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A qualitative scale for the measure of

care of children

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This Graded Care Profile has been adapted with the kind permission of the Wirral Safeguarding Children Board.

INTRODUCTION

The Graded Care Profile (GCP) scale was developed as a practical tool to give an objective measure of the care of children across all areas of need. The GCP scale was conceived to provide a profile of care on a direct categorical grade. It is important from the point of view of objectivity because the ill effect of bad care in one area may be offset by good care in another area.

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 table 1 below.

Table 1.

| |Grade 1 |Grade 2 |Grade 3 |Grade 4 |Grade 5 |

|1 |All child’s needs met|Essential needs fully met |Some essential needs |Most essential needs unmet|Essential needs entirely unmet/|

| | | |unmet | |hostile |

|2 |Child first |Child first, most of the |Child/carer at par |Child second |Child not considered |

| | |time. | | | |

|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.

To obtain a score, follow the instructions in the Instructions and Guidance Manual. The explanatory tables in the guidance give brief examples of care in all sub-areas/items for all the five grades. From these, scores for the areas are decided. The GCP uses a descriptive scale. The grades are qualitative and on the same bipolar continuum in all areas. Instead of giving a diagnosis of neglect it defines the care showing both strengths and weaknesses as the case may be. It provides a unique reference point. Changes after intervention can demonstrably be monitored in both positive and negative directions.

In practice the GCP can be used by professionals across the continuum of need in a variety of situations where care for children is of interest. Appropriate referral pathways based on the achieved scores are described in the Instructions and Guidance Manual. In children’s social care it can be used in conjunction with conventional methods in assessment of neglect and monitoring; in other forms of abuse it can be used as an adjunct in risk and need assessment. In families below level 4 on the Dorset Threshold Tool it will safeguard the child by flagging up the issues, if it is good it will relieve any anxiety that there might be.

Where risk is high and care profile is also poor it will strengthen the case and care will not be a forgotten issue, but if it is good it should not be used to downgrade the risk on its own merit as yet. In the context of children in need, it can help identify appropriate resources (depending on area of deficit) and target them.

Name (Child)________________________________________ Date of Birth ______________________

Main Carer/s __________________________________________________________________________

Carer/s signature/s of consent to complete a GCP ____________________________________________

Scorer’s Name ___________________ Scorer’s Signature ______________________ Date ___________

|Area |Sub-Area |Scores |Area Score |Comments |

|A |1. Nutrition |1 |2 |3 |4 |

|Physic| | | | | |

|al | | | | | |

|1 | | | | | |

|2 | | | | | |

|3 | | | | | |

I have seen the completed GCP scores for my child.

Signed ________________________________________________ Date ________________________

AREAS PHYSICAL SAFETY LOVE ESTEEM

Sub areas NUTRITION IN PRESENCE CARER

Items STIMULATION

HOUSING IN ABSENCE MUTUAL

ENGAGEMENT APPROVAL

DISAPPROVAL

CLOTHING

ACCEPTANCE

HYGIENE

HEALTH

This is the scheme representing all ‘items’ (represented by small letters); ‘sub areas’

(represented by numbers), and ‘areas’ (represented by capital letters) these are printed

in circles. Scores are to be noted in boxes adjacent to corresponding ‘items’, ‘sub areas’ and ‘areas’.

This represents the entire record as in the explanatory table for full reference.

| |1 |

|Sub-areas |Child priority |

|a. Quality |Aware and thinks ahead; provides |Aware and manages to provide |Provision of reasonable quality food |Provision of poor quality food |Quality not a consideration at all or|

|[pic] |excellent quality food and drink. |teasonable quality food and drink.|inconsistent through lack of awareness |through lack of effort; only |lies about quality. |

| | | |or effort. |occasionally of reasonable quality if| |

| | | | |pressurised. | |

|b. Quantity |Ample |Adequate |Adequate to |Variable to Low |Mostly low or starved |

|[pic] | | |Variable | | |

|c. Preparation |Freshly cooked/ prepared for the |Well prepared for the family. |Preparation infrequent and mainly for |More often no preparation. If there |Hardly ever any preparation. Child |

|[pic] |child. |Always thinking of the child’s |the adults, child sometimes thought |is, child’s need or taste not thought|lives on snacks, cereals or |

| | |needs. |about. |about. |takeaways. |

|d. Organisation |Meals carefully organised – child’s |Well organised- child often |Poorly organised - irregular timing, |Ill organised- no clear mealtime. |Chaotic – eat when and what one can. |

|[pic] |seating, timing & manners. |seated, regular timing. |child not encouraged to sit down to eat.| | |

|Sub-areas |1 |

| |Child priority |

|a. Maintenance |Additional features benefiting child-|No additional features but well |State of repair adequate. |In disrepair- but could be repaired |Dangerous disrepair- but could be |

|[pic] |safe, warm and clean |maintained. | |easily |repaired easily (exposed nails, live |

| | | | | |wires). |

|b. Décor |Excellent, child’s taste specially |Good, child’s taste considered |In need of decoration but reasonably |Dirty, cluttered and unhygienic |Long term engrained dirt. (Bad odour/|

|[pic] |considered. |(practical |clean. | |no clear spaces). |

| | |constraints prevent | | | |

| | |a score of 1). | | | |

|c. Facilities |Essential and additional fixtures and|All essential fixtures and fittings; |Essential to bare - child’s needs |Adults needs for safety, warmth and |Child dangerously exposed or not |

|[pic] |fittings- good heating, shower or |effort to consider the child. If |overlooked. |entertainment come first. |provided for. |

| |bath, play and learning facilities. |lacking, due to practical constraints| | | |

| | |(child comes first). | | | |

| |

|NOTE: Discount any direct external influences like repair done by other agency but count if the carer has spent a loan or a |

|grant on the house or had made any other personal effort towards house improvement. |

| Sub-areas |1 |

| |Child priority |

|a. Insulation |Well protected and dressed |Well protected, adequate for the |Adequate to variable weather |Inadequate weather protection. |Dangerously exposed. |

|[pic] |appropriately for weather. |weather. |protection. | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

|b. Fitting |Appropriate fitting and design. |Adequate fitting even if handed down.|Clothes a little too large or too |Clothes clearly too large or too |Grossly improper fitting. |

|[pic] | | |small. |small. | |

|c. Look- age 0-5 |Good condition and clean. |Effort to restore any wear and clean.|Repair lacking, usually not quite |Worn, somewhat dirty and crumpled. |Dirty, badly worn and crumpled, |

|[pic] | | |clean. | |odour. |

|c. Look- age 5+ |As above |As above, odour if bed wetter, not |Worse than above, unless child does |Same as above unless child does own |Child unable to help him/herself |

|[pic] | |otherwise. |own washing. |washing. |therefore same as above |

|Sub-areas |1 |

| |Child priority |

|Age 0 to 4 |Cleaned, bathed and teeth brushed |Regular bathing and teeth brushed |No routine. |Occasionally bathed, poor dental |Seldom bathed or |

|[pic] |more |daily. |Sometimes bathed and teeth brushed. |hygiene and occasional odour |clean. Bad dental hygiene and strong |

| |than once a day | | | |odour. |

|Age 5 to 7 |Some independence at above tasks but |Reminded and products provided for |Irregularly reminded |Reminded only now |No supervision or encouragement. No |

|[pic] |always helped and supervised. |regularly. Watched and helped if |and products provided. Sometimes |and then, minimum supervision. |products provided. |

| | |needed. |watched. | | |

|Age 7+ |Reminded, followed, helped regularly.|Reminded regularly and encouraged if |Irregularly reminded, Products not |Left to their own initiatives. |No encouragement. No products |

|[pic] | |lapses. |provided consistently. |Provision minimum and inconsistent. |provided. |

|Sub-areas |1 |

| |Child priority |

|a. Opinion sought |Not only on illnesses but also |From professionals/ |On illness of any severity. Or |Only when illness becomes moderately |When illness becomes critical |

|[pic] |other genuine health matters |experienced adults on matters of |frequent unnecessary consultation |severe (delayed consultation). |(emergencies). |

| |thought about in advance and with |genuine and immediate concern about |and/ or medication. | | |

| |sincerity. |child health. | | | |

|b. Follow up |All appointments kept. Rearranges |Fails one in two appointments due |Fails one in two appointments even if|Attends third time after reminder. |Fails to keep appointments despite |

|[pic] |if problems. |usefulness or due |it of clear benefit for reasons of |Doubts its usefulness even if it is |reminders. Misleading/ inconsistent |

| | |to pressing practical constraints. |personal inconvenience |of clear benefit to the child |explanations for not attending. |

|c. Health checks and immunisation |Visits in addition to the scheduled|Up to date with scheduled health |Omission for reasons of personal |Omissions because of carelessness, |Clear disregard of child’s welfare. |

|[pic] |health checks, up to date with |checks and immunisation unless |inconvenience, takes up if persuaded.|accepts if accessed at home. |Blocks home visits. |

| |immunisation unless genuine |exceptional or practical problems. | | | |

| |reservations. |Plans in place to address this. | | | |

|d. Disability/ chronic illness (3 |Compliance excellent, any lack of |Any lack of compliance is due to |Compliance is lacking from time to |Compliance frequently lacking for |Serious non-compliance, medication not |

|months after diagnosis) |compliance is due to pressing |difference of opinion, or pressing |time for no pressing reason |trivial reasons, very little |given. Can lie, inexplicable |

|[pic] |practical reason. Compassion for |practical reason. Compassion for |(excuses). Shows some compassion for |affection, if at all. shows little |deterioration. Shows |

| |child’s needs. |child’s needs. |child’s needs. |compassion for child’s needs. |no compassion for child’s needs. |

| |1 |

|Sub-areas |Child priority |

|a. Awareness |Excellent awareness of safety issues |Excellent awareness of safety issues. |Poor awareness and perception except |Inadequate response to safety risks. |Oblivious to safety risks. |

|[pic] |however remote the risk. | |for immediate danger. | | |

|NOTE: Please refer to the item ‘d (Safety Features)’ and the note below it. |

|b. Practice | | | | | |

|Pre-mobility age |Very careful with handling and laying|Careful whilst handling and laying |Handling careless. Frequently |Handling unsafe. Unattended even |Dangerous handling, left dangerously |

|[pic] |down. Seldom unattended |down. Frequent checks if unattended |unattended. |during care chores (bottle left in |unattended during care chores like |

| | | | |mouth) |bath |

|Acquisition of mobility |Constant attention to safety and |Effective measures against any danger |Inconsistent measures taken against |Ineffective measures if |Inadvertently exposes to dangers |

|[pic] |effective measures against any |about to happen. |danger. |at all. Improvement from mishaps soon|(dangerously hot iron near by). |

| |perceived dangers when mobile. | | |lapses. | |

|Infant school |Close supervision indoors and |Adequate supervision indoors and |Little supervision indoors or |No supervision, intervenes after |Minor mishaps ignored or the child is|

|[pic] |outdoors. |outdoors. |outdoors. Acts if in noticeable |mishaps which soon lapses again. |blamed; intervenes casually after |

| | | |danger. | |major mishaps |

|Junior & senior school |Allows out in known safe surroundings|Knows where child is, appropriate |Not always aware of whereabouts |Not bothered about |No boundaries despite knowledge of |

|[pic] |within appointed time. Checks if goes|boundaries. Reasonable time limit. |outdoors believing it is safe as long|daytime outings, |dangers outdoors. Staying away until |

| |beyond set boundaries. |Checks if worried. |as they return in time. |concerned about late |late evening/nights. |

| | | | |nights in case of child | |

| | | | |younger than 13. | |

|Sub-areas |

|Age 0-4 |Well secured in the |3-4 year old allowed to walk but |Infants not secured in pram. 3-4 year|Babies not secured, |Babies unsecured, |

|[pic] |pram, harnesses, or |close by, |old expected to catch up with adult |3-4 year olds left far behind when |careless with pram, |

| |when walking, hand |always in vision, hand clutched if |when walking, glances back now and |walking or dragged with irritation. |3-4 year old left to wander, lack of |

| |clutched. Walks at |necessary i.e. crowd. |then if left behind. | |supervision. |

| |child’s pace. | | | | |

|5 and above |5-10 year old escorted by adult |5-8 year old allowed to cross road |5-7 year olds allowed to cross with |5-7 year old allowed to cross a busy |A child left to cross a |

|[pic] |crossing a busy road, walking close |with a 13+ |an older child, (but below 13) and |road alone. |busy road alone without any concern |

| |together. |child: 8-9 allowed to |simply watched: 8-9 crosses alone. | |or thought. |

| | |cross alone if they | | | |

| | |reliably can. | | | |

|d. Safety Features |Excellent safety features- gate, |Good safety features- secure doors, |Lacking in essential safety features,|No safety features. |Definite hazards exposed electric |

|[pic] |guards, drug lockers, electrical |windows and any heavy furniture item.|very little improvisation or DIY |Some possible hazards |wires and sockets, unsafe windows |

| |safety devices, intercom to listen |Safe gas and electrical appliances, |(done too causally to be effective). |due to disrepair (tripping hazard due|(broken glass), dangerous chemicals |

| |to the baby, safety with garden pond|drugs and toxic chemicals out of | |to uneven floor, unsteady heavy |carelessly lying around. |

| |and pool etc. |reach, smoke alarm. | |fixtures, unsafe | |

| | |Improvisation and DIY if cannot | |appliances). | |

| | |afford. | | | |

|Note: this item, along with other safety provisions which are not a fixture like a bicycle helmet/safety car seat etc, can be used to score for item ‘a’ (awareness of safety) |

|Sub-areas |1 |2 |3 |4 |5 |

| |Child priority |Child first |Child & care equal |Child second |Child not considered |

|Sub-areas |1 |

| |Child priority |

|a. Sensitivity |Looks for or picks up very subtle |Understands clear signals – distinct |Not sensitive enough – messages and |Quite insensitive – needs repeated or|Insensitive to even sustained intense|

|[pic] |signals- verbal or nonverbal expression|verbal or clear nonverbal expression.|signals have to be intense to make an|prolonged intense signals. |signals or dislikes child. |

| |or mood. | |impact e.g. crying. | | |

| | | | | | |

|b. Timing of response |Responds at time of signals or even |Responds mostly at time of signals |Does not respond at time of signals |Even when child in distress responses|No responses unless a clear mishap |

|[pic] |before in anticipation |except when occupied by essential |if during own leisure activity. |delayed. |for fear of being accused. |

| | |chores. |Responds at time of signals if fully | | |

| | | |unoccupied or child in distress. | | |

|c. Reciprocation (quality) |Responses fit with the signal from the |Material responses (treats etc.) |Emotions warm towards child if in |Emotional response brisk and flat. |Disliking and blaming even if child |

|[pic] |child, both emotionally (warmth) and |lacking, but emotional responses warm|good mood (not burdened by strictly |Annoyance if child in moderate |in distress, acts after a serious |

| |materially (food, nappy change). Can |and reassuring. |personal problem), otherwise flat. |distress but attentive if in severe |mishap mainly to avoid being accused,|

| |get over stressed by distress signals | | |distress. |any warmth/guilt not genuine |

| |from child. Warm. | | | | |

|Sub-areas |1 |

| |Child priority |

|a. Beginning interactions |Carer starts interactions with child. |Carer starts interactions with child.|Child mainly starts interactions. |Child mainly starts interactions. Not|Child does not attempt to start |

|[pic] |Child starts interactions with carer. |Child starts interactions with carer.|Sometimes the carer. Carer negative |very often the carer. |interaction with carer. Carer does |

| |Carer does this more often. |Equal frequency. Positive attempt by |if child’s behaviour is defiant. | |not start interactions with child. |

| | |carer even if child is defiant. | | |Child appears resigned or |

| | | | | |apprehensive. |

| | | | | | |

| | | | | | |

|b. Quality |Frequent pleasure of engagement, both |Quite often and both enjoy equally. |Less often engaged for pleasure, |Engagement mainly for a practical |Dislikes it when child tries to enjoy|

|[pic] |enjoy it. | |child enjoys more. Carer passively |purpose. Indifferent when child |interactions, if any. Child resigned |

| | | |joins in getting some enjoyment at |attempts to engage for pleasure. |or plays on own. Carer’s engagement |

| | | |times. |Child can get some pleasure (attempts|for practical reasons only (dressing,|

| | | | |to sit on knees, tries to show a |feeding). |

| | | | |toy). | |

| | | | | | |

| | | | | | |

|Sub-areas |1 |

| |Child priority |

|Age 0-2 years |Plenty of appropriate stimulation |Enough and appropriate intuitive |Inadequate and inappropriate- baby |Little stimulation. Baby left alone |Absent- even mobility restricted |

|[pic] |(talking, touching, looking). |stimulation. Appropriate toys, |left alone while carer pursues own |while adult gets on with pursuing own|(confined in chair /pram) for carer’s|

| |Plenty of equipment |gadgets, outings and celebrations |amusements; sometimes interacts with |amusements unless strongly sought out|convenience. Inappropriate response |

| | | |baby. |by the baby. |if baby demands attention. |

|Age 2-5 years |i Interactive stimulation (talking to, |i Sufficient and of satisfactory |i. Variable – adequate if usually |i. Scarce – even if doing nothing |i Nil. |

| |playing with, reading stories and topics)|quality. |doing own thing. |else. |ii Nil, unless provided by other |

| |plenty and good quality. |ii Provides all that is necessary and|ii. Essentials only. No effort to |ii. Lacking on essentials. |sources- gifts or grants. |

|[pic] |ii Toys and gadgets (items of uniform, |tries for more. |make do if unaffordable. |iii. Child simply accompanies carer. |iii No outings for the child, may |

| |sports equipment, books etc.) – Plenty |iii Enough visits to child centred |iii. Child accompanies carer wherever|iv. Only seasonal – low key to keep |play in the street. |

| |and good quality |places locally (e.g. parks) and |carer decides, usually child friendly|up with the rest |iv Even seasonal festivities absent |

| |iii Outings (taking the child out for |occasionally away |places. | |or dampened. |

| |recreational purposes) – frequent visits |(e.g. zoos). |iv. Mainly seasonal (Christmas) low | | |

| |to child centred places locally and away.|iv Equally keen and eager. |key personal (birthday) | | |

| | | | | | |

| |iv Celebrations– both seasonal and | | | | |

| |personal, child made to feel special | | | | |

|Sub-areas |1 |

| |Child priority |

|Age 5+ years |i Education– active interest in |i Active interest in schooling, |i. Maintains schooling but little |i Little effort to maintain schooling|i Not interested or can |

| |schooling and support at home. |support at home when can. |support at home. |or mainly for other reasons like free|even be discouraging. |

|[pic] |ii Sports and leisure well |ii All affordable support. |ii. little effort in finding out but |meals etc. |ii Not bothered even |

| |organised outside school hours |iii Carer offers some help. |takes up opportunities at doorstep. |ii Child makes all the effort, carer |if child is doing unsafe/ unhealthy |

| |e.g. swimming, clubs etc. |iv Adequate |iii. Accepts |not interested. |activity. |

| |iii Friendships encouraged and | |iv. Poorly provided |iii Child finds own friends, no help |iii Not bothered. |

| |checked out | | |from carer unless reported to be |iv No provision. |

| |iv Provision– plentiful | | |bullied. | |

| | | | |iv Under provided. | |

|NOTE: Whichever describes the case best should be ticked as the score; in the event of a tie choose the higher score. |

|2. Approval |Talks about the child with |Talks fondly about the child when |Agrees with other’s praise of the |Indifferent if child praised by |If the child is praised by someone |

|[pic] |delight/ praise without being |asked, generous praise and emotional |child, low-key praise and damp |others, indifferent to child’s |else, successes rejected. |

| |asked; material and generous |reward, less of material reward. |emotional reward. |achievement, which is quietly |Achievements not acknowledged, lack |

| |emotional reward for any | | |acknowledged. |of reprimand or ridicule is the only |

| |achievement. | | | |reward if at all. |

|Sub-areas |1 |2 |3 |4 |5 |

| |Child priority |Child first |Child & care equal |Child second |Child not considered |

|4. Acceptance |Unconditional acceptance. Always |Unconditional acceptance, even if |Annoyance at child’s failure, |Unsupportive and/or rejecting if |Indifferent if child is achieving but|

|[pic] |warm and supportive even if child|temporarily upset by child’s |behavioural demands less well |child is failing or if behavioural |rejects if makes mistakes or fails. |

| |is failing. |behavioural demand but always warm |tolerated. |demands are high. Accepts if child is|Exaggerates child’s mistakes |

| | |and supportive. | |not failing. | |

|NOTE: If the style of parenting (over protective, permissive to foster independence, authoritarian) or type of values instilled is of concern, please make a note in the corresponding comment box on the record sheet. |

-----------------------

Graded Care Profile

for

Dorset Children and Young People

Graded Care Profile Summary Sheet

Parent/ carer comments:

GCP Scoring Sheet

D

C

B

A

1

1

1

1

c

b

a

d

c

b

a

d

c

b

a

2

2

2

2

b

a

c

b

a

3

3

4

c

b

a

4

5

a

b

c

d

A AREA OF PHYSICAL CARE

B AREA OF CARE OF SAFETY

C CARE OF LOVE

D CARE OF ESTEEM

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