Guest blog written by Vivienne Laing of the NSPCC

Graded Care Profile 2 (GCP2) is a tool designed by a community paediatrician, Dr OP Srivastava, and the NSPCC that helps practitioners understand the quality of care children receive and identify areas of good but also neglectful parenting. It’s now been adopted in 88 locations with over 1,200 trainers trained and 30,000 front line users in the UK. 

Since the very first conversations with GCP2 sites, managers and front-line staff alike have been telling us about the need for an antenatal version. Now, having spent the last 18 months working with Dr Srivastava, midwives and social workers from across the country, we are excited to announce that we are about to start testing a new antenatal version – Graded Care Profile 2-Antenatal (GCP2A). 

Why do we need one?

There is a growing body of evidence of the importance of the antenatal and early years period and how suboptimal parenting, early neglect or abuse can have lasting consequences on children’s future emotional and physical health. Exposure to high levels of enduring stress during these important developmental stages can make infants’ emotional regulation and immune system less effective. This can make children more vulnerable to a range of later difficulties such as depression, anti-social behaviour, addictions and physical illness. (Gerhardt 2012). 

We also know that there are particular vulnerabilities inherent in babies that are not experienced by older children, some which are directly linked to maternal behaviour during the pregnancy:  Non-accidental head injury, co sleeping, foetal alcohol disorder syndrome and neonatal abstinence syndrome.  In England infants  make up the largest proportion of Serious Case Reviews, as described in the Triennial SCR Review. There is also an ever-increasing concern about the numbers of babies going into care in the first two weeks of birth, as demonstrated in the Babies Born into Care Research in both England and Wales

These issues are made even more difficult due to the many challenges with undertaking assessments in the antenatal period. Safeguarding concerns, don’t start the day the baby is born; many are evident during the pregnancy. Perinatal mental health issues we know are linked to many post birth concerns. This, along with other concerning contextual, attitudinal or behavioural factors can combine to a potentially devastating cocktail for the developing or new born baby.  However, we also know that pregnancy is a huge window of opportunity as many expectant parents are eager to engage with services during this time. Bringing the two things together – early thorough identification of the individual and combination of concerns and potential parental eagerness – gives us a great prospect for long term change.

What does GCP2-A do?

GCP2-A is a practical, pragmatic descriptive tool that supports midwives, social workers and health visitors with identifying those expectant parents who would benefit from support antenatally to reduce the likelihood of post-natal concerns. We believe it will help professionals identify and record where parents-to-be are doing well and what type, combination and severity of concerns they might have about the family early in the pregnancy. Armed with this information, they’re better able to address these concerns and ensure the right type of support is put in place before the baby is born, with the aim to prevent concerns escalating. 

The GCP2-A tool is split into three sections:

  • Section one: when the pregnancy is confirmed or concerns emerge, a framework of six overarching questions help you decide if a full GCP2-A is required.
  • Section two: a more in-depth tool that can be used when there is the need to describe in more detail the areas of strength and challenge.
  • Section three: should be completed postnatally in the first 7-28 days. 

The main part of the tool (section two) helps professionals and parents in their awareness and preparation for the birth of the baby. As with GCP2, the tool grades the quality of consideration in relation to physical, safety, emotional and developmental preparedness. If you know GCP2 – you will recognise GCP2-A as its younger sibling.

GCP2-A is a tool to help in our fight to improve outcomes for babies and infants.  Once we have identified issues, GCP2-A can guide a tailored multi-agency response to support expectant and new families to parent their babies in a safe loving home. 

If you want to be kept up to date, please register your interest at:

If you’re interested in using the original Graded Care Profile 2, visit NSPCC Learning to find out more. 

Vivienne Laing –