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136 <h1>
136 Personal Care and Relationships
136 </h1>
153 <div class="section">
153 <h2 id="phys_contact">
153 1. Physical Contact
153 </h2>
154 <p>
154 Carers/residential staff must provide a level of care, including physical contact, which is
designed to demonstrate warmth, friendliness and positive regard for children.
154 </p>
155 <p>
155 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.
155 </p>
156 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.
156 </div>
157 <div class="section1">
157 </div>
163 <div class="section">
163 <h2 id="intimate_care">
163 2. Intimate Care
163 </h2>
164 <p>
164 Children must be supported and encouraged to undertake bathing, showers and other intimate
care of themselves without relying on carers/ residential staff.
164 </p>
165 <p>
165 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.
165 </p>
166 Unless otherwise agreed, children will be given intimate care by adults of the same gender.
166 </div>
167 <div class="section1">
167 </div>
173 <div class="section">
173 <h2 id="bedrooms">
173 3. Bedrooms
173 </h2>
174 <p>
174 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.
174 </p>
175 <p>
175 Children should be encouraged to personalise their bedrooms, with posters, pictures and
personal items of their choice.
175 </p>
176 <p>
176 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.
176 </p>
177 <p>
177 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.
177 </p>
178 <p>
178 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:
178 </p>
179 <ul>
180 <li>
180 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;
180 </li>
181 <li>
181 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.
181 </li>
182 </ul>
183 </div>
184 <div class="section1">
184 </div>
190 <div class="section">
190 <h2 id="puberty_sex_id">
190 4. Puberty and Sexual Identity
190 </h2>
191 <p>
191 Carers/residential staff must adopt a non-judgemental attitude toward children, particularly
as they mature and develop an awareness of their bodies and sexuality.
191 </p>
192 <p>
192 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.
192 </p>
193 <p>
193 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.
193 </p>
194 </div>
195 <div class="section1">
195 </div>
201 <div class="section">
201 <h2 id="pornography">
201 5. Pornography
201 </h2>
202 <p>
202 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.
202 </p>
203 <p>
203 Children must be positively discouraged from obtaining material that is potentially
offensive or pornographic.
203 </p>
204 <p>
204 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.
204 </p>
205 <p>
205 If children obtain material legally they should be required to keep it private.
205 </p>
206 </div>
207 <div class="section1">
207 </div>
213 <div class="section">
213 <h2 id="sex_act_homes">
213 6. Sexual Activity in Homes
213 </h2>
214 <p>
214 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.
214 </p>
215 <p>
215 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.
215 </p>
216 <p>
216 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.
216 </p>
217 <p>
217 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.
217 </p>
218 <p>
218 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.
218 </p>
219 <p>
219 Any actions taken in this respect will be subject to consultation and must be addressed in
Placement Plans.
219 </p>
220 <p>
220 Should carers/ residential staff suspect that children are engaging in sexual relationships,
they should:
220 </p>
221 <ol>
222 <li>
222 Ensure the basic safety of all the children concerned;
222 </li>
223 <li>
223 Inform the child's social worker and their manager/supervision social worker.
223 </li>
224 </ol>
225 </div>
226 <div class="section1">
226 </div>
232 <div class="section">
232 <h2 id="contraception_preg">
232 7. Contraception and Pregnancy
232 </h2>
233 <p>
233 Access to contraceptives will not be conditional on children giving information about their
lifestyles, and contraception will never be withdrawn as a punitive measure.
233 </p>
234 <p>
234 Whilst not encouraging it, it is understood that children may engage in sexual activity some
before they reach the age of consent.
234 </p>
235 <p>
235 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.
235 </p>
236 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.
236 </div>
237 <div class="section1">
237 </div>
243 <div class="section">
243 <h2 id="sex_exploit">
243 8. Sexual Exploitation
243 </h2>
244 <p>
244 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.
244 </p>
245 <p>
245 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.
245 </p>
246 <p>
246 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.
246 </p>
247 <p>
247 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.
247 </p>
248 <p>
248 If there is any suspicion that a child is involved in child sexual exploitation, Ofsted must
be notified.
248 </p>
249 </div>
250 <div class="section1">
250 </div>
256 <div class="section">
256 <h2 id="std">
256 9. Sexually Transmitted Infections
256 </h2>
257 <p>
257 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.
257 </p>
258 </div>
259 <div class="section1">
259 </div>
265 <div class="section">
265 <h2 id="peer_group_abuse">
265 10. Peer Group Abuse
265 </h2>
266 <p>
266 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.
266 </p>
267 <p>
267 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.
267 </p>
268 <p>
268 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.
268 </p>
269 </div>
270 <div class="section1">
270 </div>
276 <div class="section">
276 <h2 id="menstruation">
276 11. Menstruation
276 </h2>
277 <p>
277 Young women should be supported and encouraged to keep their own supply of sanitary
protection without having to request it from carers.
277 </p>
278 <p>
278 There should also be adequate provision for the private disposal of used sanitary
protection.
278 </p>
279 </div>
280 <div class="section1">
280 </div>
286 <div class="section">
286 <h2 id="enuresis_encopresis">
286 12. Enuresis and Encopresis
286 </h2>
287 <p>
287 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.
287 </p>
288 <p>
288 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.
288 </p>
289 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:
290 <ol style="list-style-type:lower-alpha">
291 <li>
291 Talk to the child in private, openly but sympathetically;
291 </li>
292 <li>
292 Do not treat it as the fault of the child, or apply any form of sanction;
292 </li>
293 <li>
293 Do not require the child to clear up; arrange for the child to be cleaned and remove then
wash any soiled bedding and clothes;
293 </li>
294 <li>
294 Keep a record, either on a dedicated form or in the child's Daily Record with detail, if
necessary, in a Detailed Record;
294 </li>
295 <li>
295 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;
295 </li>
296 <li>
296 Consider using mattresses or bedding that can withstand being soiled or wetted.
296 </li>
297 </ol>
298 </div>
299 <div class="section1">
299 </div>
305 <div class="section">
305 <h2 id="guidance_relation">
305 13. Guidance in Relation to Personal Care and Relationships
305 </h2>
306 <p>
306 The term 'Touch' is used throughout this manual in two different contexts.
306 </p>
307 <p>
307 '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.
307 </p>
308 <p>
308 This section provides guidance relating to the demonstration of affection, acceptance and
reassurance.
308 </p>
309 <p>
309 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.
309 </p>
310 However, touch is acceptable; but carers should consider the following:
311 <h3>
311 The child's background and previous experiences
311 </h3>
312 <p>
312 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.
312 </p>
313 <p>
313 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.
313 </p>
314 <p>
314 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.
314 </p>
315 <p>
315 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.
315 </p>
316 <h3>
316 The child's culture and boundaries
316 </h3>
317 <p>
317 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.
317 </p>
318 <p>
318 Carers/residential staff and children should be encouraged to use touch, positively and
safely.
318 </p>
319 <p>
319 But it is important for carers and children to know if boundaries exist within the home or
for individual children.
319 </p>
320 <p>
320 If boundaries or expectations exist for individual children they should be set out in their
Care Plan and Placement Plan.
320 </p>
321 <p>
321 If boundaries or expectations exist for the home, they should be clear. 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.
321 </p>
322 <p>
322 In the absence of any plan or expectation, the following should be taken into consideration:
322 </p>
323 <ol>
324 <li>
324 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;
324 </li>
325 <li>
325 In addition, many factors influence the power relationship between adult and child,
including gender, race, disability, age, sexual identity and role status;
325 </li>
326 <li>
326 The background of the child will also influence any decision about who represents a
'safe' adult in the eyes of the child;
326 </li>
327 <li>
327 Children from ethnic minority backgrounds may be used to different types of touch as part
of the culture;
327 </li>
328 <li>
328 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;
328 </li>
329 <li>
329 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';
329 </li>
330 <li>
330 Other parts of the body are less appropriate to be touched, by degrees. Some parts of the
body are 'no go areas';
330 </li>
331 <li>
331 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;
331 </li>
332 <li>
332 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;
332 </li>
333 <li>
333 Also, no part of the body should be touched in a way which appeared patronising or
otherwise intrusive;
333 </li>
334 <li>
334 Therefore, the context in which touch takes place is usually a decisive factor in
determining the emotional and physical safety for both parties;
334 </li>
335 <li>
335 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;
335 </li>
336 <li>
336 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";
336 </li>
337 <li>
337 Where children indicate that touch is unwelcome carers should back off and apologise if
necessary;
337 </li>
338 <li>
338 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;
338 </li>
339 <li>
339 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;
339 </li>
340 <li>
340 It is also acceptable to talk about how touch feels, about acceptable boundaries and
expectations; doing so in 'house meetings' or key worker sessions;
340 </li>
341 <li>
341 Play fighting is no alternative for this. It is unacceptable;
341 </li>
342 <li>
342 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.
342 </li>
343 </ol>
344 </div>
345 <div class="section1">
345 </div>
351 <div class="section">
351 <h2 id="appropriate_lang">
351 14. Appropriate Language
351 </h2>
352 <p>
352 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.
352 </p>
353 <p>
353 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.
353 </p>
354 </div>
355 <div class="section1">
355 </div>
361 <div class="section">
361 <h2 id="friendship_support">
361 15. Friendship and Support
361 </h2>
362 <p>
362 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.
362 </p>
363 <p>
363 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.
363 </p>
364 <p>
364 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.
364 </p>
365 <p>
365 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.
365 </p>
366 <h3>
366 Interaction on a One To One Basis
366 </h3>
367 <p>
367 Carers/residential staff must have knowledge and understanding of the child and their
background, and be able to recognise and respect any emotional 'barriers' the child has
'erected'.
367 </p>
368 <p>
368 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.
368 </p>
369 <p>
369 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.
369 </p>
370 <p>
370 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.
370 </p>
371 <h3>
371 Additional Support
371 </h3>
372 <p>
372 Consideration should be given to the need for each child to have an Advocate or Independent
Visitor - see
372 <a href="p_advocacy.html">
372 Advocacy and Independent Visitors Procedure
372 </a>
372 .
372 </p>
373 <p>
373 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.
373 </p>
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