Strengthening our response to unborn and newborn babies
Updated: 19 December 2019
What's important to us
When we are made aware of concerns for a baby before or soon after their birth, we have a unique opportunity to work with their families/whānau, hapū, iwi, family group and other professionals to assess parenting capacity and needs and implement a plan that will build a set of ‘eyes' around the baby and provide a multi-agency approach to safety.
We know that babies are extremely vulnerable. It is important that we look to the future and consider how the family/whānau will be supported to ensure not just immediate safety after birth but also the ongoing safety and wellbeing of their baby.
Practice leader oversight will focus on promoting work that is consistent with our practice standards throughout our engagement with te tamaiti and their family, whānau, hapū, iwi and family group. This includes the appropriate application of Te Toka Tumoana and Va'aifetū.
Supervisors will closely supervise cases involving unborn and newborn babies to ensure that the right decisions and actions are being taken at the right time throughout the assessment, planning and implementation process.
Early engagement and assessment
We need to engage with parents and wider family/whānau at the earliest possible point. A report of concern can be made for an unborn baby at any stage of pregnancy. This provides opportunity to:
Support ante-natal health — work with mum to establish supports such as regular ante-natal care, assistance with alcohol and drug abstinence and smoking to maximise baby's health.
Engage fathers — many dads can be a support system to their child even if they are not in a relationship with the child's mother. They may be able to provide information about pre-natal history and the mother's own history, they may have family/whānau who can be drawn on for support and, in many cases, they can provide support to the mother if the couple are able to parent safely together. If there is a concern around the safety of the father this needs to be addressed as well — as the baby's father, he will have a role in the child’s life so we need to engage him in making this as safe as possible.
Identify and utilise wider family/whānau strengths — engaging with wider family/whānau, hapū and iwi early promotes safe and family-led decision making. It is important that families/whānau are empowered and given the opportunity to address the concerns themselves. Families/whānau often possess strengths and resources to provide safe care and support to the newborn baby with minimal or no intervention from Oranga Tamariki. The important thing to consider is whether this safety and care will be enduring and what supports the family/whānau will need to maintain the plan for the baby through to and beyond their birth.
Assess parenting capacity, willingness to change and ability to maintain changes before baby is born — early assessment of parenting capacity informs decision making. Use the Tuituia assessment framework to guide your assessment, paying particular attention to the capacity to care (kaitiaki mokopuna) domains and subdomains. Reports of concern received pre-birth often relate to the parent's level of intellectual functioning, substance abuse issues, mental health and/or history of harm to their children. It is vital to have a good understanding of the parent's functioning in order to properly assess safety and implement the child’s plan. Having a clear understanding of a parent's strengths and limitations enables the family/whānau and social worker to develop a plan that will meet the safety and care needs of the baby immediately and into the future. Also bear in mind that some parents will have different needs:
- first-time parents will need to be able to learn new skills to enable them to parent safely
- parents where there have been previous concerns need the ability to change long-standing patterns of poor parenting
- parents with learning difficulties or intellectual limitations require careful assessment that may need to involve a specialist who understands the impact of disability on parenting. Your assessment needs to consider not only a capacity to parent safely but also if it will be practical to maintain any required supports long-term and if the supports are able to evolve as the child's needs change
- parents with alcohol and drug abuse issues, unmanaged mental health issues and anti-social behavioural issues may require a separate assessment specific to these issues to inform the social worker’s assessment of their capacity to care. Research has shown that pregnancy may be a window of opportunity to intervene for substance abuse problems and may be the first time that a woman has sought medical care. Pregnant women as a group are invested in the health of their babies and can no longer deny that their alcohol or drug abuse is hurting anyone but themselves. Women in recovery have reported that they wanted help during pregnancy but didn't know how to ask. Keep in mind that mothers can often abstain from alcohol and drug abuse while pregnant because of the effect on the baby but return to substance abuse post pregnancy because they think the baby will no longer be affected
- parents with unmanaged mental health issues and anti-social behavioural issues may require a separate assessment specific to these issues in order to ensure that the social worker’s assessment of parenting capacity is thorough and considers all the risk factors, strengths and support needs of the situation.
Use the child and family consult to inform robust decision making — this will help us be clear about what it is we are worried about and what we need to see change in order to address the concerns.
Consider using a facilitated group consult to explore how the history may link with current behaviour or concerns and any impact on the unborn or newborn baby.
Concern about intentional harm to the unborn baby and/or the parent not engaging often drives a risk averse, non-collaborative response that is delayed until after the baby's birth. Having a good knowledge of the history, engaging with family/whānau members and consultation with professionals involved with the family/whānau will help to inform the decision about engagement with parents.
Assessing parents known to Oranga Tamariki for their own childhood history of abuse/neglect
A person's own childhood experiences can influence their parenting both positively and negatively. A lot of our parenting knowledge is learned from how we were parented. When working with parents who have their own history of abuse and/or neglect it is vital that we take the time to:
- fully explore the history, read the file and talk to the previous social worker if possible
- consider how childhood neglect/abuse and poor parental role modelling impacts on the parent's view of the world, and influences their parenting style and the value they place on children
- consider the impact of childhood trauma on parenting and seek advice from mental health professionals as necessary
- pay attention to behavioural difficulties, learning difficulties and mental health issues that were evident in the history, particularly adolescents. Consider what impact this has had on the parent as they moved into adulthood, explore if these issues are still present and ensure these factors are considered in full when assessing parenting capacity
- identify the strengths, opportunities and supports within the family/whānau and community that will help stop patterns of generational abuse/neglect.
Reports of concern about unborn babies often come from professionals in the health and child welfare sector. We need to bring these people together to share information at the earliest point.
Using a collaborative approach right from the start ensures that we are gathering relevant historical information and working together to keep each other informed of any changes in the parents’ situation that impact on the risk to the baby. It is important that we have a mutual understanding of the concerns and the plan that will be in place to ensure the baby's safety.
Early family group conference and planning
Having a hui ā-whānau and a family group conference prior to birth allows an opportunity to work with the parents and wider family/whānau to identify clear expectations of what is needed in order to ensure that the new baby will be safely cared for.
There is no barrier to holding a family group conference before a baby is born. If a family group conference is required, a referral should be made at the earliest opportunity — irrespective of how many weeks pregnant is the mother. Assessment and safety planning can occur prior to this.
Taking a pro-active approach to early planning, well before the baby is born, provides the opportunity to:
- mobilise support and/or care systems within the wider family/whānau and community so that they are well established by the time baby is born
- give parents the opportunity to demonstrate change proven over time before baby is born
- support the family/whānau to make stable care arrangements and support early attachment in circumstances where the assessment has shown it is not safe for the baby to remain in a parent's care
- have a clear plan to minimise multiple placements for the infant
- when the decision is made for a baby to remain or return home, the plan will have clear goals, be focused on the changes that the parents need to make in order to demonstrate safety, and specific timeframes and contingencies that can be implemented immediately if the main goal is not achievable
- utilise the five eyes on under fives as a means of establishing a monitoring and support system around the newborn baby
- support the parents so that they are prepared to meet the basic needs of the baby when it is born such as adequate housing, access to medical care and safe baby sleeping arrangements
- work with health and other providers about exactly what will occur when the baby is born to ensure safety. This can then lead on to further planning when baby is ready to leave hospital
- consider implications for any siblings.
Sudden Unexplained Death in Infancy (SUDI)
Newborn infants are the most vulnerable group for Sudden Unexpected Death in Infancy (SUDI), also known as SIDS or cot death. Early engagement and planning with families/whānau provide an opportunity to work with health professionals to educate parents and wider family/whānau about the risk factors and to encourage changes to behaviour that increase the risk of SUDI such as smoking in pregnancy and using high risk sleeping practices.
Morse, B., Gehshan, S., Hutchins, E. (1997). Screening for Substance Abuse During Pregnancy: Improving Care, Improving Health. Arlington, VA: National Center for Education in Maternal and Child Health.