Identifying and Assessing Neglect using the Graded Care Profile

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Identifying and Assessing Neglect using the
Graded Care Profile

• Patrick Ayre
• Department of Applied Social Studies
• University of Bedfordshire
• Park Square, Luton
• email pga_at_patrickayre.co.uk
• Presentation can be downloaded from
• http//patrickayre.co.uk/Presentationd.htm

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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)

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• NEGLECT

• Parents who neglect their children basically just
  dont 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.

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• NEGLECT

• Parents who neglect their children basically just
  dont 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!!....

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• 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!

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• 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!!....

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Brain development

• By the age of 3, a babys 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.

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Experience Affects the Structure of the Brain

• Brain development is activity-dependent
• 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

• Difficulty regulating emotion,
• Lack of cause-effect thinking,
• Inability to recognize emotions in others,
• Inability to articulate own emotions,
• Incoherent sense of self and autobiographical
  history
• Lack of conscience.

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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)

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Emotional development

• Sensitive period for emotional development up to
  18 months
• Shaped primarily by the way in which the prime
  carer interacts with the child
• Emotional deficits harder to overcome once the
  sensitive window has passed.
• How often do we intervene assertively at this
  point?

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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.

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Capturing chronic abuse

• Single events often only significant in context
• Can often only understand present by setting in
  context of past
• Intangible Difficult to capture and compare
• High threshold for recognition
• Neglect is a pattern not an event

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The pattern of neglect atypical
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The pattern of neglect
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The pattern of neglect
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The pattern of neglect
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The pattern of neglect
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Cumulativeness
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Failure of cumulativeness
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Whats 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)

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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?optioncom_cont
  entviewarticleid183Itemid52

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GCP uses

• Pre-referral assessments
• Snapshot assessments
• Contribution to CAF assessments
• Contribution to Core Assessment (parenting
  capacity)
• Self-assessment (parents and carers)
• Young persons assessment of parenting
• Tool for setting goals and assessing progress
• Tool to facilitate discussion

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Section 47
CAF
GCP
Initial Assessment
Enquiries (GCP neglect)
Core Assessment (GCP parenting capacity)
Protection / Support Plan
GCP monitoring tool
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GCP users

• Health visitors
• School nurses
• Social workers
• Family centre workers
• Education staff

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Why choose GCP?

• Child focused
• User friendly
• Common language
• Promotes partnership

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Why choose GCP?

• Evaluates strengths as well as weaknesses
• Allows progress to be assessed
• A relatively objective measure
• Allows help to be targeted where needed

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Domains of Care
Stimulation Approval Disapproval Acceptance
Sensitivity Responsivity Reciprocity Overtures
Self actualisation
Esteem
Love and belongingness
Present absent
Safety
Physical needs
Nutrition. Housing, Clothing, Hygiene Health
Maslow, A. 1954
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What to observe
Nutrition Housing Clothing Hygiene Health
Quality, Quantity, Preparation, Organisation,
A. PHYSICAL B. SAFETY C. LOVE D. ESTEEM
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Grades of Care
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Level of care All childs needs met Essential 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
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Scoring

• Rating 1 5
• Use on every child in the family
• Use with different carers
• Complete with the parent/carer
• Use information, observation, records

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Scoring

• 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

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Scoring

• Complete the full reference scheme
• Transpose to the record sheet

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Scoring

• Complete the full reference scheme
• Transpose to the record sheet

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Sub-Area Scores Scores Scores Scores Scores Area Score Comments
(A) Physical 1. NUTRITION 1 2 3 4 5
(A) Physical 2. HOUSING 1 2 3 4 5
(A) Physical 3. CLOTHING 1 2 3 4 5
(A) Physical 4. HYGIENE 1 2 3 4 5
(A) Physical 5. HEALTH 1 2 3 4 5
(B) Safety 1. IN CARERS PRESENCE 1 2 3 4 5
(B) Safety 2. IN CARERS ABSENCE 1 2 3 4 5
(C) Love 1. CARER 1 2 3 4 5
(C) Love 2. MUTUAL ENGAGEMENT 1 2 3 4 5
(D) Esteem 1. STIMULATION 1 2 3 4 5
(D) Esteem 2. APPROVAL 1 2 3 4 5
(D) Esteem 3. DISAPPROVAL 1 2 3 4 5
(D) Esteem 4. ACCEPTANCE 1 2 3 4 5
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A
AREAS
?
Reference Sheet
Sub-areas
1
?
Items
a
b
c
d
1
3
2
3
2
?
c
a
b
2
4
2
3
?
c
a
b
2
2
2
4
3
5
?
d
a
b
c
3
3
2
2
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Scoring

• 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

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A
AREAS
Reference Sheet
Sub-areas
1
Items
a
b
c
d
1
3
2
3
2
c
a
b
2
4
2
3
c
a
b
2
2
2
4
3
5
d
a
b
c
3
3
2
2
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A
AREAS
4
Reference Sheet
Sub-areas
1
3
Items
a
b
c
d
1
3
2
3
2
4
c
a
b
2
4
2
3
2
c
a
b
2
2
2
4
3
5
3
d
a
b
c
3
3
2
2
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Targeting Items of Care
Targeted Areas Current Score Target Score Timescale Reviewed Score
1
2
3
4
5
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Assessing progress
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Unique Advantages

• 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

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Assessment Pitfalls

• Parents behaviour, whether co-operative or
  uncooperative, often misinterpreted
• Information from family friends and neighbours
  undervalued
• Coping with aggressive or frightening families
• Failure to give sufficient weight to relevant
  case history Start again syndrome
• Not enough attention is paid to what children
  say, how they look and how they behave
  maintenance of a wholly child-centred approach

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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)

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Information handling pitfalls

• 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

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Assessment pitfalls

• Rule of optimism
• Natural love
• Cultural relativism
• Too much
• not enough
• Adult services and childrens services
  (hand-in-hand or hand-to-hand?)

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Childrens services and adult services

• Working on the same case but not working jointly
• Mutual incomprehension and misunderstanding
• False expectations and assumptions
• Abdicating responsibility
• Need for interpreters

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Information handling pitfalls

• Keeping your head down
• Hesitancy to challenge other professionals or the
  conventional wisdom
• Tendency to move from facts to actions without
  showing your working

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Challenge your dodgy thinking

• I am only a and he is a, so I had better keep
  my opinion to myself.
• I am obviously in a minority, so I had better
  keep my opinion to myself.
• We need to maintain harmonious relations, so I
  had better keep my opinion to myself.

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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)