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2.2.17 Pre-birth planning

Last Modified: 23-Sep-2019 Review Date: 21-Jun-2021

Purpose

Child protection workers (CPWs) have a statutory role to assess risk factors and the likelihood of significant harm to infants after their birth including future danger, safety, wellbeing and protective factors for infants.

The purpose of this entry is to provide guidance in:

  • Identifying unborn infants who are at risk of abuse and neglect after birth.
  • Engagement with parents, families and the safety network to address concerns.
  • The use of the Signs of Safety Child Protection Practice Framework in the pre-birth planning process, including developing, testing and monitoring safety plans for a period of time (agreed to by team leader), after the birth of the infant.
  • Assessing suitability of safety network members.
  • Undertaking pre-birth meetings in order to promote the unborn infant's needs and wellbeing after birth.
Practice Requirements

 

The three overriding practice requirements for pre-birth planning are:

  • Early and consistent engagement with the parents.
  • Interagency collaboration, and
  • Determine the likelihood of the unborn infant being harmed following birth.
  • When unborn infants are identified as being at increased likelihood of significant harm after birth the matter must be subject to a Child Safety Investigation (CSI), referred for pre-birth planning and to Best Beginnings Plus (BB Plus). The pre-birth planning protocol must be recorded on Assist.

  • You must notify the Pre-Birth Project in the Professional Practice Unit whenever an intake includes pre-birth planning.

  • You must advise WA Health that pre-birth planning will be commenced to ensure effective planning for the safety of the infant after birth and the wellbeing of the parents.

  • You must work to engage and partner with the unborn infant's parents, family and safety network in order to promote the unborn infant's needs and wellbeing after birth.

  • Pre-birth planning must include pre-birth meetings with the parents, family, relevant staff from WA Health and safety network members to assess the risks to the unborn infant after birth and develop a safety plan to promote the infant's safety after birth.  Any decision not to preceed with pre-birth planning meetings for unborn infants should be discussed with your district director.

  • You must develop draft harm statements (where applicable), danger statements and safety goals and discuss these with the parents prior to the first pre-birth meeting.

  • When there is an increased likelihood of significant harm to an infant, you must decide whether action is needed to safeguard or promote an infant's wellbeing and whether they may be in need of protection under s.21 of the Act.

  • Where an unborn infant's parents are Aboriginal and/or culturally and linguistically diverse (CaLD), you must consult with the Aboriginal Practice Leader (APL) and/or a senior CaLD officer as soon as possible to gather information to assist in engaging with the parents.

  • When a pregnancy is identified and the parent-to-be is a child, you must complete the Interaction Tool to determine whether an investigation is required into whether the parent-to-be has experienced any harm.

The most important work as part of the pre-birth planning process is undertaken by you outside of the meetings. You should use the time between meetings to continue your assessment of the concerns, support the parents to complete the actions identified in the plan and gather credible evidence.    

Note: This entry should be read in conjunction with the Bilateral Schedule Interagency Collaborative Processes when an unborn or newborn baby is identified as at risk of abuse and/or neglect and Chapter 2.2 Conducting a Child Safety Investigation.       

Procedures

  • Referral
  • Intake and case allocation
  • Child protection concerns for young parents
  • Culturally responsive practice
  • Engaging with parents and families
  • Developing safety networks
  • Pre-birth planning with Signs of Safety
  • Pre-birth planning meetings
  • Post-birth planning
  • Pre-birth Project
  • Referral

    When a woman is pregnant, the unborn infant is believed to be over 12 weeks gestation and there are concerns for the needs and wellbeing of the unborn infant after birth, you must use the Interaction Tool, the resource Determining Risk Factors for an Infant and refer to High Risk Infants entry in decision making.

    When you identify unborn infants as being at increased likelihood of significant harm after birth, the matter must be subject to a Child Safety Investigation (CSI) and referred for pre-birth planning (pre-birth protocol recorded on Assist) and to Best Beginnings Plus (BB Plus). You must record the pre-birth planning protocol on Assist.             

    If BB Plus are unable to accept a referral, discuss whether they have capacity to be consulted during the life of the case. You must document your actions and any rationale as to why the referral was not successful.

    You must notify the Professional Practice Unit whenever an intake includes pre-birth planning. You must also email the relevant district to advise them of the intake and cc PrebirthPlanning@cpfs.wa.gov.au into the email. 

    For further information on the pre-birth planning trial refer to the section 'Pre-birth project' (at the end of this entry).

     

    When there is an increased likelihood of significant harm to an infant, you must decide whether action is needed to safeguard or promote the infant’s wellbeing, and whether the infant may be in need of protection (s.28 of the Act). When it is assessed that concerns for an unborn infant do not require an investigation, you may still consider the provision of social services (s.32(1)(a) of the Act).

    Interagency notification

    You must advise WA Health that pre-birth planning will commence to plan effectively for the safety of the infant after birth and the wellbeing of the parents. You may also consult other services to make a determination on whether there are child protection concerns, for example, WA Police and non-government organisations.

    The Department and WA Health share information under s.23 of the Act with one another to assist in determining whether there are child protection concerns.  Consultations between the Department and WA Health may involve:

    • requests from the Department to WA Health for information;
    • discussing concerns for an unborn infant to determine the level of risk; and/or
    • WA Health inquiring whether the pregnant woman is known to the Department, either as a current or closed case.

    You have a statutory role to assess risk factors and the likelihood of significant harm to infants after their birth including future danger, safety, wellbeing and protective factors for infants. When there is an increased likelihood of significant harm to an infant, you must decide whether action is needed to safeguard or promote an infant's wellbeing and whether they may be in need of protection as per the functions of the CEO under s.28 of the Act.

    You should use an internal Signs of Safety mapping to document clear harm statements (where previous harm has been substantiated), danger statements and safety goals at the point of intake. 

     

    External referral

    1. Written referrals are sent to the Department to report concerns for an unborn infant via Form 441 - Child Protection Concern Referral. We encourage referrals to the Department to be made as early as possible once the pregnancy is known. 

    • Metropolitan: Referrals are received by the Central Intake Team (CIT) or Crisis Care Unit (CCU).  

    • Regional: Referrals are received by the local Child Safety Team.

    2. You must contact the referrer to discuss the concerns and document this in an interaction.

    3. If the matter is intaked for CSI then it is referred for pre-birth planning and Best Beginnings plus (BB). You must record the pre-birth planning protocol on Assist.

    4. You must notify the Professional Practice Unit whenever an intake includes pre-birth planning. When emailing the relevant district to advise them of the intake, cc PrebirthPlanning@cpfs.wa.gov.au in to the email.  

    Internal referral

    ​1.  Internal referrals are considered for:

    • active Intensive Family Support (IFS) cases
    • parents who have children in the CEO's care, are expecting another child and assessment of risk for the unborn child indicates a referral to BB Plus may be an appropriate family support strategy to enable the child to remain in their care
    • children in the CEO's care who are parents or expectant parents.

     

    Where the Family and Domestic Violence Worker (SCPW FDV) responds to incidents of FDV and identifies an unborn child at risk, they must record an interaction for both open and closed cases and progressed to CSI (pre-birth protocol) as appropriate.

     

    2.  You must use the Interaction Tool to determine whether or not a CSI is required. If a CSI is required then the intake should be completed and pre-birth planning protocol recorded. 

    3.  You must notify the Pre-Birth Project in the Professional Practice Unit by email: PrebirthPlanning@cpfs.wa.gov.au whenever an intake includes pre-birth planning.

    4.  You must intake investigations relating to a child in the CEO's care (as the parent-to-be) and their unborn child to separate family groups.

    Late referral of concerns

    There are many circumstances when the Department receives a referral of child protection concerns for an unborn infant after the pre-birth planning process is supposed to commence at 20 weeks. This can include circumstances when a woman presents in labour or the infant has already been delivered.  Use the Interaction Tool to determine whether an intake to CSI is required.

    When these referrals are intaked to CSI for pre-birth planning, you must make every effort to undertake as much planning as is possible before the birth of the infant.  If the CSI has been intaked after the birth of the infant, then you must make every effort to complete post-birth planning as soon as possible.

    Late referrals may not allow time to facilitate three (or any) pre-birth planning meetings, however you should complete as much planning as possible in the contracted timeframe. This should still include a collaborative approach with the parents, WA Health and any other appropriate people or services to ensure that worries are shared, decisions are made in a timely manner and plans are outlined to promote the infant's safety.

    In cases where a woman is in labour and there are concerns for the infant's safety after birth, and the Department has either not undertaken pre-birth planning or not completed an investigation as part of pre-birth planning, an immediate preliminary investigation is required.

    The steps for this include:

    1. You (or CCU after hours) must consult with WA Health and gather information on any safety concerns for the infant, their siblings, the mother and any other relevant parties.

    2. You must gather information from Assist, Objective, Family and Domestic Violence (FDV) triage application and any other available stakeholders, regarding any safety concerns for the infant after birth.

    3. You and your team leader must assess the information available and evaluate the likelihood of significant harm occurring to the infant. Where necessary, and in collaboration with WA Health, you must develop preliminary safety plans for promoting the newborn's safety after birth until a more thorough investigation can be completed. Depending on the level of risk present, this could include planning for the level of supervision required (if any) and whether there are to be any restrictions on visitors.

    4. Where there is the possibility that parents or others may attempt to remove the infant from hospital, you should consider actions that can be taken to maintain the infant in hospital. This includes the use of s.37 (requires district director approval) or s.40 of the Act (s.40 is enacted by WA Health and must be discussed with the person in charge of the hospital).

    Referral to a different hospital

    When a pregnant woman is open for pre-birth planning and subsequently transferred to a hospital that is not her local hospital in order to give birth, pre-birth planning must continue with the parents, their family and safety network.  This ensures that support for parents continues and the safety of the infant is promoted.

    If the parent is based in a regional location you can request the next closest district to provide short-term support to the parents. Where that district has no capacity to undertake the request, you can contact the country liaison officer at the State-wide Relieving Team to request assistance.

    Support from another district and/or the country liaison officer could include assistance to get to and from pre-birth planning meetings, antenatal appointments and/or other appointments.  You should complete the Statewide Relieving Team Request for any assistance required.

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    Intake and case allocation

    Child Safety Investigations involving pre-birth planning or high risk infants must not be placed on the monitored list.

    They must be actively case managed for the life of the investigation.

    If…

    Then…

    A child in the CEO's care is pregnant and a Child Safety Investigation (CSI) is intaked for pre-birth planning for their unborn infant 

    A different child protection worker (to the child in the CEO's care) should be allocated the CSI for the unborn infant

    Districts can allocate cases involving pre-birth planning in accordance with workers professional judgement and assessment of what is in the best interests of the unborn infant at that time. When separate case management is required, you should consider if the case should also be allocated to a different team entirely.

    The table below is a guide for case allocation.     

    Scenario

    Child Safety Teamlntensive Family SupportChildren in Care Team​Best Beginnings Plus

    New case - family unknown to Department

    Yes

    ​Yes (after consult)​Yes

    Closed case – family known to Department - previous concerns for other children / siblings

    Yes​Yes​Yes

    Open case – current involvement with Intensive Family Support

    ​Yes​Yes
    Open case - other children in the CEO's care

     

    ​Yes​Yes

    Open case - parents are children in CEO's care

     Yes

    ​Yes​Yes

    Open case - poarents are children in CEO's care and ther a child protection concerns for the parents

     Yes

    ​Yes​Yes

     

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    Child protection concerns for young parents

    Things to consider: 

    • When a young woman is pregnant, the risks associated with family and domestic violence increase. Young women may be in need of support, guidance and/or intervention in order to minimise the risks posed by the perpetrator and safeguard or promote the safety of both the mother and the unborn infant.

    • A child or young person (including those in the CEO's care) who is about to become a parent may themselves need protection because of sexual or other forms of abuse. Consideration should be given to the legal age of consent for sexual activity, whether the young person had the capacity to provide consent, whether the young person has been a victim of sexual abuse and/or whether it is likely the abuse will continue.

    When the parents-to-be are children

    When you identify a pregnancy and the parent-to-be is a child (under the age of 18 years) and/or a child in the CEO's care, you must use the Interaction Tool to determine whether an investigation is required into whether the parent-to-be has experienced any harm.

    The determination about whether an investigation is required for the parent-to-be should be made separately to any determination about whether an investigation is required for the unborn infant. 

    If you decide that CSI's should be conducted for both the parent-to-be and the unborn child, they must be:

    • intaked to two separate CSIs
    • intaked to two separate family groups, and
    • allocated to two separate case managers wherever possible
     

    Intaking parents and their unborn infants

     

    Parent-to-be

    Unborn infant

    CSI required

    Intake to family group that includes:

    Biological parents of the unborn infant (child that is the parent-to-be)

    Parents of the parent-to-be

    Siblings of the parent-to-be

    Other adults who have day to day responsibility for the parent-to-be.

    Intake to family group that includes:

    Biological parents of the unborn infant (child that is the parent-to-be)

    Unborn infant

    Siblings of the unborn infant

    Other adults who will have day to day responsibility for the unborn infant

     

    Purpose of CSI

    To determine whether the parent-to-be has experienced harm.

    To conduct pre-birth planning and determine the likelihood that the unborn infant will experience harm following birth.

     

    For more information please refer to the Family Group Position Paper.  

    When the parents-to-be are children in the CEO's care 

    When you identify a pregnancy and the parent-to-be is a child in the CEO's care, you must use the Interaction Tool to determine whether an investigation is required into whether the parent-to-be has experienced any harm.

    The decision about whether an investigation is required for the parent-to-be should be made separate to any decision about whether an investigation is required for the unborn infant. 

    If you decide that CSI's should be conducted for both the parent-to-be and the unborn child, they must be:

    • intaked to two separate CSIs
    • intaked to two separate family groups, and
    • allocated to two separate case managers wherever possible.

    The parent-to-be will already be a part of a family group; a separate family group should be created for the unborn infant. 

     

     

    Please refer to the 'Intaking parents and their unborn infants' table above, and for more information, to the Family Group Position Paper.  

    You must allocate the two separate CSIs to two separate case managers. 

    This is to promote unbiased and balanced decision making in relation to both matters. It also preserves any already established relationship between the child in the CEO's care and their case manager. Decisions as the result of the pre-birth planning may not be viewed positively by the child in the CEO's care and it is critical every effort is made to maintain their relationship with their case manager.

    For example, Sally (14 years old) is in the CEO's care and Karen has been her case manager for two years. Karen discovered that Sally was pregnant and used the duty interaction tool to determine that two separate CSIs were required for Sally and her unborn infant. Karen will be completing the CSI to determine whether or not Sally has experienced harm, but her colleague will be completing the CSI and pre-birth planning process for unborn infant

         
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    Culturally responsive practice

     

    Cultural safety occurs when a person is not in fear of racism or discrimination.  They feel spiritually, socially, emotionally and physically safe to be themselves.

    You can 'set the scene' for cultural safety by approaching parents in a respectful and non-judgemental way, not 'speaking down' to the parents and showing a genuine interest in what they have to say.

    Where an unborn infant's parents are Aboriginal and/or culturally and linguistically diverse (CaLD), you must consult with the Aboriginal Practice Leader (APL) and/or local cultural advisor as soon as possible to gather information to assist in engaging with the parents and in delivering culturally responsive practice.

    Where there are cultural considerations which may prevent both parents from engaging with the Department (for example pre-birth planning is sometimes regarded as 'women's business' only), you should seek guidance from the APL and/or the CaLD Principal Policy and Planning Officer, other staff and resources to plan for how to best to engage both of the parents, including the father.

    Working with Aboriginal and Torres Strait Islander families

    You should review the Secretariat of National Aboriginal and Islander Child Care (SNAICC) resource Stronger Safer Together - a reflective practice resource and toolkit for services providing intensive and targeted support for Aboriginal and Torres Strait Islander families.

    When working with Aboriginal families, you should, in consultation with the APL, use the Tindale Map to identify (where possible) each parent's cultural group and languages spoken.  Access the Tindale Map from Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS).  

    Where families have experienced intergenerational trauma and subsequent contact with child protection systems, you should acknowledge the past and attempt to 'clear the air' for conversations to begin:           

    "I know it's hard to talk to me/you might not want to talk to me, but this is really important…"

    "I know some of your family have been in care and have had a really rough time, I don't blame you for not wanting to talk to me…"

      
     
    You must use interpreters whenever required, to communicate clearly with parents.  For more information refer to Language and Interpreter Information.
     

    Working with Culturally and Linguistically Diverse families

    Parents from culturally and linguistically diverse (CaLD) backgrounds may have experienced trauma, sexual assault, violence and loss and grief in their country of origin and/or refugee camps, resulting in post-traumatic stress, anxiety, depression and/or other mental health difficulties. The effect of this trauma can inhibit some parents from bonding with and caring effectively for an infant, and make it more difficult for them to engage in support. 

    Pregnant women and new mothers from CaLD backgrounds can be at heightened risk of anxiety, depression, post-natal depression, social isolation and family and domestic violence. 

    Protective factors and strengths for CaLD women and families can include:

    • having the ability to move around the community freely (others not controlling movements);

    • having friendships outside of the home;

    • engaging with neighbours, services and others in the community;

    • having access to transport when required (including access to public transport); and

    • having their own phone and access to finances. 

    Where parents may have a background of trauma, you should approach them with empathy and recognise their difficult experiences. Where the parents choose to share this experience, you should listen with genuine interest and allow the parents to tell their story.

    Harmful cultural practices can include female genital cutting or mutilation, arranged or forced and early marriages, and the payment of dowries. These practices can correlate with family and domestic violence. You should have separate conversations with parents to screen for harmful cultural practices and family and domestic violence.

    When gathering information about cultural practices (including harmful cultural practices, and where relevant, religious practices), use a naïve enquirers approach to 'fact check', for example:

    "If you were giving birth in your home country, who would be with you?... What would happen after the baby is born?...  Who would give you the most help?"

    "In your home country, if a Mum was feeling very, very sad after giving birth, what would happen?"

    "Would someone in your situation (e.g. arranged marriage) be able to go out on her own / catch public transport / go to the shops?"

     

    You must use interpreters whenever required, to communicate clearly with parents.  For more information refer to Language and Interpreter Information.

     

    Where required, you should refer parents to appropriate trauma informed support and mental health services:

    Naïve enquirers' approach

    When working with Aboriginal and CaLD families, consult with specialist staff (APL and/or the Principal Policy and Planning Officer, Cultural Diversity) and/or access resources and cultural/religious information to plan for how best to engage the parents and deliver culturally responsive practice.

    You should use a naïve enquirers' approach with parents, to gather information about their cultural practices, religious beliefs, family 'norms' and parenting practices, including screening for family and domestic violence.

    Consider the family's experience of trauma, intergenerational trauma and possible past contact with child protection systems. 

    For example, you can 'fact check' with parents and families what the cultural expectations are for them according to gender:

    "What kind of role do men take in your family?"

    "I would like to talk to Dad but I know it might not be culturally appropriate for him to speak with me.  Who is the best person to talk to Dad?"

     

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    Engaging with parents and families

    ​You must work to engage and partner with the unborn infant's parents, family and safety network to promote the unborn infant's safety and wellbeing after birth. This includes efforts to engage with the unborn infant's father. Efforts to engage with parents should commence as soon as an intake occurs.

    Pre-birth planning must include pre-birth meetings with the parents, family, relevant staff from WA Health and safety network members to assess the risks to the unborn infant after birth and develop a safety plan to promote the infant's safety after birth.

    Unless there is a court order directly affecting the parental rights of an individual, both parents have equal rights and must be given equal opportunity to engage with the Department.

     

    Key actions you must take:
    1. Notify both parents that a CSI is being undertaken.

    2. Meet with the parents to advise them about the pre-birth planning process and discuss the draft harm statements (where applicable), danger statements and safety goals. Explain the meeting process, the parents' right to legal representation and identify a safety network of people who can attend the meeting to support the parents.

    3. Give the parents sufficient notice to attend the pre-birth planning meeting.

    4. Provide the parents with information about the effects of shaking an infant, risks of co-sleeping and assess the infant's sleeping area to make sure it is a safe sleeping environment.

    You should consult with an Aboriginal Practice Leader (APL) when working with an Aboriginal or Torres Strait Islander family. It can be helpful to use Family Finding tools to locate and engage with other family members who might be able to talk to the parents on your behalf.

     

    Barriers to engaging with parents:

    When there are barriers to engaging with parents, such as when they have avoided contact with the Department and/or they have had other children removed from their care, you may need to try active engagement strategies such as:

    • Initially engaging with other family members or community elders or leaders, and seek their support in engaging the parents.

    • Communicating in a respectful, encouraging, supportive and non-punitive manner.

    • Maintaining frequent contact, regardless of whether the parents continue with contact.

    • Trying joint outreach with another service known to the parents.

    • Providing practical, material support early; including supporting with transport if this is a barrier.

    • Making sure that parents are able to engage easily (for example, avoid arranging meetings that parents have to travel to).

    • Asking whether the hospital venue is appropriate or considering an appropriate alternative. 

    Incarceration of the mother or father should not delay the pre-birth planning process unnecessarily. For example, a mother incarcerated at Bandyup Women's Prison should not prevent pre-birth planning meetings occurring. 

    Your engagement with the parents is essential to pre-birth planning and this should commence as early as possible. Early engagement helps to assess the risks to the unborn infant after birth, provide support to the parents to reduce these risks and refer the parents to appropriate support services. The key to success is building working relationships with mums and dads.

    Engaging the parents, family and safety network should include face to face contact and home visits wherever possible (rather than relying on telephone contact). This includes:

    • visiting parents who are incarcerated, and 
    • engaging with and involving fathers in pre-birth planning.  

    Children's attachment to their father is critical for many reasons; the child's ongoing physical, social and financial security, and attachment to the father's extended family. Before attempting to engage fathers who may be absent, use the FDV Risk Assessment Tool

    You should approach parents with kindness and respect, create opportunities for them to explain 'their story' and for parents to feel they have been heard. Give parents the opportunity to explain what has happened historically, including childhood experiences, rather than focusing solely on what has led to the current worries.

    You should plan around any identified risks in engaging with either parent to ensure they are given the same opportunity to work with the Department.

    Parents whereabouts are unknown

    You must make reasonable efforts to locate the parents.  If you are  unable to locate them and subsequently their unborn infant because they have moved, are transient, or are avoiding contact with the Department, responses vary according to the reported concerns.  Some actions that should be considered to try to locate the parents include:

    • Placing an Alert with WA Health hospitals where the mother might present to give birth, including instructions for WA Health staff to contact the Department if her location becomes known.

      • Metropolitan:  Senior practice development officers (SPDOs) have access to a list of hospital contacts for obstetric alerts.
      • Regional: You should contact the social work department at the respective hospital.

    Generic statewide alerts cannot be requested with the Department of Health at this time.
    • Make enquiries in the parents' community and with senior Department workers, for example Aboriginal Practice Leaders.

    • Place a broadcast alert on Assist within 24 hours, outlining the concerns for the infant and the best course of action if the parents are located during business hours and after hours.

    • Request Western Australia Police place an alert on their system.

    • Alert other states where it is suspected the parents have gone interstate via the Department's Interstate Liaison Officer WAInterstateLiaison@communities.wa.gov.au

    When you are not able to locate the parents and they have not participated in pre-birth planning, you must collaborate with WA Health and exchange information regarding the circumstances for the parents. You should make a preliminary assessment based on the available information and put in place contingency planning for the birth.

    For more information on the use of alerts in case practice, refer to Chapter 4.2 Case Alerts.

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    Developing safety networks

    A safety network is a group of people who care about the unborn infant and are willing to engage with the Department to address the concerns for the infant's safety. A safety network of people is used in safety planning to promote the infant's safety after birth, through the provision of supports to the parents, positive role modelling of parenting skills and coping behaviours, and by monitoring the safety and wellbeing of the infant.

    You should encourage the parents to bring along as many people as they can to participate in the safety network. A robust safety network can be an indication of the level of support available to the parents and/or the child and may equate to safety for the child.

    It is important to encourage parents to think about who they consider a part of their safety network, you can ask questions such as:

    "If you were in hospital sick, who would you want the doctor to call?" 

    "Who could you rely on to babysit if something came up?"

    "Would it help if I phoned Aunty Joan first and explained what is happening/ask her if she can help?" 

    The safety network is intended to provide lifelong connections for the infant, regardless of who has primary care of the infant. Child protection workers should:

    • use integration tools from the Family Finding Manual to develop genograms and ecomaps with parents to identify supports within the family and community, and

    • work with parents and families to develop and strengthen the safety network. 

    Some parents may become isolated from potential supports and feel embarrassed to make contact with them. You can ask the parents whether they would like help in making contact with potential support people. Supports should be a combination of facilitated (agency support services who can visit the family usually during business hours) and naturally occurring (extended family, friends and neighbours who can visit the family ad-hoc and whenever required).

    Always keep in mind that the parents and their safety network are the main attendees of the pre-birth planning meetings. Having lots of professional workers in the room can be overwhelming for the family.

     

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    Pre-birth planning with Signs of Safety

    Use the Signs of Safety Child Protection Framework (Signs of Safety) throughout the pre-birth planning process and adapt the Signs of Safety tools according to the needs of the parents. This planning is recorded as part of the "what needs to happen" or "next steps" column.

    Before the first pre-birth planning meeting, you and your team leader should complete an internal Signs of Safety mapping, analysing all of the information available, including past harm. You must develop draft harm statements (where applicable), danger statements and safety goals and discuss these with the parents before the first pre-birth meeting.

    Any danger statements or safety goals created must relate to what we are worried will happen to the infant after birth, not in utero.

    You must correlate any concerns during the pregnancy with what we are worried will happen to the infant after they are born, in the context of the abuse types. For example:

    Scenario

    Example Danger Statement

    The Child Safety Investigation is open for the abuse type of neglect and we are worried that there is a likelihood that physical harm will occur after baby is born.

    The Department is worried that mum and dad are using drugs and alcohol while mum is pregnant and that they can't keep the house clean, have food in the house and look after their own basic needs.

    If this continues after the baby is born then they might not be able to keep the baby clean, watch the baby enough and know when the baby needs help. This could lead to the baby getting sick, hurt or dying. 

     

    The purpose of pre-birth planning is to undertake planning in consultation with the parents, family, WA Health and other professionals.  This planning is recorded as part of the "what needs to happen" or "next steps" column.

    Actions recorded as part of the plan should:

    • relate to the danger statements and safety goals identified - it is misleading to ask for actions to be undertaken that do not relate to our reason for involvement in any way

    • maintain a focus on the legislative grounds for the Department's involvement - focus on the abuse type and subsequent harm being assessed, and

    • show a correlation between actions and behaviour - what behaviour change is expected as a result of the action, for example, a parent can attend drug and alcohol counselling successfully, but if they still neglect to feed, bathe and supervise their infant then what has been achieved?

    Planning can extend beyond the birth of the infant and outline what will need to happen for the infant to remain in the parents' care. Plans should outline measurable actions which should occur during the pregnancy, for example:

    • Preparation for the infant (securing safe accommodation, sourcing a cot and baby items, exploring childcare options).

    • Attending antenatal care.

    • Evidence of behavioural change.

    • Developing and enacting a person safety plan (relating to family domestic violence).

    • Safety network people taking a role with the parents.

    All notes from the meetings and the plan must be written in plain language, with pictures if necessary, in a way that the youngest person involved in the planning understands.

    You should work with parents and safety networks to develop safety plans that promote the safety and wellbeing of the infants after their birth.  Safety plans can include a visiting schedule where the infant is seen by the safety network as often as is necessary. Visiting schedules should be written in plain language in a way that is understood by the parents, for example, a calendar could be used, with a photo of the person who is visiting attached to the day of their scheduled visit.

    Signs of safety tools that you might be able to use during pre-birth planning include: 

    Pre-birth planning is an opportunity to use and adapt the Signs of Safety tools to the needs of the family over time.  "The Meeting Map" is an example of Words and Pictures - a culturally appropriate tool to engage with Aboriginal and non-Aboriginal families.  It encourages the use of pictures as representations for each stage of pre-birth planning alongside conversation and yarning. 

    Other useful resources can be found in:

     
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    Pre-birth planning meetings

       
    There may be instances where pre-birth planning meetings are not in the mother or unborn infant’s best interests, e.g. where the woman has a significant trauma history and the process will cause further distress. In these cases alternative planning must be considered, including using other Signs of Safety tools.
     

    Pre-birth planning involves interagency meetings with the parents, their family and safety network, the Department, WA Health and, in some cases, the parent's legal representatives (often this depends on Legal Aid availability). The meetings should be held as close as possible to 20, 26 and 32 weeks gestation to ensure timely decision making, but this timeframe can be adapted according to the best interests of the unborn child, for example, when there may be an increased risk of pre-mature birth.

    Planning can extend beyond the birth of the infant and outline what needs to happen for the infant to remain in the parent's care. Plans should outline measurable actions which should occur during the pregnancy, for example:

    • Preparation for the infant (securing safe accommodation, sourcing a cot and baby items, exploring childcare options)
    • Attending antenatal care
    • Evidence of behavioural change
    • Developing and enacting a person safety plan (relating to family domestic violence), and
    • Safety network people taking a role with the parents

    Pre-birth planning meetings are organised by the local district and facilitated by someone independent of the case management of the family. Facilitators who have had previous line management authority of the family, past involvement with the family or have any other conflict of interest are not considered independent and should not be appointed.

    It is best practice for the same facilitator to manage all three meetings. 

    Facilitators should refer to the Opening Statement for Pre-Birth Facilitators for information about how to commence a meeting.

    Always keep in mind that the parents and thier safety network are the main attendees of the pre-birth planning meetings.  Having lots of professional workers in the room can be overwhelming for the family.

    Each meeting should include a range of participants, including:

    • Parents and their nominated relevant supports
    • Hospital or medical service.
    • Facilitator
    • Child protection worker
    • Team leader
    • Aboriginal Practice Leader (where possible), and
    • Best Beginnings Plus worker

    The district arranges the meetings in conjunction with the facilitator. Meetings are generally held at the hospital the mother attends for her antenatal care. However, if the parents wish the meeting to be held at a different (safe) location, this should be considered in consultation with WA Health and carried out where possible.

    The most important work as part of the pre-birth planning process is undertaken by you outside of the meetings. You should use the time between meetings to continue your assessment of the concerns, support the parents to complete the actions identified in the plan and gather credible evidence.

    All notes from the meetings, including the plan, must be written in plain language, with pictures if necessary, in a way that the youngest person involved in the planning understands.

    When the third meeting has been completed, or earlier if subsequent meetings are not required, facilitators should complete the Pre-birth Facilitator Report and send it to PrebirthPlanning@cpfs.wa.gov.au.

    First meeting - preparation

    In collaboration with the parents, you should develop draft danger statements, harm statements (in relation to previous harm caused to any other children) and safety goals before the first pre-birth meeting. Where possible, forward these to the facilitator one week before the first meeting.

    You must meet with the parents to prepare them for the first meeting.  Explain:

     

    Preparation

    Facilitator

    District

     

     

     

     

     

    Actions

    Centralised tracking of case 

    Quality assurance of information of intake on Assist* 

    Meeting co-ordination including liaison with hospital * 

    Setting up of meeting room (technology, white board) 

     

    * Activities required by facilitators in pilot with KEM and Fiona Stanley Hospital

     

    Allocation of child protection worker 

    Intensive Family Support team leader considers Best Beginnings plus referral 

    Engaging family - SOS and pre-birth process explained 

    Provide legal and advocacy service information 

    Agreement with family on final danger statements and safety goals 

    Final confirmation of meeting attendees and their relationship to unborn child

    Provide a copy of final danger and harm statements, and safety goals to facilitator *

     

    First meeting

    The first pre-birth meeting is held as close as possible to the pregnant woman being 20 weeks gestation. The purpose of the first pre-birth planning meeting is to share and assess all relevant information in order to reach a common understanding of risk to the unborn infant.

    You should share the draft danger statements, harm statements (in relation to previous harm caused to any other children) and safety goals and seek the parents' views. Meeting participants is encouraged to consider interventions focused on promoting the unborn/newborn baby's health, safety and wellbeing and support for the parents and family.

    The facilitator should develop and distribute a list of next actions to the meeting attendees  at the conclusion of the meeting and the minutes of the meeting should be distributed to all parties within a week of the meeting occurring.

    Preparation

    Facilitator

    District

     

     

     

     

    During meeting

    Before the meeting you should have a brief conversation with the mother

    Opening statement 

    Ongoing management of room dynamics 

    Use  questioning approach to elicit strengths and safety within the family 

    Safety scaling question 

    Confirm next meeting date 

    Distribution of next steps before meeting closure

    Danger statements, harm statements and safety goals discussed to ensure clear understanding 

    Consider additional supports required including referral to services

     

     

     

    After meeting

    Type up and distribute record of meeting 

    Update Assist and Objective of meeting outcome

     

    Monitoring and implementing action plan 

    Follow up on referrals

    Liaison with hospital re: antenatal care 

    Information provided on Safe sleeping (SIDS) and Abusive head trauma (shaken baby) to parents – Safe Infant Sleeping information for parents, carers, and families 

    Home visit to assess sleeping environment – BB Plus safe infant sleeping checklist

    Review action plan.

     

    Second meeting

    The second pre-birth meeting is held as close as possible to the pregnant woman being 26 weeks gestation. The purpose of the second pre-birth planning meeting is to review the action plan developed in the first meeting and outline any progress made and/or changes in circumstances which have occurred.

    The second interagency meeting should review the family's circumstances, contemporary factors that have increased or decreased risk and detail any progress in addressing the issues of concern. The purpose is to identify the level of potential risk, determine if the risk is manageable and if so outline ways in which this will be managed and safety of the child is maintained.

    At this meeting, a draft safety plan should be devised, and efforts made to examine its vigour through scaling questions and testing over a period of time. It is important that the family understands their role and responsibilities in the process.

    The facilitator should develop and distribute an action plan detailing tasks for specific people to the meeting attendees either at the conclusion of the meeting or as soon as possible after the meeting.

    Preparation

    Facilitator

    District

                      Before meeting

    Print off copies of previous meeting minutes

    Organise and confirm attendees 

    Information provided on significant developments (where necessary).

                      During meeting

    Provide a copy of previous minutes 

    Ongoing management of room dynamics 

    Ensure equal participation of attendees in meeting 

    Non-negotiables established

    Review of previous actions 

    Action plan including safety plan documenting clear lines of accountability/timeframes 

    Confirm next meeting date

    Distribution of next steps for safety plan before meeting closure.

    Further identification of safety network

    Further development of safety plan – refer Helping families to develop a safety networkRoadmap: Family owned safety planning 

    Discussion with attendees that district director approval needs to be sought in relation to safety planning.

     

    Post meeting

    Type up and distribute record of meeting 

    Updating Assist and Objective with record of meeting.

    Monitoring, reviewing, implementing safety plan  

    Consideration given to external referrals to support planning

    District director consultation.

     

    Internal decision making

    Before the final pre-birth planning meeting an internal decision making meeting needs to occur at the local district; you, your team leader and district director must review the assessment to date. The facilitator should remain independent from the decisions made in relation to the unborn infant.

    Think about who else you should consult before the meeting or should attend the meeting, such as a:
    • Senior Practice Development Officer;
    • Aboriginal Practice Leader; and/or
    • District psychologist. 

    The district director has delegated decision making responsibility to decide on the next course of action from one of the following options:

    1. Further pre-birth planning not required: The Department has assessed there is no likelihood of harm to the newborn after birth. A final pre-birth meeting is not required. The Department may or may not remain involved to provide further supports as required.

    2. Sufficient safety for the newborn to go home: A safety plan is developed with the parents, their extended family (where possible) and their support network. The Department remains involved with the family in order to monitor and test the safety plan and promote the infant's safety and wellbeing.

    3. Sufficient safety for the newborn to go home under a protection order (supervision): Requires district director approval. A safety plan is developed with the parents and their support network. Relevant sections of the safety plan form conditions set out as part of the protection order (supervision). The Department remains involved with the family and monitors the conditions set out by the court.

    4. Insufficient safety for the newborn to go home: Requires district director approval. The infant is placed into provisional protection and care prior to leaving the hospital. In most cases, the decision for an infant to enter the CEO's care from hospital is coupled with planning for immediate reunification.

    Advising the parents and WA Health of the decision

    Following on from the internal decision making stage and before the final pre-birth meeting, the Department must advise the parents and WA Health of the decision. When a decision has been made for the infant to remain in the parents' care with a safety plan in place, the safety plan is discussed with the parents and safety network and agreed upon.

    When a decision has been made to place the infant into provisional protection and care, the Department should advise the parents of this decision. You should also advise the relevant hospital social worker and/or Director of Nursing and/or Maternity Service Manager of the decision, who is then responsible for advising other relevant WA Health staff including community health staff.

    The final decision must be communicated to the family and WA Health prior to the third interagency meeting including the outcome of the CSI.

    Where a decision has been made to place the newborn in provisional protection and care, you should advise WA Health as soon as practicable including a discussion on how best to notify the parents.

    Irrespective of the final decision, a third meeting must be convened to ensure mutual understanding of the decision and make post discharge plans for the child and family.

     

    Final meeting

    The final pre-birth planning meeting is held as close as possible to the infant being 32 weeks gestation. This meeting provides an opportunity to plan how to progress the decision made by the Department, bearing in mind the wellbeing of the unborn infant and their parents.

    Where possible, the final meeting should be used to plan for any practical measures that need to be taken to safeguard the child which causes the least distress possible to the newborn, mother, other patients and staff.

    Post-birth meetings are determined with the family and meeting participants on a case by case basis.

    Preparation

    Facilitator

    District

    Before meeting

    Print off copies of meeting 2 for attendees

    Notify facilitator of any significant developments in case since Meeting 2, including the decision and notification of the decision with the family.

    During meeting

    Document the final version of the safety plan 

    Confirm attendees understand Director decision and next steps

    Commence post discharge planning

    Provide family with investigation outcome including right of reply.

    Post meeting

    Distribute a written record of the meeting 

    Update Assist and Objective with meeting information

    Finalise Child Safety Investigation outcome report.

    When the safety plan is developed, discuss it with the parents and safety network to ensure that it is understood and agreed upon by all. Where the plan is for an infant to be placed into provisional protection and care from the hospital, the final meeting includes planning for the medical care of the infant and mother and development of strategies to minimise disruption to the hospital when the child is removed from the parent's care.

    Where having this discussion in the presence of the parents might result in increased risk to the infant, discussions should be held at a separate meeting between the Department and WA Health. When an after-hours response may be required, the Crisis Care Unit should be invited to participate in a discussion between the Department and WA Health.

    Where it is planned for the infant to be placed into provisional protection and care from the hospital, consider the following:

    • The obstetric, psychiatric and social circumstances of the mother and whether these factors may impact on management within the hospital.

    • Whether the parents and/or others pose a physical risk to the infant or others.  Plans should outline how safety risks will be managed in the hospital where there are people who are not permitted to access the ward for safety reasons, how the hospital will manage the situation if that person presents.

    • If there is a risk that the parents could abscond from the hospital develop plans to minimise this risk occurring. Plans should outline where parents (or other unsafe people) may abscond with the infant they are prevented from doing so by hospital security. Where a warrant under s.35 has not yet been obtained, s. 37 (apprehension without warrant) or s.40 (power to keep child under 6 years of age in hospital) may be required to maintain the infant in hospital.

    • The level of supervision, if any, that is required for contact between the mother and infant after birth. Whether mother and infant can remain on the ward together after the birth or whether the risks to the infant are so great that the infant requires care in a fully supervised area of the hospital.

    • Where contact needs to be supervised, how will this be facilitated?

    • Whether there is a risk of alcohol or drugs being transferred to the infant via breast milk, and whether breast feeding will be permitted. Whether the Department will support the mother to breast feed (by providing a pump and transport for milk etc.) after leaving the hospital.

    • Appropriate timing to provide the parents with written advice that the infant is entering the CEO's care.

    Planning with the Crisis Care Unit (CCU) 

    Where a woman presents to hospital, goes into labour, or gives birth after business hours, or where WA Health has concerns for a mother, infant or others after hours, WA Health may contact CCU to advise of the situation and seek direction.

    In cases open to pre-birth planning where CCU may have to respond after business hours for any reason and/or there are specific actions required to manage risks, you should forward a possible contact referral to CCU and then follow up with consult. Refer to Form 190 Crisis Care Referral (in related resources).

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    Post-birth planning

    Post-birth planning should occur throughout the pre-birth planning process, especially when it is likely that the Department will remain involved following the birth of the infant. Planning for after the birth of the infant should include consideration of:

    • whether the infant will require hospitalisation
    • who will have contact with the infant
    • who will support the parents following the birth
    • the Department's role following the birth
    • further planning meetings that will need to occur, and
    • the outcome of the Department's investigation.

    These considerations are particularly important when there is a risk of premature birth or if an infant is born and needs to remain hospitalised or is required to be cared for in the Neonatal Intensive Care Unit (NICU). The brains of pre-term infants are particularly immature and vulnerable, putting them at risk for abnormal brain development and later developmental problems.

    The Department must promote physical and emotional closeness between any infant born prematurely and significant people. This could include parents, grandparents, carers or significant others. Physical and emotional closeness between premature infants and significant others is especially important for infants being cared for in the NICU and can significantly increase their chances of survival and recovery.

    When the Department remains involved with a family post-birth, you must work closely with the hospital to plan for the safe discharge of the infant. When infants return home with parents and/or families with a safety plan and/or supervision order in place, you must continue to support the parents and monitor and review the safety plan for a length of time agreed with the team leader.

    Pre-birth planning is concluded and cases are transferred to Intensive Family Support (for safety planning and supervision orders) and Care Teams (for infants in provisional protection and care).

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    Pre-birth Project

    ​The Pre-birth Project is trialling a centrally coordinated model for managing the pre-birth planning protocol across the state. A review of pre-birth planning was conducted in 2017-2018 and identified some key issues in resourcing and consistency in pre-birth planning.

    The Project aims to:

    • provide two dedicated Senior Practice Development Officers (SPDOs) who will facilitate meetings at King Edward Memorial Hospital and Fiona Stanley Hospital; and

    • collect and monitor data relating to pre-birth planning occurring around the state. 

    A number of SPDOs work on this project and are located in the Professional Practice Unit. You must notify the Pre-birth Project of any pre-birth planning occurring across the state; email PrebirthPlanning@cpfs.wa.gov.au with information regarding any pre-birth planning that has been undertaken. 

    The inbox has been set up to:

    • enable the Senior Practice Development Officers allocated to the trial to progress planning of pre-birth planning meetings for women birthing at King Edward Memorial Hospital (KEMH) and Fiona Stanley Hospital (FSH), and

    • enable improved tracking of all pre-birth planning activity state-wide.

    When the third meeting has been completed, or earlier if subsequent meetings are not required, facilitators should complete the Pre-birth Facilitator Report and send it to PrebirthPlanning@cpfs.wa.gov.au.

    External referrals

    • Central Intake Team, Crisis Care Unit and Regional Child Safety Teams notify the Pre-birth Project of the new Child Safety Investigation (CSI) with pre-birth protocol intake via an email to PrebirthPlanning@cpfs.wa.gov.au
    • This email will prompt tracking of all pre-birth cases statewide and coordinate facilitation of the meetings for mother’s birthing at KEMH or FSH.

    Internal referrals

    These apply to:

    • active Intensive Family Support (IFS) cases
    • parents who have children in out-of-home care, are expecting another child.
    • children in care who are parents or expectant parents, and an investigation indicates likelihood of harm or actual harm to the child.

     

    Where the young parent-to-be is a child in the CEO's care and there are concerns that they have experienced harm, you must consult with the Duty of Care Unit regarding the concerns and the next course of action refer to:

    1. Chapter 2.1 Safety and Wellbeing Assessment - safety and wellbeing concerns regarding children in the care of the CEO, and the
    2. Child Advocate.

    Process:

    • The district managing the case completes the CSI intake (recording the pre-birth planning protocol) and notifies the Pre-birth Project of the new pre-birth intake via email to PrebirthPlanning@cpfs.wa.gov.au.

    • This email to the pre-birth inbox prompts tracking of all pre-birth cases statewide and coordinates facilitation of the meetings for mother's birthing at KEMH or FSH.

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