WS LSCB GCP User Manual - West Sussex Safeguarding Children
Contents
1. West Sussex Safeguarding Children Board Graded Care Profile User Manual With thanks to aE is a for kindly allowing Wes BEE ieee to e Graded Car rofile Page i of 9 Grades In this scale there are five grades based on levels of commitment to care Parallel with the level of commitment is the degree to which a child s needs are met and which also can be observed The basis of separation of different grades is outlined in the table below Grade 5 Grade 4 Grade 3 Grade 2 Grade 1 1 All child s Essential needs Some essential Most essential Essential needs needs met fully met needs unmet needs unmet entirely unmet hostile 2 Child first Child first most Child carer at Child second Child not considered of the time par 3 Best Adequate Borderline Poor Worst 1 level of care 2 commitment to care 3 quality of care These grades are then applied to each of the four areas of need based on Maslow s hierarchy of needs physical safety love and esteem This model was adopted not so much for its hierarchical nature but for its comprehensiveness Each area is broken down into sub areas and some sub areas to items for ease of observation An explanatory table shows all the areas and sub areas with the five grades alongside Maslow s hieracrhy of needs tah To obtain a score follow the instructions in this manual The explanatory tables give brief examples of care in all sub a2. On the other hand if learning disability is mild to moderate she may do well with some supervision as and when needed However if the GCP is on negative side in all areas then it may be better to follow it through a child protection plan even if learning disability is mild Thus a number of different combinations can be found each representing a different level of risk of harm to guide management before and after referral to the social care A completed score displayed on a Record Sheet shows a grade of care in each of four domains on one side and their constituent items or sub areas on the other side There is also a table to select area s where care is deficient to target for intervention and track Where the profile is uneven eg negative in two areas and positive in the rest they denote different levels of care neglect 1 Uniformly positive Positive 5 or 4 in all areas currently no concern child well cared for 2 Uneven Positive in some and negative in others it can be worked on using positive care as motivator 3 Uniformly negative 1 or 2 in all areas this signifies significant neglect Page 9 of 9
3. Mutual Engagement a Beginning interactions b Quality Observing what goes on between the carer and child during feeding playing and other activities gives you a sense of whether both are actively engaged Observe what happens when the carer and the child talk touch seek each other out for comfort and play babies reaching out to touch while feeding or stop feeding to look and smile at the carer Skip this part if child is known to have behavioural problems as it may become unreliable Contact between carer and child that is unplanned is the best opportunity to observe these items See if carer spontaneously talks to the child or responds when the child talks or makes noises Note who gets pleasure from this the carer and the child either or neither Note if it is play or functional e g feeding etc D Esteem 1 Stimulation Observe or enquire how the child is encouraged to learn Talking and making noises interactive play nursery rhymes or joint story reading learning social rules providing fun play equipment are such examples with infants 0 2 years If lacking try to note if it was due to carer being occupied by other essential chores Follow the explanatory table for appropriate age band The four elements i ii iii and iv in age band 2 5 years and 5 years provide a comprehensive picture Score in one of the items is enough If more items are scored score for whichever column describes the case best In the event of a tie choos
4. e the higher score also described in the explanatory table 2 Approval Find out how child s achievement is rewarded or neglected It can be assessed by asking how the child is doing or simply by praising the child and noting the carer s response agrees with delight or child s successes rejected or put down 3 Disapproval If opportunity presents observe how the child is told off otherwise enquire carefully Does the child throw tantrums How do you deal with it if it happens when you are tired yourself Beware of any difference between what is said and what is done Any observation is better in such situations than the carer s description e g child being ridiculed or shouted at Try and ask more if carer is consistent 4 Acceptance Observe or ask how carer generally feels after she he has told the child off or when the child has been told off by others e g teacher when child is not doing well or feeling sad for various reasons See if the child is rejected put down or accepted at these times with warm and supportive behaviour Scoring on the explanatory table Make sure your information is factual as far as possible Go through explanatory table Sub Areas and Items Find the description which matches best read one grade on either side to make sure then place a tick on that description photocopy the score sheet to use each time The number at the top of the column will be the score for that item or sub area W
5. ehaviour regarding safety e g lit cigarettes drugs or medication left lying in the vicinity of child in every day activity Awareness may be assumed from the presence and appropriate use of safety fixtures and equipment in and around the house or in the car child safety seat etc by observing carers handling of young babies and supervision of toddlers Also observe how carer instinctively reacts to the child being exposed to danger If observation not possible then ask about the awareness Observe or ask about child being allowed to cross the road play outdoors etc along the lines in this manual If possible check answers out with other sources Refer to the age band where indicated Page 5 of 9 2 In Absence This covers childcare arrangements where the carer is away taking account of reasons and period of absence and age of the minder This itself could be a matter for concern in some cases Check answers out with other sources Page 6 of 9 C Love 1 Carer a Sensitivity b Timing of response c Reciprocation quality of response This mainly relates to the carer s relationship with the child Sensitivity means where carer shows awareness of any signal from the child Carer may become aware yet respond a little later in certain circumstances Note the timing of the carer s response in the form of appropriate action in relation to the signal from the child Reciprocation means the emotional quality of the response 2
6. en rather than actual amount consumed as some children may have eating feeding problems 2 Housing a Maintenance b D cor c Facilities Observe If lacking ask to see if effort has been made to improve ask yourself if carer is capable of doing them him herself It is not counted if repair or decoration is done by welfare agencies or landlord 3 Clothing a Insulation b Fitting c Look Observe See if effort has been made towards repairing cleaning and ironing Refer to the age band in the explanatory table 4 Hygiene Child s appearance hair skin behind ears and face nails rashes due to long term neglect of cleanliness teeth Ask about daily routines Refer to age band in explanatory table 5 Health a Opinion sought b Follow up c Health checks and immunisation d Disability Chronic illness Ask who is consulted on matters of health and who decides when health care is needed Check about immunisation uptake reasons for non attendance if any see if reasons are valid Check with relevant professionals Distinguish genuine difference of opinion between carer and professional from non genuine misleading reasons Beware of being over sympathetic with carer if the child has a disability or chronic illness Remain objective B Safety 1 In Presence a Awareness b Practice c Traffic d Safety features This means how safely the home environment is organised It includes safety features and carer s b
7. here more than one item represents a sub area use the method described below to obtain the score for the sub area Obtaining a score for a sub area from its items scores Transfer the scores from the explanatory table to the scoring sheet for the items and sub areas without items i e Page 7 of 9 hygiene Read the score for all the items of a particular sub area if there is a clearly repeated number but none of the ticks are beyond 3 score that number for that particular sub area To record it on the scoring sheet enter the number in the box for that sub area Example the scores for the items average 2 so the sub area score is 2 areas CO Call PHYSICAL Sub areas CY NUTRITION Items gt quality quantity preparation organisation If there is even a single score of 4 or 5 score that point regardless of other scores Example the scores for the items average 3 but there is a score of 4 so the sub area score is 4 AREAS E gt Cal PHYSICAL quality quantity preparation organisation Obtaining a score for an area Follow the same principle for getting an overall score for an area by taking an average of the sub area scores Again if there is even a single score of 4 or 5 score that point regardless of other scores This method helps identify the problem even if it is one sub area or item Its primary aim is to safeguard child s welfare while being objective The average score is not used as it will not s
8. how up the low scores which are the areas of concern Transferring the scores to the summary sheet Transfer all scores in double boxes from the scoring sheet to the summary sheet This will be the sub area and area scores Comments This column in the summary sheet can be used for flagging up issues which are not detected by the profile but may be relevant in a particular case For example a child whose behaviour is difficult or a parent whose over protectiveness gives rise to concern Comments noted may then lead to additional support Targeting If a particular sub area scores highly it can be noted in the table at the bottom of the summary sheet A better score can be aimed at after a period of work Aiming for Page 8 of 9 one grade better will place less demand on the carer than by aiming for the ideal in one leap A GCP score is always in the context of a specific carer in relation to a specific child Thus if a single mother has learning disability and there is concern that she cannot care for her child then a GCP scoring should be done where possible and then her level of learning disability ascertained Each GCP amp level of learning disability need to be juxtaposed to get a fuller picture If her grades of care are on positive side then there may still be risk if learning disability is severe as it may still affect the care in more demanding situations and a view needs to be made how much and how long support she will need
9. ness in parents It may be necessary to revisit and score at another time d If the carer is trying to mislead deliberately by giving the wrong impression or information in order to make one believe otherwise score as indicated in the explanatory table e g misleading explanations for PHYSICAL Health follow up Page 4 of 9 would score 5 and any warmth guilt not genuine for LOVE Carer reciprocation would score 5 5 Once completed share a copy with the parents with whom you have completed it and ask them to sign to say they have seen the completed profile Send them a copy as soon as possible Obtaining information on different items or sub areas A Physical 1 Nutritional a Quality b Quantity c Preparation and d Organisation Take a history about the meals provided including nutritional contents milk fruits etc preparation set meal times routine and organisation Also note carer s knowledge about nutrition note carer s reaction to suggestions made regarding nutrition whether keen and accepting or dismissive Observe for evidence of provision kitchen appliances and utensils dining furniture and its use without being intrusive It is important not to lead as far as possible but to observe the responses carefully for honesty Observation at a mealtime in the natural setting without special preparation is particularly useful Score on amount offered and the carer s intention to feed younger childr
10. ow it is organised It has three main components which are described below 1 The explanatory table is laid out in areas sub areas and items There are four areas physical safety love and esteem which are labelled as A B C and D respectively Each area has its own sub areas which are labelled numerically 1 2 3 4 and 5 Some of the sub areas are made up of different items which are labelled as a b c d Thus the unit for scoring is an item or a sub area where there are no items The table below shows Area A physical sub area 1 nutrition and item a quality A Area of physical care 5 child priority 4 child first 3 child and 2 child second 1 child not carer equal considered 1 Nutrition Quality Aware and thinks Aware and Provision of Provision of poor Quality nota ahead provides manages to reasonable quality food consideration at excellent quality provide quality food through lack of all or lies about food and drink reasonable inconsistent effort only quality quality food through lack of occasionally of and drink awareness or reasonable effort quality if pressurised For some of the sub areas or items there are age bands written in bold italics Stimulation a sub area of the area esteem is made up of sub items for age bands 0 2 2 5 amp above 5 years Clearly only one will apply in any case 2 The scoring sheet The
11. re is a scoring sheet which accommodates the entire system down to the items It gives an overview of all scores and should be completed as the scores are decided from the explanatory table AREAS gt ON PHYSICAL Sub areas gt NUTRITION Dooe ALOL quality quantity preparation organisation Page 3 of 9 3 The summary sheet It is printed on an A4 sheet At the top there is room to make note of personal details date and to note who the main carer is about whom the scoring is done Areas and sub areas are in a column vertically on the left hand side and scores 1 to 5 in a row of boxes horizontally against each sub area Next to this is a rectangular box for noting the overall score for the area which is worked from the scores in sub areas described later Next to the area score there is another box to accommodate any comments relating to that area At the bottom there is a separate table designed to target sub area s or item s where care is particularly deficient and to follow them up Area Sub Area Scores Area Comments Score 1 1 2 3 4 5 Nutrition 2 Housing 1 2 3 4 5 lt gt 3 Clothing 1 2 3 4 5 4 Hygiene 1 2 3 4 5 5 Health 1 2 3 4 5 Workers who have used this say that although it looks complicated at first it gets easier once familiar with the tool How to use 1 Discuss with the parent or carer your wish to comple
12. reas items for all the five grades From these scores for the areas are decided Instructions The Graded Care Profile GCP gives an objective measure of care of a child by a carer It gives a qualitative grading for actual care delivered to a child taking account of commitment and effort shown by the carer Personal attributes of the carer social environment or attributes of the child are not accounted for unless actual care is observed to be affected by them Thus if a child is provided with good food good clothes and a safe house the GCP will score better irrespective of the financial situation The grades are on a 1 5 scale Grade one is the worst and five the best This grading is based on how the carer s responds to the child s needs This is applied in four areas of need physical safety love and esteem Each area is made up of different sub areas and some Sub areas are further broken down into different items of care The score for each area is made up of scores obtained for its items An explanatory table is prepared giving brief examples of levels of care for the five grades against each item or sub area of care Scores are obtained by matching information elicited in a given case with those in the explanatory table This is taken advantage of in designing Page 2 of 9 the follow up and targeting intervention Methods are described below in detail It can be scored by the carers s themselves if need be or practicable H
13. te a GCP with them Go through the parents leaflet with them and leave them a copy Once you are sure they have understood ask them to sign the consent form on the summary sheet Fill in the relevant details at the top of the record sheet Keep the form for your records and note that consent has been given in your case recording system 2 The Main Carer is the main carer present when you do the graded care profile It can be either or both parents or another main carer Note who is involved in the top right corner of the record sheet 3 Methods It is necessary to do a home visit to make observations You need to be familiar with the area headings to be sure everything is covered during one or more visits This document can be shared with the family during the visit or you can fill it in afterwards Carers using it themselves can simply go through the explanatory table 4 Situations a As far as possible use the usual state of the home environment and don t worry about any short term smaller upsets e g no sleep the night before b Don t take into account any external factors on the environment e g house refurbished by welfare agency unless carers have positively contributed in some way by keeping it clean adding their own bits in the interest of the child like a safe garden outdoor or indoor play equipment or safety features etc c Allowances should be made for background factors e g bereavement recent loss of job ill
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