Assessing and planning for safety for babies

Assessing safety

Working with new and expectant parents requires the continual assessment of safety and an effort to build as much support around the family as possible.

The following tips are for assessing safety—particularly for new parents. Find more information specific to the safety assessment of children where there is parental alcohol or other drug use in Safety assessment and safety planning.

Assessing safety before a baby goes home

Your work with parents during the antenatal period should give you a good sense of what safety looks like at the time the baby is ready to go home. However, if this is the first time you are meeting with the parents about your concerns, focus your assessment on:

• understanding the specific needs of the baby and any special needs or care required
• how alcohol and other drugs use may affect a parent’s willingness, motivation or ability to meet the needs of their baby
• what the parents have done to address their substance use during the pregnancy
• things that may trigger substance use or things about caring for their baby that a parent may find hard (particularly caring for a baby with high needs, foetal alcohol syndrome or neonatal abstinence syndrome)
• the parents’ level of dependence, drug type and use and how this affects emotions, behaviours and relationships between the parents and others
• the parents’ thoughts, feelings and readiness to address their problematic substance use
• the presentation of both parents at the time of your assessment
• the parents’ understanding of the risks of alcohol and other drugs, including co-sleeping
• the parents’ intentions about sleeping and feeding arrangements and responses to information about risks of substance use and co-sleeping
• the safety of the home and the availability of safe sleeping surfaces for a baby
• practical assistance that parents may need to help them care for and keep their baby safe
• whether there is a safe adult in the home who understands the worries and who does not drink or use substances
• who in their safety and support network can help them care of their baby
• indicators of bonding and attachment (remember that a parent not taking every opportunity to visit their child in a nursery does not necessarily mean they do not care or are not bonded).

You will need to complete an SDM safety assessment before a baby goes home. Refer to Carry out a safety assessment for procedural guidance on safety assessments.

Name your worries

Be clear with the parents and their safety and support network about what the worries are with both parents.

Some may be immediate concerns such as safe alcohol and other drugs use, co-sleeping and breastfeeding. Others will be things to work towards through case planning goals over time, such as reducing or stopping substance use, and treatment and recovery. Be clear about Child Safety's bottom lines, why Child Safety is worried about their alcohol and other drugs use and how it causes danger or risk to their baby. The following suggestions may help.

I am worried that:

• when your baby is born and you binge drink unexpectedly, you will not be able to feed or care for him or her in the way you need to because you will be intoxicated
• when your baby is born that if you keep topping up your methadone with other drugs you may overdose or it will change the way you think, feel and respond to your baby
• when you are sleep deprived or struggling as many new parents do, you may turn to drugs to cope or you may fall asleep sharing the lounge or bed with your baby after you have used.

I am curious about:

• How you feel hearing that I am worried about your alcohol and other drugs use.
• What you think worries me the most.
• Whether others said they are worried.
• What others have said they are worried about.

What triggers a parent's alcohol and other drugs use

Explore what triggers a parent’s alcohol and other drug use. Ask them:

• When I have talked with parents before, they have been able to name the things, people or places that would make them want to drink or use. Can you relate to this?
• What things make you want to drink or use drugs?
• Have you thought about what may trigger you once you have the baby?

Some common triggers include:

• not being able to settle their baby
• lack of sleep
• overnight feeding
• when the baby is irritable.

Safety plans

Using drugs (including prescribed medications) or alcohol may make parents fall into a deep sleep, which can be dangerous for their baby. Tell them that if they are going to use drugs or drink alcohol:

• They should never have the baby sleep with them in their bed. They should always put their baby in his or her cot.
• They may not wake for the baby’s next feed or if the baby becomes distressed.
• They need to make a ‘safety plan' and have a responsible adult to take care of the baby if they decide to use drugs or alcohol.

Help the parents make a list of telephone numbers of people who can help them in times of stress- the family's safety and support network. The list could include:

• family members or friends
• their GP
• their child health nurse
• their drug and alcohol counsellor.

Safe sleeping, breastfeeding and drug storage

Ask parents what they know about the key safety issues of safe sleeping, breastfeeding and drug storage. Gauge their opinions and make an assessment as to how safe that makes them. Ask them about:

Safe sleeping

• Have you read anything or spoken to anyone about the dangers for your baby if you co-sleep when you have been drinking or using drugs?
• What are your thoughts about it?
• Where do you plan on feeding your baby during the day? During the night?
• What things might help or get in the way of you being able to follow through?
• Can I have a look at where (the child) will be sleeping? I might be able to help.

Breastfeeding

• Have you read anything or spoken to anyone about alcohol and other drugs use and breastfeeding?
• What are your thoughts about breastfeeding your baby?
• Would it be helpful if we talk with your nurse or early childhood nurse?

Drug storage

• What have you already thought of and put in place to store your drugs?
• What have you put in place to make sure drug items (paraphernalia) are not left lying around and are thrown away safely? Have you put these plans in place already or are you about to?
• Would it be useful if we talk with your alcohol and other drugs workers about how to make sure you have things in place?
• Can you show me how you are storing and disposing of drugs and the things you use (paraphernalia) or would you be more comfortable showing your alcohol and other drugs worker? I would need your alcohol and other drugs worker to see and let me know what is in place.

As with many aspects of your work, go beyond just words. Follow through on all of the suggestions and questions. Come from a place of trust and non-judgement. All parents deal with the stress of making changes to their home and lifestyle to keep their babies safe. But your role as a change agent means having real conversations about the safe times and the unsafe times. This helps them make their home safer.

Building a safety and support network

Assess what people and services a family already has around them. Think about how to build on that so the child has as much support as possible and is more known and seen in the community.

Get a picture of who knows what about each parent's alcohol and other drugs use. Talk to the parent using questions such as:

• Have you spoken with anyone in your family or professionals about your alcohol and other drugs use before?
• What was it like for you?
• What was helpful?
• What was not?
• Who in your life knows something, everything or nothing about your alcohol and other drugs use?
• What have they seen or heard?
• What would they be most worried about for you/for your baby?
• If they were here, what would they say to you/to me?

Find out who is able to help them and who could potentially make life harder:

• Who do you turn to for support now?
• Who will you turn to for help about being a parent?
• If you were watching your life as a movie, who would you say are the people who help, hurt or hinder you when it comes to taking control of your alcohol and other drugs use?
• What did these people say or do when you said you were having a baby?
• When was the last time you needed to turn to someone? Who was it you turned to and how did they help?
• How do you think they could help you with your substance use and with being the parent you want to be?
• Is there anything that would hold you back from seeking help?