Assessing wellbeing and social vulnerability in the perinatal period
Assessing wellbeing and social vulnerability in the perinatal period
The Maternity Disadvantage Assessment Tool (MatDAT)
Why is social vulnerability important in pregnancy and early parenthood?
The impact of social-risk factors are associated with poor outcomes for mothers and babies. Unlike GPs and Health Visitors, maternity services do not have a systematic way of assessing social complexity. This can lead to inconsistencies in care planning, influenced by unconscious bias, as well as muddying communication between services.
In 2023, MBBRACE (Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries) recommended to:
Develop a UK-wide specification for identifying and recording the number and nature of social risk factors, updated throughout the perinatal care pathway, to offer appropriate enhanced support and referral.
What is the Maternity Disadvantage Assessment Tool (MatDAT)
This tool was initially named the Maternity Vulnerability Assessment Tool (MatVAT) and was later renamed the Maternity Disadvantage Assessment Tool (MatDAT).
The Lambeth Early Action Partnership (LEAP) interdisciplinary Health Team identified this gap. It developed the Maternity Disadvantage Assessment Tool (MatDAT) (2018-2019) to help assess social complexity in maternity. Characteristics included:
- Safeguarding tiers (familiar to most early years practitioners, facilitating communication)
- Intuitive, RAG-rated categories (using red, amber, yellow and green)
- A holistic guide building on practitioner’s expertise
- A booking assessment, minimising burden for front-line midwives
- An associated Care Planning Guide supporting personalised care planning
Extensive consultation was undertaken with local NHS maternity services, commissioners, safeguarding and mental health leads, service users and other stakeholders.
A six-month pilot in two NHS Trusts was undertaken (August 2020-Spring 2021) to explore the feasibility and acceptability of the MatDAT for midwives.
An independent evaluation used semi-structured interviews and focus groups with midwives and relevant stakeholders. The use of the tool was measured using routine data. Ethical approval was received from The Health Research Authority (HRA).
Key findings
Piloting the tool during the Covid pandemic was challenging. Staff changes and social distancing affected training and implementation. Despite this, the tool was overall considered acceptable by the midwives who used it:
- 51% of midwives applied a MatDAT level to subsequent bookings, even if they moved teams.
- The structured framework helped confirm midwives’ intuition and articulate their concerns.
- On one site, MatDAT was used as the basis of multi-disciplinary safeguarding discussions (to escalate and de-escalate concerns).
- MatDat was useful to communicate complexity when referring internally.
- Integrating MatDAT into electronic documentation systems was essential for wider implementation.
- Local adaptation to fit with differences in Local Authority safeguarding thresholds was also vital.
- The planning guide supported personalised care plans.
- When compared to other measures of disadvantage, MatDAT had similar levels of IMD (Index of Multiple Deprivation) and ethnicity across all levels.
The MatDAT is a promising tool that places minimal burden on midwives. It has the potential to improve consistency in the assessment of social complexity in maternity. The Royal College of Midwives (RCM) launched the tool in Spring 2024 with an associated i-learn module.
Author
Dr Juliet Rayment, Independent Research Consultant
