Testing the Graded Care Profile 2 Antenatal tool
The acceptability, validity and reliability of GCP2A
Graded Care Profile 2 Antenatal (GCP2A) is an assessment tool for practitioners to use with expectant parents to identify any issues that may cause harm to the unborn baby or lead to safeguarding concerns post-birth. GCP2A is based on the widely used Graded Care Profile 2 (GCP2), which was designed to measure the quality of care a child receives from their caregivers and is frequently used when there are concerns about possible neglect.
This report sets out the findings following the testing of the GCP2A tool. The testing included:
- interviews with practitioners who used the tool, the parents they assessed and academic experts in the field
- surveys exploring practitioners’ experiences and confidence using the tool before and after training
- inter-rater reliability testing to check the extent to which two similarly trained practitioners who use the tool on the same families will reach the same results
- concurrent validity testing to look at how well the tool measures what it sets out to measure.
Authors: Emma Smith, Emma Belton, Samantha Kyriacou, Sophie Bell and Susan Cooke
Download the report (PDF)
Key findings
Practitioners see GCP2A as a much-needed tool
The interviews highlighted that many professionals felt GCP2A could help practitioners to identify safeguarding concerns at the earliest possible stage and could have a huge impact if it was more widely adopted.
Practitioners felt GCP2A supports better communication with families
Practitioners reported that the tool helped them to broach potentially difficult and sensitive subjects with families. They also noted how in allowing them to highlight the families’ strengths as well as areas of need, the tool supported improved engagement between professionals and families.
Families found their assessments with GCP2A helpful and learned new things
Parents and carers spoke about learning new things from their assessment, such as safer sleeping practices and the importance of bonding with their baby. They also appreciated how the assessment explored their strengths, rather than solely focusing on areas of need.
Issues identified with the earliest version of the tool have been resolved
Practitioners and experts raised concerns about the sensitivity and accessibility of the language used in the tool. They also expressed concerns around the grading system and whether the highest grades would be achievable for the families they typically assessed, including families facing challenges around poverty and poor mental health. GCP2A tool was revised in light of the issues highlighted.
Overall, inter-rater reliability and internal consistency of the tool was good
The inter-rater reliability and internal consistency testing showed that, in most cases, the levels of agreement between pairs of practitioners assessing the same cases were good, and that the items on the scale for each area related well with one another. However, one item (Home and Finances) was not completed by several practitioners from one service, suggesting that some practitioners may need further support in this area.
Recommendations
The GCP2A tool should be kept under review
The GCP2A development team should refine the guidance and training around the tool, supporting practitioner awareness and understanding around the tool’s grading system.
Ideally, further inter-rater reliability testing should be implemented on a smaller scale
The GCP2A development team should run further inter-rater reliability testing at least six months after the revised guidance is in place. This will help to assess whether the refined guidance results in practitioners more consistently getting the same grades in all areas.
Service lead
Citation
Please cite as: Smith, E. et al, (2025) The Graded Care Profile 2 Antenatal: Testing the acceptability, validity and reliability of the tool. London: NSPCC.
