Transcript Assessing neglect using the Graded Care Profile

Identifying and
Assessing Neglect using the
Graded Care Profile
Patrick Ayre
Department of Applied Social Studies
University of Bedfordshire
Park Square, Luton
email: [email protected]
Presentation can be downloaded from:
http://patrickayre.co.uk/Presentationd.htm
A child centred approach
The purpose of assessment is to understand
what it is like to be that child (and what it will be
like in the future if nothing changes)
NEGLECT
Parents who neglect their children basically just
don’t know any better because of their own poor
upbringings. If we send them to a family centre
for Parental Skills training, all will be well.
NEGLECT
Parents who neglect their children basically just
don’t know any better because of their own poor
upbringings. If we send them to a family centre
for Parental Skills training, all will be well.
IF ONLY!!....
NEGLECT
So neglected children who come into care may be a bit
thin, a bit dirty, badly in need of seeing a doctor or
dentist, maybe a bit wild.
But we can place them with foster carers for a bit of
looking after, a bit of TLC, a bit of structure and
everything will be fine. The children will absolutely love
it and will immediately start to thrive. Simple really!
NEGLECT
So neglected children who come into care may be a bit
thin, a bit dirty, badly in need of seeing a doctor or
dentist, maybe a bit wild.
But we can place them with foster carers for a bit of
looking after, a bit of TLC, a bit of structure and
everything will be fine. The children will absolutely love
it and will immediately start to thrive. Simple really!
IF ONLY!!....
Brain development
By the age of 3, a baby’s brain has
reached almost 90 percent of its adult
size.
 The growth in each region of the brain
largely depends on receiving
stimulation.
 This stimulation provides the foundation
for learning.

Experience Affects the Structure
of the Brain
Brain development is “activitydependent”
 Every experience excites some neural
circuits and leaves others alone
 Neural circuits used over and over
strengthen, those that are not used are
dropped resulting in “pruning”
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Poor integration of hemispheres and
underdevelopment of the orbitofrontal cortex
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Difficulty regulating emotion,
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Lack of cause-effect thinking,
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Inability to recognize emotions in others,
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Inability to articulate own emotions,
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Incoherent sense of self and
autobiographical history
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Lack of conscience.
Other physiological issues
 Serotonin:
emotional stability and
feeling good
 Malnutrition: cognitive and motor
delays, anxiety, depression, social
problems, and attention problems
 Myelination
 Sensitive periods (infancy &
attachment)
Emotional development
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Sensitive period for emotional
development: up to 18 months

Shaped primarily by the way in which
the prime carer interacts with the child
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Emotional deficits harder to overcome
once the sensitive window has passed.
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How often do we intervene assertively
at this point?
Building a child
Building a child is like building a house,
each new level built on the one below. If
the lower levels are unsound, no amount
of tinkering with the upper floors will make
it stable.
Capturing chronic abuse

Single events often only significant in context;
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Can often only understand present by setting
in context of past
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Intangible: Difficult to capture and compare
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High threshold for recognition
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Neglect is a pattern not an event
The pattern of neglect: atypical
The pattern of neglect
Intervention
Intervention
The pattern of neglect
'Good enough' level
Intervention
Intervention
The pattern of neglect
Intervention ceases
'Good enough' level
Intervention
Intervention
The pattern of neglect
Cumulativeness
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Threshold for
intervention
Failure of cumulativeness
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Threshold for
intervention
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What’s the problem?
 Chronic
abuse and the principle of
cumulativeness
Files very long and badly structured
Patterns missed and ‘chronic abuse’
overlooked
The problem of proportionality
Acclimatisation (case, agency and
geographical)
The assessment of neglect

An approach based on the Graded Care
Profile by Dr OP Shrivastava
GCP provides:
 Framework for making assessment
 Baseline measurement
 An element of objectivity
 Judgement about care
 Reliable standardised evidence
http://www.lutonlscb.org/index.php?option=com_content&view=article&id=
183&Itemid=52
GCP uses
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Pre-referral assessments
Snapshot assessments
Contribution to CAF assessments
Contribution to Core Assessment (parenting
capacity)
Self-assessment (parents and carers)
Young person’s assessment of parenting
Tool for setting goals and assessing progress
Tool to facilitate discussion
Section 47
CAF
GCP
Initial Assessment
Enquiries (GCP – neglect)
Core Assessment
(GCP parenting capacity)
Protection / Support Plan
GCP – monitoring tool
GCP users
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Health visitors
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School nurses
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Social workers
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Family centre workers
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Education staff
Why choose GCP?
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Child focused
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User friendly
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Common language
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Promotes partnership
Why choose GCP?
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Evaluates strengths as well as
weaknesses
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Allows progress to be assessed
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A relatively objective measure
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Allows help to be targeted where
needed
Domains of Care
Stimulation
Sensitivity
Responsivity
Self
actualisation
Reciprocity
Overtures
Esteem
Love and belongingness
Safety
Approval
Disapproval
Acceptance
Present &
absent
Physical needs
Maslow, A. 1954
Nutrition. Housing, Clothing,
Hygiene & Health
What to observe
A. PHYSICAL
B. SAFETY
Nutrition
Quality,
Housing
Quantity,
Clothing
Preparation,
Hygiene
Organisation,
Health
C. LOVE
D. ESTEEM
Grades of Care
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Level of care
All child’s Essential
needs met needs fully
met
Some
essential
needs met
Most
essential
needs unmet
Essential
needs entirely
unmet/hostile
Commitment
to care
Child first
Child priority
Child/carer at
par
Child second
Child not
considered
Quality of
care
Best
Adequate
Equivocal
Poor
Worst
Scoring
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Rating 1
5
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Use on every child in the family
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Use with different carers
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Complete with the parent/carer
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Use information, observation, records
Scoring
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Score as actually fits the manual –
DO NOT JUSTIFY BY REASONS
If there is a score of 4 or 5, this
overrides any other scores
Scores between 1 and 3, record the one
which crops up most
If there is an even split, the highest
score is entered
Scoring
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Complete the full reference scheme
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Transpose to the record sheet
Scoring
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Complete the full reference scheme
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Transpose to the record sheet
Sub-Area
Scores
1. NUTRITION
1
2
3
4
5
2. HOUSING
1
2
3
4
5
3. CLOTHING
1
2
3
4
5
4. HYGIENE
1
2
3
4
5
5. HEALTH
1
2
3
4
5
(B)
Safety
1. IN CARER’S PRESENCE
1
2
3
4
5
2. IN CARER’S ABSENCE
1
2
3
4
5
(C)
Love
1. CARER
1
2
3
4
5
2. MUTUAL ENGAGEMENT
1
2
3
4
5
1. STIMULATION
1
2
3
4
5
2. APPROVAL
1
2
3
4
5
3. DISAPPROVAL
1
2
3
4
5
4. ACCEPTANCE
1
2
3
4
5
(A)
Physical
(D)
Esteem
Area
Score
Comments
AREAS
Sub-areas
A
?
1
Items
Reference Sheet
?
a
3
2
c
3
d
1
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a
4
3
b
2
b
2
c
2
b
2
c
2
b
3
c
2
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a
2
4
3
5
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a
3
d
2
Scoring
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Score as actually fits the manual –
DO NOT JUSTIFY BY REASONS
If there is a score of 4 or 5, this
overrides any other scores
Between 1 and 3, when there are more
of one score, record the one with the
most
If there is an even split, the highest
score is entered
AREAS
Sub-areas
A
Reference Sheet
1
Items
a
3
b
2
c
3
d
1
a
4
b
2
c
2
a
2
b
2
c
2
b
3
c
2
2
3
4
3
5
a
3
d
2
AREAS
Sub-areas
A
4
1
Items
Reference Sheet
3
a
3
2
c
3
d
1
4
a
4
3
b
2
b
2
c
2
b
2
c
2
b
3
c
2
2
a
2
4
3
5
3
a
3
d
2
Targeting Items of Care
Targeted
Areas
1
2
3
4
5
Current
Score
Target
Score
Timescale Reviewed
Score
Assessing progress
Unique Advantages
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Common language, common reference
Objective measure – child focussed
Effective tool to promote partnership
assessments and planning with parents
User friendly
Comprehensively covers all areas of
care
Child and carer specific
Assessment Pitfalls
Parents’ behaviour, whether co-operative or
uncooperative, often misinterpreted
 Information from family friends and neighbours
undervalued
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Coping with aggressive or frightening families
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Failure to give sufficient weight to relevant
case history; ‘Start again syndrome’
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Not enough attention is paid to what children
say, how they look and how they behave;
maintenance of a wholly child-centred
approach
A child centred approach
The purpose of assessment is to
understand what it is like to be that child
(and what it will be like in the future if
nothing changes)
Information handling pitfalls
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Picking out the important from a mass of
data
Facts recorded faithfully but not always
critically appraised
Too trusting/insufficiently critical;
Decoyed by another problem
False certainty; undue faith in a ‘known
fact’
Discarding information which does not fit
the model we have formed
Department of Health (1991) Child abuse: A study of inquiry
reports, 1980-1989, HMSO, London
Assessment pitfalls
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Rule of optimism
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Natural love
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Cultural relativism
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Too much
not enough
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Adult services and children’s services
(hand-in-hand or hand-to-hand?)
Children’s services and adult
services
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Working on the same case but not working
jointly
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Mutual incomprehension and
misunderstanding
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False expectations and assumptions
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Abdicating responsibility
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Need for ‘interpreters’
Information handling pitfalls
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Keeping your head down
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Hesitancy to challenge other
professionals or the conventional
wisdom
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Tendency to move from facts to
actions without ‘showing your working’
Challenge your dodgy thinking
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I am only a… and he is a…, so I had
better keep my opinion to myself.
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I am obviously in a minority, so I had
better keep my opinion to myself.
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We need to maintain harmonious
relations, so I had better keep my
opinion to myself.
A final thought
“We are guilty of many errors and many faults
but the worst of our crimes is abandoning our
children, neglecting the fountain of life. Many of
the things we need can wait. The child cannot.
Right now is the time his bones are being
formed, his blood is being made, and his
senses are being developed. To him we cannot
answer 'Tomorrow.' His name is 'Today.'”
Gabriela Mistral (Chilean poet, 1889-1957)