Identifying and Assessing Neglect using the

Graded Care Profile

Patrick Ayre

Department of Applied Social Studies

University of Bedfordshire

Park Square, Luton

email: pga@patrickayre.co.uk

Presentation can be downloaded from:

http://patrickayre.co.uk/Presentationd.htm

A child centred approach

The purpose of assessment is to understand what it is like to be that child (and what it will be like in the future if nothing changes)

NEGLECT

Parents who neglect their children basically just don’t know any better because of their own poor upbringings. If we send them to a family centre for Parental Skills training, all will be well.

NEGLECT

Parents who neglect their children basically just don’t know any better because of their own poor upbringings. If we send them to a family centre for Parental Skills training, all will be well.

IF ONLY!!....

NEGLECT

So neglected children who come into care may be a bit thin, a bit dirty, badly in need of seeing a doctor or dentist, maybe a bit wild.

But we can place them with foster carers for a bit of looking after, a bit of TLC, a bit of structure and everything will be fine. The children will absolutely love it and will immediately start to thrive. Simple really!

NEGLECT

So neglected children who come into care may be a bit thin, a bit dirty, badly in need of seeing a doctor or dentist, maybe a bit wild.

But we can place them with foster carers for a bit of looking after, a bit of TLC, a bit of structure and everything will be fine. The children will absolutely love it and will immediately start to thrive. Simple really!

IF ONLY!!....

Brain development

By the age of 3, a baby’s brain has reached almost 90 percent of its adult size.

The growth in each region of the brain largely depends on receiving stimulation.

This stimulation provides the foundation for learning.

Experience Affects the Structure of the Brain

Brain development is “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”

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.

Other physiological issues

Serotonin: emotional stability and feeling good

Malnutrition: cognitive and motor delays, anxiety, depression, social problems, and attention problems

Myelination Sensitive periods (infancy &

attachment)

Emotional development

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?

Building a child

Building a child is like building a house, each new level built on the one below. If the lower levels are unsound, no amount of tinkering with the upper floors will make it stable.

Capturing chronic abuse

Single events often only significant in context;

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

The pattern of neglect: atypical

The pattern of neglect

Intervention Intervention

The pattern of neglect

'G ood enough' level

Intervention Intervention

The pattern of neglect

Intervention Intervention

'G ood enough' level

Intervention ceases

The pattern of neglect

Cumulativeness

T h r es h o ld f o rin te r v en tio n

SEXUAL

ABUSE

PHYSICAL

ABUSE N

EGLECT

NEGLECT

NEGLECT

Failure of cumulativeness

T h r es h o ld f o rin te r v en tio n

SEXUAL

ABUSE

PHYSICAL

ABUSE

NEGLECT

NEGLECT

NEGLECT

NEGLECT

What’s the problem?

Chronic abuse and the principle of cumulativenessFiles very long and badly structured

Patterns missed and ‘chronic abuse’ overlooked

The problem of proportionality

Acclimatisation (case, agency and geographical)

The assessment of neglect An approach based on the Graded Care

Profile by Dr OP Shrivastava

GCP provides: Framework for making assessment Baseline measurement An element of objectivity Judgement about care Reliable standardised evidencehttp://www.lutonlscb.org/index.php?option=com_content&view=article&id=183&Itemid=52

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

Section 47

Enquiries (GCP – neglect)

CAF

GCP

Initial Assessment

Core Assessment (GCP parenting capacity)

Protection / Support Plan

GCP – monitoring tool

GCP users

Health visitors

School nurses

Social workers

Family centre workers

Education staff

Why choose GCP?

Child focused

User friendly

Common language

Promotes partnership

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

Domains of Care

Physical needs

Safety

Love and belongingness

Esteem

Self actualisation

Sensitivity

Responsivity

Reciprocity

Overtures

Stimulation

Approval

Disapproval

Acceptance

Present & absent

Nutrition. Housing, Clothing, Hygiene & Health

Maslow, A. 1954

What to observe

A. PHYSICAL

B. SAFETY

C. LOVE

D. ESTEEM

Nutrition

Housing

Clothing

Hygiene

Health

Quality,

Quantity,

Preparation,

Organisation,

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

Scoring

Rating 1 5

Use on every child in the family

Use with different carers

Complete with the parent/carer

Use information, observation, records

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

Scoring

Complete the full reference scheme

Transpose to the record sheet

Scoring

Complete the full reference scheme

Transpose to the record sheet

Sub-Area Scores Area Score

Comments

(A) Physical

1. NUTRITION 1 2 3 4 5

2. HOUSING 1 2 3 4 5

3. CLOTHING 1 2 3 4 5

4. HYGIENE 1 2 3 4 5

5. HEALTH 1 2 3 4 5

(B)Safety

1. IN CARER’S PRESENCE 1 2 3 4 5

2. IN CARER’S ABSENCE 1 2 3 4 5

(C) Love

1. CARER 1 2 3 4 5

2. MUTUAL ENGAGEMENT 1 2 3 4 5

(D) Esteem

1. STIMULATION 1 2 3 4 5

2. APPROVAL 1 2 3 4 5

3. DISAPPROVAL 1 2 3 4 5

4. ACCEPTANCE 1 2 3 4 5

Reference Sheet

AREAS ?

Sub-areas 1 ?

a b c d13 2 3

Items

2 ?

c2

3

c2

4

?5

d

a b4 2

2

3

2a b

a b c

?

3 3 2 2

A

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

Reference Sheet

AREAS

Sub-areas 1

a b c d13 2 3

Items

2

c2

3

c2

4

5

d

a b4 2

2

3

2a b

a b c3 3 2 2

A

Reference Sheet

AREAS A 4

Sub-areas 1 3

a b c d13 2 3

Items

2 4

c2

3

c2

4

35

d

a b4 2

2

3

2a b

a b c

2

3 3 2 2

Targeting Items of Care

Targeted Areas

Current Score

Target Score

Timescale Reviewed Score

1

2

3

4

5

Assessing progress

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

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

A child centred approach

The purpose of assessment is to understand what it is like to be that child (and what it will be like in the future if nothing changes)

Information handling pitfalls

Picking out the important from a mass of data

Facts recorded faithfully but not always critically appraised

Too trusting/insufficiently critical; Decoyed by another problem False certainty; undue faith in a ‘known

fact’ Discarding information which does not fit

the model we have formed

Department of Health (1991) Child abuse: A study of inquiry reports, 1980-1989, HMSO, London

Assessment pitfalls

Rule of optimism

Natural love

Cultural relativism

Too much

not enough

Adult services and children’s services (hand-in-hand or hand-to-hand?)

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’

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’

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.

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)