Safer Care Practice and Personal Care

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Safer Care Practice and Personal Care

REGULATIONS AND STANDARDS

The Fostering Services (England) Regulations 2011
Regulation 11 - Independent fostering agencies—duty to secure welfare

Fostering Services: National Minimum Standards:
STANDARD 1 - The child's wishes and feelings and the views of those significant to them
STANDARD 6 - Promoting good health and wellbeing

Introduction
Personal Care
Friendship and Support
Relationships and Sex
Puberty and SexualIdentity
Pornography
Sexual Activity
Contraception and Pregnancy
Sexual Exploitation
Sexually Transmitted Infections
Bedrooms
Peer Group Abuse
Menstruation
Enuresis and Encopresis
Guidance in Relation to Personal Care and Relationships and the Use of Touch
Appropriate Language
Safe Caring Plan

1. Introduction

Foster carers constantly have to balance risks in the everyday decisions they make with regard to the child or young person they support so are accountable for the day-to-day decisions they take. Some practices have to be different to safeguard everyone.

Children and young people who are looked after are often particularly vulnerable due to their previous life experiences, so foster carers need to understand and manage the particular risks with care.

Good, safer caring is about foster carers being aware of the risks involved for particular children in different situations and making well thought through decisions, in partnership with the child's social worker and the Agency. Risks around safe caring must be made in a risk sensible way not a risk averse way to support a child or young person to grow and learn.

As an Agency, safe caring practices around personal care or any type of support should be ingrained into practice and recorded on care and placement plans as well as the safe caring plan. These should be written in conjunction with the foster carers and children's social worker and reviewed frequently to reflect the changing needs of the child or young person.

2. Personal Care

Carers must provide a level of care which is designed to demonstrate warmth, respect and positive regard for children.

Children must be supported and encouraged to undertake bathing, showers and other intimate care of themselves without relying on carers if this is possible due to age and disability.

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

Unless otherwise agreed, children who require personal care by adults will be given care by a foster carer/adult of the same gender.

3. Friendship and Support

One of the prime tasks for foster carers is to work with the children to maximise opportunities for forming and benefiting from positive relationships with adults.

Warmth and understanding are essential, but everyone needs to know and understand when a relationship is inappropriate. What is important is that foster carers need to be putting the children's interests first and always considering what is appropriate in any given situation with a particular child.

Where it is known that a child has been a victim of sexual abuse and it is likely they will behave towards foster carers in a sexual manner, particular rules will have to be drawn up for carers. This may involve the need to avoid being alone with the child, by always having a third person present.

Children who have suffered many unexpected losses in adult relationships are likely to be constantly fearful of being abandoned again.

Carers 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.

Foster carers 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.

Other people's feelings and views, both adults and children, need to be taken into account. If there is any indication that a relationship is viewed as inappropriate, the foster carers should discuss the matter with each other and their Supervising Social Worker in order to understand what the concerns may be, explain their own perspectives and consider how they should modify their behaviour to ensure they are acting in the child's best interests.

In general, if they feel in any doubt about their own or other people's feelings, foster carers should step back, consider what they are doing and discuss the issues with their Agency.

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, foster carers must be aware of the dangers that this type of work can bring and be clear where the boundaries in such relationships lie.

4. Relationships and Sex

Research says that if parents/foster carers talk to children about this subject they are more likely to delay having sex and use contraception when they do.

All children need age-appropriate communication, guidance, and information about these issues.

Foster carers may want to think about:

Starting early, carers do not need to know it all, but if the child asks a question and the foster carer doesn't know the answer, they should say they will get back to the child and make sure you they do;
Checking out what a child/young person knows, so if the child asks a question, ask the child what they think it means;
Being proactive and not waiting for the child to raise the subject. This could involve talking to a young person about something that has been on the television or in the news to get their views. This should also cover topics such as friendships, respect and trust;
Finding books, leaflets or appropriate websites dependent on age for the child to look at, or look at them together;
Find out where local services are that can help. Contact local youth services or look online for more information;
Being truthful as stories e.g. about storks can be confusing and will need to be changed later.

Effective relationships and sex education at home and at school is essential if young people are to make responsible and well informed decisions about their lives and resist peer pressure.

5. Puberty and Sexual Identity

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

Foster carers 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.

A child or young person who is 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 each child's Placement Plan.

6. Pornography

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.

A child or young person must be positively discouraged from obtaining material that is potentially offensive or pornographic.

If they obtain such material that is suspected to be illegal it must be confiscated. This should be discussed with the child's social worker and Agency, if there are concerns that the child has been exposed to extreme pornography, then advice should be sought from the children's social worker and Agency about what support the child may need and whether it is deemed a safeguarding issue (depending on where and who is supplying the pornography).

If children obtain material legally they should be required to keep it private.

7. Sexual Activity

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 to the local authority's Children's Social Care Services under the Multi-Agency Safeguarding Children Procedures as potentially suffering from Significant Harm.

The Agency and foster carers 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.

When considering the placement (or ongoing placement) of children over the age of 13, all concerned including the Agency and foster carer 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.

Where children aged 13 - 18 are placed together with no identified risk of exploitative or abusive behaviour, foster carers must monitor any developing relationships, sensitively but positively discouraging children from engaging in under-aged 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 Supervising Social Worker and Agency who should consult the child's social worker and consideration should be given to consulting the Child Protection Agencies (see Section 9, Sexual Exploitation).

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

8. Contraception and Pregnancy

Access to contraceptives will not be conditional on children giving information about their lifestyles and contraception will never be withdrawn as a punitive measure.

Whilst not encouraging it, it is understood that children may engage in sexual activity; some before they reach the age of consent. In such circumstances the Supervising Social Worker should consult the child's 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. Foster carers should not give advice on contraceptive choices.

If a child is suspected or known to be pregnant the carers should notify the Supervising Social Worker, who should consult the child's social worker to decide on the actions that should be taken.

9. Sexual Exploitation

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.

The Agency and foster carers 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.

Where there is any suspicion that a child or young person is engaged in such behaviour it should be addressed in the child's Placement Plan, and strategies to be adopted to help the child find alternative lifestyles need to be identified.

In addressing these behaviours consideration must be given to the extent to which the child is suffering or likely to suffer Significant Harm - and whether it is necessary to refer the child to the local authority's Children's Social Care Services in the area where the child is living under the Multi-Agency Safeguarding Children Procedures.

If there is any suspicion that a child is involved in sexual exploitation, the Regulatory Authority must be notified.

10. Sexually Transmitted Infections

If it is known or suspected that a child has a sexually transmitted infection (including HIV), the Supervising Social Worker and child's social worker must be informed so that they along with the foster carer can decide what action needs to be taken.

Where appropriate, the issue should be discussed and any questions answered as openly and honestly as possible. This may require obtaining factual information, and contacting the Sexual Health clinic.

11. 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, the 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.

Where a child's bedroom window is large enough for a child to climb out of, a risk assessment should be carried out as to the likelihood of the child putting themselves at risk by climbing out of the window. If a risk is identified, the Supervising Social Worker should consider strategies to reduce/prevent the risk, which should be outlined in the child's Placement Plan.

Children's privacy should be respected. Unless there are exceptional circumstances, foster carers should knock the door before entering children's bedrooms.

The exceptional circumstances where foster carers may have to enter a child's bedroom without asking permission include:

To care for a baby/young child;
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. The taking of such action is a form of physical intervention.

12. Peer Group Abuse

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 and young people.

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.

If at any time foster carers suspect children are engaged in abusive sexual relationships as perpetrators and/or victims, they must immediately inform the Supervising Social Worker, who must consult the child's social worker make a referral to the local authority's Children's Social Care Services in the area where the child is living under the Multi-Agency Safeguarding Children Procedures.

13. Menstruation

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

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

14. Enuresis and Encopresis

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.

Foster carers and Supervising Social Workers, together with the social workers for the children concerned, should consider the possible 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 may advise on the most appropriate strategy to adopt. In the absence of such advice, the following should be adopted:

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;
Keep a record, either on a dedicated form or in the child's Daily Record with detail, if necessary, in a Detailed Record;
Consider making arrangements for the child to have any supper in good time before going to bed and arranging for the child to use the toilet before going to bed also consider whether the child should be woken to use the toilet during the night;
Consider using mattresses or bedding that can withstand being soiled or wetted.

15. Guidance in Relation to Personal Care and Relationships and the Use of Touch

Physical Contact

Foster carers must provide a level of care, including physical contact, which is designed to demonstrate warmth, friendliness and positive regard for children and young people.

Physical contact should be given in a manner which is safe, protective, and appropriate to the child's age and is given in a way that minimises the risk of confusion for the child or young person.

The term 'Touch' is used throughout this manual 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 foster carers to demonstrate affection, acceptance and reassurance.

However, touch is acceptable and can help a child or young person belong but carers should consider the following:

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 foster 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 shared with the foster carers during the placement planning process.

Dependent on 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 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.

Foster carers and children should be encouraged to use touch, positively and safely. But it is important for foster carers and children to know if boundaries exist for individual children within the foster home.

If boundaries or expectations exist for individual children, they should be set out clearly in their Placement Plan, for example, if foster carers are not expected to allow children to sit on their laps, or to carry children, this should be stated in writing.

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

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;
In addition, many factors influence the power relationship between adult and child, including gender, race, disability, age, sexual identity and role status;
The background of the child will also influence any decision about who represents a 'safe' adult in the eyes of the child;
Children from ethnic minority backgrounds may be used to different types of touch as part of the 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;
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';
Other parts of the body are less appropriate to be touched, by degrees. Some parts of the body are 'no go areas';
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;
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;
Also, no part of the body should be touched in a way which appeared patronising or otherwise intrusive;
Therefore, the context in which touch takes place is usually a decisive factor in determining the emotional and physical safety for both parties;
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;
A fleeting or clumsy touch may confuse a child or may feel uncomfortable or even cause distress. Foster 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";
Where children indicate that touch is unwelcome, foster carers should back off and apologise if necessary;
Foster carers should talk to others involved with the child and record their interactions. If particular strategies work, or not, others should be informed so they can build on or avoid making the same mistake;
Touch of an equally positive and safe nature is acceptable between carers; demonstrating positive role models for children and showing that adults can get along and use touch in non-abusive or non- threatening ways;
It is also acceptable to talk with children about how touch feels, about acceptable boundaries and expectations;
Play fighting is no alternative for this. It is unacceptable;
The key is for foster carers to help children experience and benefit from touch, positively and safely; as a way of communicating affection, warmth, acceptance and reassurance.

16. Appropriate Language

It is essential that all carers 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 the child/carer relationship and lead to an escalation of disruptive and challenging behaviour.

All carers need to be aware that any complaints relating to foul and abusive language will be treated seriously and may lead to disciplinary measures.

17. Safe Caring Plan

The Agency will have safer caring plans in place.

A family safer caring plan is a general plan which is written during the fostering assessment process which details the house rules for living safety together once a foster child is placed. This should include details around the foster carer's own children, the foster carers, other members of their family network and other people who share the foster carers' lives. This could include information such as what is appropriate to wear, how privacy will be maintained and how the household will deal with any bullying incidents.

A child specific safer caring plan is an additional plan which complements the family safer caring plan. This takes into account the child's needs and the potential issues which could be an issue. The Agency should complete this plan when a child is placed and then regularly review this plan when things change to support and protect everyone, in particular foster carers, from allegations.

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