Key message six: Dynamic assessment and support go hand in hand

Of course, assessment is central to the social work role. However, currently there is no national guidance or widely adopted pre-birth assessment framework and practice around assessment of the unborn. And the pregnant mother and father varies greatly across the country.

Often the assessment period is long, and as I've already said, given this short window of opportunity for change, it left little time to actually provide the help and support. And this led to quite a lot of frustration, particularly from parents, but also from from teams themselves.

Often some of the specialist support that was needed required further referrals. And again, this took time shortening that window in which change was possible. An assessment is a snapshot in time. However, what we've learned from the change project and from better understandings of trauma informed practice and trauma responsive practice, dynamic assessments are much more helpful in terms of really understanding what is happening for that family in the here and now.

Given the multiple disadvantage and many adversities often experienced by parents who are coming under the scrutiny of children's social care during pregnancy, it often requires a multi-agency response. Given the demands on social workers and the limited resources. This often resulted in multiple referrals being made. And as a result of that, what the families told us was the understandings of their problems and ways in which they were assessed sometimes became very confusing with different messages being given about what the priority was.

And sometimes those priorities didn't reflect what parents felt were the biggest issues for them. So a dynamic approach to assessment, a coordinated approach to assessment is really important and to give families the best possible opportunities to make use of the help and support they receive.

We know that preparing for parenthood requires not just practical preparation, but also huge emotional preparation. What parents and practitioners told us was that often assessments and help focused largely on that practical preparation, with insufficient focus on the emotional preparation for parenthood.

Parents also told us that there was an over-reliance on their history, particularly if they were already known to children's social care because of previous children, or indeed if they'd been looked after in their own childhoods. Of course, history matters. But making sense of that history and why it matters is a really important conversation to have with parents. Otherwise, it feels just like judgment and criticism, rather than giving them insights into their own behavior that might really help them bring about the change that's needed. We'll hear more about this in the clip below from Sheena Webb.

So a trauma informed approach to assessment is key. And as you'll hear from Sheena, the starting point of this is that under pinned by robust formulation and an understanding of the parents priorities and needs and that shared across that multi-agency system throughout the assessment, practitioners may also use some standardised measures and assessments.

And Jane Barlow will discuss this in her film.

The use of standardised assessments alongside professional judgment and decision making helps to provide a more robust assessment of that parent and unborn's needs, and also helps to build the evidence base.

In the resources below. You can also hear from some local authorities who've developed specialist assessment tools, frameworks and protocols to help improve their assessment of unborn babies and their parents.

So I'd like to talk to you a little bit about how we might use an understanding of trauma to inform how we approach assessment of parents, and in particular, how we might approach assessing mothers who are being assessed pre-birth, who may already have had an extensive experience of trauma in their past and who are in the midst of a very traumatic situation in terms of the care proceedings and the uncertainty of the outcome. 

This is divided into four areas. We're gonna think first about assessment, then we're gonna think about how we formulate what we've got from the assessment. Then we're gonna think about how we plan interventions, and finally we're gonna think about how we might report on what we found. 

So if we start with the area of assessment, I think the first thing to hold in mind is that, um, any parent, um, involved in an assessment is coming into a situation which they perceive as threatening. And so that is already going to activate their nervous system. They're gonna be on high alert for bad things, essentially. But I think the real tricky thing for trauma survivors is their nervous system is already primed for bad things. And very often they have developed many strategies to try and sort of cope with threat, um, and fear. And all of those strategies are going to be brought to bear as they come into this assessment process. So when you are coming in to assess somebody, that is probably what you're going to meet. You're gonna meet somebody who's primed for something bad to happen. And because survivors of trauma protect themselves in lots of different ways, and not all of those ways are obvious to us, that can really affect how they present, particularly in these sort of first or early meetings, particularly when under pressure. 

We talk a lot in our reports around, uh, appearance, insight, their, uh, their engagement, their motivation. These are quite critical factors I think in our decision making about whether we think a parent is going to be able to engage in intervention and is going to be able to make positive changes. But actually, if you think about how do we assess those things, we're often assessing them through the dialogue we're having, the way a person presents emotionally, the way they describe things. And there are lots of things affecting parents in this moment that are kind of distorting that picture a little bit. 

When it comes to things like substance use, for example, we know that people may be at different stages in that cycle of change. And just because somebody is at a very early stage, maybe not quite able to acknowledge what's going on, it doesn't mean that there is not potential for things to move to the next stage. We often get worried when parents minimise concerns or deny that bad things have happened. And yet very often I think that is a self-protective mechanism against shame. Um, and I've found often once you start to engage with a parent and you work in a shame sensitive way, gradually that parent will be able to start to acknowledge the harm that has been caused. But in that first assessment, it's very, very difficult. I think there's always a degree of social desirability. People want to kind of, um, come across really well.

Very often at the start of intervention, a lot of the motivation, a lot of the drivers are extrinsic. And by that I mean they're coming from the outside. It's the social worker that's saying "You need to do this" or the school that's saying "You need to do this." That is not, I don't think, an unusual place for parents to start. They themselves have not necessarily reached a point where they think that something is a problem. That in my view does not mean they can't go on to develop what I would call intrinsic motivation, which is actually "Do you know what? I realise there's something for myself that needs to change for the better" but I think that may be a tall order for somebody right at the beginning of a process. 

Other things that I think we really need to think about are cultural differences. How cultural trauma has affected people. There are many misperceptions and missteps that can occur when we come from different cultures around how things are communicated, the language that's used, the non-verbal communication that can cause us to maybe misperceive how a person is presenting. But also many parents have experienced trauma and adversity and disadvantage just by virtue of their identity, whether that be due to their race and culture, their socioeconomic status, their gender, their sexuality. And they may bring with them the weariness of people who may be coming from a position of power, a position of authority. And again, that may well affect the interaction in these early stages. And we also need to be aware that we bring something too. You know, when you are going into make an assessment, you are also bringing your own, um, implicit biases. You are bringing, um, your previous history in terms of people you've worked with before and what you've seen happen before. Um, you're bringing your own level of cultural competence, but also potentially cultural biases that you may not be aware of. And the thing about implicit biases, we don't really know we have it. And so it's another dimension that we need to be just a little cautious and curious about when we are appraising how somebody is presenting to us that we're not bringing something of our own into that appraisal. 

And then finally, we have the impact of trauma itself. And we know that many parents and very often many mothers involved in pre-birth assessments will have experienced a lot of relational trauma, often very early in life. And that will have disrupted their ability to trust other people at a visceral level, even if they want to up here, you know, engage with us, even if they think "Oh, this person seems nice," the body may be sending signals saying "It's not safe. It's not safe." And that may show in non-verbal communication. People who've experienced a lot of trauma may struggle with emotional regulation, particularly within an assessment situation, which feels anxiety provoking.

So what you may get is either people being quite restless and agitated, people getting quite distressed, maybe even angry, or you may get people going the other way, numbing, dissociating and coming across maybe a little bit cold.

And the other thing, as I said before is that shame plays a big role here. Shame and trauma are often very interlinked. Often parents have been shamed and denigrated in the past. And very often when you're coming in and you're asking questions that feel potentially maybe like they're coming from a place of critique, um, uh, even if that's not how it's intended, what you may get is very defensive responses. This defensiveness is really a protective mechanism around shame. The reality is also is that a lot of parents who have experienced a great deal of trauma will be presenting with very complex needs.

You know, they may have mental health needs, they may have substance use needs, they may have difficulties in relationships, and you're coming in to assess and it may feel quite overwhelming. It may feel like there's a lot there. So right from the outset, trauma is pulling a lot of strings in our assessment process. And it's not that we can kind of crack all of that in one go, but it's really helpful to be aware of that right from the outset.

What we are wanting to do as soon as possible is establish some kind of connection to try and help to settle the other person's nervous system. It's so hard, you know, as Deb Dana says here, "Trauma compromises our ability to engage with others by replacing patterns of connection with patterns of protection." 

So we want to her hold in mind that before we get to the thinking clever bits, very often we have to establish a foundation of safety first. If I don't feel safe, I can't really settle in my emotions. And if I can't settle in my emotions, it's actually quite difficult for me to connect with you. And if I'm not feeling that sense of visceral safety and connection, then it's hard for me to access my upper brain. And it's the upper brain I need to think about the answers to your questions, be able to engage with you in the level that maybe you want me to. We need to work from the bottom upwards.

If we go too quickly, trying to get people to engage in very difficult questioning, you may find that people struggle. So one of the things I'm really holding in mind when I go in and assess people is that in this experience, that they're coming into with me in the room, there's a kind of 360 degree experience. There is what they are thinking about me, what they are sensing, smelling, touching, hearing. What they are feeling emotionally, physically, and how they are kind of sensing me and experiencing me in a relationship. And of course, because that person's mind and body is so tuned around trauma, they may well be very sensitive to certain triggers, any triggers to do with power, triggers to do with uncertainty, um, feeling scrutinised, feeling invalidated, feeling, uh, misunderstood, unseen. These are all of the consequences of having experienced relational trauma, new people, new tasks, new demands. All of these can overload the nervous system. And one of the real tricky things I think about local authority assessments is we're often treading around the exact location of a person's trauma.

Now, I'm not suggesting that we don't assess these things. We need to assess these things. You know, genograms are really helpful. But the minute you start drawing out a genogram, it's very likely that you are going to be touching on aspects of a person's trauma.

When you start talking about childhood, when you start talking about relationships - these are often the places where trauma happens. And so these will be the sore spots in that person's mind. And so we need to tread really, really carefully. And as I said, when we're treading around these things, very often what you're going to elicit is shame. And shame can often elicit, uh, defensiveness or avoidance.

This is from the Crown Prosecution guidance actually on pre-trial therapy. But it's a really helpful description. It says "Self-blame and shame are extremely complex. They can be factors in why many people avoid disclosing or fully disclosing aspects of traumatic incidents. Avoidance can also relate to fears of not being believed, fear of the potential impact of disclosure and reporting and fear of the accused." 

And of course, for mothers involved in pre-birth assessments, that fear of disclosure and the consequences will be very, very high because they will, of course, feel that anything they disclosed could actually be used against them within the proceedings.

And so I often think, you know, when I'm meeting a new person and I'm starting an assessment, I, I'm often holding in my mind that actually they are, you know, protecting themselves. They probably have a lot of kind of mental bodyguards that are on alert trying to keep me at bay. And so it's my job to try and help that person feel as safe as possible so that those bodyguards can maybe step back a little bit so I can just get to know them. 

We often have to ask about trauma and I think one of the things we need to think about when we're asking about trauma is to do it as safely as we can. 

That means that we need to be really transparent about the process - what we're gonna talk about so people can be pre-warned. We need to explain to people what's the purpose of this. 

You know, sometimes I use an analogy of saying, you know, it's like when you go to the doctor and you have to show the doctor where it hurts. You need to understand a little bit about what you've experienced in order to be able to know how we can help you. 

It's helpful to give people as much choice as you can. You may have a whole schedule of stuff you need to get through, but you can give people choice about what order that's done in.

When it comes to very sensitive experiences, just remember we don't need to know every single detail of what happened. We just need to know perhaps that something happened. I think our own curiosity can cause us to elicit more information than we need and bearing in mind that information's gonna go into a report that other people are gonna read. 

I think giving the trauma survivor as much control over disclosure as possible is a really helpful thing to do. And very often when you do that, survivors are able to manage that really, really well. The other thing to remember is some parents may have spoken about their trauma over and over again. Others may never have said the words out loud. And there's a real potential here for both harm, but also for healing if it's done in the right way. I think a sensitive assessment can really be a starting point for healing, particularly if you are able to validate and acknowledge the pain that that person has experienced. You know, then they have an experience of disclosure where they're believed, where they're listened to and understood and that's an incredibly valuable thing.

We also need to be thoughtful about how we're gonna take care of the information afterwards. You know, who, who is this information gonna be shared with? When and in what form? And it's really important that parents know that. Think about what that person needs afterwards, both immediately after the assessment when they may be feeling quite distressed, but also maybe in the future in terms of what they've disclosed. 

Sometimes I might say, is there anything you'd like me to do with this information? And it's really important that we as practitioners have the right training, the right supervision and support to know how to respond to disclosures, because it's not an easy thing to deal with. 

When we're thinking about screening for trauma, one of the things to be cautious of is that we don't want to just sort of throw universal screening measures out to people. It's not necessary for every single person to be screened for all of their trauma.

You wanna have a clear understanding of the nature and purpose of the screening.

You wanna consider the potential impact on the client and think about are there any other ways of getting this information? 

Quite often we have like a tonne of background information and we don't necessarily need more. Really think about what you need to screen for. Um, maybe you're actually looking for symptoms rather than experiences and think about where and when you are doing it and in what format. 

In general, we don't want to just dish out ACE [Adverse Childhood Experiences] questionnaires within waiting rooms. We want to be having sensitive conversations with people and giving them as much privacy, dignity and control as we can. 

And as I said, if we are gonna be the one screening, we need to feel that we know what to do with what comes afterwards. It's really important that your team has some kind of protocol for how to deal with ethical dilemmas and information sharing that can inevitably come about when people are talking about historical abuse, for example. 

I generally take a kind of point to where it hurts approach because actually working in a trauma informed way doesn't mean that we're actually forcing people to talk about their trauma. Very often, we know that someone's experienced a lot of trauma and that's probably enough for us to know for now, unless we're the person that's gonna be doing the therapy and digging around in it, maybe we really don't need to know that much at all.

But sometimes, what I will do is just say "Look, you know, I don't need to know any details, but some people have had very difficult experiences in the past. Have those sorts of things happened to you? Just you can just indicate yes or no and roughly how old you were." And sometimes that's enough. We don't want to leave people alone with it. So we do wanna ask, we do wanna inquire.

Um, we know that, um, a lot of people have suffered for a long time because they haven't been given the opportunity to disclose. But at the other end of the spectrum, I think if people are disclosing too much too quickly, they may not be ready to tolerate that. Um, and that could cause some destabilisation. 

So I think we can find a sort of happy medium here. I think one of the worst things we can do, which I think we do a lot in care proceedings, I'm afraid, is sort of get people to disclose loads and loads of detailed information about their trauma and then we write them in reports. Those reports are then used for the care proceedings, but actually no meaningful benefit ever arises for that person in terms of their recovery from trauma.

So I know that when we're assessing, we are assessing to think about what the needs and risks are for the child. But at the same time, I think we can also offer the parent an opportunity to start to think about and talk about their trauma in a safe way with a view to them getting some kind of help.

So just to pull this little bit on assessment together, I guess, you know, one of the things we can do from the outset is to try and minimise the degree to which we might trigger or re-traumatise a person in the process of assessment. If we have triggered someone, if something is difficult, because that may be unavoidable, the next best thing is to acknowledge, to say “Look, I know this is really painful to talk about and I'm sorry that I have to ask you this.” I think trying to meet people where they are, that goes back to building from the safety, building from that place of connection. You can't really rush people too far along. Um, because actually what you're gonna probably get is disengagement, trying to pace things, trying to be transparent, trying to bring that person along with you.

Um, and remembering that yes, this is an assessment, but also it'd be really great if this could also be part of a pathway towards help, um, for this parent, for this mother. Pay attention to these hidden relational dynamics. As I said, stay curious about what might be going on. 

Even if the interaction may be quite difficult or unpleasant, there may be a way of understanding that... that helps you to understand this parent and reflective practice is really helpful for this. Speaking in supervision about what happened and reflecting on the context for that parent. It's really useful as a practitioner to build your own language for the things that are hard to say. 

There are certain words that we can tiptoe around or subjects that we find difficult, and I think over time you kind of gradually find that form of words that is a little bit easier for people to tolerate and really make sure that as you are doing the assessment, even though you're paying attention to the relational. And as I said, you are inquiring sensitively around trauma.

It's really helpful to have some kind of systematic way of collecting and evaluating information. There's lots of frameworks out there, but things that make sure you go through all the different domains. 

And one of the reasons why that's so important when you're working with someone with a lot of trauma is that the emotions, the difficult interpersonal kind of dynamics can derail us from being systematic in terms of gathering the information that we need. 

So it's a hard balance to strike, but I think it's a really important balance to strike, because I think that how we assess a person influences in the longer term how, um, that person may engage, and it may well have an impact on the ultimate outcome.

It's not just a predictive validity that is important, but the method of assessment and dialogue, which impacts the engagement with any treatment plan, i.e. the method of risk assessment itself could affect the risk outcome. 

So let's turn to formulation. So this is the point where we've gathered information and now we're trying to make sense of it. And I think, again, what's really tricky about this is that how we evaluate something, how we look at something can skew what we see, what we observe is not nature itself, but nature exposed to our method of questioning. Within care proceedings we have hanging behind us, often some quiet kind of fixed, algorithmic, legalistic frameworks of thinking. For example, we have a tendency to isolate risk factors, you know, so when we do that, the danger is, you know, here we go. We say, well this parent has a mental health problem and that is what means that the child is at risk of harm. So what we need to do is diagnose that mental health problem and then we'll treat it and then the child will not be at risk of harm. Now, I'm sure you can see the flaws in that, uh, on many levels. One is it assumes that diagnosis is something that is a kind of perfect and fixed process, which I'm sure you are aware it isn't. You'll probably meet many parents who've got multiple diagnoses that seem to change from one assessment to another. It also assumes that treatment, um, is a, available and b kind of works perfectly to eliminate risk. And the biggest problem with this though, is it ignores the complexity of people's lives. And the reality is that if you look at how, for example, a parent's mental illness might affect their child's mental, physical wellbeing, there are many, many factors not just to do with the parent, but to do with the way the parent interacts with the child to do with other systemic resources and stresses that will impact the outcome on the child in a complicated way. So the danger within care proceedings is that we're always reducing things to very sort of simple arguments when actually we're talking about very complex, um, people and complex families. The other tricky thing I think in proceedings is there is a tendency for all of us to, um, reach for the shiny object. And by that what I mean is there are often certain things in an assessment that will jump out at us. If you, if you look at this, um, slide for a minute and think about what's jumping out at you, some of you might pick out, um, the psychotic episode. Some of you might pick out, you know, the ex-partner being on the sex offender register. And those may well be the key risks, but actually they may well not be, they may well be risks that are very historical or have been dealt with. It may be that the overcrowded home or the leak in the bathroom is the thing that is causing the most stress on this parent at this point in time. So we need to be watchful about what our mind tends to get drawn to and what we think is important. 'cause we are in danger of making assumptions and I think we need to be clear about what are we formulating? We use this term formulation. Well what does it mean? Um, formulation generally means coming up with some kind of understanding or explanation of what's going on. But this is complex again, in care proceedings because we're thinking about the child. That's our primary, um, focus. So we're thinking about, you know, what is impacting upon the child's wellbeing. But when we're assessing the parent, we're assessing a whole bunch of other factors. 

Risk indicators like domestic abuse and substance misuse. There are things that we know will directly impact on the child's wellbeing, but we're also looking at all these contextual factors from the past to think about, well how do those factors influence the risk indicators and how does that influence the child? So again, when we use the term formulation, we need to be really thoughtful about, well what are we formulating? 'cause actually it's quite complicated. So another way of thinking about this is if you were to think about formulating just one thing, so an episode of using substances. So let's say a, a parent had been abstinent and then they lapsed because they were visiting some friends in the yellow, you might say, these are the proximal factors, these are the things in the moment that led that parent to pick up. You know, that they were with friends who were using, maybe one of the friends had said something cruel to them and they were feeling quite triggered and upset and maybe they felt the strong emotional need and maybe in the moment they really struggled to hold onto the consequences. You know, so their decision making was affected in the moment, but those proximal factors are actually affected by a whole bunch of other contextual factors that might have influenced why this parent was at the party. Maybe other stressors that are going on at the time, maybe they haven't had access to the treatment that they need to be able to sustain their abstinence. And we might think about those as sort of contextual or ongoing stresses. And then of course we've got all the historical stuff that is in the red that happened before the parent ever picked up a substance, which may be to do with, um, their genetics, but it may be to do with what they experienced in utero in their early attachment or in their environment when they were growing up. That meant that they developed a particular way of experiencing their emotions and dealing with social situations and problem solving, which meant that they were more likely maybe than another person when presented with substances to be using them to, to, to cope with or deal with a particular situation. It's really just to illustrate that even when we're just talking about one behavior at one point in time, there are many, many factor that might influence why this person did what they did. You know, one of the things I see is that over time, and I think this really affects mothers who are involved in recurrent care proceedings over time, a more and more simplified and fixed story seems to embed within the system. And I think that's just to do with files and information moving between teams and getting summarized. And very often the person's history gets reduced to soundbites, gets reduced to a series of headlines about things that have happened. I think one of the things we need to do when we're formulating is to be a bit critical about where has this information come from? Am I getting this from primary source or has this been passed on through 2, 3, 4 sets of proceedings? So trying not to take for granted the information that you've been given. If it's been given by second or third hand sources try to get the original sources. I'm often asking for what was the verbatim report? 

Can I see the actual police report of the incident? Consider the interpersonal influences on what is recorded and indeed the practitioner related influences on what's recorded. We make decisions as practitioners about what we write down in the notes. If we're carrying biases, that's going to play out. If the parent has got very strong self-protective mechanisms to do with their trauma, which practitioners find unpleasant very often this will also influence what's being recorded and what's being passed on. I'm really always curious about what has been tried in the past and have any barriers been addressed. You know, very often parents are referred to one service after another after another, and there's this kind of building narrative of non-engagement, non-engagement. I'm want to be really curious about why, and in particular I want to be curious about whether trauma has played a role in that person's non-engagement with services to date. Are there any untapped resources, any opportunities for change that haven't been explored? Parents who have complex needs relating to trauma because of the nature of those needs and how overlapping they are often bounce between services. Getting a little bit of help for this here and a little bit of help for this there, but very often not getting help for what's really underlying that in terms of the trauma. So I really also want to know, has there been any attempt to look at this parent's needs through a trauma lens before? Has there been any attempt to engage this parent in a trauma-informed way? 'cause again, that may be something that hasn't been tried yet and there's an opportunity. I'm always trying to harvest strengths from the information as well as risks. I ask myself a question, why isn't it worse? And I'm also looking for what is not there as well as what is there. Um, we have a a natural bias towards saying, well this person did this and this person did this, but actually maybe this person has never been in an abusive relationship. Well that's a strength and I wanna write that down and be systematic again, as I said before, um, it can be helpful again in your formulation to use some kind of framework to make sure that you are not getting into biases in terms of how you are appraising the information within a trauma-informed framework. We really want to be curious about behaviors. Yes, behaviors may be very risky and very concerning and they may well be things that absolutely need to change. But what we can also do is try and think about is there any connection between this behavior and that person's trauma? Because that will give us real cues as to how that person might be able to change. Seeing past tricky behaviors is an important aspect of trauma-informed work. And I think one of the difficulties is, is particularly when we're faced with a lot of tricky behaviors, we actually develop implicit formulations. We don't even know we're doing it. We all do it. If you think about some of the language that we use, disguised compliance, uh, this person was unwilling to engage. They prioritized drugs over their children. They were unable to see risks, they lacked insight. They were unable to parent because of their trauma. Hidden in each of those statements is an assumption about the cause of the problem. Disguised compliance suggests that that person is somehow willfully trying to deceive professionals. And that may or may not be the case, but quite a lot of times what's happening is a parent is really frightened and just trying to sort of give professionals 

what they think they need to give them whilst trying to kind of keep a distance and protect themselves. When we say a parent prioritized their drugs over their children, it kind of gives this idea that the parent was like sitting there going, you know, my drugs or children, my drugs or children and then just chose the drugs and knowingly kind of placed their children at a lower level of priority. And I just don't think that that's how it happens. I think it's not necessarily a conscious choice, but parents are often very caught within addictive processes. They are often using substances to self-medicate, and the fear of the feelings that come when they don't use is often getting in the way of them being able to make, um, clear sighted appraisals about what's in the best interest for their children. So we want to be really careful to separate fact from opinion. We want to distinguish evaluations from observations, you know, um, I might see a person, um, shouting or, um, slamming a door, but if I call it aggressive, I'm evaluating that behavior. I may, um, describe a person as asking for help, but they're not accepting help, help when it's being offered. But I might label that as manipulative. That is a label. It's not a description and there is an assumption in that. So we want to really distinguish what our hypothesis is about the behavior from the factsthat are in front of us. It's absolutely okay for us to state our hypothesis, but make sure it's clear, which is which I saw the parent do X, Y, and Z. This is what I saw. My opinion is that this was related toor driven by such and such. 

As I said before, I really wanna dig into the role that trauma might have played in a parent's journey through services so far. And not just their historical trauma, but, and this is particularly true for parents, um, and mothers involved in recurrent care proceedings, I also want to think about the trauma that they've experienced through separation from their children through being involved in care proceedings and the interactions with professionals along the way, which we know are significantly impactful for parents.

We wanna ask ourselves some questions, you know, how do we think trauma has interfered with this person's capacity to engage and take things on and use the tools that people have been trying to get them to use? 

How has trauma got in the way of them being able to understand their children's needs?

How has it got in the way of them being able to stay mentally present in the groups that we've sent people to? 

For example, I'm really wanting to know also about that parent's own understanding of their own trauma. Some parents have got a good language about their own trauma. Some parents have absolutely no idea that there's any link between what they're experiencing now, their suffering and what was done to them in the past. 

I really want to know how professionals have viewed them in the past and I want to think about where are they in their journey of recovery from trauma. Have they already done lots of psycho-educational work? 

Have they got a good understanding? 

Have they already done some therapy or actually have they never, ever sat in a room with anybody for more than about 10 minutes to talk about how they feel about things? 

Once I know what stage of person is at, then I can think, well, what building blocks do we need to put in place to help that person move to the next stage? If they're very early, the building block may just be around attending an appointment and coping with being in a room with someone. For other people it might be developing a language for their emotions that they've never, ever had without. Those building blocks are very difficult for people to engage in.

The other things we want them to engage in. And I also want to ask myself a question. How will I know when this person has moved forward? 

I think the more we understand that this is a journey of recovery when we're talking about complex trauma, the more we can think about where is that person. What do they need to move to the next bit? And how will we know, um, that they're actually continuing to move forward? 

And in that regard, what I really am interested in when we're thinking about pulling a formulation together is to move away from lists and move towards stories very often. And we all trained in this way, you know. We're kind of trained to kind of come up with a list of risk factors and a list of protective factors and how that affects the person's presentation and how that affects the risk to the, the child.

But actually, whilst that tells us something, it doesn't really tell us the story about where that person is in this journey. Um, and it doesn't tell us about the relationships between each of these things.

When I'm formulating, I want to actually describe how the nuts and bolts all kind of interact with each other. How each cog turns the next cog. And so it's helpful to operationalise as much as you possibly can. 

So if we're thinking about... we know this child, for example, may be at risk of harm. We know that their physical emotional needs haven't been met in the past, then we work backwards and we say "Ok, we know that there are parental behaviours that have resulted in this. The parent has been sleeping a lot, they've been spending a lot of food, money on drugs. They haven't been able to respond emotionally. Those are the behaviours that the child has directly experienced." 

Well, ok. So let's take a step back from there. Why has that parent engaged in those behaviours? Well, they have an addiction to heroin. They've been experiencing very low mood and they're very socially isolated. 

And then we can even take another step back and think, ok, but what's been driving those things? Well actually, there are things that contributed to the onset of heroin use. This person experienced childhood trauma that led to, you know, emotional suffering. And also they were in a neighbourhood where there was a lot of drugs around. Those things meant that they were more likely to pick up and use heroin and find it a helpful way of managing emotion.

But we also want to think about what are the things that are keeping it going in the here and now? Given that it started, why hasn't it stopped? Well, maybe this parent has really, um, low self-worth and actually is not really able to recognise that her absence, her emotional absence from the child is of any importance to that child because maybe she never had much of that herself. So she doesn't really know it's a thing.

And maybe there's a physical dependence that's making it hard to stop. And maybe this person is hugely anxious about entering treatment because they've never talked to people before about their feelings. They're anxious about meeting new people and those things are meaning that this parent is staying stuck within this addiction. 

But there are also may be things that are stopping it getting worse. And maybe this parent does try to, doesn't want to protect her children. Maybe she's using a loan, which would be helpful in the future when she's trying to stop, because she doesn't have all these associates around her. 

Maybe she has a secure tenancy, so at least they haven't become homeless and maybe there is some family nearby who are the ones who have been able to kind of raise the alarm that something is not ok. 

So this is what I mean about building a story. And one of the problems with proceedings, as I said, is that it's legal. And so it pulls us often into very dialectical thinking. We're in an adversarial process. Um, very often we're asked to make an evaluation. Does this parent have capacity or not? These dialectics, I think are not very helpful in our formulation. You can see that there's a poor fit. Um, it suggests that there's this kind of point in time where you can just sort of look inside a parent and go "Yes, they have capacity" or "No, they don't have capacity." 

In reality, as we've described, parents' lives are dynamic, the children's lives are dynamic. They're within a broader context of shifting and moving all the time. And so one of the things we want to think about is, yes, we might be doing an assessment at this point in time, but we also want to think about where that fits in in the overall trajectory.

You know, some parents... we might be assessing right at an early stage when they've just started using, and we might be thinking about, you know, um, what's gonna start them escalating.

For some parents, they may have been through the cycle of stopping and starting again and stopping and starting again a number of times. And there may be different factors involved each time.

You know, sometimes a parent stops because there's been a change of partner or they've had a particularly useful worker in their substance misuse team, but then that worker leaves or then the relationship breaks down or somebody dies and then they relapse.

When we want to establish people into sustainable recovery, we need to understand all of these, um, factors and that this is a dynamic process. Recovery from substances, and I would argue from trauma and other issues, including domestic abuse. It just doesn't happen up like that. It's not this thing where we go "I wasn't ok, and then now I'm ok." 

It's, you know, a bit bouncy and a bit up and down. And so the difficulty I think in formulating is we have to look at that pattern and then consider the children's timescales alongside that to think about, well, is this gonna work for the child? 

So this kind of moves us into thinking about intervention planning, because one of the things that happens is we often come up with this kind of list of risks, this kind of sort of shopping list of things that parent needs to go and address. 

So I like to try and change these kind of static risks into dynamic opportunities. So if a parent has a history of offending, then the dynamic opportunity is how can we build their relationship with probation?

If a parent has a history of exposure to trauma, then the dynamic opportunity is can we start to help them build insight into the impact of their trauma?

If a parent has experienced the previous removal of a child, maybe the dynamic opportunity is to come alongside that parent to help them understand the reasons why that happened and how they can change things for the future.

If the static risk is that they've been using substances, the dynamic opportunity is building their motivation to change. 

If a static risk is a history of mental health, maybe a dynamic opportunity is working with a parent to reduce their feelings of stigma so that they can engage in mental health services. 

When we're planning these interventions, we need to really think about what order they come in. You cannot peel an onion from the inner layer first, so person is not yet stabilised in terms of their substance use. They're not going to be able to benefit from parenting work or trauma work. 

I think within care proceedings there's this terrible pressure on parents to do all of these interventions and to do them all at once, and I'm not sure that that really helps people. I like to try and work out, you know, where is this person at in terms of their recovery from trauma, you know, so if this person actually is struggling to connect with anybody, then the first priority is just to stabilise into a regular pattern of attendance and just to start to get that conversation going.

Some parents are coming in particularly into recurrent proceedings. Some mothers actually have been able to do some work and are actually ready to hit the ground running, in which case, we'll meet them where they're at there and think about "Ok, what do they need right now?"

The reality is that although I know there is a lot of pressure because of the timescales and proceedings, pushing parents too far, um, when they're not ready is not necessarily helpful. I think if we can meet people where they are, we've got a, actually a greater chance of getting to where we need to go.

The other thing I think is important is to think about what your assumption is that's underlying the choice of intervention. So again, we tend to have this kind of shopping list approach where we go, a person has experienced this, this, this, this, and therefore they need this, this, this, this.

Now I'm not saying that any of these interventions are not valuable, for some people they absolutely are. But they're not necessarily valuable for everybody. And each one of these interventions is linked to an assumption about what we think is driving that issue.

So if you are referring somebody to a psycho-education programme around say domestic abuse or substance abuse, you're kind of assuming that the reason they're continuing to do those things is because they don't know about, um, what to do differently, or they don't know that this is a harmful thing. But actually parents have often been through many psycho-education groups. What they really need is support with dealing with the emotional barriers.

And the same thing goes with things like, um, behaviourally-based parenting programmes. Again, that may be really useful for a parent who's just never had that and so will really enjoy building up those skills. But some parents absolutely know what it is they need to do, but again, maybe their emotional needs, their past trauma, may be getting in the way of them doing that. 

So if the intervention is based on a, an assumption about the parent that's not correct, it's just not gonna work. And I guess the final thing I think, which is sort of not necessarily within our gift as practitioners to necessarily deal with... we still have this division between services that's based on budget lines, based on government departments and absolutely not based on an understanding of how people's minds actually work. And so parents are often getting sent to here to do mental health and over here to do parenting and here to do substance misuse when really all of this is part of the same thing for them. I think as much as we can be that person that's trying to get the system to think together and work together, and the more we can access integrative interventions for parents, I think the more successful they'll be. Particularly if you think about mothers who are pre-birth and pregnant, you know, schlepping between this place and this place, you know, to be able to give them something holistic, um, urely makes more sense. 

So I think the other tricky thing that comes up a lot, um, when I'm working in care proceedings is how do we measure change?

How do we know this is safer, better than it was before?

As I said before, we're looking at a dynamic picture. We're looking at something that's happening over time, but we have this starting point of going, well, we know this child has been exposed to risk and harm. We know the story about what's kind of brought that about. And what we're trying to do is offer interventions and see how that parent responds to the intervention and then maybe offer another intervention. And that cycle may have happened across a long period of time through child need, child protection and so on.

But we want to be seeing is there any change being made? And if not, why not?

What are the barriers?

What's stopping things from changing over time?

That picture of how a parent is responding to intervention gives us some indication of maybe how things are gonna be in the future. And so when we're coming to our decision making, we're wanting to pull together not just the static assessment of the historical risks and strengths, but this dynamic assessment of how things have changed over time, what's worked, what hasn't worked, looking at the evidence base, looking at how they respond to crises, which is often a really helpful way of testing out whether a person's change is sustainable. And then we've gotta kind of integrate all of that with thinking about what does this mean for the children, the children's needs and their timescales. Again, it's kind of trying to get to the story of things to make our decision. When we just look at a slice of time that can be a little bit deceptive. We might, over a period of a couple of months see something that looks pretty hopeful. We might be involved in another period of time and see something that looks pretty discouraging and concerning, but sometimes it's only when we look at the whole picture that we have a sense of whether there is really something happening over time. Is there any sustainable, meaningful change happening over time? And I think for mothers who are involved in recurrent proceedings, this is particularly important because actually we probably have got quite a lot of information about what's happened over a long period of time that we can draw on. And we have to get away from this idea, as I said, of there being this fixed point where a person is changed. You know, I've done the work and I'm changed now, so nothing bad will ever happen again and I can never be unchanged. Recovery goes up and down. What we want to see is whether people are looking more robust than they were before. I think the other problem with this is it puts us under immense pressure to sort of know when this point is and then we say, we think that this is positive and then something else happens and then we feel like we got it wrong or we didn't get it wrong. It was positive at the time, but things have shifted.

What's important is to think about, okay, so what were the dynamic risk factors that came to play here?

That means there was a bit of a downturn, and how can we mitigate those in the future?

Another thing to consider in terms of how we measure change is there is a tendency for us to measure change through the things that are easily measurable and observable, which is understandable. So we tend to look at things like attendance, drug testing, where the parents admit to what's happened in the past. Do they accept threshold police reports, psychometric reports, and so on and so forth. Those feel tangible, those feel, um, robust. But actually when you are working with people with complex trauma, all those are really telling you is what's poking above the water. Um, these are the visible behaviors. They're not necessarily telling you anything about what's happening underneath in terms of psychological change. So it's not to say that we shouldn't take this evidence into account, it is really important, but survivors, the relationship between their behavior and what's going on underneath is quite complicated. I'm really looking for, um, parents to be able to acknowledge that they've been through suffering and also to acknowledge that their suffering has led to things that have probably caused their children to suffer as well. I'm looking for parents who can make links between what they've experienced and the patterns that they get into in the here and now. I really want to hear parents talk about the future with a sense of realism and to hold onto an openness for future help if things go wrong. I'm really reassured when I start to see parents actually living, connecting with new people, with safe networks starting to feel closer to their children, starting to build more positive relationships with different professionals and different services. They wanna see evidence that parents are able to tolerate their emotions and connect with their own emotions, not just shut them all down, that they can problem solve, that they can reflect on their own thoughts. And I also want to see evidence that parents can have some relationship with themselves and value themselves as as human beings. This is such an important part of recovering from trauma. 

Well, finally, I just wanted to say a little bit about reporting. I think we don't talk about this very much, but of course a lot of what we do in our assessments gets put into a report and that report gets shared with people and scrutinized and read by parents and read by families and all of the parties. And I just wanted to share with you some lived experience around this. For some parents who've been through proceedings, my truth being used as a weapon against me, you know, any childcare kind of proceedings works around trauma. You know, it isn't for the faint hearted. And when you're having to have your trauma and your life dragged up with professionals that don't have a clue about you other than what's on a piece of paper, they used it against me. They tried to put it up in court as a reason to be against me for having my children back with me as evidence for why the children shouldn't return home, rather than have any compassion or trying to have any understanding of why I came into this situation I did and why my illness became bad. And so you can hear these mothers describe how having their trauma talked about and written about and kind of used as a reason for them not having their children in their care was immensely distressing for them. Um, so when I'm writing a formulation or when I'm writing a report, I really want to try and tell a story that is accurate, but that is also one that can be heard by the parent because that may be important for them in understanding what's gone on. And so the first thing I want to think about is my language. If my language is very triggering and very jarring, it's gonna make it difficult for parents to read the report. We have a immensely rich language, we've got lots of other options. So I think some of these phrases that we use like, um, you know, Mrs. Brown's Chaotic Drug Use or Mrs. Brown has failed to engage neglected her children. I think there are other ways of saying the same thing. You know, Ms Brown's Day-to-Day life is affected by her drug use. Um, she attended one out of the 10 sessions. She's struggled to meet her children's basic needs. Um, finding a language that doesn't, um, minimize the concerns, but also doesn't trigger feelings of shame. The other thing is accuracy. So many parents are triggered when there are even small mistakes in reports. And we might think, well, that's not a big deal, spelling of a name. But given that this report may be deciding their life, given the power that we have in our hands when we make mistakes, it means that maybe we can't be trusted. It makes us seem unreliable. And I think that can be a real threat cue for parents. Conversely, I think if we can write the reports with compassion, if we can talk about trauma with care, then we can actually provide some containment and healing for the parent as they're reading our report. This parent says, humanize the reports as well. I really struggled to read reports that spoke about me like I was a case and not a person.I found it helpful when professionals would talk about me holistically. I appreciate that you are writing a report on my drug use, but make me a person who uses drugs, not just a drug user, if that makes sense. I want the formulation to be digestible and written in really plain, straightforward language. I think parents have a right to know exactly where we're making the decision we're making, and therefore that decision has to be articulated in language that they can understand, in a story that they can follow. 

But on top of that, as I said before, there is an opportunity here to start a healing process. Narrative is often felt to be an important aspect of a person's recovery. Very often parents are carrying stories in their heads that they are bad, that they are broken, um, that they are shameful. And actually, if we can start to tell a different story, a story that is more trauma informed, that they have been harmed and hurt, and that these harms have led them to protect themselves with certain things that have got them to this place, then that is a much easier story for them to carry, and one which opens more doors in terms of their recovery. So I really want to think about the narrative that I'm sharing. I really want to support parents to change their relationship with their own history so that it isn't just this dark thing shut behind a closed door, which is all about them being bad into something that is not pleasant, but it's something they can start to look at, start to tolerate and start to understand. The other thing is that this story is a story that may well be read by the child in the future. I think it's really helpful when you can write this narrative and write this story with the child of the future in mind so that they can understand that this was nothing to do with not being loved or not being wanted. This was nothing to do with a parent being, um, evil or bad. This was to do with a parent who had been harmed and who was struggling and therefore struggled to care for them. Bessel Vander Cox says, as soon as the story starts being told, the act of telling itself changes the tail. The mind cannot help but make meaning out of what it knows. And the meaning we make of our lives changes how and what we remember. When we start to use actually our left brain, our more verbal brain to make sense of things, um, we're actually helping people to process their trauma to some degree. But when we write things in ways that elicit shame that are very triggering, we cause people to shut down. So just give you a little bit of an example for comparison. Maybe a typical report or ordinary report might say something like, Ms.P has struggled to prioritize her children's needs due to her ongoing drug use and dangerous relationships. There have been several attempts by professionals to engage Ms.P, which have not been successful. She often presents as angry and reluctant to discuss issues in meetings. She was referred to the Freedom program but only attended one session. She has also failed to engage with her GP for help with her mental health. Ms. P's own upbringing was characterized by violence and drug use, and it is likely this has impacted on her parenting. Sadly, Ms. P continues to use drugs and there is evidence that she's still in contact with her ex-partner. This means that the children are ongoing risk of harm despite our efforts to help her. Now, there's nothing wrong with that. It's accurate, it's clear, but there's quite a lot of words in there that probably would trigger shame. The story feels very much around her being pathological. So just to give you a comparison about what I mean, um, this might be a kind of slightly more trauma informed approach. 

Ms. P disclosed several traumatic experiences during her childhood. The background documents confirmed that she spent several years in care moving between placements, which broke down. These experiences are likely to have affected Ms.P's emotional and social development to the extent that as she became a teenager, she was more at risk of using drugs and less able to protect herself in relationships. Unfortunately, Ms. P's emotional needs have not been understood by the services that she has worked with leading her to being discharged because she was seen as uncooperative. However, it is likely that Ms.P has found it very difficult to trust professionals that are a part of a system that she feels let her down so much in the past. Sadly, this has led to a situation where Ms.P has continued to use drugs to manage her overwhelming emotions and where she has struggled to separate from a partner who has been very violent to her. This has made it difficult for her to protect her children and meet their basic care needs. And so we are still saying the same thing. We are still saying that the situation is still concerning and the children are still at risk, but we're also telling a story about how we got her and one which we hope will be one that Ms.P can understand, but also professionals can understand and think about. Maybe if this mother was to come back into care proceedings at a later date.There are some doors open here for things to try in the future. As we come to the end of this, um, discussion around trauma and assessment, I just wanted to share with you some more survivor voices this time describing their experience of having had a trauma informed approach to assessment and intervention within proceedings. Just taking that time to look at me as a person, you know, as a mother, as a person that has had a bad childhood, has had a very traumatic childhood, traumatic adulthood, you know, and actually giving me space to feel safe to grow and bond with these people. Because the empathy was there. I wouldn't even be sitting here. They showed me understanding. They taught me about the trauma, and also they made me be kinder towards myself and love myself, which I didn't have and except me for me. And understand that everything's okay, that my trauma doesn't have to define me or my future. Thank you for listening. 

In this film, I will be describing a pre-birth practice framework that was developed with funding from the Department for Education and the NSPCC [National Society for the Prevention of Cruelty to Children] explicitly to help frontline practitioners such as social workers to undertake pre-birth assessment, that is assessment of pregnant women, about whom there are concerns in terms of the risk of harm to the unborn or newborn baby. 

Effective pre-birth assessment is the cornerstone to preventing child abuse from the very beginning of a child's life. A range of risk factors that compose a threat to either the development of the unborn baby during pregnancy or the safety of the newborn infant exist. Assessment during the pre-birth period, such as... should as such be aimed at the identification of risk factors that either pose an existing risk to, uh, the development of the unborn baby. And that can be the focus of supportive intervention aimed at the reduction or elimination of the risk behaviours during pregnancy, or that may pose a future risk to the newborn infant and should inform, um, decisions about the legal steps that need to be initiated, such as, for example, uh, pre-proceedings to protect the newborn baby or be the focus of targeted and evidence-based interventions, um, to reduce or eliminate, uh, the factors that have been, uh, identified, uh, prior to the birth of the infant. 

This pre-birth assessment model is underpinned by the use of structured professional judgment, so that is, uh, the judgment of the, uh, social worker in terms of their, uh, day-to-day interactions with the families, but it's also supported by a range of evidence-based standardised tools and methods of working with parents, um, that can be, uh, utilised as part of, uh, pre-birth assessment. 

Also, central to this model is, um, the assessment of parental capacity to change. This is a more effective way of, um, assessing risk to an infant, uh, by moving really from a one-off cross-sectional assessment of risk to a much more dynamic assessment of their capacity to change, uh, by looking at their, uh, the, uh, risk factors that are present, uh, before an intervention and then, uh, after, again, after they have received, uh, support. So this assessment framework is really underpinned by the very latest empirical evidence about development during pregnancy and, uh, the post-natal period, um, in terms of what we, um, now know about the factors that can have a, a significant impact on the long-term wellbeing or, uh, development of the child. 

So this pre-birth practice framework, um, involves six stages, um, that should ideally be undertaken, um, as early on in pregnancy as possible, and ideally before, um, 18 weeks. The first stage is the pre-bi... in the pre-birth assessment should really begin with information gathering. This should include speaking to the family to gather a social history and to collate information. Also, um, from external agencies and practitioners, there are a range of standardised and validated assessment tools that can be used at this point of the assessment process. Um, if the parents refuse to engage, uh, then the pre-birth assessment must of course proceed through the gathering of information from, um, external agencies and, uh, practitioners. 

The Department of Health Assessment Framework that was, uh, updated in 2013 specifies a range of dimensions, uh, that should be assessed across three interrelated, uh, domains. So that is parenting capacity, family, and, uh, environmental, uh, factors. And what we've done is update, uh, this pre-birth department of health assessment framework, uh, so that it's, uh, based on, uh, the factors that are relevant to this particular period. Here you can see a template that is populated with some of the key factors, uh, that we now, uh, uh, recognise to represent risk to an unborn or newborn baby alongside some of the, uh, protective factors that might reduce concern, um, if present. And these are the sorts of factors that have, uh, been used to populate, um, the, uh, the assessment framework. 

Here, you can see, uh, the same template, uh, but with some further risk and protective factors, uh, that have been, uh, identified as being core for this particular, uh, period. I talked earlier about the use of validated, um, standardised tools. So this framework provides practitioners with a range of the, uh, sort of, uh, standardised tools and measures that can be used easily, um, by social workers to assess, uh, some of the domains that are part of this model of pre-birth assessment. Um, most of these tools can be used both at the beginning of the, um, assessment time, as time ones we call it, and then again, uh, with parents who have been supported to, uh, address any of the, uh, problem areas, uh, that need addressing, um, at time two, I'll say a bit more about that in a moment in terms of, uh, the, uh, assessment of capacity to change. 

So the second stage is known as case conceptualisation and basically involved evaluating and making sense of the needs of the unborn baby in the context of the prospective family environment based fundamentally on all of the data that's being collected as part of the, um, core assessment. Information gathering is, uh, of course a key part of core assessment, but also it is also key to this really is the way in which you then make a sense of the data. And you can see here, uh, uh, the resilience matrix, which can be used during or at the end of the data gathering process to help practitioners to organise the material that has been collated, um, to produce a, a, a rather nice visual map. 

And this matrix really supports the integration of information about the unborn baby or child, the family and the environment, and supports practitioners to focus on the impact of these factors.  

Um, in terms of the vulnerability of the, uh, the baby or, or the child Evaluation of the quality of the information that has been gathered can also be helped. Uh, if we use, uh, this discrepancy matrix that you can see here, there are five kinds of discrepancy in relation to data, uh, that's collected during an in as... an assessment, um, including, for example, contradictory information from different professionals about a family, um, different professionals, drawing different conclusions from the same information, uh, where parents' intentions are contradicted by the reality of their actions, um, where the way a parent talks about their child is inconsistent, contradictory, or incoherent. And also, uh, just the, you know, the workers' intuition, their professional judgment, which suggests a concern that is, uh, that is hard to, uh, that's, that's hard to pin down. 

And this discrepancy matrix shown here can be used to identify, um, some of these discrepancies and, um, uh, and, and really also to identify where information at a fam, about a family is, um, unknown or missing. 

Stage three of the pre-birth assessment involves, um, taking the information obtained during the cross-sectional assessment that I've referred to earlier on to identify and agree, um, a set of defined goals with families, um, using, uh, tools such as, um, goal attainment, uh, scaling. Um, this slide shows you, uh, an example of, uh, goal attainment, uh, scaling that you can use directly with parents to not only identify the area of concern, but also to make clear the type of changes that need to happen. 

Um, in terms of, um, you know, the amount of change, um, for any concern to be, uh, reduced, a range of methods of working have been identified to support pregnant women and their partners. And, um, some of the key areas in which support can be given, um, using evidence-based approaches include, um, promoting the parent's capacity to regulate their emotions, um, developing the mother's capacity for mind mindedness or, uh, reflective functioning, um, her relationship, thereby with the unborn baby, the relationship between the couple, um, and also, uh, support with, uh, mental health and, uh, substance dependence. In addition, of course, to help with practical issues such as housing and finance.  

Stage five involves the re-administration of the standardised tools that we used in stage one as part of the cross-sectional assessment. Um, this step may also involve you compiling additional information from, uh, for example, your own professional observations regarding the parent's motivation and engagement, and, uh, other factors that have either, um, supported or hindered the parent from achieving, um, the necessary change. This time, the data allows you to objectively report on the specific factors that have changed and why, um, including the extent of changes and the level of engagement with the goals and the, um, intervention or support that's been, uh, provided. 

This slide provides a template for the recording of the data that you've collected as part of your, uh, capacity to change assessment.And then the final step in this practice framework involves an overall assessment of, uh, resilience and risk alongside, um, the use of, uh, this risk, uh, matrix to assess the overall level of, of future risk to the infant. 

So this framework really provides a model of organising the data, um, that has been collected as part of each step of the process, um, to assess, uh, risk, uh, resilience and capacity to change. So it's addressing things such as how well did the parent engage with the process? Um, did they appear to be motivated to achieve change? Um, which of the tools that we used showed, um, a need for further improvement, uh, was the improvement that was changed, that was observed, sustained over time? And was it sufficiently great really to be confident about, uh, the safety of the unborn baby, uh, going forward? And as I mentioned earlier, uh, the risk matrix, uh,  this has a tool that has been, uh, uh, has, that has preliminary evidence showing its accuracy as a method of, uh, uh, predicting, uh, future risk. It's fairly, uh, self-explanatory. 

So that's the, uh, the, the process really for assessment of risk. This all needs to be undertaken, um, within, uh, you know, the, the wider, uh, context. Uh, think in terms of thinking about, uh, you know, pre-birth court procedures, um, planning, uh, for removal, uh, if that's necessary, ideally to permanent foster care placements. And, um, of course the use of, uh, good practice guidelines, uh, for, for any removal, uh, that's needed. 

Aimed at senior leaders in social care and health service, this briefing explores pre-birth assessment. It calls for a review of local assessment practices and encourages improvements in policies and protocols to better support families during the critical perinatal period.

This podcast from the NSPCC explores effective pre-birth assessments in children’s social care, discussing good practice, common challenges, and how the NSPCC's pre-birth assessment tool, Graded Care Profile 2 Antenatal can be used to support timely and informed safeguarding decisions to support parents. 

Lushey, C. J., Barlow, J., Rayns, G., & Ward, H. (2018). Assessing parental capacity when there are concerns about an unborn child: Pre‐birth assessment guidance and practice in England. Child Abuse Review, 27(2), 97-107. https://doi.org/10.1002/car.2496 

• Broadhurst, K., Mason, C., Bedston, S., Alrouh, B., Morriss, L., McQuarrie, T., Palmer, M., Shaw, M., Harwin, J., & Kershaw, S. (2017). Vulnerable birth mothers and recurrent care proceedings. Lancaster University.
• Mason, C., Broadhurst, K., Ward, H., Barnett, A., & Holmes, L. (2022).Born into Care: Developing best practice guidelines for when the state intervenes at birth. Nuffield Family Justice Observatory.