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4.7.2 Personal Care and Relationships

Every looked after child will have a Health Action Plan based on annual health assessments which will inform arrangements for their care. Each child must also have an individual Safety Plan which is regularly reviewed and updated by their social worker. All foster carers are supported to develop a Safe caring Plan as part of their assessment/approval process.

Social workers and carers should contact the Looked After Children’s Nurse for advice and support for children and young people wherever this might be helpful.

See also:

AMENDMENT

In May 2018 this chapter was extensively revised and should be re-read in full.


Contents

  1. Physical Contact
  2. Intimate Care
  3. Bedrooms
  4. Puberty and Sexual Identity
  5. Pornography
  6. Sexual Activity in Children's Homes
  7. Contraception and Pregnancy
  8. Sexual Exploitation
  9. Sexually Transmitted Infections
  10. Abusive Relationships
  11. Menstruation
  12. Enuresis and Encopresis
  13. Personal Care and Relationships
  14. Communication and the Use of Language
  15. Friendship and Support


1. Physical Contact

Carers/residential staff must provide a level of care, including physical contact, which is designed to demonstrate warmth, friendliness and positive regard for children.

Physical contact should be given in a manner which is safe, protective and avoids the arousal of sexual expectations, feelings or in any way which reinforces sexual stereotypes.

Whilst carers/ residential staff are actively encouraged to play with children, it is not acceptable to play-fight or participate in overtly physical games or tests of strength with the children.


2. Intimate Care

Children must be supported and encouraged by their carers to undertake bathing, showers and other intimate care of themselves to an extent appropriate to their age and development, without relying inappropriately on carers/ residential staff.

It is important for children to be supported to learn about their bodies and what is ‘personal/intimate’. The NSPCC has produced some very helpful guidance material for parents, carers and children: PANTS.

All arrangements must emphasise that children's dignity and their right to be consulted and involved will be protected and promoted; and, where necessary, carers/ residential staff will be provided with specialist training and support.


3. Bedrooms

Each child over 3 will have their own bedroom or, where this is not possible, the sharing of a bedroom will have been agreed by the social worker and the foster carers' supervising social worker must have conducted a risk assessment and any arrangements must be outlined in the child's Placement Information Record. It is not uncommon for young siblings to share a room.

Children should be encouraged to personalise their bedrooms with posters, pictures and personal items.

Children of an appropriate age and level of understanding should be encouraged and supported to purchase furniture, equipment or decorations. For older children this should be part of a plan to prepare them for independence.

Children's rooms should be kept in good structural repair and be clean and tidy. The furniture must conform to safety standards (e.g. flame retardant materials, etc).

Children's privacy should be respected. Unless there are exceptional circumstances, carers/ residential staff should knock the door before entering children's bedrooms; and then only enter with their permission. The exceptional circumstances where carers/ residential staff may have to enter a child's bedroom without asking permission include:

  • To wake a heavy sleeper, undertake cleaning, return clean or remove soiled clothing; though, in these circumstances, the child should have been told/warned that this may be necessary;
  • To take necessary action, including forcing entry, to protect the child or others from injury or to prevent likely damage to property. Note: The taking of such action is a form of Physical Intervention (see Restrictive Physical Intervention Procedure).


4. Puberty and Sexual Identity

Carers/residential staff must ensure a positive attitude toward children, particularly as they mature. It is essential that children are engaged in age-appropriate discussion, and have access to relevant media, about their bodies, puberty and their developing sexuality.

Carers/residential staff and social workers must also support children who are exploring or are developing their sexual identity or who have decided to embrace a particular lifestyle. They must ensure access to relevant information and support.


5. Pornography

All materials published, circulated or available to children (including the internet) must promote and encourage healthy lifestyles and images of men, women and relationships that are positive and encouraging.

Children must be positively discouraged from accessing/obtaining material that is potentially offensive or pornographic and helped to understand how such material can represent a distorted view of adult relationships.

If there are concerns that a child has been exposed to extreme pornography, this should be shared by the carers/residential staff with the child's social worker and their manager/supervising social worker who will consider with their managers what additional action/support is required.

All children and young people must receive information and guidance about staying safe online. All placements should ensure that effective parental controls are in place on their Wi-Fi/internet facilities.

See Cambridgeshire & Peterborough Safeguarding Children Board, E-Safety: Children Exposed to Abuse Through the Digital Media.


6. Sexual Activity in Children's Homes

Children under the age of 13 are deemed to be incapable of giving consent to sexual activity. Therefore, children of this age who engage in sexual activity must be referred under Safeguarding Children Procedures (as a Child Protection Referral) as potentially at risk of significant harm.

Children's social workers, placement officers and care providers must be alert to the potential for sexual relationships when considering the placement of children in group living situations.

Carers/ residential staff must monitor any developing relationships sensitively talking with, and supporting, young people to keep safe and develop caring and non-exploitative relationships.

Carers/ residential staff should be mindful of their duty to consider the overall welfare of children, and this may mean recognising that illegal activity is taking place and working to minimise risks and consequences. If there is a concern that a child is engaging in illegal behaviour, it must be discussed with their social worker who will consider whether further action is required, including under the Safeguarding Children Procedures.

Any actions taken in this respect will be subject to consultation and must be addressed in Placement Plans.

Should carers/ residential staff believe that children are engaging in sexual relationships, they should talk to both children to ensure their safety and inform the child's social worker and their manager/supervising social worker.


7. Contraception and Pregnancy

Information about, and access to, contraception are essential in supporting young people as they explore and develop personal relationships. Their provision must not be conditional on a young person giving information about their lifestyle and contraception must never be withdrawn as a punitive measure.

It is understood that children may engage in sexual activity, some before they reach the age of consent.

In such circumstances, the carers' Supervising Social Worker/residential manager should consult the social worker to agree what support and advice the young person needs and how they will be supported to access this.

If a child is thought, or known, to be pregnant the carers/residential staff should notify their manager and the child's social worker.


8. Sexual Exploitation

Children may have previously exchanged sex for rewards, gifts, drugs, accommodation and money and may remain at risk whilst looked after. It is essential that children are understood to be victims of exploitation rather than being responsible and any concerns must immediately be reported by the carers/residential staff to their managers and the child's social worker to decide on the actions that should be taken.

Carer/residential staff must be alert to such concerns and should do all they can to create an environment which encourages children to be open about their past or present attitudes and behaviours and which demonstrates they will be supported to guide them away from such risks.

See Safeguarding Children and Young People from Sexual Exploitation Procedure.

If there is concern that a child in residential care is involved in child sexual exploitation as victim or perpetrator, notification to Ofsted must be considered by the manager.


9. Sexually Transmitted Infections

If it is thought that a child has a sexually transmitted infection or blood-borne virus (including HIV and AIDS), they must be provided with appropriate emotional support to help them understand the implications of this. Carers/residential staff must notify their managers and the child's social worker, who will consider together what further information, advice and support can be obtained and ensure the young person is supported to access this.


10. Abusive Relationships

The possibility of young people’s personal relationships being/becoming abusive will always be taken seriously but it is equally important not to label or stigmatise normal sexual exploration and experimentation between children.

Behaviour is not necessarily a cause for concern unless it is compulsive, coercive, age-inappropriate or between children of significantly different ages, maturity or mental abilities.

If at any time carers/residential staff are concerned that children are engaged in abusive relationships as perpetrators and/or victims, they must first ensure that both young people are safe and immediately inform their manager and the children's social workers who will together consider next steps.


11. Menstruation

Carers must talk to all children about the onset and effects of puberty so that girls have an understanding of menstruation before they experience it and also provide reassurance and explanation as appropriate.

Young women should be supported and encouraged to keep their own supply of sanitary protection without having to request it from carers and in residential settings there must be adequate provision for the private disposal of used sanitary protection.


12. Enuresis and Encopresis

If it is thought that a child is likely to experience enuresis, encopresis or may be prone to smearing, it should be discussed openly, with the child if possible, and strategies adopted for managing it. These strategies should be outlined in the child's Placement Information Record.

Carers/residential staff, their managers and the child's social worker should consider the reasons for enuresis and encopresis. It is important to fully explore possible physical causes through the GP but it could also be symptomatic of anxiety and worries about previous experiences including abuse and neglect.

With advice from the GP and the LAC Nurse, it may be appropriate to consult a Continence Nurse or other specialist, who could advise on appropriate strategies. However, in general:

  • Talk to the child in private, openly but sympathetically;
  • Do not treat it as the fault of the child, or apply any form of sanction;
  • Do not require the child to clear up. Arrange for the child to be cleaned and remove, then wash, any soiled bedding and clothes;
  • Discretely keep a detailed record of frequency, times, etc;
  • Ensure the child uses the toilet before bedtime and limits their fluid intake during the evening; also consider waking the child to use the toilet during the night;
  • Consider using mattresses or bedding that can withstand being soiled or wetted.


13. Personal Care and Relationships

The term 'Touch' is used in two different contexts.

'Touch' as a form of physical intervention designed to prevent a child or others from being injured or to protect property from being damaged; and the use of 'Touch' to enable carers/residential staff to demonstrate affection, acceptance and reassurance.

This section provides guidance relating to the demonstration of affection, acceptance and reassurance.

It is acknowledged that touch raises particular issues for those working with children. Carers may be anxious about allegations of inappropriate physical contact with children.

Touch is acceptable; but carers should consider the following:

The child's background and previous experiences

The child may have had particular experiences which make it difficult to accept touch from an adult or the child's experiences may lead to a need for more touch than is acceptable.

Some children, including some with disabilities, have particular sensitivity to touch. It is essential that this is fully understood and care arrangements adjusted in response.

It is therefore important for carers to obtain information about the child's background before acting, in any way not just in terms of the use of touch.

If there are particular needs that the child has or if it appears that the child may respond more or less favourably to touch, this must be reflected in the planning process.

Dependent upon the age and level of understanding of the child, they should be involved in this assessment and planning; and should be encouraged to consent to being touched; or to place conditions on it.

The child's culture and boundaries

The culture or values of the household should be such that touch is encouraged as a positive and safe way of communicating affection, warmth, acceptance and reassurance.

It is important for carers and children to know what boundaries exist within the home, including any personalised to individual children. All foster carers are supported to develop a Safe Caring plan as part of their assessment/approval.

Where boundaries or expectations have been agreed for individual children they should be set out in their Care Plan and Placement Information Record.

Boundaries and expectations exist in a residential setting should be clear/explicit and understood by all. For example, if carers are not expected to allow children to sit on their laps, or to carry children, this should be stated, preferably in writing.

In developing any plan, the following should be considered:

  • When thinking about who might be an inappropriate person to touch a child, it is vital to consider what each adult represents to them. Personal likes and dislikes will play a part in any relationship;
  • Many factors influence the power relationship between adult and child, including gender, race, disability, age, sexual identity and role status;
  • The background and views of the child will also inform any decision about who represents a 'safe' person in their eyes;
  • Children may be used to different approaches to physical contact as part of their background, upbringing or culture;
  • Children who have been subject to physical or sexual abuse may be suspicious or fearful of touch. This is not to say that children who have experienced abuse should not be touched, it may be beneficial for the child to know different, safer and more reliable adults who will not use touch as a form of abuse;
  • No part of the body should be touched in a way which appears patronising or intrusive;
  • Carers should touch be confident and should verbalise their affection, reassurance and acceptance, reinforcing this where appropriate, by touching and making positive comments. For example, by touching a child's arm and saying "Well Done";
  • Where children indicate that touch is unwelcome, carers should back off and apologise if necessary, seeking to reassure the child and perhaps discuss what would be more acceptable;
  • Carers should talk to colleagues or supervising social worker and record their interactions with children. If particular strategies work, or not, other carers should be informed so they can build this or avoid repetition;
  • Touch of an equally positive and safe nature is acceptable between carers, demonstrating positive role models for children, showing that adults can get along and use touch in non-abusive or threatening ways;
  • It is also acceptable to talk about how touch feels, about acceptable boundaries and expectations. In a residential setting, this might be done in 'house meetings' or key worker sessions;
  • Some children may not have boundaries to their own use of touch and this can cause carers to feel uncomfortable. In such circumstances, the child should be gently directed towards a more appropriate form of contact and given reassurance.


14. Communication and the Use of Language

It is essential that all carers/residential staff are aware that the use of foul and abusive language must not be directed towards children under any circumstances. This would only have the effect of demeaning children, have a negative effect on child/carer relationships and would be likely to lead to an escalation of any disruptive or challenging behaviour.

All residential staff must be aware that any observations of, or complaints relating to, abusive, discriminatory or demeaning language either aimed at, or expressed in front of, children will be treated seriously and may lead to disciplinary measures. For foster carers, it could prompt a review of their terms of approval and suitability to foster.


15. Friendship and Support

Confidence in, and developing a good rapport with, particular adults is a fundamental element of good care practice. Whilst children are in foster or residential care a variety of problems may arise and, at times of stress or crisis, every child needs an adult to turn to.

Warmth and understanding are essential, but everyone needs to know and understand when a relationship is inappropriate.

Carers and residential staff must put the children's interests first and always consider what is appropriate in any given situation with a particular child.

Interaction on a One To One Basis

Carers/residential staff must have knowledge and understanding of the child and his or her background, and be able to recognise and respect any emotional 'barriers' the child has 'erected'.

It is not a matter of carers never becoming involved in close one to one relationships with a child, it is a vital part of the 'caring' task. However, carers must be clear where the boundaries in such relationships lie.

Managers and supervising social workers must talk to staff/carers in supervision about relationships between them and the child(ren) they care for and must be alert to any indication of over-involvement or a lack of, or uncertainty around, boundaries in those relationships.

It should be noted that the Sexual Offences Act, 2003, made it a specific offence for someone in a ‘position of trust’ to be sexually involved with a young person under the age of eighteen.

Additional Support

Consideration should be given to the need for each child to have an Advocate or Independent Visitor - see Advocacy and Independent Visitors Procedure.

Appropriate support must be provided to all children including those who are refugees or asylum seekers, and those who are disabled children and with communication difficulties.

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