Judgements of health and social care professionals on a child protection referral of an unborn baby: factorial survey

Background Midwives and children’s services social workers have responsibilities to identify and support pregnant women where there are child protection concerns. Professionals seek to anticipate the risk of harm and initiate interventions to provide support to families. There is little research on how professionals prioritise risk factors and the challenges they face in protecting unborn babies.

Objective To measure the impact of identified risk factors regarding child protection referrals of unborn babies on the professional judgements of midwives and children’s services social workers.

Methods A factorial survey design using vignettes with randomised factors within a standardised structure, administered digitally using Qualtrics software.

Participants & settingMidwives (n = 250) and children’s services social workers (n = 88) from one Health and Social Care Trust in Northern Ireland.

Results One thousand and ninety-six vignettes were completed by 118 participants. Analysis using multiple regression showed that the risk factors together accounted for 44% of the variance in perceived risk of harm and of the variance on perceived need for a referral. The significant Independent Variables (IVs) in order included: drug use, alcohol use, age, antenatal care attendance, mental wellbeing, domestic violence and the pregnant woman's I the childhood experiences. There were no significant differences between midwives and social workers regarding judgements about important risk factors.

Conclusions This survey provided an ordering of major risk factors influencing decision making to protect an unborn baby from the perspective of experienced social workers and midwives. The study helps professionals in judging the seriousness of risk factors. The interaction effects between risks requires further research.