3.2.2 Pregnant Women, Partners and Babies where there is Substance Misuse (MAPLAG)
A summary of this chapter is available – see the Factsheets section in Local Resources.
Safeguarding Children Living in Families with Drug and / or Alcohol Misuse Protocol
NICE Quality Standard QS 204 Foetal Alcohol Spectrum Disorder
This chapter was updated in October 2022. The above link was added to NICE Quality Standard QS 204 Foetal Alcohol Spectrum Disorder.
This protocol is applicable for all staff working with women, and their partners, who use drugs and/or misuse alcohol during pregnancy.
The purpose of this procedure is:
- To encourage pregnant women who use, or are suspected of using drugs and / or misusing alcohol to seek early antenatal care and, where appropriate drug or alcohol treatment;
- To normalise antenatal and postnatal care as much as possible whilst recognising the social and medical issues associated with drug and / or alcohol use and providing appropriate services to address these;
- To encourage communication between all practitioners so that advice to the woman is consistent, and that any concerns about drug / alcohol misuse or safeguarding children are identified and dealt with appropriately.
It is important to ensure early identification of women who use drugs and/or misuse alcohol in order to provide appropriate care. All pregnant women must be asked by their community midwife about their use of prescribed and non-prescribed drugs (both legal and illicit) and alcohol. This is an integral part of the health (booking) assessment.
If a pregnant woman discloses drug use and/or alcohol misuse to any worker or drug use / alcohol misuse is suspected (as Section 3, Multi-Agency Pregnancy Liaison and Assessment Group (MAPLAG) Process below}), she must be referred to the Vulnerability Midwifery Team based at Jessop Wing. This is the responsibility of the worker to whom this information is disclosed and must be done as soon as they become aware of the pregnancy and the drug use and/or alcohol misuse. The woman must be informed that she has been referred.
A member of the Vulnerability Midwifery Team acts as the care coordinator for all pregnant women where there are issues relating to drugs and alcohol and will ensure onward referral for discussion at MAPLAG for all cases that meet the criteria (see Section 3, Multi-Agency Pregnancy Liaison and Assessment Group (MAPLAG) Process).
2. Route for Multi-Agency Assessment
Where a pregnant woman and/or her partner misuses drugs and/or alcohol, assessment needs to consider if there is the potential for the family life and unborn baby to be affected. It also needs to take account of whether there are any associated activities that impact on the unborn child, and result in concerns for the child's welfare or safety.
Assessment of risk will be undertaken by multi-agency collaboration (MAPLAG).
The purpose of the meeting is to share detailed information and make recommendations regarding the level of risk in respect of safeguarding children. This ensures timely onward referral for each family, either to Social Care services (identified child protection issues) or Multi-Agency Support Team (MAST) (family identified as having additional needs).
3. Multi-Agency Pregnancy Liaison and Assessment Group (MAPLAG) Process
Criteria for discussion at MAPLAG for either the pregnant woman or her partner are:
- Currently in treatment for drug or alcohol misuse;
- Any ongoing problematic or dependent drug use during current pregnancy, including ongoing problematic or dependent cannabis use;
- Any ongoing problematic or dependent drinking during current pregnancy;
- Suspicion of drug use where indicators of use are evident but no disclosure e.g. street sex work, criminal activity known to be associated with drug use, past drug and /or alcohol misuse.
"Problem or problematic drug use tends to refer to drug use which could either be dependent or recreational. In other words, it is not necessarily the frequency of drug use which is the primary 'problem' but the effects that drug taking have on the user's life (i.e. they may experience social, financial, psychological, physical or legal problems as a result of their drug use)" Drugscope.
The woman and her partner need to be informed about the MAPLAG process.
Women who are identified as using drugs and/or misusing alcohol will be discussed for the first time at MAPLAG at 20 weeks gestation.
Sheffield MAPLAG is comprised of named representatives from the agencies, which a woman is likely to have contact with during her pregnancy. This includes:
- Vulnerability midwife;
- Paediatric liaison in drug and alcohol use;
- Children's social care team manager;
- MAST assistant service manager;
- Clinical nurse specialist from substance misuse pregnancy clinic.
MAPLAG is chaired and minuted by staff from the Safeguarding Children Vulnerability Service, and is held fortnightly.
Details of all workers involved with the family are noted on the front sheet of the MAPLAG minutes. Prior to discussion at MAPLAG an update of the situation will be requested from all workers, including GP's and primary care practitioners. Checks are undertaken with the Probation service; Children’s social care and MAST services; Substance misuse services, Mental health services and 0-19 service.The discussion for each woman, her partner and the family follows a set agenda including:
- Details of the referral to the Vulnerability Midwifery Team including drug and alcohol misuse;
- Social, medical, psychological and forensic history;
- Mental health issues;
- Health and care of pregnant woman and unborn baby;
- Progress in managing any drug and/or alcohol misuse and details of any treatment plan including alcohol screening tool score (pre pregnancy and pregnancy);
- Attendance at appointments and cooperation, or non-compliance, with support services;
- The woman and her partner's perception of the situation, and commitment to change;
- Care of any existing children and any relevant information about previous pregnancies;
- Whether any family/friends support network is available;
- Whether the woman and/or partner, or any of their children are known to Children’s Social Care and why, including whether known as a children subject to a child protection plan or a person posing a risk to children;
- Preparation for the baby's birth;
- Details of all workers involved with the family.
An initial risk assessment and action plan will be made based on this information to provide coordinated support for the woman and her partner, stating where necessary who will action certain pieces of work. The minutes will be circulated to all members of the group, the prescriber and significant workers.
The meeting will agree who will make the risk assessment known to the woman and her partner. This is done by outlining the strengths and the difficulties identified in their case.If an initial risk assessment cannot be made due to insufficient information being available to the meeting, the case will be brought back for further discussion and risk assessment at the next appropriate meeting. The date for next discussion will be written in the Action Plan.
4. MAPLAG Risk Assessment
The MAPLAG risk assessment:
- Child Protection issues identified - Referral into Sheffield Safeguarding Hub;
- Family identified as having additional needs - FCAF to be completed with mother and partner identifying additional support that would benefit the family.
Following the risk assessment, a multi-agency meeting should be convened to ensure all parties, including the parents are clear of the outcome, e.g. Multi-agency meeting, Child Protection Conference, Child in Need meeting, Team Around the Family meeting. This should happen prior to the birth of the baby.A birth plan must be completed and forwarded to the Vulnerability Midwifery Team
5. Planning Meeting Following Birth
A planning meeting should be held wherever possible in cases assessed as needing Social Care intervention. The planning meeting needs to be chaired and minuted and the minutes filed in the women's obstetric notes.The purpose of the planning meeting is to ensure that the community based care of the woman, her partner and the baby is well co-ordinated prior to discharge into the community. The meeting should include midwife, health visitor, drugs/alcohol worker and social worker.
6. Exiting MAPLAG Process
Once a woman has been referred to MAPLAG, her case will be closed and exited from the MAPLAG process:
- If she is not pregnant;
- If her or her partner’s substance misuse does not fit the criteria (see Section 2, Route for Multi-Agency Assessment) (Where child protection issues are identified the community midwife will refer the family into Sheffield Safeguarding Hub);
- If the expectant parents move out of city (all relevant information will be shared with new local authority;
- Following birth.
7. Storage and Copying of MAPLAG Minutes
MAPLAG minutes are strictly confidential and are to be shared only with workers in contact with the woman, her partner and the family.
Disclosure of this material to other parties must be appropriate to the purpose and only to the extent necessary to achieve that purpose.
MAPLAG minutes should be kept within the client's file and should be kept for the length of time the agency would usually keep their clients files.