1. Identifying and Assessing Neglect using the Graded Care Profile
Patrick Ayre
Department of Applied Social Studies
University of Bedfordshire
Park Square, Luton
Presentation can be downloaded from:

2. 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)

3. Understanding and assessing 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.

4. Understanding and assessing 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!!....

5. Understanding and assessing 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!

6. Understanding and assessing 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!!....
The damage is not on the surface, it often runs quite deep and we need to understand how it got there in order to put it right. Painful though it is, we need to understand what it does to you to be neglected.

7. Understanding and assessing neglect
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.

8. Experience Affects the Structure of the Brain
Understanding and assessing neglect
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”

9. Understanding and assessing neglect

10. Understanding and assessing neglect

11. Understanding and assessing neglect

12. Understanding and assessing neglect
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.

13. Other physiological issues
Understanding and assessing neglect
Serotonin: emotional stability and feeling good
Malnutrition: cognitive and motor delays, anxiety, depression, social problems, and attention problems
Myelination
Sensitive periods (infancy & attachment)

14. Emotional development
Understanding and assessing neglect
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?

15. Understanding and assessing neglect
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.

16. Capturing chronic abuse
Understanding and assessing neglect
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

17. The pattern of neglect: atypical

18. Understanding and assessing neglect
The pattern of neglect

19. Understanding and assessing neglect
The pattern of neglect

20. Understanding and assessing neglect
The pattern of neglect

21. Understanding and assessing neglect
The pattern of neglect

22. Understanding and assessing neglect
Cumulativeness
Child protection system is triggered when threshold of likely significant harm has been crossed.
Physical and sexual abuse, where a serious precipitating incident comes to light which clearly crosses the threshold at once.
Many chronic cases may be characterised by a lengthy pattern of actions or incidents, none of which is in itself sufficient to trigger intervention. They have to get added together like this

23. Failure of cumulativeness
Understanding and assessing neglect
Failure of cumulativeness

24. Understanding and assessing neglect
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)
Three principle reasons for this failure of cumulativeness.
The first is that the incidents giving rise to concern may lie scattered through the relevant files, recorded and responded to separately with no one making cumulative connections between them. They may lie unshared on the files of a variety of different interested agencies or unremarked within the files of a single agency. Picked up and put down Many 'duty worker' and 'team responsibility' systems may be prone to this failing.
The notion of proportionality: uncomfortable about invoking the full might of the system over a 'minor' incident, even where this incident is just one of a very worrying series.
Acclimatised to unacceptably low standards, typified by remarks such as 'What can you expect from this family?' or 'That's the way they are; they've always been the same'. Conditions likely to cause significant harm come to be regarded as the norm and all future incidents come to be judged against this depressed standard with the result that incidents have to be increasingly bad to be identified as causing concern at all and the cumulative effect on the child is overlooked.

25. 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
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26. GCP uses 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

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

28. GCP users Health visitors School nurses Social workers
Family centre workers
Education staff

29. Why choose GCP? Child focused User friendly Common language
Promotes partnership

30. 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

31. Love and belongingness
Domains of Care
Stimulation
Approval
Disapproval
Acceptance
Sensitivity
Responsivity
Reciprocity
Overtures
Self actualisation
Esteem
Love and belongingness
Present & absent
Safety
As Prakash said he used Maslow’s work to build on using the four domains and further sub-dividing them.
Physical needs
Nutrition. Housing, Clothing, Hygiene & Health
Maslow, A. 1954

32. What to observe Nutrition Housing Clothing Hygiene Health Quality,
Quantity,
Preparation,
Organisation,
A. PHYSICAL
B. SAFETY
C. LOVE
D. ESTEEM

33. Grades of Care Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Level of care
All child’s 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

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

35. DO NOT JUSTIFY BY REASONS
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

36. Scoring Complete the full reference scheme
Transpose to the record sheet

38. Scoring Complete the full reference scheme
Transpose to the record sheet

39. Sub-Area
Scores
Area Score
Comments
(A)
Physical
1. NUTRITION 1 2 3 4 5
2. HOUSING
3. CLOTHING
4. HYGIENE
5. HEALTH
(B)
Safety
1. IN CARER’S PRESENCE
2. IN CARER’S ABSENCE
(C)
Love
1. CARER
2. MUTUAL ENGAGEMENT
(D)
Esteem
1. STIMULATION
2. APPROVAL
3. DISAPPROVAL
4. ACCEPTANCE

40. AREAS A ? 1 ? Items a b c d 3 2 3 1 2 ? a b c 4 2 2 3 ? a b c 2 2 2 4
Reference Sheet
Sub-areas 1 ?
Items a b c d 3 2 3 1 2 ? a b c 4 2 2 3 ? a b c 2 2 2 4 3 5 ? a b c d 3 3 2 2

41. DO NOT JUSTIFY BY REASONS
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

42. AREAS A 1 Items a b c d 3 2 3 1 2 a b c 4 2 2 3 a b c 2 2 2 4 3 5 a b
Reference Sheet
Sub-areas 1
Items a b c d 3 2 3 1 2 a b c 4 2 2 3 a b c 2 2 2 4 3 5 a b c d 3 3 2 2

43. AREAS A 4 1 3 Items a b c d 3 2 3 1 2 4 a b c 4 2 2 3 2 a b c 2 2 2 4
Reference Sheet
Sub-areas 1 3
Items a b c d 3 2 3 1 2 4 a b c 4 2 2 3 2 a b c 2 2 2 4 3 5 3 a b c d 3 3 2 2

45. Targeting Items of Care
Targeted Areas
Current Score
Target Score
Timescale
Reviewed Score 1 2 3 4 5

46. Assessing progress

47. 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

48. Understanding and assessing neglect
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

49. 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)

50. Information handling pitfalls
Understanding and assessing neglect
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, , HMSO, London

51. Assessment pitfalls Rule of optimism Natural love Cultural relativism
Too much
not enough
Adult services and children’s services (hand-in-hand or hand-to-hand?)

52. Children’s 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’

53. 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’
JB (Late 2006)
Wirral Children and Young People's Services (Social Care) should seek to ascertain whether assessment practice and judgments about thresholds in child safeguarding cases across the borough as a whole currently accord with recognised accepted local and national standards… The findings of Children and Young People's Services’ enquiries this enquiry should be reported to LSCB, together with an action plan identifying the steps to be taken to remedy any shortfalls which are identified
JLS (late 2008)
The LSCB should consider auditing both core assessments and common assessments in order to ensure that staff, on a multi agency basis, are adequately trained and have sufficient skills to undertake good quality assessments. In the light of this audit training needs should be identified and a training programme implemented.
SCRs are not individual events but should be viewed as a cumulative repository of knowledge
Failure to use case history (JB) New file started despite 12 years of involvement.
A couple of months for cases to arrive may lead to a ‘start again syndrome culture.
Use of case history (JB) when there were acute concerns about the care she received from her father, teenager placed with grandmother and grandfather with severe drink problems, he had masturbated in front of her, she had assaulted her; when this broke down, placed with her father who used to send her out to buy drugs for him and may have encouraged her into a sexual relationship with his dealer.

54. 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.
Incomplete Remember, this is a sales pitch (give the client what they need) Always think of your audience, what do they need to know? In this case:

55. Gabriela Mistral (Chilean poet, 1889-1957)
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, )