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5.9.3 Personal Care and Relationships

Contents

  1. Physical Contact
  2. Intimate Care
  3. Bedrooms
  4. Puberty and Sexual Identity
  5. Pornography
  6. Sexual Activity
  7. Contraception and Pregnancy
  8. Child Sexual Exploitation
  9. Sexually Transmitted Infections
  10. Menstruation
  11. Enuresis (Bed Wetting) and Encopresis (Soiling)
  12. Guidance in Relation to Personal Care and Relationships
  13. Appropriate Language
  14. Friendship and Support


1. Physical Contact

Carers must provide a level of care, including physical contact, which demonstrates warmth, friendliness and respect 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 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 to undertake bathing, showers and other intimate care without relying on carers.

Such arrangements must emphasise that children's dignity and their right to be consulted and involved will be protected and promoted; and, where necessary, carers 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 the bedroom will have been agreed by the placing authority and the foster carers’ supervising social worker must have conducted a risk assessment and any arrangements must be outlined in the child’s Placement Plan.

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

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 the child for independence.

Children's rooms should be kept in good structural repair and be clean and tidy. The furniture should conform to standards of flame retardant materials as advised by trading standards.

Children's privacy should be respected. Unless there are exceptional circumstances, carers should knock the on 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. N.B. The taking of such action is a form of Physical Intervention.


4. Puberty and Sexual Identity

Carers must adopt a non-judgemental attitude toward children, particularly as they mature and develop an awareness of their bodies and sexuality.

Similarly carers must adopt the a non-judgemental approach to children who explore or are confused about their sexual identity, gender or who have decided to embrace a particular lifestyle so long as it is not abusive or illegal.

Children who are confused about their sexual identity or gender must be afforded equal access to accurate information, education and support to enable them to move forward positively. As necessary this must be addressed in Placement Plans.


5. Pornography

The use of online filters can help to ensure that younger children do not accidentally access pornographic or sexual images online. See UK Safer Internet for more information.

Older young people are likely to be curious about sex and relationships and may search for online for pornographic or sexual material. It is important that carers have an open discussion with young people about pornographic images and the impact that viewing these can have on young people and their own developing relationships. The NSPCC have produced comprehensive guidance for parents and carers on how to talk to young people about online porn and healthy relationships.

For more information please see Online porn - Advice on how to talk to your child about the risks of online porn and sexually explicit material (NSPCC).


6. Sexual Activity

Children under the age of 13 not capable in law of giving consent to sexual activity. Therefore, children of this age who engage in sexual activity must be referred under the West Yorkshire Consortium Safeguarding Children Procedures (as a Child Protection Referral).

Where children aged 13 - 18 are placed together with no identified risk of exploitative or abusive behaviour, carers should monitor any developing relationships, sensitively but positively discouraging children from engaging under age sexual relationships.

Overall, carers 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 any suspicion that a child is engaging in illegal behaviour it must be discussed with the child’s social worker who will consider what further action is required under the West Yorkshire Consortium Safeguarding Children Procedures.

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

Should carers believe that children are engaging in sexual relationships, they should:
  1. Ensure the basic safety of all the children concerned;
  2. Inform the child’s social worker and their manager/supervision social worker.


7. Contraception and Pregnancy

Young people who are looked after should be given information on contraceptives.

If a young person is known to be sexually active, the child’s social worker, young person and carer should discuss what can be done to minimise risk of pregnancy or infection, including facilitating contact with relevant agencies providing contraceptive advice; such as the Brook Advisory Service.

If a child is suspected or known to be pregnant the carers should notify their supervising social worker and the child’s social worker to decide on the actions that should be taken.


8. Child Sexual Exploitation

The following should be read in conjunction with relevant West Yorkshire Consortium, Safeguarding Children and Young People from Child Sexual Exploitation: Policy, Procedures and Guidance.

Child Sexual Exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology. Boys as well as girls can be sexually exploited.

Foster carers must be aware of and alert to possible indicators of Child Sexual Exploitation and know what to do if they have any concerns.

Any issues related to Child Sexual Exploitation should be addressed in the child's Placement Plan, along with strategies to keep them safe.

Any concerns that a Child in Care is being sexually exploited must be reported to Ofsted (see Notifications of Significant Events Procedure).


9. Sexually Transmitted Infections

If it is known or suspected that a child has a sexually transmitted infection the child should be referred, with the parents’ consent if possible, to the local Genito-Urinary Medicine Clinic, who will provide the young person with advice, counselling, testing and other support.

Only those immediate carers of the child who need to know will be informed of any suspicion or the outcome of any tests and the strategies or measures to be adopted.

The only other individuals who will be told are the child's GP and Health Visitor.

Before disclosing to any other agency or individual, the following criteria must be satisfied:

  • The child (where appropriate) and the parents have given their written consent to the disclosure;
  • The disclosure would be in the best interests of the child;
  • Those receiving the information are aware of its confidential nature.

9.1 Consent to Testing

The permission of the child aged 16 or over must be given before testing.

If a child under 16 has sufficient age and understanding, his or her permission must be given before testing.

Wherever possible, the consent of the parents should be obtained. In order for parents to be able to participate in decision-making, they must be provided with adequate information and given appropriate support including access to counselling both before the test and in the event of a positive diagnosis.

Where parental consent is not forthcoming, but there is a clear medical recommendation that testing is in the child's best interests, legal advice should be obtained as to whether the test can proceed.

In relation to HIV Testing and Prevention, the National Children’s Bureau have issued Guidance for Practitioners Supporting Young People (see NCB Practice guidance: supporting young people with HIV testing and prevention).


10. Menstruation

Young women should be supported and encouraged to keep their own supply of sanitary protection without having to request it from carers.

There should also be adequate provision for the private disposal of used sanitary protection.


12. Enuresis (Bed Wetting) and Encopresis (Soiling)

If it is known or suspected that a child is likely to experience enuresis (bed wetting), encopresis (soiling) 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 Plan.

Carers and the child’s social worker should consider the reasons for enuresis and encopresis; there may be a variety of reasons but it is likely that such behaviour is symptomatic of anxiety and worries about previous experiences including abuse and neglect.

It may be appropriate to consult a Continence Nurse or other specialist, who can advise on the most appropriate strategy to adopt. In the absence of such advice, the following should be adopted:
  1. Talk to the child in private, openly but sympathetically;
  2. Do not treat it as the fault of the child, or apply any form of sanction;
  3. Do not require the child to clear up; arrange for the child to be cleaned and remove then wash any soiled bedding and clothes;
  4. Keep a record, either on a dedicated form or in the child's Daily Record;
  5. Consider making arrangements for the child to have any supper in good time before bed, and arranging for the child to use the toilet before retiring; also consider arranging for the child to be woken to use the toilet during the night;
  6. Consider using mattresses or bedding that can withstand being soiled or wetted.


13. Guidance in Relation to Personal Care and Relationships

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

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.

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 on the age and level of understanding of the child, s/he 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.

Carers and children should be encouraged to use touch, positively and safely.

If boundaries or expectations exist for individual children they should be set out in their Care Plan and Placement Plan.

In the absence of any plan or expectation, the following should be taking into consideration:

  1. 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;
  2. For each child, what constitutes an intimate part of the body will vary; but generally speaking it is acceptable to touch children's hands, arms, shoulders. It may be appropriate to hug or cuddle children, or carry or give them 'piggy backs';
  3. A fleeting or clumsy touch may confuse a child or may feel uncomfortable or even cause distress. Carers should touch with confidence, and should verbalise their affection, reassurance and acceptance; by touching and making positive comments. For example, by touching a child's arm and saying "Well Done";
  4. Where children indicate that touch is unwelcome carers should back off and apologise if necessary;
  5. 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;
  6. It is also acceptable to talk about how touch feels, about acceptable boundaries and expectations; doing so in 'house meetings' or key worker sessions;
  7. Play fighting is no alternative for this. It is unacceptable;
  8. The key is for carers to help children experience and benefit from touch, positively and safely; as a way of communicating affection, warmth, acceptance and reassurance.


14. Appropriate Language

The use of foul and abusive language directed towards children is totally inappropriate. Any complaints relating to foul and abusive language will be treated seriously and may lead to disciplinary measures.


15. Friendship and Support

Confidence in and good rapport with carers is a fundamental element in good care practices. Whilst children are in foster care a variety of problems will arise, at times of stress or crisis every child needs an adult to turn to.

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.

See also Friendship for All (The Children Society) - disabled children and/or those in the care system, are more likely to miss out on friendship which causes them to be socially isolated. Professionals delivering foster care and short breaks services are invited to implement simple changes to practice and strengthen carer training to increase friendship in the lives of children. Friendship For All provides freely downloadable, nationally piloted and evaluated resources.

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