Legal ethical and practice issues. Centre for Child and Family Research Loughborough University Warwick University Medical School NSPCC

1. Centre for Child and Family Research
Loughborough University
Warwick University Medical School,
NSPCC

2. To explore the legal, ethical and practical issues
in undertaking a social work assessment, where
there are concerns that an unborn child is likely
to suffer significant harm
To consider the implications for introducing a
pre-birth risk assessment practice model

3.  An assessment undertaken during the pre-
birth period, by social workers in
collaboration with other relevant
professionals (eg midwives)
 Undertaken when there are concerns that an
unborn child is likely to suffer significant
harm
 In order to understand the child and the
parents’ circumstances and needs so as to
establish whether further action is required to
protect the child’s welfare

4.  Development of the unborn child is adversely
affected by exposure to:
◦ toxic substances eg alcohol, heroin, crack cocaine
◦ chronic maternal stress during pregnancy
 Parental adversities are associated with
atypical or anomalous parent-child
interactions that affect the development of
attachment from pregnancy onwards

5. Between 2007 and 2013:
7143 birth mothers appeared in 15,645 care
applications concerning 22,790 infants and
children.
15.5% of mothers in care proceedings are
‘recurrent mothers’, linked to 25% of children
(Broadhurst et al, 2014)

6.  Support parents to change lifestyles, behaviours and
relationships that can cause harm to the unborn child
 Support parents to develop an attachment to the baby;
and develop an understanding of the baby’s separate
needs
 Safeguard the baby during pregnancy and beyond
 Help professionals make a decision as to whether or
not the baby can safely remain with birth parents

7.  The Children Act 1989 provides the
legislative framework through which the state
can intervene to safeguard and promote the
welfare of a child.
◦ It does not refer to unborn children
 Statutory national guidance (Working
Together to Safeguard Children,
HMGovernment, 2013) makes reference to
taking formal steps to protect an unborn
child.

8.  A pregnant woman has absolute rights over her
body.
 She can refuse medical treatment even if doing so
would harm her unborn child
 Law provides some recognition of foetus but
limited to viability/intent to cause harm
 Criminal prosecution of eg substance misusing
mothers for harming unborn child has not been
successful – and raises huge ethical issues
 Generally an unborn child does not have legal
rights until personhood is achieved at birth

9.  Social workers are required to undertake an
assessment, where there are concerns about the
welfare of an unborn child
BUT
 A pregnant woman can ultimately refuse to
engage with social work assessments/
interventions to safeguard her unborn child.
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10.  Preventative action: referral to a substance misuse
service to help the mother overcome her difficulties and
reduce the risk of harm to her unborn child.
 Plan for interventions post birth: a place in a mother
baby unit.
 Certain actions cannot be taken until the birth of the
baby and this includes initiating care proceedings.
 Assessment and intervention frequently delayed
 Lack of clarity problematic for practitioners and parents

11. ◦ Documentary analysis of English Local
Safeguarding Children Boards (LSCB) pre-
birth assessment guidance.
◦ Interviews with 18 practitioners including:
social workers, family support workers,
midwives, drug and alcohol workers, a
health visitor, psychologist and psychiatrists.

12.  Just one third (n=48/33%) of
English LSCBs acknowledged the
lack of legal status of a foetus.
 Reference to a pregnant woman’s
right to autonomy over her own
body was also rarely recognised
(n=36/26% of LSCBs).
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13.  Despite lack of guidance many practitioners were aware of the
complexities:
 ‘I mean, clearly, we have a problem because the foetus has no
status in law (Mental health worker).
 The assessment has to happen whether she [pregnant
woman] wants it or not. Referrals come in to social care, we
have to investigate and it is much better if she gets involved
in that process (Social Worker).
 I mean we can’t just not do an assessment. We have got to do
it. We have got to do it on the information we can gather. I
mean the difference is we haven’t got a live child to see… the
foetus having no rights until it is born and everything else,
that is morally quite difficult for us at times (Social worker).

14.  A family is turning to us and saying ‘you’re putting
so much stress on my family,, you’re upsetting us’.
But ultimately, we have to safeguard that baby
(Social worker).
 That [stress] might affect the baby… (Health visitor).
 It adds to their level of stress, that the women
who are vulnerable to mental illness, you know,
they feel sometimes that we’re making things
worse for them and setting them up to relapse or
to become unwell. I’m not sure that’s always the
case but I think it can very much feel like that
sometimes for women (Psychiatrist).
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15.  21/29 LSCBs prioritised work with expectant
parents (often following a serious case
review)
 Pre-proceedings process provides a
framework for working with parents before
the birth
However:
 Majority of referrals between 12-18 weeks
(range 8-20 weeks)
 Delays between referral and assessment
 Window of opportunity often lost
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16.  Referral and decision to undertake pre-birth
assessment – by 16 weeks gestation
 Core cross sectional assessment; case
conceptualisation; goal setting- by 22 weeks
 Intervention – by 36 weeks
 Assessing capacity to change; analysis and
decision making – prior to birth
 MORE ABOUT pre-birth assessment and
interventions?
◦ Symposium 20 Tuesday 14th April, 15.00

17.  Broadhurst,K., Harwin, J., Shaw, M and Alrouh, B.
(2014) ‘Capturing the scale and pattern of
recurrent care proceedings: initial observations
from a feasibility study’ Family Law, online
 HM Government (2013) Working Together to
Safeguard Children, London: Department for
Education
 Masson, J.M., Dickens, J, Bader, KF & Young, J
2013, Partnership by Law? The pre-proceedings
process for families on the edge of care
proceedings, School of Law, University of Bristol,
Bristol