that several challenges remain in the way of best practice including delays, time and resource constraints as well as shortfalls in considering a parents capacity to learn or change, and support network involvement. These are all areas covered within the ParentAssess framework.
ParentAssess encourages within the pre-birth assessment framework to consider the themes recognised within this Nuffield report; such as parents own histories (including trauma and loss) the flexibility of the framework also permits for areas around the child’s experience, specific risk factors and parents daily living skills and abilities to be considered before their baby arrives, as well as be re-visited after birth as part of any finished assessment or addendum. We strongly encourage inclusion of any other information from professionals, tools or resources that strengthen your assessment and stress that assessments must not be prescriptive.
Much of where the guidance around the post-natal period of ‘six weeks’ centres on health advice to professionals, in both physical recovery and mental health as something internationally recognised and acknowledged as a recovery need. The World Health Organisation recognises the need for birthing parents to have increase physical and mental health support in the hours and days immediately following birth.
WHO urges quality care for women and newborns in critical first weeks after childbirth
Health NICE Guidance (National Institute for clinical excellence) whilst aimed at Healthcare professionals and providers, their Postnatal Care Guidelines (2021) are also important to those receiving post-natal care and their families. In recognition of supporting perinatal mental health their recommendations include having separate and specialist guidance to professionals in this area (with reference to ‘complex social factors’) This is one of the most concrete in explaining that the immediate post-natal period is a critical time for any parent and their mental health including ‘the possibility of onset of symptoms of mental health problems in pregnancy and the post-natal period particularly in the first few weeks after childbirth’. Perinatal mental health instead focusses on the whole period of pregnancy and post-delivery. As social workers we know the important links between mental health, behaviour and capacity including within Court proceedings; something the ParentAssess course content also addresses.
Physical and hormonal recovery from birth can have implications for the body and for mental health; a reason why many assessments in Psychological or Psychiatric fields are resistant to assessing parents during this immediate period unless there is a significant or safeguarding issue present needing immediate treatment. Both sets of NICE guidance inform the UK health / GP led six to eight week ‘postnatal check’ which all birthing parents are routinely offered.
As an assessor there are important stages and information which can be gathered during this period of time to inform the assessment and not need to involve additional sessions with parents whilst they recover and when the baby is newly born. Observations of care can continue as can gathering information from other carers, support network or professionals (midwives, health visiting, GP, children’s centre or family support workers) which is often the case for colleagues supporting parents in any form or parent and child placement (both fostering or family residential assessment) Parents are often routinely moved from hospitals to such placements for safety and support reasons, and informally assessments do begin from the point of their arrival with observations included in this.
In terms of Case Law and any legal context, during the research for this article I could find limited examples of guidance around case law and post-natal assessment specifically and I would be interested to hear from anyone else who has more information. There is reference to some pre- and post-natal assessment, including court attendance late on in pregnancy (for existing child proceedings) but nothing concrete I could find relating for example to the appeal of assessments which were completed within the six-week post-natal period.
In Nottingham City Council V LW (2016) there is guidance about the issuing of proceedings and timeframes when babies are born; with heavy emphasis on pre-birth risk assessment and planning which should complete ‘at least 4 weeks before the mother’s expected date of delivery’; other learning and good practice guidance is largely already referred to within the PLO guidance which includes allowing sufficient time for parents and local authority to seek legal advice, and the local authority to form a ‘rigorous’ plan following an assessment of risk. It is only right when making life changing decisions for children and their parents that they can seek advice and be supported.
There is also one appeal matter (Re F, 2021 EWVA Civ 469) in which Lord Justice Peter Jackson explains that there was ‘no good reason’ to require a mother to attend court less than a month before her due date and her application to adjourn should have been granted; such circumstances are described as ‘rare’ given the welfare of the child often determines delay should be avoided at all costs.
Although pre-birth safeguarding assessments need to be completed to gather information and to inform safety and care planning up until the stage of babies arrival, any ongoing interventions such as a parenting assessment or other information potentially causing anxiety need to be reviewed about when it should proceed or cease for ethical reasons. If the parent has other pre-existing health or risk factors, is finding the assessment process to difficult to work with ethically the assessor should review whether the assessment is right to continue raising this with both management oversight and legal advice as necessary. Some parents with their consent may be content to continue the assessment and visits closer to the time of their due date; but assessors are encouraged to think about this carefully and as a general rule not re-commence assessment until is six weeks post-delivery, and even then be considering physical and mental recovery on an individual basis. All the while still ensuring any care plan, placement and monitoring ensure the safety and welfare of the child.
Footnote: At the time of writing this I am also reminded that it is ‘CPD’ season as we are all invited to renew our social work England registration, for those professionals that this applies to. This underpins our practice alongside the law and serves as an important reminder to us all.
There are always Social Work ethical standards and values, and our professional standards which would be relevant to consider in this context which include:
1.3 Working in partnership with people to promote their wellbeing and achieve best outcomes.
1.7 Recognise and use responsible the power and authority I have when working with people, using interventions when necessary, least intrusive, proportionate and in people’s best interests
2.4 Practice in ways that demonstrate empathy, perseverance, authority, professional confidence and capacity, working with people to enable full participation in discussions and decision making.
3.1 Work within Legal and ethical frameworks, using my professional authority and judgement appropriately.
Further reading / resources:
NSPCC – Podcast: Podcast: Understanding pre-birth assessments | NSPCC Learning
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