Pre-birth assessments offer social workers a structured opportunity to assess parental capacity and identify both risks and support needs prior to the birth. When initiated early, these assessments can enable parents to make meaningful changes in advance of their child's arrival. Early identification of concerns allows parents greater opportunity to engage with support and, where appropriate, seek legal advice. An absence of early planning can result in rushed decisions, limited parental engagement and a lack of transparency in safeguarding processes (Barlow et al. 2016). A local authority (LA) in England, Kirklees, sought to fix this and the New Beginnings Pre-Birth Model was born. By design, pre-birth assessments are inherently intrusive. They often require parents to disclose deeply personal and often traumatic life experiences to a practitioner with whom they may have little established trust. This dynamic can inhibit open engagement, leading to assessments based on incomplete information and reinforcing deficit-focused narratives around parental non-engagement (Rollins 2018). Yet, pre-birth assessment practice varies across England, with no national authorised guidance for good practice (Ward et al. 2022). Following a report from the Nuffield Family Justice Observatory (Alrouh et al. 2022) sharing concerning statistics regarding the number of babies entering care at birth, Kirklees LA identified the need to improve pre-birth interventions in our area, which led to the development of the New Beginnings programme. The New Beginnings pre-birth model brings together key professionals at the earliest possible point of concerns being identified. Using principles of restorative practice, professionals work with parents to break down the barriers to providing a safe and secure environment for their baby. Partnership working is at the heart of New Beginnings, allowing ‘Parents and professionals to co-define needs and goals, and work collaboratively to identify and build on strengths throughout the pregnancy’ (Mason et al. 2023). In Kirklees, pre-birth assessments are conducted using a Child and Family Assessment and fall under the category of Child in Need. The assessments are completed within 45 working days, which is significantly shorter than the previous assessment model (which aimed to have the assessment completed before 33 weeks gestation). This means that support needs are identified earlier and are more targeted before birth, giving a greater opportunity to support change to enable parents to care for their child safely, at home. Another major change is how the meetings are run. Instead of the social worker leading and minuting, an independent facilitator now chairs Child in Need meetings, using the 6Ps model (see Figure 1). This creates space for the social worker to focus fully on engaging with the family as well as addressing some of the power imbalances between the professionals and the family. Finally, we have embedded a formulation-based approach, which helps us develop a shared, deeper understanding of each family's circumstances—focusing on strengths, not just challenges and guiding us in planning the right support. We do this through having the 6Ps model displayed on a screen for everyone to see during the meeting. It is completed by the facilitator, alongside families and professionals. Everything that is written is visible to everyone in the room, making the process more transparent and inclusive. Once a shared understanding has been created, the next steps are then formed and agreed by everyone present. This becomes the basis for the pre-birth assessment and creates the Child In Need Plan. Across the LA, a 6Ps formulation model is used. This is an adaptation made by Leeds City Council (Leeds City Council 2025) of a formulation framework, originally developed by Weerasekera (1993). Initially designed for use by psychiatrists, the 5Ps model continues to be widely applied across mental health services. For use in social care, an extra ‘P’ was added (the ‘Predicting Factors’) to capture risk. Formulation encourages professionals to bring together information in a restorative and consistent way with families, to better understand the broader context of strengths and specific areas of needs. This promotes the implementation of timely and targeted interventions, service provisions and referrals that better meet the interests and engagement levels of the family at that time. The model is spilt into 6 areas (the Ps) and information is filtered through the model, allowing practitioners to understand how everything is interlinked, viewing the needs of the unborn child through a holistic lens. Formulation is versatile and fluid; if you can define what it is you have concerns about or what you want to gain a better understanding of, you can formulate it. In the context of a pre-birth assessment, we want to understand the presenting issues in relation to how parents can care for a newborn baby safely. This is the focus of the formulation. This is where we describe current concerns, in a detailed and evidence-based way. In the context of a pre-birth assessment, these will be happening in the present, which would impact the care given to a newborn baby. Such as; Mum is currently 22 weeks pregnant and has self-reported using cocaine three times over the last 4 weeks, amounting to 1 g each time. Presenting issues should be unbiased and factual; concerns we can evidence. We can also describe concerns that have been reported to us, which will later need to be explored for accuracy. This is where we capture relevant historical information. Historical information must be considered in the context of how it is impacting the present situation. This is also where we consider current challenges and vulnerabilities; things which we cannot change, such as a mental health diagnosis, but may make the family more susceptible to the presenting issues. This is where we capture potential future risk and is the only area of the model that is based on the unknown, therefore it that cannot be checked for accuracy. We consider the presenting issues and think about what is likely to happen in the future if those presenting issues are not addressed. This is where we consider all the positives and strengths. This allows the family to discuss who is in their support network and what is currently going well for them. We may also capture past achievements, leading to conversations about why things were going well at that time and how we might replicate that moving forward. The acknowledgment of protective factors does not negate presenting issues but rather gives a holistic view of the current circumstances. Identifying protective factors is also important for creating ‘next steps’, as building on existing positives supports sustainable change. This is the area of the model that captures triggers to the current concerns. It helps us with behaviour sequencing and understanding what might happen right before the current concern. Such as; When Mum has an argument with her partner, this leads her to take cocaine. It can help to identify support needs to manage triggers. This is where we consider all the barriers to change in relation to the Presenting Issues. This area will highlight things such as gaps in our understanding, engagement and alignment struggles and is the focus of our next steps and planning. The identification of the perpetuating factors allows us to break down the barriers to change. By creating ‘next steps’ which directly attempt to remove these barriers, we can devise a plan that is unique to the family's current circumstances and positively affect change on their presenting issues. These next steps are created collaboratively between professionals and families, ensuring everyone is aligned with the plan. The following example summarises how this works in practice, exploring a pre-birth assessment which followed the New Beginnings model. Initially, there were concerns regarding the expectant mother's engagement with antenatal and statutory services, including repeated missed appointments, limited communication and an assumption from professionals that she was dismissive of concerns raised. Through formulation, these presenting issues were able to be understood in the context of her trauma of previous child removal and a negative experience of working with services in the past. Perpetuating factors were identified including the absence of an established, trusting relationship with professionals and the mother's limited understanding of the purpose of a pre-birth assessment, which she experienced primarily as a pathway to removal rather than an opportunity to access support. Formulation directly informed the planning of the assessment and next steps. Actions were focused on relational work and explicit conversations, clarifying the aims of the pre-birth assessment and the thresholds for decision making. This was accompanied by collaborative exploration of practical and emotional support options, including family support and relevant community and perinatal services. From the mother's perspective, these changes reduced feelings of judgement and scrutiny and increased her sense of agency, resulting in greater openness in discussions allowing for a more accurate assessment of parenting capacity. By comparing the outcomes from pre-birth assessments prior to and since the implementation of the New Beginnings process, there have been some positive observations. We conducted a comparative analysis between a random sample of 100 assessments using the previous pre-birth model and the first 100 cases implemented under the new model. Although a thorough analysis has not yet been completed, preliminary findings indicate a positive trend, suggesting the new approach may offer meaningful improvements in practice. Like any new approach, implementing the New Beginnings model came with its challenges. One of the first was ensuring timeliness alongside social worker capacity and the complexity of co-ordinating multi-agency meetings at times that worked for professionals and families alike. We also faced difficulties in engaging families who were harder to reach, particularly those with prior involvement in social care. Many of these parents had a deep distrust of services, which understandably meant they felt hesitant to engage. To address these challenges, we expanded the team and introduced the Contact Liaison Officer (CLO) role. The CLO's role is to support the family to meaningfully engage in the assessment process. This begins at the point of the family's allocation to a social worker and ends when the assessment has been completed. This then allows the social worker to use their time more effectively, such as undertaking more direct work with the parents. The involvement of families in the meetings is regarded as a central priority. By adopting a restorative and inclusive approach, the meetings aim to reduce the negative emotions often associated with social care involvement. This commitment is reflected in the consistently positive feedback received from participating families. A recurring theme within this feedback is the sense of being listened to. When invited to express their desired outcomes for the meeting, families frequently articulate a wish to be ‘heard’ and ‘not judged’. Subsequent evaluation indicates that these expectations are generally met. Additional feedback highlights an appreciation for the more relaxed atmosphere fostered during these meetings, such as arranging chairs in a circle rather than behind desks, which contribute to a conversational and less formal tone. Participants value the transparency afforded by being able to view written notes in real time and families with prior experience of social care involvement often compare these formulation-based meetings to earlier encounters, reporting that the former feel more inclusive and less judgmental. Using formulation to underpin New Beginnings has proven to be a versatile and useful way of analytical thinking and making sense of complex information. As staff members we have found it to be an effective basis for promoting thoughtful and collaborative planning and allows us to embody a restorative practice model, which is embedded across Kirklees children's services. We feel this approach supports our goal of keeping families safely together, where possible, in a way that is sustainable and stable. The authors have nothing to report. Research data are not shared.
Hepworth‐Lodge et al. (Thu,) studied this question.