Born into care in Scotland: circumstances, recurrence and pathways

7. The pre-birth period

Information was extracted from the case files on families' involvement with services prior to the birth of the infant in the sample, including formal child protection interventions. Pre-birth child protection processes involve social workers and other professionals assessing the risk of harm to unborn children, with national guidance on child protection having made reference to unborn babies since 2014 (Scottish Government, 2014). This guidance has been recently updated (Scottish Government, 2021) and clearly sets out the timescales for pre-birth assessment and planning, and the responsibilities of relevant agencies.

Families' involvement with services pre-birth

All but three of the families were known to children's services prior to the birth of the infant in the case file sample, with half involved with services at least 20 weeks before birth. Although families were recorded as being known to services, we do not have information on the level of support offered and how families engaged with services. In line with previous research in Wales (Griffiths et al., 2020), there is no evidence that this group of mothers, including first-time mothers, concealed their pregnancies or avoided contact with services.

We collected data on families' first involvement with services, to gain a sense of whether they were already known to services or whether concerns about this unborn child triggered referral to children's services. In some cases, information is missing or not fully recorded or evident from the case files.

Some families were involved with existing support services, including substance misuse services, mental health support, the Family Nurse Partnership, community learning disability nurse, criminal justice social workers, and children's services social workers. Some became known to children's services through a referral from a community midwife, health visitor or specialist maternity service, including the New Beginnings Service in Dundee and the Special Needs in Pregnancy Service (SNIPS) in Glasgow. Other families were involved with the police due to domestic abuse incidents or concerns about drug and alcohol misuse.

Pre-birth planning

A core principle of GIRFEC (Getting it right for every child) (Scottish Government, 2015) is that planning should take place at the earliest appropriate time, to enable services to be provided in the way which best safeguards, supports and promotes the wellbeing of children, with a child's plan drawn up to co-ordinate a single plan of action. Where there are professional concerns about an unborn child, an inter-agency child protection case conference (CPCC)^[17] should be held, no later than 28 weeks gestation (or within 21 days of concerns being raised if later in pregnancy), to agree a plan to minimise risk of harm to the child. Where the child is believed to be at actual or potential risk of significant harm, their name should be placed on the Child Protection Register (CPR) and a multi-agency Child Protection Plan developed, including what steps need to be taken at birth, such as referral to the reporter and/or application for a Child Protection Order (CPO).

A CPCC was known to have been held pre-birth for at least 59 (84%) of the infants in the case file sample. A CPCC was not held for five of the infants pre-birth, and for six infants this information was not evident or recorded. On average, the CPCC was held eight weeks before birth, ranging from between 27 weeks prior to birth to the week of birth.^[18] Whilst a CPCC was held pre-birth for the majority of infants, for some it was held later than the timescales laid down in the national guidance in place at the time (Scottish Government, 2014, 2021).Over a quarter (29%) of the infants in the sample were known to have been born prematurely and/or had low birth weight, and it is important that pre-birth planning takes into account the possibility that babies will be born early.

Overall, 61 (87%) of the infants in the case file sample were known to have been placed on the Child Protection Register prior to becoming looked after away from home via the CHS, and for the majority (50) this occurred prior to birth. Forty-six unborn children were placed on the CPR on same day as their pre-birth CPCC, with four registered at a later date, but still before birth. Seven infants were placed on the CPR after birth, with the CPR registration date for four infants unknown. Only one infant was known to have not been on the CPR, with information on CPR registration unknown for eight infants.

Key findings

• All but three of the families were involved with services prior to the birth of the infant, including existing support services, specialist maternity services, and the police.
• A pre-birth child protection case conference was known to have been held for the majority of infants (84%), an average of eight weeks before birth.
• Where there was a pre-birth case conference, 46 out of the 59 infants were placed on the Child Protection Register that day.
• Overall, 50 (71%) of the infants were known to have been placed on the Child Protection Register before birth.