Solution FocusedInterventions in NeglectThe Graded Care Profile

Aims and Objectives• To enable participants to have working knowledge of GCP• To support participants to quantify neglect by use of aworking tool to use together with service users• To enhance or enable communication between professionalsand service users• To offer a guide to identify a programmed plan of care andsetting of achievable targets, for professionals and service users• To have an awareness and understanding of how the GCP is used to

support the legislation in regards to safeguarding children.

Introducing a More ObjectiveMeasure of Care

• Judging the quality of care is an essential component of any assessment but how well do we do it?

• Judgements are subjective and prone to bias

• Intangible: Difficult to capture and compare

• High threshold for recognition

• Cumulativeness and acclimatisation

The Graded Care Profile• The Graded Care Profile (GCP) scale was developed as a practical tool in response to the Children Act 1989 to provide a measure of care in four domains or areas: Physical, Safety, Love, and Esteem, on a bipolar continuum.

• It is seen as providing practitioners with a common tool or frame of reference to aid informed assessment of care & neglect

“Every Child Has a Right to Good Enough Parenting”

The GCP Provides:• A Shared Framework for Assessment/Intervention• A Reliable Standardised Evidence Base• A Baseline Measurement Tool• A Common Measure of Objectivity• A Framework in Which to Make Judgements about Care –Highlighting Areas of Strength & Concern• Opportunity to Highlight Areas not Always Apparent

Cross Discipline Assessment Tool• Pre-referral assessments• Snapshot assessment• Contribution to Core Assessments /Integrated Assessment(parenting capacity)• Monitoring assessments• Self assessments – parents / carers• Young peoples assessments of parents / carers• Identification of areas of strength & weakness• Tool for setting goals for parenting• Tool to facilitate discussion

User Friendly

The Graded Care Profile is an assessment tool that can be used in all cases including the following user groups•– Parents with learning disabilities•– Physical disabilities•– Parents with Dependency Issues – Drugs/Alcohol•– Adult Mental health•– Different cultural and ethnic backgrounds

Differentiates Care .....• Between different carers• Provides better evidence

Good enough parentingGood Enough” parents show pride and pleasure in their child’s progress together with many other positive emotions such as affection, tenderness, interest, delight and many others, which will increase the child’s self-confidence and self-esteem.

There are also, at times, negative, feelings towards their children such as frustration, fatigue, anger boredom, anxiety, fear, disappointment and many others, which parents learn to accept as normal when occurring only occasionally.

Professionals need understanding and awareness of when the negative feelings are becoming excessive and when they may swamp the positive ones.

When to Use the Graded Care Profile• Concerns regarding Parenting• Child Exhibiting Problems• Children in Need• Children in Need of Protection• Programme of Intervention• Any Other Concerns

Promotes Greater Objectivity•1. Parenting Strength Child focused•2. Based on developmental outcomes Not opinions•3. No extrapolation Based on actual observations•4. Captures negative & positive care Bipolar continuum

• Common language, common reference

• Objective measure – child focussed

• Effective tool to promote partnership assessments andplanning with parents

• User friendly

• Covers all areas of care

• Child and carer specific

Domains of Care (Maslow 1954)

Derived from Maslow’s Hierarchy of Needs but more specific to compel holistic approach to assessment & remove generalised commentary.

The categorisation of differentgrades of careGrade 1 Grade 2 Grade 3 Grade 3 Grade 4

1. Level of Care

All child’sneeds met

Essentialneedsfully met

Someessentialneedsunmet

Mostessentialneedsunmet

Essentialneedsentirelyunmet/hostile

2.Commitment of Care

Child is First

Child is a priority

Child and parents needs on par

Child is secondary

Child is not considered

3 Quality of Care

Good Adequate Equivocal Poor Worse

What to observe…….

PHYSICAL Nutrition QualityHousing QuantityClothing PreparationHygiene OrganisationHealth

SAFETY

LOVE

ESTEEM

Sub areasNUTRITION

1 2 3 4 5

A Quality Aware andproactive;providesexcellentquality foodand drink.

Aware andmanages toprovidereasonablequality foodand drink.

Provisionofreasonablequalityfoodinconsistentthroughlack ofawarenessor effort.

Provisionof poorqualityfoodthroughlack ofeffort; onlyoccasionally ofreasonablequality ifpressurised

Qualitynot aconsiderateon at all orlies aboutquality.

B Quantity Ample Adequate Variable Low Starved

C Preparation Painstakinglycooked/prepared for thechild.

Wellpreparedfor thefamilyalwaysaccommodating child’sneed,sometimesfor thechild.

Preparationinfrequentand mainlyfor theadults,childsometimesaccommodated.

More oftennopreparation. If there is,child’s needor taste notaccommodated.

Hardlyever anypreparation. Childlives onsnacks/cereals.

D Organisation

Mealselaboratelyorganised –seating,timing,manners.

Wellorganised oftenseating,regulartiming.

Poorlyorganised irregulartiming,improperseating.

Notorganised noclearmeal time.

Chaotic –eat whenand whatone can.

SCORING

• 4 AREAS (A, B, C & D) – Physical, Safety, Love & Esteem• SUB-AREAS (up to 5 in each Area)• Each Sub Area is scored from 1 - 5• Use on Every Child in the Family• Use with Primary Carer/s & Different Carers• Make sure information is as factual as possible• Draw on Information, Observation & Records• Complete the full reference scheme• Transpose to the record sheet

• Obtaining a score for a sub-area from score in its items• 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• However If there is even a single score above point 3,

score that point regardless of mode. / average. • If there is a score of 4 or 5, go with highest score

Positives of the GCP

• Embraces numerous presenting concerns in adult behaviour (such as domestic violence, mental health problems or substance misuse problems)• Use as referral, initial, core assessment and court tool• Supports core assessment tool• Links to conference requirements and core group planning• Retrospective application possible• Clarification with criminal justice system about threshold for police investigation and prosecution via crossing public interest threshold• Engagement of adult services• Use across all families (birth, foster and extended)

• Links across prevention and protection• Links with existing tools across agencies such as percentiles• Supports links across information collection, analysis and planning• It is evidence-based (linking theory, research and practice wisdom)• Links to model of change• Common language• Potential to engage• Identifies strengths and weaknesses• Allows children to understand own experiences and challenge parents• Holistic focus to contextualise concern (e.g. dirty child or house)• Picks up patterns of concern over time• Links to Assessment Framework

Negatives

• Not useful as a child protection tool but can help analyse and contextualise information collected• Potentially deskilling• Language alienation• Focus is younger children rather than adolescents• Does not address unborn children• Unusable unless adopted by inter-agency system• Does not negate the need for parallel assessments on the origins of parental behaviour (domestic violence, mental health, substance misuse)• Links with emotional abuse and boundary issues between emotional abuse and neglect needed• Does not negate the need to use circumstance specific assessment tools e.g. failure to thrive