Key message two: Provide help and support as early as you can

The born into Care research and prior research has highlighted the frustration that parents often feel because help and support comes to late in pregnancy.

Practitioners also told us that delays in receiving referrals meant that they had such a short time in which to do assessments and then offer help and support to bring about the change that might be needed in order to give the family the best chance possible of taking their baby home, reasons for this is complex and of course not the same in every part of the country. But what we could tell from the research that there was in-built delay into the structure of both maternity and child protection services.

Historically, most children's social care services didn't receive or accept referrals regarding borns and pregnant women until quite late into the gestation period. This was often talked about in terms of viable pregnancies. We're really pleased to say that since the report has been published, most local authorities have really brought their referral timescales forward and are working with women and their partners much earlier in the pregnancy.

And this really matters because pregnancy is such a short window in which to assess and then provide support and help. What parents told us was they were often left waiting, anxieties rising because they knew that they were likely to come under the scrutiny of children's social care.

We also know from the backgrounds of the parents that we interviewed and what they told us about the multiple disadvantage and adversity that they experienced, that it took time in order to build those relationships.

And we'll talk more about this as we move through the resources. So providing help and support at the earliest possible opportunity really matters. It's not just children's social care. We heard from midwives that often the timing of booking appointments and the time allowed in appointments made it very difficult for those that didn't feel very confident or skilled in asking difficult safeguarding questions to be able to identify those at an early point.

This again meant more delay. The way in which service alignment works, often the timing of the midwife visits with and appointments with the mother didn't align with when children's social care accepted referrals. And so again, that led to drift and delay and finally, the structure of children's social care. Often families were passed across multiple teens during that pre-birth period, a front door where the referral was received and assessing team and then perhaps moving on to longer term teams or court teams.

This meant a lot of stop and start and again meant delay for the for the much needed help and support for families. Whilst the way in which these teams are structured might make good bureaucratic sense and be led by resources and resource constrained. Since what it meant for families was discontinuity in relationships, a lot of stop and start and having to get to know professionals and build trust again. And as we will hear later on in the resources, if we look at this through the lens of trauma, this didn't support trauma informed practice.

To hear more about how some local authorities are trying to do their best to provide the right help and support an earliest possible point in pregnancy. Have a look at some of the links below.

Claire: Ok. So we are really pleased to be able to speak to Tom Batterby, from Kirklees, um, local authority from children's services, where he's the Formulation Programme Manager. Um, really thanks for coming, Tom. Um, we just wanted to, to hear a bit more really about your New Beginnings programme. so just wanted to tell us a bit about what you've been up to. 

Tom: Absolutely. Thanks for having me, Claire. So, New Beginnings was, was formed in response to a report from the Nuffield Institute, highlighting that the highest number of babies born into care from 2019 to 2020 were in the Yorkshire and Humber. So in Kirklees, we recognised that and really wanted to improve a number of, of key areas across practice, really. One was a cons... the consistency of the approach. Um, in terms of undertaking the assessments itself, the involvement of parents, it was very much recognised that the earlier we involve expecting parents, the more likely we are to have not only better outcomes, but a much fairer and more restorative experience. Um, and also the timeliness of decision making. So really look at perhaps what was causing any drift, um, or an extension of any sort of assessment process. And then we also wanted to think about how do we best use that assessment time? So thinking more about how we use the assessment as an intervention rather than reaching the end, the end of an assessment process, and then making any recommendations. 

So as we went about that journey, the, the Born Into Care Review became more and more kind of in our, um, sight, and we were paying more and more attention to it. And, and that did two things really for us. One was, it was very affirming because some of the initial thoughts and ideas we'd had very much aligned with a lot of the themes and the recommendations that were made from it, but also generated new thoughts and new considerations and highlighted what best practice really looked like and sounded like in that area, and led us to think about how, how do we incorporate that? Um, so much so that the, the written version of, of the practice model, the New Beginnings model, directly references Born into Care throughout, so we can really demonstrate how we've taken the learning from that and applied it into the model that was subsequently created. 

Claire: So Tom, can you just tell us a little bit more about the New Beginnings practice model and some of the kind of key ingredients? 

Tom: Absolutely, yeah. So the, the New Beginnings practice model essentially replaces what was the existing pre-birth assessment model, um, and the key differences between now and then, uh, mainly centre at the, at the beginning of the process itself. Um, so we've replaced what is regarded as the initial child in need meeting, um, with what we would call a formulation meeting. So the, the formulation team, which is a service area I'm responsible for, operate across children's services and work on practice development in terms of the, the use of the model across the piece, but are also, uh, incorporated into process and existing, uh, uh, areas of service.  

Claire: Mm-Hmm. 

Tom: And this being one of them. So the initial child in need meeting has been replaced by a formulation meeting, and that looks quite different to what you might regard as a, as a traditional meeting. So although it still involves all of the people hat you would expect to be involved in terms of key agencies, the expecting parents, family members, et cetera, um, we sit in a horseshoe or restorative circle you might call it, and the meeting is structured using what, what many know as the six Ps of formulation. So we physically have the, the model up on a wall or the screen depending on the room that we're in. Um, and those six areas of thinking become the structure to the conversation. Mm-Hmm. So using family friendly language, what that does is breaks down the conversation into what you might describe as more manageable chunks, um, which is helpful from not just a visual perspective. It removes this idea of professional taking notes that we don't see and then get minutes X amount of days or weeks later. Everything that's discussed is there to be seen and is recorded in that way and, and shared and produced afterwards. So there's a visual kind of element to it, but there's also a very much an analytical element to it as well, which is really ensuring that we're thinking about and focusing on the things that we need to think about right from the moment go. Um, and, and I guess from a trauma-informed perspective and a restorative approach, it also enables us to acknowledge things without, uh, taking a, a, a judgmental or, uh, predisposing based, um, thinking towards things.  

So the way the model separates what's happening right now from what we're worried about is really crucial because as professionals and expecting parents, I'm sure we have lots of worries. What we're able to do is walk that back to, and what are the things that we know and are having reported to us and are seeing and experiencing that cause us to have those worries? What do those things look like? How can we describe and define them?  

Claire: Mm-Hmm. 

Tom: It also helps separate our thinking from the past to the present. So many expecting parents, uh, may enter this assessment process having previously had a child removed or indeed have worked with services in, in different ways in the past. Um, so we want to ensure that that doesn't define them entering that space.  

Claire: Mm-Hmm.  

Tom: That, that's something that we're mindful of, but we're not making any assumptions as to, excuse me, as to what that means now. So if, for example, there has been a previous removal, we'd obviously want to carefully consider the circumstances around that, but very much think about what that means now.  

Claire: Yeah, absolutely. Yeah. Thanks, that's really helpful. And you've also mentioned, um, a specific role called the Contact Liaison Officer and that, and that feels like, you know, given what we know about, um, how difficult it is for some parents to, to, to, to get involved with anybody that represents the state, let alone a social worker. Mm-Hmm.Um, that feels like a really key role. Could you just tell us a little bit more about that? 

Tom: Yeah, of course. Yeah. So the Contact Liaison Officer role was created, uh, just, just coming up to a year ago now. And it was very much an opportunity for practitioners in a business support role who have contact with families, um, but not direct contact. Um, it was very much an opportunity for them to move into roles that they feel they were well suited to. 

Claire: Mm-Hmm.  

Tom: Uh, but didn't necessarily require any qualifications or a case holding of any description. And it really aligned nicely with New Beginnings from the point of view that one of our intended outcomes was to involve parents and effectively engage, expecting parents from the very beginning. Um, thinking about restorative practice, thinking about things being fair, but also the feedback that we'd had prior to its inception about not feeling listened to or the assessment process being confusing or unclear, not waiting and waiting for a decision. And it being quite a, a long waiting game with a, an end decision that was obviously quite scary and frightening. 

So the, the role of the Contact Liaison Officer as, as the name suggests, is to engage in liaise with the expecting parents throughout the assessment process. So the Contact Liaison Officer will attend the allocation meeting, um, and ensure that she has, that the Contact Liaison Officer has all of the information that is needed in terms of the multi-agency group, but also has a sense of who the parents are. 

Claire: Mm-Hmm.  

Tom: Um, once they've been notified of social care involvement, the CLO as we'd call them, would then go out and visit those expecting parents and any kind of relevant family members, talk to them about the assessment process, explain the formulation meeting, what that looks like, what to expect, who will be there, what happens if it feels a bit too much, um, explore any barriers to attending, uh, and we'll physically attend the meeting with them.So although the Contact Liaison Officer wouldn't necessarily play an active part in the discussion, the presence is very much felt and is, is often very reassuring, um, as they've had the opportunity to develop a bit of re... of a relationship with the expecting parents.  

Claire: Yeah. Yeah.  

Tom: Um, they'll then, um, record what whatever's written during the meeting that will be recorded and uploaded by the CLO. Um, and the CLO will have done all the logistical elements of the, is often very time consuming around the organisation of the meeting. So co-ordinating diary availability, booking the room, all the stuff that can take up a lot of time for the allocated social worker.  

Claire: Yeah.  

Tom: Um, which, um, with the facilitation of the meeting being done by the formulation team, and then the role of the CLO means that what social workers tell us is that they can focus on their conversation and the things that they want to consider and speak about without having all the added responsibility of both logistics and co-ordination... 

Claire: Yeah. 

Tom: ... within that space itself.  

Claire: Yeah. That's really important. Yeah. Thank you. And, um, sort of finally, I mean, I know it's really early days, it's 18 months in, but you have had some really positive feedback from parents and other, uh, your social workers and other, other professionals, um, and some sort of green shoots of, of really interesting data, you know, outcome data. Would you just tell us a little bit about sort of the impact you think you are seeing? 

Tom: Absolutely. Yeah. So I, I, I would say that it's absolutely not perfect. We're constantly making tweaks. We have regular reviews to look at what's working and what could work better. So the CLO attending the allocation meeting, for example, was a relatively new decision taken to try and impact on timeliness and give us a much better chance of meeting the, uh, having the formulation meeting within 15 days of referral. Um, but yeah, we've taken kind of a two stranded approach to evaluation. 

So we collect... the CLO collects feedback from all of the professionals and family members following the formulation meeting. Um, and we've also looked at data, um, from the, the first 40, um, families that came through the New Beginnings process and the, the last 40 that came through the pre-birth assessment process that existed prior to New Beginnings. So, um, I'll share some feedback in a moment, but just in terms of data, the, the last 40, so the, the, um, existing process were in terms of baby remaining at home or baby being removed, that was a 50/50 split.  

Out of those 40 that were, it was 20 and 20, um, we can't say for certain yet that as a result of New Beginnings, the, uh, the updated outcomes are solely about that. Obviously there will be circumstances that affect it, but, um, the, the 40, the first 40,  and we're just coming up to a hundred cases now, but the first 40 had, um, 33, uh, remaining at home and seven removed. So that's gone from a 50/50 split, so to an 83% to and 17%. So that very number alone is, is obviously really encouraging.  

We've then broken that down into four kind of categories. So we've got, uh, expecting parents that entered the process where there was a previous removal and the outcome was that the baby was removed, no previous removals, but the baby was removed in in terms of the outcome of the assessment, no previous removals and baby remained at home and previous removals and baby remained at home. So really breaking up those... 

Claire: Mmm-hmm. 

Tom:...two outcomes in, in much more depth and detail. Uh, so prior to New Beginnings, um, 45% of those were previous removals with the baby being removed as, as the outcome which drops to 23%, um, following New Beginnings. So a real impact on those expecting parents that have entered that assessment process, having previously had a baby removed, um, that the, the outcome of those babies being removed has reduced. Um, and, and then the, the, uh, kind of flip side to that, so no previous removals and baby remaining at home has also increased. So that's come from 32% to 60%. So we're also seeing an impact on those expecting parents that have entered the assessment process, having not had any either in service involvement or not, certainly not had a baby previously removed. That those kind of new concerns, if you will, also has re, resulted in a reduction in the number of those, um, being born into care.  

In, in terms of the feedback, we've collected feedback from pretty much all 97 families, but the first 36, um, the themes really were that they, they didn't feel listened to that prior. The, the, the, the term being listened to came up over and over and over again. Um, and encouragingly the feedback post New Beginnings has been that, um, they felt listened to. So to give you a couple of quotes, some of the desired outcomes prior to New Beginnings were to be listened to and have my voice heard, to know what we needed to do to be listened to and be part of what was going on, to be listened to and not feel I was lower than people, to not be judged purely on the past. And to have the opportunity to get my points across and say things that I need to say. Um, and what, what they've kind of told us from that is, well, a number of things really. 

So, um, the, the, the, the experience felt very different. Um, it was useful that they felt listened to. So I think from a data perspective, we're seeing signs that it's making a difference in terms of outcomes, but really importantly, and particularly thinking about the Born Into Care Review, experientially, it's different as well. It feels fairer. Clearer. Yeah. More restorative, uh, more trauma-informed to use professional language, um, and the expecting parents that are, um, going through the New Beginnings model, those that have been part of prior assessment processes, talk about how it's felt much fair and much more engaging, much clearer. 

So for us, putting outcomes to one side for a second, even if we'd only achieve that, that made it worth doing because it's obviously a very difficult assessment to be part of. So anything that we can do to help ensure that feeling fairer and clearer and restorative, it's really important, is, is good. Yeah. It's really important, particularly when we know there's a high chance that parents will come into the system again. So, you know, where, where they're left is just so important in terms of what might happen to that next baby.  

Claire: Yeah. Thank you so much, Tom. That's really, really interesting. And if people want to find out more, um, you are happy for them to, to...  

Tom: Absolutely. 

Claire: To make contact. Yeah. Great. 

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• Brown, R., & Ward, H. (2014). ‘Cumulative jeopardy: How professional responses to evidence of abuse and neglect further jeopardise children’s life chances by being out of kilter with timeframes for early childhood development’, Children and Youth Services Review, 47, pp. 260–267.  
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