PROTOCOL FOR
MULTI-AGENCY ASSESSMENT
OF PREGNANT WOMEN
AND THEIR BABIES
IN CASES WHERE THERE IS
DRUG / ALCOHOL USE
Multi-Agency Pregnancy Liaison and
Assessment Group (MAPLAG)
JULY 2008
Title
of Protocol for Multi-Agency Assessment of
Protocol
Pregnant Women and their Babies in Cases
where there is Drug / Alcohol Use
Application All SSCB partner agencies
Date
of June 2000
initial
ratification
Date
of July 2008
revision
Date of 2nd September 2008
ratification
Date of next July 2010
review
Section
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
Contents
Page No.
Introduction
3
Route for Multi-Agency Assessment
3
Multi-Agency Pregnancy Liaison and
4
Assessment Group (MAPLAG) process
MAPLAG Risk Assessment
5
Case Review
6
Following birth
6
Exiting MAPLAG process
6
Storage and copying of MAPLAG
7
minutes
MAPLAG PROTOCOL - July 2008
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1.0 Introduction
1.1 This protocol is applicable for all staff working with women, and their
partners, who use drugs and/or misuse alcohol during pregnancy. It
should be used in conjunction with Sheffield’s Integrated Practice Manual,
‘Sheffield Safeguarding Children Board Interagency Protocol for
Gathering Information when working with Drug/Alcohol Misusing Parents’
and South Yorkshire Safeguarding Children Boards’ Child Protection
Procedures 2007.
1.2 The purpose of this protocol is:
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To encourage pregnant women who use, or are suspected of using
drugs and / or misusing alcohol to seek early antenatal care and,
where appropriate, 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 establish an action plan to meet the needs of the pregnant woman,
her baby and any other children within the family. The action plan
should also try to meet the needs of the woman’s partner wherever
possible
To encourage communication between all professionals 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.
1.3 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.
1.4 If a pregnant woman discloses drug use and/or alcohol misuse to any
worker or drug use / alcohol misuse is suspected (as in 1.1), she MUST
be referred to the Specialist Midwife in drugs and alcohol use 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.
1.5 The specialist midwife in drugs and alcohol acts as the care coordinator
for all pregnant women where there are issues relating to drugs and
alcohol.
2.0 Route for Multi-Agency Assessment
2.1 Where a pregnant woman uses drugs and/or misuses alcohol,
assessment needs to consider if there is the potential for the family life
MAPLAG PROTOCOL - July 2008
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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.
2.2 Assessment of risk will be undertaken by multi-agency collaboration
(MAPLAG).
3.0 Multi-Agency Pregnancy Liaison and Assessment Group (MAPLAG)
process
3.1 Criteria for discussion at MAPLAG are:

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Any problematic drug use during current pregnancy, including
problematic cannabis use
Any 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.
(Problematic use is defined as use that affects lifestyle i.e. social, financial,
psychological, physical or legal problems as a result of their drug and / or
alcohol use (Drugscope 2009))
3.2 The woman needs to be informed, both verbally and by leaflet, about
the MAPLAG process.
3.3 Women who are identified as using drugs and/or misusing alcohol (as in
s3.1) will be discussed for the first time at MAPLAG at 20 - 24 weeks
gestation.
3.4 MAPLAG is comprised of named representatives from the agencies,
which a woman is likely to have contact with during her pregnancy. This
includes:
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Specialist midwife in drug and alcohol use
Specialist social worker
Specialist GP
Liaison health visitor in drug and alcohol use
Senior practitioner from Social Care Work Department
Interviewing officer from Social Care Work Department
3.5 MAPLAG is chaired and minuted by staff from the SSCB Substance
Misuse Development Project, and is held fortnightly.
3.6 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 GPs and primary
care professionals.
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3.7 The discussion for each woman and her family follows a set agenda
including:
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Details of the referral to the specialist midwife in drug and alcohol use.
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
their treatment plan
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 to the list
(previously known as Child Protection Register)
Information about the pregnant woman’s partner; whether they are a
drug and/or alcohol misuser, any available details of the partner’s
treatment plan
Preparation for the baby’s birth
Details of all workers involved with the family
Confidential information slot (e.g. information from the police).
3.8 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 woman’s
GP, prescriber, significant workers and any social workers involved.
3.9 The meeting will agree who will make the contents of the minutes known
to the mother and her partner. This will usually take the format of a letter
to be given to the woman and her partner outlining the strengths and
difficulties identified in their case and the current risk assessment, and will
provide an opportunity for the woman and her partner to reply to the
current MAPLAG assessment.
3.10 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.
4.0 MAPLAG Risk Assessment
4.1 The MAPLAG risk assessment:
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
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Tier 1 (Low risk) – monitoring of mother/partner and baby through
normal universal pathways
Tier 2 (Medium risk) – targeted support – multi-agency meeting with
mother/partner to look at CAF.
Tier 3 (High risk) – Referral into social care services (Child Protection
concerns identified)
4.2 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,
Children in Need meeting). This should happen prior to the birth of the
baby.
4.3 A birth plan should also be completed and forwarded to the specialist
midwife for drugs and alcohol and the senior practitioner, Jessop wing
social care services. The birth plan can request that a parenting
assessment is completed on the ward, and also should indicate whether a
5 day stay in hospital is needed for mother and baby.
5.0 Case Review
5.1 All cases will be brought back to MAPLAG at 32 weeks. The discussion
will review the previous minutes; look at the action plan; update the
information, including feedback from mother and partner, and all workers
involved. If a birth plan hasn’t already been completed a provisional one
needs to be added at this stage, which will indicate whether a 5 day
hospital stay is needed for mother and baby.
6.0 Following birth
6.1 A pre-discharge meeting should be held wherever possible in cases
assessed as needing Tier 3 intervention. This will be indicated in the
MAPLAG action plan. The pre-discharge meeting needs to be chaired
and minuted and the minutes filed in the women’s obstetric notes.
6.2 The purpose of the pre-discharge meeting is to ensure that the
community based care of the woman and her baby is well co-ordinated
prior to their discharge into the community. The pre-discharge meeting
should include midwife, health visitor, drugs/alcohol worker and social
worker.
6.3 In cases where the MAPLAG action plan has not indicated a predischarge meeting to be needed, the specialist midwife in drug and
alcohol use will co-ordinate the discharge.
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7.0 Exiting MAPLAG process
7.1 Once a woman has been referred to MAPLAG, her case will only be
closed and exited from the MAPLAG process:
 If she is not pregnant
 If her substance misuse does not fit the criteria in 1.1 (where
safeguarding children issues are identified the case will be passed to
the safeguarding midwifery team.)
 If the woman moves out of city (all relevant information will be shared
with new local authority)
 Following birth (all cases are discussed for the final time following birth)
8.0 Storage and copying of MAPLAG minutes
8.1 MAPLAG minutes are strictly confidential and are to be shared only with
workers in contact with the woman and her family.
8.2 Disclosure of this material to other parties must be appropriate to the
purpose and only to the extent necessary to achieve that purpose.
8.3 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.
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