Key message three: Pre-birth work requires a specialist focus

The benefits and pitfalls of having specialisms within children's social care has long been debated. There are, of course, benefits, but also challenges of specialist practice. However, what the born into care work demonstrated was that practitioners did feel the pre-birth work was different in children's social care, and equally midwives felt that working with women who were at risk of safeguarding interventions and separation from their baby at birth was also a specialist type of work and required a different set of skills and knowledge.

Where no specialist team existed within children's social care and unborns, pregnant women were being assessed and worked with within generic teams, they often were not given priority because of the competing demands of practitioners working with other children at risk in the here and now. The pregnant woman and her unborn baby fell down the priority list. As I've already discussed, pregnancy is such a short window in which to do the required assessments and provide the help and support to bring about the changes and a allay professional concerns. Where there is delay in starting that work that opportunity diminishes even more.

In areas where there were specialist children's social care teams or where there were specialist vulnerable women or safeguarding caseloading midwives, we were told that improved interagency communication. Relationships were formed between those practitioners. It provided consistency in relationships, not just between those practitioners, but also between the families and those workers. Social workers told us how much it helped when the same midwife came to call groups in child protection conferences because they really knew that family.

Equally in pre-birth teams there was consistency of social worker right from the beginning of the assessment until the end of the process. This made for more robust decision making and earlier planning, which helped both social workers and families. In some areas of the country where pre-birth teams was not possible they have started introducing specialist workers who focused on pre-birth work.

In other areas as you'll hear in the links below inter-agency specialist teams have been formed to provide the help and support directly to the family.

The Birth Charter for women with involvement from children’s social care from Birth Companions also details the importance of specialist and continuous support in the pre-birth period (see pages 4-5).

Baby & Me is an innovative specialist pre-birth service in Newport City Council that works with parents at risk of having a baby removed at birth. The team provides trauma-informed intensive support in partnership with health and social care colleagues.

You can learn more about Baby & Me through this animation and from this evaluation by Research in Practice. You can also hear more in audio clip one above featuring Laura Bibey, Baby & Me Team Manager.

Jig-So is a multi-agency early intervention project in Swansea that supports vulnerable expectant parents (aged 16-24) from 17 weeks of pregnancy through the child's first two years. The project offers services from midwives, family facilitators, nursery nurses, and early language development workers.

You can find out more about Jig-So in this evaluation report by Swansea University and in this case study from the Centre for Justice Innovation. You can also hear more in the Nuffield Family Justice Observatory film below which focuses on specialist teams, including Jig-So. 

The DAISY Project in Walsall Council, is an intensive, attachment-based pre-birth and infant initiative. It supports parents from 12 weeks' gestation to 26 weeks post-birth, using therapeutic approaches like mentalisation to build parenting capacity and prevent newborn removals.

You can find out more about the DAISY Project in this case study from the Centre for Justice Innovation and in this evaluation report from the University of Oxford. You can also hear more in audio clip two above featuring Jo Greenway, Therapeutic Family Time and Intervention Service Manager at DAISY. 

Sunderland City Council have a specialist pre-birth team which sits within Together for Children.

You can hear more about the work of this team in the audio clip three above featuring Rebecca Pears, Team Manager for pre-birth work at Sunderland City Council.

• Barlow, J., Ward, H., & Rayns, G. (2018). Risk assessment during the prenatal period. In Horwath, J., & Platt, D. (Eds.). The child’s world: The essential guide to assessing vulnerable children, young people and their families (3rd ed.). Jessica Kingsley Publishers.

• Barlow, J., Dawe, S., Coe, C., & Harnett, P. (2016). An evidence-based, pre-birth assessment pathway for vulnerable pregnant women. The British Journal of Social Work, 46(4), 960-973. https://doi.org/10.1093/bjsw/bcu150

• Critchley, A. (2019). Jumping through hoops: Families’ experiences of pre-birth child protection. In L. Murray, L. McDonnell, T. Hinton-Smith, N. Ferreira & K. Walsh (Eds.), Families in motion: Ebbing and flowing through space and time (pp. 135–154). Emerald Publishing Limited. https://doi.org/10.1108/978-1-78769-415-620191009

• Mason, C., Robertson, L., & Broadhurst, K. (2019). Pre-birth assessment and infant removal at birth: Experiences and challenges. Summary. Nuffield Family Justice Observatory. https://www.nuffieldfjo.org.uk/resource/pre-birth-assessment-and-infant-removal-at-birth-experiences-and-challenges

• Pearson, J., Jay, M., O’ Donnell, M., Wijlaars, L., & Gilbert, R. (2020). Characterizing newborn and older infant entries into care in England between 2006 and 2014. Child Abuse & Neglect, 109. https://doi.org/10.1016/j.chiabu.2020.104760

• Public Law Working Group (PLWG). (2021). Recommendations to achieve best practice in the child protection and family justice systems. Final report (March 2021). https://www.judiciary.uk/wp-content/uploads/2021/03/March-2021-report-final_clickable.pdf

• 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.