identifying and assessing neglect using the graded care profile patrick ayre department of applied...
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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: [email protected]
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)