Identifying and Assessing Neglect using the Graded Care Profile

1. 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

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. 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. 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. 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. 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!!....

7. 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 • 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”

12. 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 • 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 • 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. 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 • 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. The pattern of neglect

19. The pattern of neglect

20. The pattern of neglect

21. The pattern of neglect

22. Cumulativeness

23. Failure of cumulativeness

24. 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)

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 http://www.lutonlscb.org/index.php?option=com_content&view=article&id=183&Itemid=52

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. 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. 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

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

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. 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

40. A AREAS ? 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. 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. A AREAS 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. A AREAS 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

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. 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 • 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