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282 <h2>
282 Personal Care and Relationships
282 </h2>
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287 <div id="scope_box">
287 <h3>
287 AMENDMENT
287 </h3>
288 <p>
288 This chapter was reviewed and by Bexley in April 2017 to acknowledge additional points of
clarification with regard to expectations and boundaries around relationships (throughout the
chapter).
288 </p>
288 </div>
289 <div id="sections">
291 <h3 id="sections_list">
291 Contents
291 </h3>
292 <ol>
293 <li>
293 <a href="#phys_contact">
293 Physical Contact
293 </a>
293 </li>
294 <li>
294 <a href="#intimate_care">
294 Intimate Care
294 </a>
294 </li>
295 <li>
295 <a href="#bedrooms">
295 Bedrooms
295 </a>
295 </li>
296 <li>
296 <a href="#puberty_sex_id">
296 Puberty and Sexual Identity
296 </a>
296 </li>
297 <li>
297 <a href="#pornography">
297 Pornography
297 </a>
297 </li>
298 <li>
298 <a href="#sex_act_homes">
298 Sexual Activity in Homes
298 </a>
298 </li>
299 <li>
299 <a href="#contraception_preg">
299 Contraception and Pregnancy
299 </a>
299 </li>
300 <li>
300 <a href="#sex_exploit">
300 Sexual Exploitation
300 </a>
300 </li>
301 <li>
301 <a href="#std">
301 Sexually Transmitted Infections
301 </a>
301 </li>
302 <li>
302 <a href="#peer_group_abuse">
302 Peer Group Abuse
302 </a>
302 </li>
303 <li>
303 <a href="#menstruation">
303 Menstruation
303 </a>
303 </li>
304 <li>
304 <a href="#enuresis_encopresis">
304 Enuresis and Encopresis
304 </a>
304 </li>
305 <li>
305 <a href="#guidance_relation">
305 Guidance in Relation to Personal Care and Relationships
305 </a>
305 </li>
306 <li>
306 <a href="#appropriate_lang">
306 Appropriate Language
306 </a>
306 </li>
307 <li>
307 <a href="#friendship_support">
307 Friendship and Support
307 </a>
307 </li>
308 </ol>
309 <h3 id="phys_contact">
309 1. Physical Contact
309 </h3>
310 <p>
310 Carers/residential staff must provide a level of care, including physical contact, which is
designed to demonstrate warmth, friendliness and positive regard for children.
310 </p>
311 <p>
311 Physical contact should be given in a manner which is safe, protective and avoids any sexual
connotations.
311 </p>
312 <p>
312 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.
312 </p>
313 <h3 id="intimate_care">
313 2. Intimate Care
313 </h3>
314 <p>
314 Children must be supported and encouraged to undertake bathing, showers and other intimate care of
themselves without relying on carers/ residential staff.
314 </p>
315 <p>
315 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/ residential staff will be
provided with specialist training and support.
315 </p>
316 <p>
316 Unless otherwise agreed, children will be given intimate care by adults of the same gender.
316 </p>
317 <h3 id="bedrooms">
317 3. Bedrooms
317 </h3>
318 <p>
318 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.
318 </p>
319 <p>
319 Children should be encouraged to personalise their bedrooms, with posters, pictures and personal
items of their choice.
319 </p>
320 <p>
320 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.
320 </p>
321 <p>
321 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.
321 </p>
322 <p>
322 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:
322 </p>
323 <ul>
324 <li>
324 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;
324 </li>
325 <li>
325 To take necessary action, including forcing entry, to protect the child or others from injury or
to prevent likely damage to property. NB The taking of such action is a form of Physical
Intervention.
325 </li>
326 </ul>
327 <h3 id="puberty_sex_id">
327 4. Puberty and Sexual Identity
327 </h3>
328 <p>
328 Carers/residential staff must adopt a non-judgemental attitude toward children, particularly as
they mature and develop an awareness of their bodies and sexuality.
328 </p>
329 <p>
329 Carers/residential staff must adopt the same approach to children who explore or are confused
about their sexual identity or who have decided to embrace a particular lifestyle so long as it is
not abusive or illegal.
329 </p>
330 <p>
330 Children who are confused about their sexual identity or indicate they have a preference 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.
330 </p>
331 <h3 id="pornography">
331 5. Pornography
331 </h3>
332 <p>
332 All materials published, circulated or available to children (including the internet) must promote
and encourage healthy lifestyles and images of men and women that are positive and encouraging.
332 </p>
333 <p>
333 Children must be positively discouraged from obtaining material that is potentially offensive or
pornographic.
333 </p>
334 <p>
334 If they obtain such material that is suspected to be illegal it must be confiscated. This should
be discussed by the carers/residential staff with the child's social worker and their
manager/supervision social worker. If there are concerns that the child has been exposed to
extreme pornography, the concerns should be shared by the carers/residential staff with the
child's social worker and their manager/supervision social worker who will consider with their
managers what additional action is required.
334 </p>
335 <h3 id="sex_act_homes">
335 6. Sexual Activity in Homes
335 </h3>
336 <p>
336 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 suffering from Significant
Harm.
336 </p>
337 <p>
337 Children's social workers, placement officers and care providers must be alert to such
relationships when considering the placement of children under 13. Children of this age who are
likely to be at risk from each other (or from older children) should not be placed together.
337 </p>
338 <p>
338 When considering the placement (or ongoing placement) of children over the age of 13, managers
must assess the risk of sexual relationships developing and should ensure strategies are in place
to reduce or prevent these risks if they are likely to be exploitative or abusive.
338 </p>
339 <p>
339 Where children aged 13 - 18 are placed together with no identified risk of exploitative or abusive
behaviour, carers/ residential staff must monitor any developing relationships, sensitively but
positively discouraging children from engaging in under-age sexual relationships.
339 </p>
340 <p>
340 Overall, 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 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 Safeguarding Children Procedures.
340 </p>
341 <p>
341 Any actions taken in this respect will be subject to consultation and must be addressed in
Placement Plans.
341 </p>
342 <p>
342 Should carers/ residential staff suspect that children are engaging in sexual relationships, they
should:
342 </p>
343 <ol>
344 <li>
344 Ensure the basic safety of all the children concerned;
344 </li>
345 <li>
345 Inform the child's social worker and their manager/supervision social worker.
345 </li>
346 </ol>
347 <h3 id="contraception_preg">
347 7. Contraception and Pregnancy
347 </h3>
348 <p>
348 Access to contraceptives will not be conditional on children giving information about their
lifestyles, and contraception will never be withdrawn as a punitive measure.
348 </p>
349 <p>
349 Whilst not encouraging it, it is understood that children may engage in sexual activity some
before they reach the age of consent.
349 </p>
350 <p>
350 In such circumstances, the carers' Supervising Social Worker/residential manager should consult
the social worker to agree what reasonable steps can be taken to minimise risk of pregnancy or
infection, including facilitating contact with relevant agencies providing contraceptive advice,
such as the Brook Advisory Service.
350 </p>
351 <p>
351 If a child is suspected or known to be pregnant the carers/residential staff should notify their
managers and the child's social worker to decide on the actions that should be taken.
351 </p>
352 <h3 id="sex_exploit">
352 8. Sexual Exploitation
352 </h3>
353 <p>
353 Children may have previously exchanged sex for rewards, gifts, drugs, accommodation and money.
Some maintain this lifestyle whilst continuing to be accommodated by the authority. Such
situations must be reported to by the carers/residential staff to their managers and the
child's social worker to decide on the actions that should be taken.
353 </p>
354 <p>
354 Carer/residential staffs must be alert to such behaviours 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 lifestyles.
354 </p>
355 <p>
355 Where there is any suspicion that a child is engaged in such behaviour it should be addressed in
the child's Placement Plan together with strategies to be adopted to help the child find
alternative lifestyles need to be identified.
355 </p>
356 <p>
356 In addressing these behaviours consideration must be given to the extent to which the child is
suffering Significant Harm and whether it is necessary to refer the child under Safeguarding
Children Procedures in the area where the child is living.
356 </p>
357 <p>
357 If there is any suspicion that a child is involved in child sexual exploitation,
357 <a href="http://trixresources.proceduresonline.com/nat_cont/contacts/ofsted.html"
target="_blank" rel="noopener">
357 Ofsted
357 </a>
357 must be notified.
357 </p>
358 <h3 id="std">
358 9. Sexually Transmitted Infections
358 </h3>
359 <p>
359 If it is known or suspected that a child has a sexually transmitted infection (including HIV and
AIDS), carers/residential staff must notify their managers and the child's social worker, who will
decide what measures to take.
359 </p>
360 <h3 id="peer_group_abuse">
360 10. Peer Group Abuse
360 </h3>
361 <p>
361 The possibility of peer abuse will always be taken seriously but we recognise it is equally
important not to label or stigmatise normal sexual exploration and experimentation between
children.
361 </p>
362 <p>
362 Behaviour is not a cause for concern unless it is compulsive, coercive, age-inappropriate or
between children of significantly different ages, maturity or mental abilities.
362 </p>
363 <p>
363 If at any time carers/residential staff suspect children are engaged in abusive sexual
relationships as perpetrators and/or victims, they must immediately inform their managers and the
child's social worker and make a referral under the Safeguarding Children Procedures.
363 </p>
364 <h3 id="menstruation">
364 11. Menstruation
364 </h3>
365 <p>
365 Young women should be supported and encouraged to keep their own supply of sanitary protection
without having to request it from carers.
365 </p>
366 <p>
366 There should also be adequate provision for the private disposal of used sanitary protection.
366 </p>
367 <h3 id="enuresis_encopresis">
367 12. Enuresis and Encopresis
367 </h3>
368 <p>
368 If it is known or suspected 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 Plan.
368 </p>
369 <p>
369 Carers/residential staff, their managers 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.
369 </p>
370 It may be appropriate to consult a Continence Nurse or other specialist, who may advise on the most
appropriate strategy to adopt. In the absence of such advice, the following should be adopted:
371 <ol style="list-style-type:lower-alpha">
372 <li>
372 Talk to the child in private, openly but sympathetically;
372 </li>
373 <li>
373 Do not treat it as the fault of the child, or apply any form of sanction;
373 </li>
374 <li>
374 Do not require the child to clear up; arrange for the child to be cleaned and remove then wash
any soiled bedding and clothes;
374 </li>
375 <li>
375 Keep a record, either on a dedicated form or in the child's Daily Record with detail, if
necessary, in a Detailed Record;
375 </li>
376 <li>
376 Consider making arrangements for the child to have any supper in good time before retiring, 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;
376 </li>
377 <li>
377 Consider using mattresses or bedding that can withstand being soiled or wetted.
377 </li>
378 </ol>
379 <h3 id="guidance_relation">
379 13. Guidance in Relation to Personal Care and Relationships
379 </h3>
380 <p>
380 The term 'Touch' is used throughout this manual in two different contexts.
380 </p>
381 <p>
381 '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.
381 </p>
382 <p>
382 This section provides guidance relating to the demonstration of affection, acceptance and
reassurance.
382 </p>
383 <p>
383 It is acknowledged that touch raises particular issues for those working with children. Some
people have views about applying a 'hands off' or 'hands on' policy with children result from
scandals of child abuse, or fear of violence from children. Carers may be anxious about
allegations of inappropriate physical contact with children.
383 </p>
384 <p>
384 However, touch is acceptable; but carers should consider the following:
384 </p>
385 <h4>
385 The child's background and previous experiences
386 </h4>
387 <p>
387 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.
387 </p>
388 <p>
388 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.
388 </p>
389 <p>
389 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.
389 </p>
390 <p>
390 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.
390 </p>
391 <h4>
391 The child's culture and boundaries
392 </h4>
393 <p>
393 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.
393 </p>
394 <p>
394 Carers/residential staff and children should be encouraged to use touch, positively and safely.
394 </p>
395 <p>
395 But it is important for carers and children to know if boundaries exist within the home or for
individual children.
395 </p>
396 <p>
396 If boundaries or expectations exist for individual children they should be set out in their Care
Plan and Placement Plan.
396 </p>
397 <p>
397 If boundaries or expectations exist for the home, they should be clear.
397 </p>
398 <p>
398 In the absence of any plan or expectation, the following should be taken into consideration:
398 </p>
399 <ol>
400 <li>
400 When thinking about who is an appropriate person to touch a child, it is vital to consider what
the adult represents to the particular child. Personal likes and dislikes will play a part in
any relationship;
400 </li>
401 <li>
401 In addition, many factors influence the power relationship between adult and child, including
gender, race, disability, age, sexual identity and role status;
401 </li>
402 <li>
402 The background of the child will also influence any decision about who represents a 'safe' adult
in the eyes of the child;
402 </li>
403 <li>
403 Children from ethnic minority backgrounds may be used to different types of touch as part of the
culture;
403 </li>
404 <li>
404 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;
404 </li>
405 <li>
405 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';
405 </li>
406 <li>
406 Other parts of the body are less appropriate to be touched, by degrees. Some parts of the body
are 'no go areas';
406 </li>
407 <li>
407 Therefore, it may be appropriate to touch a child's back, ears or stroke their hair or knees -
if the child indicates such touch is acceptable. To go beyond this would be unacceptable, even
if the child appeared to accept it;
407 </li>
408 <li>
408 In any case, no part of the body should be touched if it were likely to generate sexualised
feelings on the part of the adult or child;
408 </li>
409 <li>
409 Also, no part of the body should be touched in a way which appeared patronising or otherwise
intrusive;
409 </li>
410 <li>
410 Therefore, the context in which touch takes place is usually a decisive factor in determining
the emotional and physical safety for both parties;
410 </li>
411 <li>
411 What message is being sent out to the child? If the intention is to positively and safely
communicate affection, warmth, acceptance and reassurance it is likely to be acceptable;
411 </li>
412 <li>
412 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";
412 </li>
413 <li>
413 Where children indicate that touch is unwelcome carers should back off and apologise if
necessary;
413 </li>
414 <li>
414 Carers should talk to colleagues and record their interactions with children. If particular
strategies work, or not, colleagues should be informed so they can build on or avoid making the
same mistake;
414 </li>
415 <li>
415 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;
415 </li>
416 <li>
416 It is also acceptable to talk about how touch feels, about acceptable boundaries and
expectations; doing so in 'house meetings' or key worker sessions;
416 </li>
417 <li>
417 Play fighting is unacceptable;
417 </li>
418 <li>
418 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.
418 </li>
419 </ol>
420 <h3 id="appropriate_lang">
420 14. Appropriate Language
420 </h3>
421 <p>
421 It is essential that all carers/residential staff are aware that the use of foul and abusive
language directed towards children is totally inappropriate and unnecessary. This will only have
the effect of demeaning children, have a negative effect on child/carer relationship and lead to
an escalation of disruptive and challenging behaviour.
421 </p>
422 <p>
422 All carers/residential staff need to be aware that any complaints relating to foul and abusive
language will be treated seriously and may lead to disciplinary measures.
422 </p>
423 <h3 id="friendship_support">
423 15. Friendship and Support
423 </h3>
424 <p>
424 Confidence in and good rapport with particular adults is a fundamental element in good care
practices. Whilst children are in foster or residential care a variety of problems will arise, at
times of stress or crisis every child needs an adult to turn to.
424 </p>
425 <p>
425 Warmth and understanding are essential, but everyone needs to know and understand when a
relationship is inappropriate. The fine line between what is 'proper' warmth and understanding and
what is regarded as 'improper' is likely to vary depending on the needs and experiences of the
individual child.
425 </p>
426 <p>
426 Where it is known that a child has been a victim of sexual abuse and it is likely he or she will
behave towards carers in a sexual manner, particular rules will have to be drawn up for
carers/residential staff. This may involve the need to avoid being alone with the child, by always
having a third person present.
426 </p>
427 <p>
427 What is important is that carers and residential staff need to be putting the children's interests
first and always considering what is appropriate in any given situation with a particular child.
427 </p>
428 <h4>
428 Interaction on a One To One Basis
428 </h4>
429 <p>
429 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'.
429 </p>
430 <p>
430 Carers/residential staff should be sufficiently aware of their own feelings, so that they can
recognise the dangers of a relationship with a child becoming sexualised and stop to consider what
is happening and what they are doing.
430 </p>
431 <p>
431 Other people's feelings and views, of both adults and children, need to be taken into account. If
there is any indication that a relationship could be viewed as inappropriate, the
carers/residential staff should discuss the issues with their managers/supervisors and the
child's social worker.
431 </p>
432 <p>
432 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 aware of the dangers,
which this type of work can bring and be clear where the boundaries in such relationships lie.
432 </p>
433 <h4>
433 Additional Support
433 </h4>
434 <p>
434 Consideration should be given to the need for each child to have an Advocate or Independent
Visitor - see
434 <a href="p_advocacy.html">
434 Advocacy and Independent Visitors Procedure
434 </a>
434 .
434 </p>
435 <p>
435 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.
435 </p>
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