Tackling child neglect: Patrick Ayre on the graded care profile’s benefits

Despite more recogniton of the dangers of child neglect, practitioners are still applying alarmingly high thresholds for intervention. The graded care profile can help, says Patrick Ayre

When we are undertaking an assessment in a child welfare or child protection context, it is vital that we should be able to make a reliable judgement about the quality of the care being received by the children involved.

However, the findings of serious case reviews (which take place when a child dies or is seriously injured and abuse or neglect are suspected) repeatedly suggest that this is something which we do not do very well. The judgements we make can be highly subjective and prone to bias.

The factors which we are trying to capture are notoriously intangible and hard to pin down. Most importantly, despite our increased recognition of neglect as a serious and widespread component of the harm that children suffer, we still seem to be applying alarmingly high thresholds for recognition and intervention.

To tackle this challenge more effectively, more agencies have been turning to the graded care profile, an assessment tool devised by Dr Om Prakash Srivastava, a consultant community paediatrician and designated doctor for Luton Teaching Primary Care Trust.

Hierarchy of needs

The graded care profile is based on psychologist Abraham Maslow’s hierarchy of needs. The tool allows practitioners to explore four areas, or “domains” of care – physical care, safety, love and esteem – and to judge the parenting which they observe against simple predetermined criteria. The results of the assessment are entered on to a summary sheet which pinpoints those areas of deficit which require further attention.

Srivastava and colleagues from the local safeguarding community and the University of Bedfordshire have been evaluating the use of the graded care profile since its adoption by Luton Area Child Protection Committee in 1999 and have been impressed with the results achieved.

For many users, the most important aspect of the tool’s success has been the fact that it can be employed by practitioners from any agency involved in child welfare. In that regard, it pre-dated the common assessment framework by nearly 10 years. Richard Fountain, service manager for family support and child protection in Luton children and families services, says: “The profile gives the agencies a common language, a common frame of reference.”

From the beginning, graded care profile assessments completed by any agency have been accepted by the local authority’s  children’s services as evidence of the need for intervention in cases that meet certain criteria. This has reduced the need for further assessment and minimised the potential for inter-agency misunderstanding. 

Marguerite Williams, an experienced health visitor and adviser on child protection in Luton, says: “It has been important in helping to build strong interagency collaboration in child welfare cases.”

Another advantage often cited during evaluations is the profile’s user-friendliness. It is easy to learn and it has been found that experienced practitioners need as few as two hours’ training to become competent in using it. They find it so easy to apply in practice that it can be used by parents and carers to rate themselves and to identify their own difficulties, and by children to assess the parenting which they receive.

The structure of the assessment process means that strengths are highlighted alongside weaknesses, and areas of concern are identified sufficiently precisely to allow intervention to be targeted specifically at areas of weakness, which can result in considerable resource savings.

For example, family centres can expect to stop receiving rather vague referrals asking for generalised “parenting training”. Instead, the graded care profile provides them with a concise analysis of the care being given which allows them to devise shorter but more intensive programmes.

Easier reassessments

We all know that in theory at least “assessment is a process not an event” but, in reality, busy workers often see assessment as a task to be completed once before moving on. The graded care profile makes periodic reassessment easy.

It was designed to be used by workers to make a baseline assessment at the beginning of intervention and then to be reapplied regularly to gauge progress. This is an aspect of the tool which families have found particularly helpful, as it has provided them with specific targets to aim for and a clear idea of what it is they are trying to achieve and how they will be judged.

It fits neatly into the wider framework of integrated assessment which is now emerging, making a useful contribution at  pre-referral, and common assessment framework initial and core assessment stages. 

● For further information, contact Richard Fountain at Luton Council on 01582 547560 or by e-mail

Patrick Ayre is a writer, an independent child care consultant and senior social work lecturer at the University of Bedfordshire

This article appeared in the 29 March issue under the headline “Common ground”