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No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 1

Grad

ed C

are P

rofile

A

qualita

tive s

cale

for

measurin

g c

are

of c

hild

ren

V

ER

SIO

N 3

Ju

ne

20

15

Dr. L

eo

n P

oln

ay

Dr. O

. P. S

rivasta

va

E

meritu

s P

rofe

ssor in

Com

munity

C

onsulta

nt C

om

munity

Pae

dia

tricia

n, N

HS

P

ae

dia

trics, U

niv

ers

ity o

f Nottin

gh

am

C

am

brid

geshire

Com

munity

Serv

ices &

Desig

nate

d

D

octo

r for C

hild

Pro

tectio

n, N

HS

Luto

n.

No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 2

IN

TR

OD

UC

TIO

N

Wh

en

we

are

un

de

rtak

ing

an

asse

ssme

nt in

a ch

ild w

elfa

re o

r child

pro

tectio

n co

nte

xt, it is vita

l tha

t we

sho

uld

be

ab

le to

ma

ke

a re

liab

le ju

dg

me

nt a

bo

ut th

e q

ua

lity o

f the

care

be

ing

rece

ived

by

the

child

ren

inv

olv

ed

. Ho

we

ver, th

e fin

din

gs o

f serio

us ca

se re

vie

ws a

t bo

th lo

cal a

nd

na

tion

al le

vels re

pe

ate

dly

sug

ge

st tha

t this is so

me

thin

g th

at w

e d

o n

ot d

o v

ery

we

ll. Th

e ju

dg

me

nts w

e m

ake

can

be

hig

hly

sub

jective

; pro

ne

to b

ias a

nd

va

ry a

ccord

ing

to w

hich

ag

en

cy is a

ssessin

g th

e q

ua

lity o

f care

.

Wh

en

we

are

face

d w

ith id

en

tifyin

g n

eg

lect o

f child

ren

, the

facto

rs tha

t we

are

tryin

g to

cap

ture

are

no

torio

usly

inta

ng

ible

an

d h

ard

to p

in d

ow

n. M

ost im

po

rtan

tly, d

esp

ite o

ur in

crea

sed

reco

gn

ition

of

ne

gle

ct as a

serio

us a

nd

wid

esp

rea

d co

mp

on

en

t of th

e h

arm

tha

t child

ren

suffe

r, we

still see

m to

be

ap

ply

ing

a

larm

ing

ly h

igh

th

resh

old

s fo

r re

cog

nitio

n

an

d

inte

rve

ntio

n.

To

ta

ckle

th

is ch

alle

ng

e

mo

re

effe

ctive

ly, N

orfo

lk LS

CB

ha

s de

cide

d to

ad

op

t the

Gra

de

d C

are

Pro

file, a

s a sin

gle

an

d m

ulti a

ge

ncy

asse

ssme

nt to

ol fo

r use

in situ

atio

ns w

he

re n

eg

lect o

f child

ren

is kn

ow

n o

r susp

ecte

d.

Th

e G

rad

ed

Ca

re P

rofile

(GC

P) sca

le w

as d

ev

elo

pe

d a

s a p

ractica

l too

l to g

ive

an

ob

jectiv

e m

ea

sure

of th

e

care

of ch

ildre

n a

cross a

ll are

as o

f ne

ed

. Th

is scale

wa

s con

ceiv

ed

to p

rov

ide

a p

rofile

of ca

re o

n a

dire

ct

cate

go

rical g

rad

e. It is im

po

rtan

t from

the

po

int o

f vie

w o

f ob

jectiv

ity b

eca

use

the

ill effe

ct of b

ad

care

in

on

e a

rea

ma

y be

offse

t by g

oo

d ca

re in

an

oth

er a

rea

.

It is a d

escrip

tive

scale

. Th

e g

rad

es in

dica

te q

ua

lity of ca

re a

nd

are

reco

rde

d u

sing

the

sam

e 1

to 5

scale

in

all a

rea

s. Inste

ad

of g

ivin

g a

dia

gn

osis o

f ne

gle

ct it de

fine

s the

care

sho

win

g b

oth

stren

gth

s an

d

we

ak

ne

sses a

s the

case

ma

y b

e. It p

rov

ide

s a u

niq

ue

refe

ren

ce p

oin

t. Ch

an

ge

s afte

r inte

rve

ntio

n ca

n

de

mo

nstra

bly b

e m

on

itore

d in

bo

th p

ositiv

e a

nd

ne

ga

tive

dire

ction

s.

It can

be

use

d to

imp

rov

e u

nd

ersta

nd

ing

ab

ou

t the

leve

l of co

nce

rn a

nd

to ta

rge

t spe

cific are

as o

f wo

rk as

it hig

hlig

hts a

rea

s of g

rea

ter risk

of p

oo

rer o

utco

me

s an

d sh

ou

ld b

e u

sed

in a

ll case

s wh

ere

ne

gle

ct is

susp

ecte

d o

r ide

ntifie

d. T

he

GC

P ca

n b

e u

sed

with

the

fam

ily b

y in

div

idu

al w

orke

rs, or g

rou

ps o

f wo

rkers,

to in

form

fam

ily a

ction

me

etin

gs a

nd

child

pro

tectio

n C

ore

Gro

up

me

etin

gs. It ca

n a

lso b

e u

sed

prio

r to

ad

op

ting

the

Sig

ns o

f Sa

fety

ap

pro

ach

.

Hie

rarch

y o

f ne

ed

s

Th

e G

rad

ed

Ca

re P

rofile

is ba

sed

on

psy

cho

log

ist Ab

rah

am

Ma

slow

’s hie

rarch

y o

f ne

ed

s. Th

e to

ol a

llow

s

pra

ctition

ers to

exp

lore

fou

r are

as, o

r “do

ma

ins” o

f care

– p

hy

sical ca

re, sa

fety

, love

an

d e

stee

m –

an

d to

jud

ge

th

e

pa

ren

ting

, w

hich

th

ey

o

bse

rve

a

ga

inst

simp

le

pre

de

term

ine

d

criteria

. T

he

re

sults

of

the

asse

ssme

nt a

re e

nte

red

on

to a

sum

ma

ry sh

ee

t, wh

ich p

inp

oin

ts tho

se a

rea

s of d

eficit, w

hich

req

uire

furth

er a

tten

tion

.

Fo

r ma

ny

use

rs, the

mo

st imp

orta

nt a

spe

ct of th

e to

ol’s su

ccess h

as b

ee

n th

e fa

ct tha

t it can

be

em

plo

ye

d

by

pra

ctition

ers fro

m a

ny a

ge

ncy in

volve

d in

child

we

lfare

. In th

at re

ga

rd, it p

re-d

ate

d th

e co

mm

on

asse

ssme

nt fra

me

wo

rk b

y ma

ny

ye

ars. T

he

pro

file g

ive

s the

ag

en

cies a

com

mo

n la

ng

ua

ge

, a co

mm

on

fram

e o

f refe

ren

ce.”

No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 3

In

No

rfolk

, G

rad

ed

C

are

P

rofile

a

ssessm

en

ts co

mp

lete

d

by

a

ny

a

ge

ncy

sho

uld

b

e

acce

pte

d

by

child

ren

’s serv

ices a

s ev

ide

nce

of th

e n

ee

d fo

r inte

rven

tion

in ca

ses th

at m

ee

t certa

in crite

ria. T

his w

ill

red

uce

th

e

ne

ed

fo

r fu

rthe

r a

ssessm

en

t a

nd

m

inim

ize

the

p

ote

ntia

l fo

r in

ter-a

ge

ncy

misu

nd

ersta

nd

ing

. Wo

rk is o

ng

oin

g in

resp

ect o

f this a

spe

ct.

Ide

ntifie

s Stre

ng

ths a

nd

we

ll as a

rea

s of C

on

cern

Th

e stru

cture

of th

e a

ssessm

en

t pro

cess m

ea

ns th

at stre

ng

ths a

re h

igh

ligh

ted

alo

ng

side

we

ak

ne

sses, a

nd

are

as o

f con

cern

are

ide

ntifie

d su

fficien

tly p

recise

ly to

allo

w in

terv

en

tion

to b

e ta

rge

ted

spe

cifically

at

are

as o

f we

ak

ne

ss, wh

ich ca

n re

sult in

con

side

rab

le re

sou

rce sa

vin

gs. F

or e

xam

ple

, fam

ily ce

ntre

s can

stop

rece

ivin

g ra

the

r va

gu

e re

ferra

ls ask

ing

for g

en

era

lised

“pa

ren

ting

train

ing

”. Inste

ad

, the

Gra

de

d C

are

Pro

file p

rov

ide

s the

m w

ith a

con

cise a

na

lysis o

f the

care

be

ing

giv

en

wh

ich a

llow

s the

m to

de

vise

sho

rter

bu

t mo

re in

ten

sive p

rog

ram

me

s.

It is de

sign

ed

to b

e u

sed

by

wo

rkers to

ma

ke a

ba

selin

e a

ssessm

en

t at th

e b

eg

inn

ing

of in

terv

en

tion

an

d

the

n to

be

rea

pp

lied

reg

ula

rly to

ga

ug

e p

rog

ress. T

his is a

n a

spe

ct of th

e to

ol w

hich

fam

ilies h

av

e fo

un

d

pa

rticula

rly h

elp

ful, a

s it ha

s pro

vid

ed

the

m w

ith sp

ecific ta

rge

ts to a

im fo

r an

d a

clea

r ide

a o

f wh

at it is

the

y a

re try

ing

to a

chie

ve a

nd

ho

w th

ey

will b

e ju

dg

ed

.

It fits ne

atly

into

the

wid

er fra

me

wo

rk o

f inte

gra

ted

asse

ssme

nt, m

ak

ing

a u

sefu

l con

tribu

tion

at p

re-

refe

rral, a

nd

ea

rly he

lp, in

itial a

nd

core

asse

ssme

nt sta

ge

s.

It inv

olv

es g

rad

ing

care

In th

is scale

the

re a

re five

gra

de

s ba

sed

on

leve

ls of co

mm

itme

nt to

care

. Pa

ralle

l with

the

lev

el o

f

com

mitm

en

t is the

de

gre

e to

wh

ich a

child

’s ne

ed

s are

me

t an

d w

hich

also

can

be

ob

serv

ed

. Th

e b

asis o

f

sep

ara

tion

of d

iffere

nt g

rad

es is o

utlin

ed

in ta

ble

1 b

elo

w.

Ta

ble

1.

G

rad

e 1

. G

rad

e 2

. G

rad

e 3

. G

rad

e 4

. G

rad

e 5

.

1

All

child

’s n

ee

ds

me

t

Esse

ntia

l n

ee

ds

fully

me

t

So

me

e

ssen

tial

ne

ed

s un

me

t

Mo

st e

ssen

tial

ne

ed

s un

me

t

Esse

ntia

l n

ee

ds

en

tirely

un

me

t/ho

stile

2

Ch

ild first

Ch

ild p

riority

C

hild

/care

r at p

ar

Ch

ild se

con

d

Ch

ild

no

t

con

side

red

3

Be

st A

de

qu

ate

E

qu

ivoca

l P

oo

r W

orst

1. =

Leve

l of ca

re; 2

= C

om

mitm

en

t to ca

re; 3

= Q

ua

lity o

f care

Th

ese

gra

de

s are

the

n a

pp

lied

to e

ach

of th

e fo

ur a

rea

s of n

ee

d b

ase

d o

n M

aslo

w’s m

od

el o

f hu

ma

n

ne

ed

s – p

hy

sical, sa

fety

, lov

e a

nd

be

lon

gin

gn

ess a

nd

este

em

. Th

is mo

de

l wa

s ad

op

ted

no

t so m

uch

for its

hie

rarch

ical n

atu

re b

ut fo

r its com

pre

he

nsiv

en

ess. E

ach

are

a is b

rok

en

do

wn

into

sub

-are

as, a

nd

som

e

sub

-are

as to

item

s, for e

ase

of o

bse

rva

tion

. A re

cord

she

et sh

ow

s all th

e a

rea

s an

d su

b-a

rea

s with

the

five

gra

de

s alo

ng

side

.

Th

e fo

ur ‘a

rea

s’ – p

hy

sical, sa

fety

, lov

e a

nd

este

em

are

lab

elle

d a

s – A

, B, C

an

d D

resp

ectiv

ely

. Ea

ch a

rea

ha

s its ow

n ‘su

b-a

rea

s’, wh

ich a

re la

be

lled

nu

me

rically

– 1

, 2, 3

, 4 a

nd

5. S

om

e o

f the

‘sub

-are

as’ a

re

ma

de

up

of d

iffere

nt ‘ite

ms’, w

hich

are

lab

elle

d a

s – a

, b, c, a

nd

d. T

hu

s the

un

it for sco

ring

is an

‘item

’ or

a ‘su

b-a

rea

’ wh

ere

the

re a

re n

o ite

ms. T

o h

elp

ob

tain

a sco

re, a

cod

ing

ma

nu

al is p

rep

are

d w

hich

giv

es

No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 4

brie

f exa

mp

les (co

nstru

cts) of ca

re in

all su

b-a

rea

s/item

s for a

ll the

five

gra

de

s. From

the

se, sco

re fo

r the

are

as a

re w

orke

d a

s pe

r instru

ction

s.

Ba

sed

on

wh

at w

e k

no

w a

bo

ut a

child

’s ne

ed

Item

s an

d su

b-a

rea

s are

ba

sed

on

facto

rs, wh

ich h

av

e b

ee

n sh

ow

n to

be

ar re

latio

n to

child

de

velo

pm

en

t.

Ca

re co

mp

on

en

t rela

ting

to th

e ite

ms/su

b-a

rea

s are

ba

sed

mo

re o

n in

tuitiv

e th

an

lea

rnt e

lem

en

ts (skills)

ke

ep

ing

th

e

inte

rest o

f ch

ild

up

pe

rmo

st, a

s so

me

skills

the

mse

lve

s co

uld

b

e

con

trov

ersia

l a

nd

e

ver

cha

ng

ing

(e.g

. pla

cing

ba

bie

s to sle

ep

on

the

ir ba

cks). Th

is sho

uld

min

imise

score

s be

ing

affe

cted

by

cultu

re, e

du

catio

n, a

nd

po

verty

, exce

pt in

extre

me

circum

stan

ces.

Wh

en

sho

uld

it be

use

d?

(Un

de

r Re

vie

w a

s of Ju

ne

20

15

)

In p

ractice

it can

be

use

d in

a v

arie

ty o

f situa

tion

s wh

ere

care

for ch

ildre

n is o

f con

cern

. In ch

ild

pro

tectio

n situ

atio

ns, it ca

n b

e u

sed

in co

nju

nctio

n w

ith co

nve

ntio

na

l me

tho

ds in

asse

ssme

nt o

f ne

gle

ct

an

d m

on

itorin

g; in

oth

er fo

rms o

f ab

use

it can

be

use

d a

s an

ad

jun

ct in risk

an

d n

ee

d a

ssessm

en

t. Wh

ere

risk a

pp

ea

rs low

bu

t care

pro

file is p

oo

r it will sa

feg

ua

rd th

e ch

ild b

y fla

gg

ing

up

the

issue

s, if the

care

pro

file is g

oo

d it w

ill relie

ve

an

y a

nxie

ty th

at th

ere

mig

ht b

e. W

he

re risk

is hig

h a

nd

care

pro

file is a

lso

po

or it w

ill stren

gth

en

the

case

an

d ca

re w

ill no

t be

a fo

rgo

tten

issue

, bu

t wh

ere

the

care

pro

file is g

oo

d,

it will th

en

be

mo

re d

ifficult to

do

wn

gra

de

the

risk o

n its o

wn

me

rit. In th

e co

nte

xt of ch

ildre

n in

ne

ed

, it

can

he

lp id

en

tify a

pp

rop

riate

reso

urce

s (de

pe

nd

ing

on

are

a o

f de

ficit) an

d ta

rge

t the

m. In

the

con

text o

f

child

he

alth

it can

be

use

d to

ide

ntify

care

de

ficit wh

ere

the

re is co

nce

rn a

bo

ut g

row

th, d

eve

lop

me

nt a

nd

care

, po

st-na

tal d

ep

ressio

n, re

pe

ate

d a

ccide

nts, o

r simp

ly w

he

re ca

re is th

e so

le co

nce

rn.

A u

nifo

rm ca

re p

rofile

(sam

e g

rad

e o

f care

in a

ll are

as) p

ose

s less o

f a p

rob

lem

in d

ecisio

n m

ak

ing

tha

n

un

ev

en

care

pro

files. F

rom

an

inte

rven

tion

po

int o

f vie

w th

e G

CP

will g

ive

a p

oin

t of fo

cus.

Fin

ally

it sho

uld

be

rem

em

be

red

tha

t the

GC

P p

rov

ide

s a m

ea

sure

of ca

re a

s it is actu

ally

de

livere

d

irresp

ectiv

e o

f oth

er in

tera

cting

facto

rs. In so

me

situa

tion

s wh

ere

con

du

ct an

d p

erso

na

lity o

f on

e o

f the

pa

ren

ts is of g

rav

e co

nce

rn, a

go

od

care

pro

file o

n its o

wn

sho

uld

no

t be

use

d to

dism

iss tha

t fact. A

t

pre

sen

t it brin

gs th

e issu

e o

f care

to th

e fo

re fo

r con

side

ratio

n in

the

con

text o

f ov

era

ll asse

ssme

nt.

Wh

ere

a sin

gle

ag

en

cy h

as co

nce

rns a

bo

ut a

child

an

d n

eg

lect is th

ou

gh

t to b

e a

facto

r, the

GC

P w

ill be

use

d in

pa

rtne

rship

with

the

pa

ren

ts. Wh

ere

the

pa

ren

ts do

no

t ag

ree

with

its use

or re

fuse

to e

ng

ag

e,

the

n

the

to

ol

ma

y

still b

e

use

ful

to

assist

ind

ivid

ua

l p

ractitio

ne

rs d

ecid

e

wh

ere

b

est

to

focu

s th

eir

inte

rve

ntio

n.

Wh

ere

con

cern

s ab

ou

t a ch

ild re

qu

ire m

ulti a

ge

ncy

inte

rven

tion

, a d

ecisio

n m

ay

be

ma

de

to co

mp

lete

a

GC

P. D

ecisio

ns a

bo

ut w

ho

will e

ng

ag

e th

e fa

mily

an

d w

hich

pro

fessio

na

ls will g

ath

er w

hich

info

rma

tion

will h

ave

to b

e m

ad

e.

Fin

ally

, the

GC

P is a

too

l to co

mp

lem

en

t pro

fessio

na

l jud

gm

en

t. Use

d a

s a m

ulti-a

ge

ncy

too

l, it will

con

tribu

te to

we

ll info

rme

d d

ecisio

n-m

ak

ing

ba

sed

on

clea

rly u

nd

ersto

od

an

d w

ell a

rticula

ted

con

cern

s

acro

ss diffe

ren

t discip

line

s.

No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 5

Ho

w to

Use

1.

Fill in

the

rele

va

nt d

eta

ils at th

e to

p o

f the

reco

rd sh

ee

t.

2.

Th

e M

ain

Ca

rer: is w

ho

m th

ese

ob

serv

atio

ns m

ain

ly re

late

to –

on

e o

r bo

th p

are

nts a

s the

case

ma

y be

, sub

stitute

care

r or e

ach

pa

ren

t sep

ara

tely if n

ee

d b

e. M

ak

e n

ote

of it in

the

ap

pro

pria

te

pla

ce a

t the

top

righ

t corn

er o

f the

reco

rd sh

ee

t.

3.

Me

tho

ds: F

or p

rescrip

tive sco

ring

it is ne

cessa

ry to

do

a h

om

e v

isit to m

ak

e o

bse

rva

tion

s. In th

at

case

carry

a ch

eck

list of su

b-a

rea

s an

d ite

ms to

en

sure

tha

t the

y a

re co

vere

d d

urin

g th

e v

isit.

Alte

rna

tively

, carry

the

cod

ing

ma

nu

al itse

lf an

d if fe

asib

le, sh

are

it with

the

pa

ren

t/care

r. It can

also

be

use

d re

trosp

ective

ly w

he

re a

lrea

dy th

ere

is en

ou

gh

info

rma

tion

on

item

s or su

b-a

rea

s to

en

ab

le sco

ring

. Ca

rers u

sing

it for th

em

can

simp

ly g

o th

rou

gh

the

ma

nu

al.

4.

Situ

atio

ns:

a)

So

far a

s pra

cticab

le u

se th

e u

sua

l state

of a

n e

nv

iron

me

nt a

nd

disco

un

t an

y te

mp

ora

ry

insig

nifica

nt u

pse

ts e.g

. no

slee

p th

e n

igh

t be

fore

,

b)

Disco

un

t effe

ct of e

xtra

ne

ou

s facto

rs on

the

en

viro

nm

en

t (e.g

. ho

use

refu

rbish

ed

by

we

lfare

ag

en

cy) u

nle

ss care

rs ha

ve

po

sitively

con

tribu

ted

in so

me

wa

y –

kee

pin

g it cle

an

,

ad

din

g th

eir o

wn

bits in

the

inte

rest o

f the

child

like a

safe

ga

rde

n, o

utd

oo

r or in

do

or p

lay

eq

uip

me

nt o

r safe

ty fe

atu

res e

tc.

c) A

llow

an

ces

sho

uld

b

e

ma

de

fo

r b

ack

gro

un

d

facto

rs, w

hich

ca

n

affe

ct in

tera

ction

tem

po

rarily

with

ou

t ne

cessa

rily u

pse

tting

stea

dy

state

e.g

. be

rea

vem

en

t, rece

nt lo

ss of

job

, an

d illn

ess in

pa

ren

ts. It ma

y b

e n

ece

ssary to

rev

isit an

d sco

re a

t an

oth

er tim

e.

d)

If care

r is tryin

g to

misle

ad

(de

libe

rate

ly g

ivin

g w

ron

g im

pre

ssion

or in

form

atio

n in

ord

er

to

ma

ke

o

ne

b

elie

ve

o

the

rwise

) sco

re

as

ind

icate

d

in

the

m

an

ua

l (e

.g.

‘misle

ad

ing

exp

lan

atio

n’- g

rad

e fiv

e fo

r PH

YS

ICA

L He

alth

/follo

w u

p o

r ‘pu

t an

act sh

ow

ing

care

’ –

gra

de

five

for LO

VE

Ca

rer re

cipro

catio

n), o

the

rwise

score

as if it is n

ot tru

e.

5.

Ob

tain

ing

Info

rma

tion

on

diffe

ren

t item

s or su

b-a

rea

s:

A) P

HY

SIC

AL

1. N

utritio

na

l: (a) q

ua

lity (b

) qu

an

tity (c) p

rep

ara

tion

an

d (d

) org

an

isatio

n

Ta

ke

a g

oo

d a

nd

skilfu

l histo

ry a

bo

ut th

e m

ea

ls pro

vid

ed

inclu

din

g n

utritio

na

l con

ten

ts (milk,

fruits e

tc.), pre

pa

ratio

n, se

t me

al tim

es, ro

utin

e a

nd

org

an

isatio

n. A

lso n

ote

care

r’s kn

ow

led

ge

ab

ou

t nu

trition

, no

te ca

rer’s re

actio

n to

sug

ge

stion

s ma

de

reg

ard

ing

nu

trition

(wh

eth

er ke

en

an

d

acce

ptin

g

or

dism

issive

). O

bse

rve

for

ev

ide

nce

o

f p

rov

ision

, k

itche

n

ap

plia

nce

s a

nd

u

ten

sils,

din

ing

furn

iture

an

d its u

se w

itho

ut b

ein

g in

trusive

. It is imp

orta

nt n

ot to

lea

d a

s far a

s po

ssible

bu

t to o

bse

rve

the

resp

on

ses ca

refu

lly fo

r ho

ne

sty. O

bse

rva

tion

at m

ea

ltime

in n

atu

ral se

tting

(with

ou

t spe

cial p

rep

ara

tion

) is pa

rticula

rly u

sefu

l. Sco

re o

n a

mo

un

t offe

red

an

d th

e ca

rer’s

inte

ntio

n to

fee

d yo

un

ge

r child

ren

rath

er th

an

actu

al a

mo

un

t con

sum

ed

as so

me

child

ren

ma

y

ha

ve

ea

ting

/fee

din

g p

rob

lem

s.

2. H

ou

sing

(a) M

ain

ten

an

ce (b

) Dé

cor (c) F

acilitie

s

Ob

serve

. If de

ficien

t ask

to se

e if e

ffort h

as b

ee

n m

ad

e to

rem

ed

y, a

sk yo

urse

lf if care

r is cap

ab

le

of d

oin

g th

em

him

/he

rself. D

iscou

nt if w

elfa

re a

ge

ncie

s or la

nd

lord

do

es re

pa

ir or d

eco

ratio

n.

No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 6

3. C

loth

ing

(a) In

sula

tion

(b) F

itting

(c) Loo

k

Ob

serve

. Se

e if e

ffort h

as b

ee

n m

ad

e to

wa

rds re

stora

tion

, clea

nin

g, iro

nin

g. R

efe

r to th

e a

ge

ba

nd

in th

e m

an

ua

l.

4. H

yg

ien

e

Ch

ild’s a

pp

ea

ran

ce (h

air, sk

in, b

eh

ind

ea

rs an

d fa

ce, n

ails, ra

she

s du

e to

lon

g te

rm n

eg

lect o

f

clea

nlin

ess, te

eth

). Ask a

bo

ut p

ractice

. Re

fer to

ag

e b

an

d in

ma

nu

al.

5. H

ea

lth (a

) Op

inio

n so

ug

ht (b

) follo

w-u

p (c) S

urv

eilla

nce

(d) D

isab

ility

Se

e if p

rofe

ssion

als o

r som

e k

no

wle

dg

ea

ble

ad

ults a

re co

nsu

lted

on

ma

tters o

f he

alth

, che

ck

ab

ou

t imm

un

isatio

n a

nd

surv

eilla

nce

up

tak

e, re

aso

ns fo

r no

n-a

tten

da

nce

if an

y, se

e if re

aso

ns

can

be

ap

pre

ciate

d p

articu

larly

if ap

po

intm

en

t do

es n

ot o

ffer a

clea

r be

ne

fit. Co

rrob

ora

te w

ith

rele

va

nt p

rofe

ssion

als. D

isting

uish

ge

nu

ine

diffe

ren

ce o

f op

inio

n b

etw

ee

n ca

rer a

nd

pro

fessio

na

l

from

no

n-g

en

uin

e m

islea

din

g re

aso

ns. B

ew

are

of b

ein

g o

ve

r symp

ath

etic w

ith ca

rer if th

e ch

ild

ha

s a d

isab

ility or ch

ron

ic illne

ss. Re

ma

in o

bje

ctive.

B) S

AF

ET

Y

1. In

Pre

sen

ce (a

) Aw

are

ne

ss (b) P

ractice

(c) Tra

ffic (d) S

afe

ty F

ea

ture

s

Th

is Su

b-A

rea

cov

ers h

ow

safe

ly e

nv

iron

me

nt is o

rga

nise

d. It in

clud

es sa

fety

fea

ture

s an

d ca

ree

r’s

be

ha

vio

ur re

ga

rdin

g sa

fety (e

.g. lit cig

are

ttes le

ft lyin

g in

the

vicin

ity o

f child

) in e

ve

ry d

ay

activ

ity.

Th

e a

wa

ren

ess m

ay

be

infe

rred

from

the

pre

sen

ce a

nd

ap

pro

pria

te u

se o

f safe

ty fixtu

res a

nd

eq

uip

me

nt in

an

d a

rou

nd

the

ho

use

or in

the

car (ch

ild sa

fety

sea

t etc.) b

y o

bse

rvin

g h

an

dlin

g o

f

yo

un

g b

ab

ies a

nd

sup

erv

ision

of to

dd

lers. A

lso o

bse

rve h

ow

care

r instin

ctive

ly re

acts to

the

child

be

ing

exp

ose

d to

da

ng

er. If o

bse

rvatio

n n

ot p

ossib

le, th

en

ask

ab

ou

t the

aw

are

ne

ss. Ob

serve

or

ask

ab

ou

t child

be

ing

allo

we

d to

cross th

e ro

ad

, pla

y o

utd

oo

rs etc. a

lon

g th

e lin

es in

the

ma

nu

al.

If po

ssible

ve

rify fro

m o

the

r sou

rces. R

efe

r to th

e a

ge

ba

nd

wh

ere

ind

icate

d.

2. In

Ab

sen

ce: T

his co

ve

rs child

care

arra

ng

em

en

ts wh

ere

the

care

r is aw

ay

, tak

ing

acco

un

t of

rea

son

s a

nd

p

erio

d

of

ab

sen

ce

an

d

ag

e

of

the

m

ind

er.

Th

is itse

lf co

uld

b

e

a

ma

tter

for

inv

estig

atio

n in

som

e ca

ses. C

he

ck fro

m o

the

r sou

rces.

C) LO

VE

:

1.

Ca

rer (a

) Se

nsitiv

ity (b

) Re

spo

nse

Syn

chro

nisa

tion

(c) Re

cipro

catio

n

Th

is ma

inly

rela

tes to

the

care

r. Se

nsitiv

ity d

en

ote

s wh

ere

care

r sho

ws a

wa

ren

ess o

f an

y sig

na

l

from

the

child

. Ca

rer m

ay

be

com

e a

wa

re ye

t resp

on

d a

little la

ter in

certa

in circu

msta

nce

s.

Re

spo

nse

syn

chro

nisa

tion

de

no

tes th

e tim

ing

of ca

rer’s re

spo

nse

in th

e fo

rm o

f ap

pro

pria

te

actio

n in

rela

tion

to th

e sig

na

l from

the

child

. Re

cipro

catio

n re

pre

sen

ts the

em

otio

na

l qu

ality

of

the

resp

on

se.

2.

Mu

tua

l En

ga

ge

me

nt (a

) Ove

rture

s (b) Q

ua

lity

It is a d

ya

dic tra

it infe

rred

from

ob

serv

ing

mu

tua

l inte

ractio

n d

urin

g fe

ed

ing

, pla

yin

g, a

nd

oth

er

activ

ities. O

bse

rve w

ha

t ha

pp

en

s wh

en

the

care

r an

d th

e ch

ild ta

lk, to

uch

, see

k o

ut fo

r com

fort,

see

k o

ut fo

r pla

y, b

ab

ies re

ach

ing

ou

t to to

uch

wh

ile fe

ed

ing

or sto

p fe

ed

ing

to lo

ok

an

d sm

ile a

t

the

ca

rer.

Sk

ip

this

pa

rt if

child

is

kn

ow

n

to

ha

ve

b

eh

av

iou

ral

pro

ble

ms

as

it m

ay

be

com

e

un

relia

ble

.

Sp

on

tan

eo

us

inte

ractio

n

is th

e

be

st o

pp

ortu

nity

to

o

bse

rve

th

ese

ite

ms.

Se

e

if ca

rer

spo

nta

ne

ou

sly ta

lks an

d v

erb

alise

s with

the

child

or re

spo

nd

s wh

en

the

child

ma

kes o

ve

rture

s.

No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 7

No

te if th

e p

lea

sure

is de

rive

d b

y b

oth

the

care

r an

d th

e ch

ild, e

ithe

r or n

eith

er. N

ote

if it is

leisu

re e

ng

ag

em

en

t or fu

nctio

na

l (e.g

. fee

din

g e

tc.)

D) E

ST

EE

M

1. S

timu

latio

n:

Ob

serve

o

r e

nq

uire

h

ow

th

e

child

is

en

cou

rag

ed

to

le

arn

. S

timu

latin

g

ve

rba

l in

tera

ction

,

inte

ractiv

e

pla

y,

nu

rsery

rhy

me

s o

r jo

int

story

rea

din

g,

lea

rnin

g

socia

l ru

les,

pro

vid

ing

de

ve

lop

me

nta

lly stim

ula

ting

eq

uip

me

nt a

re su

ch e

xam

ple

s with

infa

nts (0

– 2

ye

ars). If la

ckin

g,

try to

no

te if it w

as d

ue

to ca

rer b

ein

g o

ccup

ied

by

oth

er e

ssen

tial ch

ore

s. Follo

w th

e co

nstra

ints

in th

e m

an

ua

l for a

pp

rop

riate

ag

e b

an

d. T

he

fou

r ele

me

nts (i, ii, iii a

nd

iv) in

ag

e b

an

d 2

-5 y

ea

rs

an

d 5

- ye

ars a

re co

mp

lem

en

tary

. Sco

re in

on

e o

f the

item

s cou

ld su

ffice. If m

ore

item

s are

score

d,

score

for w

hich

eve

r colu

mn

de

scribe

s the

case

be

st. In th

e e

ven

t of a

tie ch

oo

se th

e h

igh

er sco

re

(also

de

scribe

d in

the

ma

nu

al).

2. A

pp

rov

al:

Fin

d o

ut h

ow

an

d h

ow

mu

ch ch

ild’s a

chie

ve

me

nt is re

wa

rde

d o

r ne

gle

cted

. It can

be

asse

ssed

by

ask

ing

ho

w th

e ch

ild is d

oin

g o

r simp

ly b

y p

raisin

g th

e ch

ild a

nd

no

ting

the

care

r’s resp

on

se

(ag

ree

s with

de

ligh

t or n

eg

lects)

3. D

isap

pro

va

l:

If o

pp

ortu

nity

pre

sen

ts, o

bse

rve

h

ow

th

e

child

is

rep

rima

nd

ed

fo

r u

nd

esira

ble

b

eh

av

iou

r,

oth

erw

ise e

nq

uire

tactfu

lly (do

es th

e sh

e th

row

tan

trum

s? H

ow

do

you

de

al if it h

ap

pe

ns w

he

n

yo

u a

re tire

d y

ou

rself?

) Be

wa

re o

f discre

pa

ncy

be

twe

en

wh

at is sa

id a

nd

wh

at is d

on

e. A

ny

ob

serv

atio

n is b

ette

r in su

ch situ

atio

ns e

.g. ch

ild b

ein

g rid

icule

d o

r sho

ute

d a

t. Try

an

d p

rob

e if

care

r is con

sisten

t.

4. A

ccep

tan

ce:

Ob

serve

or p

rob

e h

ow

care

r ge

ne

rally

fee

ls afte

r she

ha

s rep

rima

nd

ed

the

child

or w

he

n th

e ch

ild

ha

s be

en

rep

rima

nd

ed

by

oth

ers (e

.g. te

ach

er), w

he

n ch

ild is u

nd

era

chie

vin

g o

r fee

ling

sad

for

va

riou

s rea

son

s. Se

e if th

e ch

ild is re

jecte

d (d

en

igra

ted

) or a

ccep

ted

in su

ch circu

msta

nce

s as

sho

wn

by

wa

rm a

nd

sup

po

rtive

be

ha

vio

ur.

6.

Sco

ring o

n th

e m

an

ua

l: Ma

ke

sure

you

r info

rma

tion

is factu

al a

s far a

s po

ssible

. Go

thro

ug

h th

e

con

structs in

the

ord

er –

(Su

b-A

rea

s an

d Ite

ms) a

s in th

e m

an

ua

l. Fin

d th

e co

nstru

ct wh

ich

ma

tche

s be

st, rea

d o

ne

gra

de

on

eith

er sid

e to

ma

ke

sure

, the

n p

lace

a tick o

n th

at co

nstru

ct (use

pe

ncil w

hich

can

be

era

sed

an

d m

an

ua

l reu

sed

). Th

e n

um

be

r at th

e to

p o

f the

colu

mn

will b

e th

e

score

for th

at ite

m o

r sub

-are

a. W

he

re m

ore

tha

n o

ne

item

rep

rese

nts a

sub

-are

a, u

se th

e

me

tho

d d

escrib

ed

be

low

to o

bta

in th

e sco

re fo

r the

sub

-are

a.

7.

No

tes: U

se th

e co

lum

n se

ction

an

d th

e n

ote

s sectio

n in

ea

ch o

f the

are

as to

ad

d a

ny

com

me

nts

in re

latio

n to

the

scorin

g. T

he

se ‘sp

ace

s’ can

be

use

d fo

r flag

gin

g u

p issu

es, w

hich

are

no

t

de

tecte

d b

y the

scale

bu

t ma

y b

e re

lev

an

t in a

pa

rticula

r case

. Fo

r exa

mp

le, a

child

wh

o is

tem

pe

ram

en

tally

difficu

lt to e

ng

ag

e w

ith (in

the

‘ma

nu

al e

ng

ag

em

en

t’ a su

b-a

rea

of ‘lo

ve’) o

r a

pa

ren

t(s) wh

ose

ov

er p

rote

ctiven

ess g

ave

rise to

con

cern

(ma

y score

be

tter in

the

sub

-are

a o

f

‘disa

pp

rov

al’ in

‘are

a’ o

f este

em

). Th

ese

ma

y n

ee

d se

pa

rate

exp

ert e

valu

atio

n.

No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 8

8.

Ob

tain

ing

a sco

re fo

r a su

b-a

rea

from

score

in its ite

ms:

a) R

ea

d th

e sco

re fo

r all tick

s for d

iffere

nt ite

ms o

f a p

articu

lar su

b-a

rea

: if the

re is a

clea

r mo

de

bu

t no

ne

of th

e tick

s are

be

yon

d th

ree

(3) sco

re th

e m

od

e fo

r tha

t pa

rticula

r sub

-are

a.

Exa

mp

le: N

utritio

n

Qu

ality

Qu

an

tity

Pre

pa

ratio

n

Org

an

isatio

n

Sco

re fo

r Su

b-A

rea

Nu

trition

he

re w

ou

ld b

e 2

b) If th

ere

is no

clea

r mo

de

(score

s ev

en

ly o

r un

eve

nly sp

ilt) bu

t no

tick is a

bo

ve

po

int th

ree

, use

the

hig

he

r score

.

Qu

ality

Qu

an

tity

Pre

pa

ratio

n

Org

an

isatio

n

Sco

re fo

r Su

b A

rea

Nu

trition

he

re w

ou

ld b

e 3

c) If the

re is a

sing

le sco

re a

bo

ve

po

int 3

, score

tha

t po

int re

ga

rdle

ss of m

od

e.

Qu

ality

Qu

an

tity

Pre

pa

ratio

n

Org

an

isatio

n

Sco

re fo

r Su

b A

rea

Nu

trition

he

re w

ou

ld b

e 4

9.

Ob

tain

ing

a sco

re fo

r an

‘are

a’ fro

m sco

re in

its con

stitue

nt su

b-a

rea

s: - Sa

me

as a

bo

ve

(6)

No

rfolk

LSC

B G

rad

ed

Ca

re P

rofile

Ve

rsion

3 Ju

ne

20

15

Pag

e 9

10

. Th

is me

tho

d h

elp

s ide

ntify th

e p

rob

lem

ev

en

if it is on

e su

b-a

rea

or ite

m. Its p

rima

ry a

im is to

safe

gu

ard

ch

ild’s

we

lfare

w

hile

b

ein

g

ob

jectiv

e.

Be

side

s, if

ma

the

ma

tical

com

pu

tatio

n

like

calcu

latin

g th

e m

ea

n a

re d

on

e to

ob

tain

a co

mm

on

score

it will n

ot b

e p

ossib

le to

refe

r to a

n ite

m

or su

b-a

rea

s wh

ich g

ave

a p

oo

r score

in o

rde

r to ta

rge

t it wh

ich is a

n a

dv

an

tag

e w

ith th

is scale

.

Th

is is wh

y it h

as b

ee

n le

ft as a

cate

go

rical sca

le.

11

. Tra

nsfe

rring

the

score

from

the

Re

cord

she

et to

the

‘Su

mm

ary sh

ee

t’. Tra

nsfe

r all sco

res to

the

sum

ma

ry sh

ee

t an

d th

en

ide

ntify

the

are

as fla

gg

ed

for a

tten

tion

tog

eth

er w

ith th

e a

ction

req

uire

d w

ithin

a g

ive

n tim

esca

le.

12

. Use

‘Asse

ssing

Pro

gre

ss’ she

et to

reco

rd th

e in

itial a

ssessm

en

t follo

we

d b

y a

diffe

rtnly co

lou

red

line

with

ide

ntifie

s targ

et sco

res a

nd

/or w

hich

ma

ps p

rog

ress. A

be

tter sco

re ca

n b

e a

ime

d a

t

afte

r a p

erio

d o

f inte

rve

ntio

n. B

y a

imin

g fo

r on

e g

rad

e b

ette

r will p

lace

less d

em

an

d o

n th

e ca

rer

tha

n b

y a

imin

g fo

r ide

al in

on

e le

ap

.

13

. Use

th

e

Su

mm

ary

sh

ee

t a

nd

A

ssessin

g

pro

gre

ss sh

ee

t to

d

iscuss

con

cern

s w

ith

pa

ren

ts, in

sup

erv

ision

an

d in

mu

lti ag

en

cy m

ee

ting

s.

Jun

e 2

01

5

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 10

GRADED CARE PROFILE

Child’s Name Date of Birth Age

Agency Date completed Client Number

Using the Graded Care Profile

The Graded Care Profile is an assessment tool, which can be used to assist in the assessment of neglect. The tools will identify strengths

and difficulties across a number of child development areas. It is likely to be triggered by concerns about the care the child is receiving.

Whilst it may be focussed on assessing difficulties, the Graded Care Profile also identifies strengths. Focussing on strengths assists the

assessor to appreciate the potential that exists within the family for change and improvement. This potential will inform decisions about

possible support or interventions to meet areas of need.

The Graded Care Profile has been adopted by the LSCB in Norfolk where neglect is an area of concern for a child's welfare. The 'tools' can

be used across the Children's Continuum of Need and Response model and by practitioners from various agencies.

How to use the Graded Care Profile:

• Work through the four areas, ticking the description that best describes the care that the child receives

• Use the Scoring Grid at the end of each area section to record a baseline score for each item

• Use the Scoring Grid to record an ‘overall score’ for each sub-area (see Summary Guidance)

• Use the Scoring Grid to record any areas that you consider should be flagged for attention/intervention.

• Use the Scoring Grid to record relevant comments/ evidence in relation to strengths and difficulties.

• Transfer the sub-area scores to the Summary Score sheets

• Use the ‘Areas flagged for intervention’ sheet to identify the needs assessed and action/ interventions indicated.

• Record your decisions and further actions on the final sheet.

• Needs and interventions can then be incorporated into the care planning processes of the relevant agency or inserted into the

Early Help form Form.

• Guidance notes are available to support the use of this tool.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 11

A Area of Physical Care

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

1) Nutrition

A. Quality Provides good

quality and healthy

food and drink

Provides reasonable

quality and healthy

food and drink.

Provides reasonable

quality healthy food

but inconsistently.

Provides poor quality

food or an unhealthy

diet through lack of

awareness or effort.

Improves when

prompted.

Does not consider

the health or quality

of diet. When

prompted, very little

improvement.

B. Quantity Enough food all of

the time.

Enough food nearly

all the time.

Enough food most of

the time.

Sometimes not enough

food or inappropriate

feeding

Not enough/too

much food most of

the time.

D. Organisation Meals organised and

well timed. Family

sitting together to

eat food.

Well organised, often

seating together and

regular timing of

meals.

.

Organised sometimes ,

irregular timing

Not well organised,

no clear meal times.

Chaotic, eat when

and whatever food is

there.

C. Preparation Always carefully

prepared or cooked

for the child.

Well prepared and

usually taking

account of the

child’s needs.

Prepared mainly to

meet the parent’s

needs. The child’s

needs sometimes

accommodated.

Often little

preparation. The

child’s needs and

tastes are not

accommodated or the

child inappropriately

prepares their own

meal.

Hardly ever any

preparation. Child

lives on

snacks/cereals/junk

food and is expected

to prepare their own

food.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 12

A. Maintenance Well maintained

Additional features

that benefit the

child. e.g. insulation,

double glazing,

draught proofing and

house safe for

children.

Reasonably well

maintained and some

additional features.

Efforts made to

benefit the child

only lacking if

issues such as

money interfere

No additional

features but well

maintained.

In disrepair. Some

repairs could be

carried out by the

parents

Dangerous disrepair

(exposed nails, live

wires) and some

repairs could be

carried out by the

parent/carer

A Area of Physical Care

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

2) Housing

B. Décor

(relates to house

generally and child’s

bedroom)

Good, clean showing

evidence of care.

Child’s bedroom has

age appropriate

decor

Showing evidence of

being kept clean and

with some evidence

of child’s

development age and

choice.

In need of some

decoration and kept

reasonably clean.

In urgent need of

decoration. Grubby

very untidy and

cluttered.

In very urgent need

of decoration. Very

chaotic and dirty

and/or an unpleasant

smell.

NOTE: Discount any direct external influences like repair done by other agency but count if the carer has spent a loan or a grant on the house or had

made any other personal effort towards house improvement.

C. Facilities All essential

facilities in good

working order and

there is play and

learning space.

Essential facilities.

Effort to maximise

benefit for the

child. Lacking only

due to practical

constraints e.g.

finance.

Essential to bare

Little effort to

maximise benefit to

the child.

Very bare. Adult

needs are met first

and child needs met

if anything is left.

Bathing facilities

very poor

Child dangerously

exposed or not

provided for e.g.

lack of heating,

electricity. Lack of

working facilities

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 13

A Area of Physical Care

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

3) Clothing

B. Fitting Clothing fits very

well and bought

especially for child

Fits well, may not

necessarily be new.

Sometimes

inadequate fit.

Often inadequate

fit.

Completely

inadequate fit.

A. Insulation e.g.

harm, warm

clothing

Well protected with

appropriate

garments.

Mostly well

protected

Adequate to variable

weather protection. Inadequate weather

protection.

Dangerously

inadequate. Child is

exposed to bad

weather.

C. Appearance Clothes always very

clean and well cared

for.

Clean and cared for. Not always clean or

cared for.

Appears worn,

sometimes dirty and

crumpled.

Appears to be dirty,

badly worn and

crumpled/and or

unpleasant odour.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 14

A Area of Physical Care

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

4) Hygiene

Child Aged 5 - 7

Some independence

with keeping clean and

bathing but always

helped and

supervised.

Usually reminded to

keep clean and

bathe. Supervised

and helped if needed.

Sometimes but not

always reminded to

keep clean and bathe

Not always routinely

monitored.

Reminded only now

and then with

minimum supervision.

No concerns or

interest shown about

keeping personal

hygiene.

Child aged 0 - 4 Always appears clean

and bathed and hair

is clean and clearly

cared for daily.

Usually appears

clean, bathed and

hair usually clean and

brushed .

Presentation is varied.

and/or babies are

usually clean. Older

toddlers less so.

Often but not

always appears dirty

and hair and nails

seem uncared for.

Always appears with

dirty skin, hair and

nails seen Rarely

bathed, clean or hair

cared for.

Child Aged 7 + Reminded, helped and

monitored. Reminded regularly

and followed up if

not done.

Sometimes reminded. Usually left to their

own initiative.

No concerns shown

about personal

hygiene.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 15

Area of Physical Care

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

5) Health

A. Opinion sought

and professional

advice given

Appropriate opinion

sought not only on

illnesses but also

other genuine health

matters. All advice

followed.

Opinion sought on

issues of genuine

and immediate

concern about child

health. Advice

followed.

Opinion sought on

illness of any

severity. Advice

followed.

Help initially sought

but delayed even

when illness

becomes quite

serious.

Help sought but

delayed or ignored

even when illness

becomes critical or an

emergency. Advice

may be not followed.

B. Follow Up

All appointments

kept. Re-arranged

if there is a

problem.

Fails one in two

appointments

because they doubt

their importance or

have other pressing

practical priorities.

Fails one in two

appointments even if

they are important

because it’s

inconvenient for the

parent.

Attends third time

after reminder.

Contests the

importance even if

it’ is of benefit to the

child.

Fails a needed follow

up a third time

despite reminders.

Misleading or

doubtful

explanations.

C. Surveillance

and oversight of

health matters

Visits in addition to

the standard

checks. Up

to date with

immunisations unless

valid

reservations.

Up to date with

standard checks and

immunisation unless

parent refuses for

no obvious reason.

Omissions for

reasons of adult’s

personal

convenience but

takes up if

persuaded.

Omissions because

of carelessness,

accepts service if it

is provided at home.

Clear disregard of

child’s welfare.

Frustrates home

visits.

A

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 16

Area of Physical Care

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

5) Health

D. Disability /

chronic illness (3

months after

diagnosis)

Compliance with

treatment and

advice is excellent.

Any issues due to

differences of

opinion. Very good

affection shown.

Compliance is good.

Any issues relate to

practicality or

finance. Good

affection shown.

Compliance is

sometimes lacking

for no apparent

reasons.

Inconsistent

affection shown.

Compliance is

frequently lacking

and trivial reasons

offered as excuses.

Little affection

shown.

Serious compliance

failure. Medication

not given.

Inexplicable

deterioration. Any

affection appears

contrived.

A

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 17

A4 Hygiene

1 2 3 4

5 Flagged for Attention Overall Score Record Sheet

D Nutrition Organisation

C Nutrition Preparation

A Nutrition Quality

B Nutrition Quantity

A1 Nutrition

C Housing Facilities

A Housing Maintenance

B Housing Décor

A2 Housing

C Clothing Appearance

A Clothing Insulation

B Clothing Fitting

A3 Clothing

A Child Hygiene

A Health opinion sought A5 Health

B Health Follow Up

C Health Surveillance and oversight of health

matters

D Disability / chronic illness (3 months after

diagnosis)

A4 Hygiene

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 18

Comments / Evidence (e.g. what you have observed). Recording strengths as well as the difficulties ensure that the

potential of the family to change is recognised and their achievements built upon.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 19

B Area of Safety

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

1) In Presence of Parent

B. Practice at

Pre-mobility age

Always cautious with

handling and laying

down child. Baby

seldom left

unattended.

Cautious whilst

handling and laying

down child. Frequent

checks if

unattended.

Handling of child is

uncertain.

Frequently

unattended when in

the house.

Handling of child is

uncertain.

Unattended during

care chores e.g.

feeding bottle

left in mouth.

Dangerous handling.

e.g. left dangerously

unattended whilst

feeding or bathing.

B. Practice at

Infant School

Close supervision

indoors and

outdoors.

Supervision indoors.

No direct

supervision outdoors

if known to be at a

safe place.

Little supervision in

or out of doors.

Intervenes only if in

considerable danger.

No supervision.

Intervenes after

mishaps which soon

lapses.

Minor mishaps ignored

or the child is blamed.

Intervenes casually

even after major

mishaps and lapses.

A. Awareness of

Safety

Very aware of

appropriate safety

and risk issues.

Aware of important

safety and risk

issues.

Poor awareness of

safety and risk

except for immediate

danger.

Rarely notices

safety or risk issues

Unconcerned about

safety or risks.

B. Practice at

Acquisition of

mobility

Constant alertness

and effective

measures against any

dangers.

Alert and effective

measures against any

danger.

Action taken to

prevent danger are

of limited use.

If action is taken it

is ineffective. Short

term improvement

after mishaps soon

lapses.

Inadvertently

exposes to serious

dangers. E.g. hot

iron/drinks left

nearby.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 20

5 to 10 year old

escorted by adult

when crossing a

busy road. Walk

closely together.

Well secured in the

pushchair or pram

or walks at child’s

pace with hand

firmly held.

Infants not secured

in pram. 3 to

4 year old expected

to keep up with

adult when walking.

Occasional glance

back if left behind.

Not always aware of

whereabouts

outdoors. Believing

it is safe as long as

the child returns on

time.

B Area of Safety

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

1) In Presence of Parent

C. Traffic

Age 5 and above

5-8 year old allowed

to cross road with a

13+ child. 8-9 year

old allowed to cross

alone if they are

safe to do so.

5-7 year old allowed

to cross with a child

who is under 13. 8-9

year old allowed to

cross alone.

5-7 year old

allowed to cross a

busy road alone

because they are

believed to be safe.

At age 7 child

crosses a busy road

alone without any

concerns regarding

safety.

B. Practice

Junior and Senior

School

Allows out in known

safe surroundings

with agreed time

limits and checks.

Allows out in

unfamiliar

surroundings if felt

to be safe. Sets

reasonable time

limits and checks.

Unconcerned about

daytime outings but

concerned about

late nights in case

of child younger

than 13.

Unconcerned

despite knowledge

of dangers

outdoors. E.g.

railways,ponds,

unsafe building, or

staying away until

late evening.

C. Traffic

Age 0-4

3 to 4 year old

allowed to walk, but

close by parent.

Always in sight,

hand held firmly if

necessary e.g.

crowds or by roads.

Babies not secured

in pushchair. 3 to 4

year old child left

far behind when

walking.

Babies, toddlers

unsecured, careless

with pram or

pushchair. 3 to 4

year old child left

to wander

unsupervised.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 21

B Area of Safety

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

1) In Presence of Parent

D. Safety

Features This item along with

other safety

provisions which are

not fixtures, such as

bike helmets or

safety car seats can

be used to help to

score Item 1

(Awareness of safety)

All relevant safety

features. Gates,

guards, secure

windows, locked

medicine cabinets,

smoke alarms,

household chemicals

secured, electrical

and gas safety

devices, intercom,

safety within

garden e.g. pond.

Most essential

features.

Improvisation and

DIY safety features

when they cannot be

afforded.

No safety features

and some hazards

through lack of

repair or concerns.

No safety features

and dangerous

hazards or

disrepair. E.g.

exposed electric

wires and sockets,

unsafe or broken

windows, dangerous

household chemicals

or no smoke alarms.

Lacking in essential

features, very little

improvisation or

DIY is ineffective.

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Page 22

2) Safety in Absence of Parent

B Area of Safety

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

Child is left in care

of a competent and

safe adult. Never in

the sole care of a

young person under

16.

Child aged is left

for a short time

with a young person

over 13 who is

familiar, competent

with no significant

problems. The

above applies to

babies only in

urgent situations.

When out playing a

0-7 year old is left

with an 8-10 year

old or person not

known to be

competent.

When out playing a

0-7 year old is left

alone or with a

slightly older child

i.e. 8 or less, or with

an unsuitable young

person or adult.

When out playing

leaves a young

child/baby with

child aged 10-13 or

a person not known

to be competent.

Norfolk LSCB Graded Care Profile Version 3 June 2015

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1 2 3 4

5 Flagged for Attention Overall Score Scoring Grid

D Safety Features

C Traffic

A Awareness

B Practice

B1 In

Presence of

Parents

B2 Safety in

Absence of

Parents

Comments / Evidence (e.g. what you have observed). Recording strengths as well as the difficulties ensure that the

potential of the family to change is recognised and their achievements built upon.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 24

Not sensitive

enough. Signals have

to be intense to be

noticed e.g. child

crying.

C Area of Responsiveness

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

1) Carer

C. Appropriate

responsiveness to

the child

Warm emotional and

practical responses

appropriate to the

signal.

Practical responses

e.g. treats are

lacking but

emotional responses

are warm and

reassuring.

Emotional and

practical responses

warm if in good

mood. Otherwise

flat.

Emotional response

is brisk, flat and

functional.

Annoyance if child

in moderate

distress but

attentive if in

severe distress.

Unpleasant/punitive

even if child in

distress. Acts

after a serious

mishap mainly to

avoid criticism.

Any warmth or

remorse is

deceptive.

A. Sensitivity

Anticipates or picks

up very subtle signals

both verbal or

nonverbal expressions

including emotions or

mood.

Understands distinct

verbal or clear

nonverbal expressions

including emotions or

mood.

Insensitive. Needs

repeated or

prolonged and

intense signals to be

noticed e.g.

screaming.

Insensitive to even

repeated and

prolonged intense

signals or is even

averse to signals.

B. Timing of

response

Responses well timed

with signals or even

anticipates those

signals.

Responses mostly

timely except when

occupied by

essential chores.

Not timely if

distracted. Timely if

they are not

otherwise occupied or

if the child is

distressed.

Responses delayed

even when child is in

distress.

No responses unless

there is a clear

mishap.

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Page 25

Approaches mainly

by child and,

sometimes by the

carer. Negative

response if the

child’s behaviour is

defiant.

C Area of Responsiveness

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

2) Mutual Engagement

A. Overtures –

two way

communication

Two way with parent

usually going first

and engaging child.

Equally positive by

both. Parent

responds even if

the child is defiant.

Mainly by the child.

Seldom by the

carer.

Child appears

resigned or

apprehensive and

does not make

approaches.

B. Quality Both engage and

enjoy it.

Frequent pleasure

shown.

Both engage and

enjoy it.

Pleasure is usually

shown.

Sometimes engaged

and pleasure shown.

The child gets most

enjoyment and the

carer passively joins

in and occasionally

gets enjoyment.

Engagement mainly

practical.

Indifferent when

child attempts to

engage. Child can

derive some

pleasure e.g.

attempts to sits on

knees, tries to show

toys.

Dislikes approaches

by the child. Child

is resigned or plays

on its own. Carer

engages only if told

to do so.

CAUTION: If child has temperamental/behavioural problems, scoring in this sub-area (mainly quality item) can be affected unjustifiably. Scoring should

be done on the basis of score in area C/1 (Carer) and problem noted as comments.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 26

1 2 3 4

5 Flagged for Attention Overall Score Scoring Grid

C2 Mutual

Engagement

Comments / Evidence (e.g. what you have observed). Recording strengths as well as the difficulties ensure that the

potential of the family to change is recognised and their achievements built upon.

C Appropriate responsiveness to the child

A Sensitivity

Awareness B Timing of response

C1 Carer

A Overtures two way communication

Awareness B Quality

Norfolk LSCB Graded Care Profile Version 3 June 2015

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Inadequate and/or

inappropriate. Baby

left alone while

carer does what

they want.

Occasional

interactions with

the baby.

D Area of Esteem

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

1) Stimulation

Excellent provision.

Provides all that is

necessary and tries

for more. Adapts if

carer can’t afford.

Essentials only. No

effort to improvise

if unaffordable.

Lack of even

essential toys.

None unless

provided by others

e.g. gifts or grants.

Age 0 – 2 years

A great deal of

appropriate

stimulation. E.g.

talking, touching,

reading &looking.

Many positive

educational toys.

Adequate and

appropriate

stimulation.

Some positive

educational toys.

Baby left alone

while carer pursues

own interests

unless the baby

demands attention.

None. Even mobility

restricted e.g.

confined in

chair/pram for the

carer’s convenience.

Irritated if the

baby demands

attention.

Age 2 – 5 years

i Interactive

stimulation

talking to and playing

with the child. Reading

stories and discussion.

Plenty and good

quality.

Sufficient and of

satisfactory quality.

Variable.

Deficient even if

the carer is totally

unoccupied

No stimulation.

Age 2 – 5 years

ii Toys and gadgets

items of uniform,

sports equipment

books etc.

Norfolk LSCB Graded Care Profile Version 3 June 2015

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Very good but may be

limited e.g. by

finances.

Child accompanies

carer going where

carer decides but

usually in child

friendly places.

D Area of Esteem

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

1) Stimulation

Active interest in

school which is

supported at home.

Active interest in

school. Support at

home when carer is

free of essential

tasks.

Some interest in

school. but little

support at home,

even if carer has

spare time.

Little interest and

poor support in

school. Interest for

other reasons e.g.

free meals.

Disinterested or

even discouraging.

Age 2 – 5 years

iii Outings

taking the child out

for recreational

purposes

Frequent visits to

child centred places

both locally and

further away.

Enough visits to

child centred places

locally (e.g. parks)

and occasionally

further away.

Child accompanies

carer e.g. local

shopping. Plays

outside and outings

to keep up with

others.

No outings for the

child. May play in the

street if carer goes

out locally

Age 2 – 5 years

iv Celebrations

seasonal and personal.

Notable, happy, fun

and appropriate.

Mainly seasonal and

low key personal e.g.

birthdays.

Only seasonal. Low

key to keep up with

other people.

Even seasonal

festivities absent or

dampened.

Age 5+ years

Education

Age 5+ years

ii Sports and leisure

Well organised

outside school hours

e.g. clubs and

swimming.

All support that is

affordable.

Not active in finding

activities, but will

use local facilities.

Child finds activities

for themselves

Parent/carer is

indifferent.

Disinterested even if

the child is involved

in other unsafe or

unhealthy activities.

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Page 29

Poor provision.

Supports if a child is

from a family who

are friendly with

carer.

D Area of Esteem

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

1) Stimulation

Age 5+ years

iii Peer/friend

interaction

Assisted and new

friends checked.

Some assistance and

new friends checked.

Child finds own

friends. No help from

carer unless serious

problems e.g.

bullying.

Disinterested,

indifferent or even

discouraged.

Well provided and

tries to provide

more.

Age 5+ years

iv Provision equipment

Fully provided e.g.

sports gear or

computer.

Some limited

provision.

No provision made

and even

discouraged.

2) Approval

Talks fondly about

the child when

asked. Generous

praise and emotional

reward, less

practical reward e.g.

financial

constraints.

Talks about the

child with pleasure

and praises without

prompting.

Appropriate

emotional and

practical rewards

for achievement.

Agrees with other

people’s praise of

the child. Gives low

key praise and some

emotional rewards.

Uninterested if

the child is praised

by others.

Indifferent to the

child’s achievement

which is only briefly

acknowledged.

Undermines if the

child is praised.

Achievements are

not acknowledged.

Reprimanded or

mocking is the only

response.

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Page 30

Inconsistent

boundaries or

methods. Shouts or

ignores child. Low

level physical and

moderate other

sanctions.

D Area of Esteem

Sub-areas 1 All Needs Met

2 Essential Needs

Met

3 Some Essential

Needs Unmet

4 Many Essential

Needs Unmet

5 Most/ all Essential

Needs Unmet

3) Disapproval

Unconditional

acceptance, even if

temporarily upset

by child’s behaviour.

However, always

warm and

supportive.

Mild and consistent

verbal disapproval if

a set limit is

crossed.

Consistent verbal

and low level

physical and other

sanctions if any set

limits are crossed.

Inconsistent.

Shouts/harsh

verbal or moderate

physical, or severe

other sanctions.

Terrorised.

Ridiculed, severe

physical or cruel and

spiteful other

sanctions.

Unconditional

acceptance. Always

warm and supportive

even if child is

failing.

Annoyance at child’s

failure.

Unsupportive or

rejecting if the

child is failing.

Indifferent if child

is achieving and

rejects or belittles

if the child makes

mistakes or fails.

4) Acceptance

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Page 31

1 2 3 4

5 Flagged for Attention Overall Score Scoring Grid

D2 Approval

Comments / Evidence (e.g. what you have observed). Recording strengths as well as the difficulties ensure that the

potential of the family to change is recognised and their achievements built upon.

A Age 0 – 2 years

B Age 5 + years

D1 Stimulation

D2

D3 Disapproval D3

D4 Acceptance D4

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 32

Graded Care Profile (GCP) – Summary Sheet

Area Sub-Area Sub-Area Score

A Physical

1. Nutrition

2. Housing

3. Clothing

4. Hygiene

5. Health

1. In Carer’s Presence

2. In Carer’s Absence

1. Carer

2. Mutual Engagement

1. Stimulation

2. Approval

3. Disapproval

4. Acceptance

B Safety

C Responsivenes

s

D Esteem

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 33

Areas flagged for attention – Physical, Safety, Responsiveness, Esteem

Area, sub area

and score E.g. Physical: Housing: Maintenance:

Score

Description and child’s need E.g. Description: Dangerous disrepair (exposed live

wires).

Child’s Need: Child needs to be kept safe from electric

shocks

Action required E.g. 1. Parent to buy some electric masking tape and

wrap around exposed wire/broken socket until the

landlord repairs. 2. Parent and worker to notify the

landlord of the danger and request immediate repair

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 34

Decisions

Please record your decisions after completing the Graded Care Profile. Areas identified at level 4 and 5 may be indicative of neglect

Where this harm is considered ‘significant’, Child Protection Procedures must be followed.

This should be discussed with your manager.

Concerns about neglect in this case have not been substantiated. �

Some concerns about neglect in this case have been substantiated, but I do not consider that this child is suffering significant harm. �

Concerns about neglect in this case have been substantiated and I am concerned that this child is suffering significant harm. �

Further Action arising from this assessment

In the Graded Care Profile you may have recorded items ‘flagged for attention’. These flagged items may indicate the need for discussions with your

manager and/or further discussions within a multi-agency setting to confirm actions, decisions and interventions. Many agencies will have systems to

record plans and interventions to meet the needs of children.

⇒ This agency [or named agency] will undertake on-going work with this family. �

⇒ Agency to undertake on-going work with this family with the support, advice and guidance of other agencies.

� ⇒ This is not appropriate for this agency and a referral will be made to a more appropriate agency.

⇒ Referral to Children’s Social Care due to Child Protection concerns �

On-going work. Choose one or more of the following options:

⇒ No further action �

Consent

For sharing information or referral to another agency the consent of the child/parent is usually required. Please confirm whether the consent of the

child/parent has been obtained.

⇒ I have obtained consent to share information/refer to another agency. �

⇒ I do not have consent to share information/refer with another agency but have Child Protection concerns and obtaining consent

may harm the child.

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 35

Comments / Evidence

Name of Professional Date Completed

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 36

Child: Date

Physical Safety Love Esteem

Nutritio

n

Housing Clothing Hygiene Health Carer

Present

Carer

Absent

Carer Mutual Stimulatio

n

Approva

l

Disapprov

al

Acceptan

ce

1

2

3

4

5

Black Line = Assessment Red Line: Progress after weeks

Assessing Progress

Norfolk LSCB Graded Care Profile Version 3 June 2015

Page 37

EXAMPLE : Date

Physical Safety Love Esteem

Nutrition Housing Clothing Hygiene Health Carer

Present

Carer

Absent

Carer Mutual Stimulatio

n

Approva

l

Disapprov

al

Acceptan

ce

1

2

3

4

5

Black Line = Assessment Red Line: Progress after weeks

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