Personal Care and Relationships

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.

2. Intimate Care

Children must be supported and encouraged to undertake bathing, showers and other intimate care of themselves without relying on carers/ residential staff.

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.

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/ 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. N.B. The taking of such action is a form of physical intervention.

4. Puberty and Sexual Identity

Social workers and carers/residential staff must adopt a non-judgemental attitude toward children, particularly as they mature and develop an awareness of their bodies, gender identity and sexuality. Support should include a focus on safe and healthy relationships.

Social workers and carers/residential staff must be supportive to all children exploring their gender identity or sexuality including any decision they make to tell others.  Staff and carers should be alive to issues such as everyday sexism, misogyny, homophobia and gender stereotyping and take positive action to build a culture where these are not tolerated. 

Children, no matter their gender identity, sex or sexual identity must be afforded equal access to accurate information, education and support. They should be able to decide for themselves, which pronouns they would like to use to identify and describe themselves, rather than having labels attached to them by others. As necessary this must be addressed in Placement Plans.

5. Pornography

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

Children must be positively discouraged from obtaining material that is potentially offensive or pornographic. Older young people are likely to be curious about sex and relationships and may search online for pornographic or sexual material. It is important that staff or 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.

If they obtain such material that is suspected to be illegal it must be confiscated pending discussion by the carers/residential staff with the child's social worker and their manager/supervising social worker. The care team should consider with their managers what additional action is required, which may involve a safeguarding investigation and/or support for the young person who has viewed the images.

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

6. Sexual Activity in 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 suffering from significant harm.

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.

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.

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.

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.

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

Should carers/ residential staff suspect 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

Access to contraceptives will not be conditional on children giving information about their relationships or sexual activity 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 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.  Staff/carers should ensure children of both sexes receive appropriate contraceptive and sexual health advice.

If a child is suspected or known to be pregnant, or has fathered a child the carers/residential staff should notify their managers and the child's social worker to decide on the actions that should be taken.

8. Sexual Exploitation

The following should be read in conjunction with the Surrey Safeguarding Children Partnership Procedures.

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. (Working Together to Safeguard Children).

Child sexual exploitation is never the victim's fault, even if there is some form of exchange. For more information please see Child sexual exploitation: definition and guide for practitioners - GOV.UK. This advice is non-statutory, and has been produced to help practitioners to identify child sexual exploitation and take appropriate action in response.

Where a member of staff is concerned that a child or young person is involved in, or at risk of, sexual exploitation, they should discuss their concerns with a senior member of staff or the home's Designated Child Protection Manager and the child's social worker to decide on the actions that should be taken.

If it is decided that action needs to be taken to protect the child, the Multi-Agency Safeguarding Children Procedures should be triggered.

Carer/residential staffs must be alert to the indicators of child sexual exploitation and be aware that often children and young people who are sexually exploited do not see themselves as victims. In such situations, discussions with them about the concerns which staff  have should be handled with great sensitivity.

Where there is any suspicion that a child is  involved in sexual exploitation the issues raised and actions planned should be addressed in the child's Care Plan and  Placement Plan.

9. Sexually Transmitted Infections

If it is known or suspected that a child has a sexually transmitted infection (including HIV), carers/residential staff must notify their managers and the child's social worker, who will decide what measures to take.

10. 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.

Behaviour is not usually 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 suspect children are involved 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.

11. 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 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.

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.

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 with detail, if necessary, in a Detailed Record;
5. 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;
6. Consider using mattresses or bedding that can withstand being soiled or wetted.

13. Guidance in Relation to Personal Care and Relationships

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 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 may raise particular anxiety for those working with children with a 'hands off' or 'hands on' policy being preferred as a result from scandals of child abuse, or fear of violence from children. Carers may be anxious about allegations of inappropriate physical contact with children.

However, touch is an essential component required for positive child development and should be part of day to day care, with  carers  considering 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.

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/residential staff and children should be encouraged to use touch, positively and safely.

But it is important for carers and children to know if boundaries exist within the home or for individual children.

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

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.

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

1. 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;
2. In addition, many factors influence the power relationship between adult and child, including gender, race, disability, age, sexual identity and role status;
3. The background of the child will also influence any decision about who represents a 'safe' adult in the eyes of the child;
4. Children from different backgrounds may be used to different types of touch as part of their family norms, culture or religion;
5. Children who have been subject to physical or sexual abuse may be suspicious or fearful of touch, or alternatively may seek inappropriate 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;
6. 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'; the NSPCC PANTS resources give tools to talk with children about safe touch;
7. Other parts of the body are less appropriate to be touched, by degrees. Some parts of the body are 'no go areas';
8. 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;
9. 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;
10. Also, no part of the body should be touched in a way which appeared patronising or otherwise intrusive;
11. Therefore, the context in which touch takes place is usually a decisive factor in determining the emotional and physical safety for both parties;
12. 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;
13. 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";
14. Where children indicate that touch is unwelcome carers should back off and apologise if necessary;
15. 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;
16. 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;
17. It is also acceptable to talk about how touch feels, about acceptable boundaries and expectations; doing so in 'house meetings' or key worker sessions;
18. Play fighting or tickling is no alternative for this. It is unacceptable;
19. 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

It is essential that all carers/residential staff are aware that the use of foul and abusive language directed towards children or in their presence is totally inappropriate and unnecessary. This will only have the effect of demeaning children, have a negative effect on child/carer relationship, act as a negative role model and potentially lead to an escalation of unwanted behaviour.

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.

15. Friendship and Support

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.

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.

Where it is known that a child has been a victim of sexual abuse and it is possible he or she will present  in a sexual or inappropriate 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. The child should be aware and involved in drawing up the rules as appropriate.

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.

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 particular emotional needs the child has, including strategies they have developed.

Carers/residential staff should be sufficiently aware of their own feelings, so that they can recognise the potential of a relationship with a child becoming problematic and stop to consider what is happening and what they are doing.

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.

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.