The next question is how to put the GCP into use to improve early recognition, institute appropriate intervention and monitor progress in cases of neglect. This can best be elucidated by describing how it was done in one local authority.
The GCP was introduced at a point when working with neglect had already been identified as posing a problem. Having been accepted by the local area child protection committee, the GCP was initially piloted by the health visitors in 1999. They found it to be a useful professional tool which helped them to quantify care objectively in cases of neglect, something which they had been unable to achieve previously. Following this successful trial, it began to be used by social workers. It was introduced to staff in both sectors by providing them with three hours training and was characterized as a useful practical tool rather than as a management-led burden being imposed from above. Since its intro-duction, the expansion in its use has been driven largely by grass-roots enthusi-asm, with management support, rather than being compelled by management.
A multi-agency protocol was developed whereby health visitors were encouraged to use this scale whenever they had substantial concerns about parenting. If the grade of care was three, four or five in any area, this would be picked up, worked on, and tracked. If the score did not improve or got worse, a referral to the social services was indicated. After receiving the referral, social workers were expected to incorporate the use of the GCP in their initial assess-ment. The scores obtained would be analysed alongside other findings and
would help to inform decisions. If the case was allocated to a family centre for parenting work, a baseline score was obtained and areas and levels of care deficit were identified, helping to target intervention where it was most needed.
Figure 8.3 shows the record sheet on which the score is recorded.
In September 2003, an evaluation of the current use of the GCP was undertaken by convening a conference of those professionals who had been trained in its use and were employing it in day-to-day practice. Feedback was gathered through workshops and a structured questionnaire. This is being analysed in detail but the initial findings are outlined below. At the present time health visitors are the most frequent users within the health sector. They employ the GCP in making referrals to social services in accordance with the agreed local protocol. Social workers are then undertaking a baseline scoring for planning further intervention. Some cases are passed on to family centre workers for work on areas of deficit.
Family centre workers are the most frequent users in the field of social care and are finding the GCP very helpful in identifying parenting needs, targeting intervention and monitoring progress. They select those areas from the GCP where grades of care are poor (three, four or five), and institute matching inter-vention, setting a pathway towards the goal of achieving the next better grade and making sure it has been achieved before moving further. It is found easy to explain the process to carers, who usually share the same goal. Progress is scored periodically and even small improvements or deteriorations of a single grade are measurable. If the care does not improve or actually deteriorates, appropriate feedback is sent to the relevant social worker who connects the case with the child protection process for further deliberation.
It was noted that in the past, in the absence of the GCP, empathy and com-passion for carers which had developed over time could sometimes interfere with effective assessment and intervention. This was felt to be no longer the case as GCP scores are relatively unaffected by one’s feelings and depend upon observation undertaken according to externally established guidelines.
However, it was noted that where grades of care remained poor, some workers felt the need to provide justifications for the lack of progress. They were advised to enter their comments in the box provided on the forms without letting this affect the scores themselves. At times, this approach could appear to workers to be harsh towards the carers but it was explained that the scoring was designed to safeguard the interests of the children rather than those of the carers. Some carers who took part in the scoring had commented on the negative wording in some of the grade descriptors, particularly those leading to a score of five. However, this could not readily be changed without losing the grade separation, since a score of five in principle represents the most negative end of the continuum. The GCP is scored individually for a particular child with a particular carer which usefully highlights differential care within the same family where it exists.
GRADED CARE PROFILE (GCP) SCALE
Name (Child) ……… Main Carer/s ………
Date of Birth ……… Rater’s Name ………
Unit Number ……… Rater’s Signature ………
Date of Scoring ………
Other Identification Date ………
AREA Sub-area SCORES AREAScore 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
TARGETING PARTICULAR ITEM OF CARE
Any item with disproportionately high score can be identified by reference to the manual as: capital leters for an ‘area’, numericals for a ‘sub-area’, and small letter for an ‘item’. (A/1/b = physical – nutrition – quantity)
Targeted items Current Score Period Target Score Actual Score
1.
2.
3.
4.
5.
Figure 8.3 The record sheet on which the final GCP score is recorded
From the children’s social services perspective, it was originally intended that the GCP be used as a ‘snapshot’ assessment, visibly displaying the care profile at a particular point in time. It was later discovered to be effective in many other ways including:
· contributing to the usefulness of pre-referral assessments by health staff wishing to refer a family to social services
· as a contributory assessment tool for initial assessments
· as a means of assessing parenting capacity during the completion of core assessments
· providing a baseline and allowing ongoing monitoring of progress.
Although some of the professionals who had been trained had not used the GCP for a variety of reasons, there was a consensus that it was a useful tool in its own right. It also complemented conventional assessment methods in provid-ing an objective sense of direction, particularly in chronic cases and in between detailed assessment points. It had been used in a wide variety of ways. Some professionals had used it in conjunction with the carers, some in conjunction with other professionals and some in conjunction with older children to get an insight into their perspectives on their own care. It was generally felt to be working as intended but needed a rolling programme of interactive refresher sessions to monitor the quality of its use and to address such difficulties as arose from time to time. It was hoped that it would gradually become embedded as one of the armoury of tools habitually deployed in the field of family assessment.
Since the inception of the use of the GCP locally, there had been a signifi-cantly enhanced focus on identifying issues of neglect both at early stages and within the child protection arena. In consequence, work with families where neglect is a primary concern had increased markedly. It might be speculated that, in the absence of the GCP, some of these additional cases might not have been identified until the consequences for the children involved became grave and unmistakable in their impact.
Messages for practice
· Health visitors have found the objective measure of care a useful professional tool.
· Family centre workers too have found the GCP helpful in identifying parenting needs.
· In the absence of the GCP empathy and compassion for carers could interfere with effective assessment and intervention.
Summary
The assessment of neglect should be a continuous process which aims to identify problems early enough to allow the adverse consequences on health and development to be reversed or minimized. It is an intricate and time con-suming undertaking but the Graded Care Profile has a useful part to play within it by providing a visible, objective measure of parental care at a particu-lar point in time. It can be used by all professionals and even carers and older children (under supervision) and can promote the provision of a seamless service. It also helps workers to identify strengths and weaknesses, to choose suitable interventions, to set targets (by grades), and to monitor progress. It provides a sense of direction in long-standing cases where it complements other detailed assessments. There seems no reason why it cannot be extended to the education–social services interface and it is proposed that exploration of this possibility will form the next stage in its development.