Personal Care and Relationships

1. Physical Contact

Foster Carers/residential staff must provide a quality level of care, including physical contact, which promotes warmth 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, taking showers and other intimate care of themselves without relying solely on foster carers/residential staff. Foster Carers should ensure that children are supported, appropriate to their age, development, cultural and individual needs.

3. Bedrooms

All children aged over 3 will have their own bedroom wherever possible, where this is not possible, the sharing of the bedroom should have been previously agreed prior to the commencement of the placement and the child's social worker must have conducted a risk assessment. Any arrangements must be outlined in the child's Placement Plan. Risk Assessments must should be regularly reviewed in consultation with a Team Manager, if need be.

Children should be actively encouraged to personalise their bedrooms, with posters, pictures etc and they should be provided with requested items to make their personal space feel as homely as possible.

Children of an appropriate age and level of understanding should be encouraged and supported to purchase furniture, equipment or decorations. Older children should be supported as part of preparation planning to prepare them for independence.

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

Children's privacy should be always respected. Unless there are exceptional circumstances, foster carers/ residential staff should knock the door before entering a child's bedroom; and then only enter with their permission.

There are exceptional circumstances where foster carers/residential staff may have to enter a child's bedroom without asking permission include:

• To wake a heavy sleeper;
• To undertake cleaning;
• To return clean or remove soiled clothing; though.

In all of these possible circumstances, the child should have been forewarned that this may be necessary during their placement;

4. Puberty and Sexual Identity

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

Foster Carers/residential staff must adopt the same approach to children who confused about their sexual identity or who have decided to embrace a particular lifestyle choice so long as it is not abusive, harmful to themselves or others or illegal.

5. 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. To ensure that children are safe, secure and protected and not exposed to inappropriate information, computers accessible to them in placement will have 'parental controls' and be monitored – this includes the use of mobile phones, iPads, laptops and other relevant IT equipment.

Children must be positively discouraged from obtaining material that is potentially offensive or pornographic, or likely to have a negative impact on their development and wellbeing.

If they obtain such material that is suspected to be illegal it must be confiscated. This should be discussed by the foster carers/residential staff with the allocated social worker, team manager/, supervising social worker and their Team Manager, if need be.

If there are concerns that the child has been exposed to pornography the foster carer or the placement should be liaising with the Supervising Social Worker, Allocated Social Worker and the Team Manager as to what additional action is required.

6. Sexual Activity in Residential Placements

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 residential 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 an ongoing placement) of children over the age of 13, Team Managers must assess the level risk of sexual relationships developing and should ensure strategies are in place to reduce or prevent these risks if they are likely to be either exploitative and/or abusive.

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

Overall, foster 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 allocated social worker who will consider what further action is required under the Merton Safeguarding Children Partnership and the London Safeguarding Children Procedures.

Any actions taken in this respect will be subject to Team Manager consultation and must be addressed in a Child's Placement Plans.

If the Foster Carers/ residential staff suspect children are engaging in sexual relationships, they should:

1. Initiate a discussion with the child or young person to ensure their basic safety of all the children concerned;
2. Offer forums for children to share their views and wishes;
3. Inform the child's social worker and their Team Manager/Supervising Social Worker.

7. Contraception and Pregnancy

It is important that all carers pro-actively educate children in an age appropriate way about sexuality, relationships, sexual health, contraception and how to access relevant health services Accessing 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 foster carers' Supervising Social Worker Residential Manager should consult the allocated 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 'Check it Out Service'.

8. Sexual Exploitation

See also: Child Sexual Exploitation: Definition and Guide for Practitioners (DfE, 2017).

Children may have previously been sexually exploited and given gifts, drugs, accommodation, mobile phones or money. Children may continue to be exploited or at placed at risk of exploitation while accommodated by the local authority. In these situations all observations and/or incidents should be reported by the foster carers/residential staff to their Team Managers and the allocated social worker to decide on the actions that should be taken.

Foster Carer/residential staff must have a working awareness as to the indicators of potential exploitation or grooming, such as:

• Children repeatedly absconding and missing;
• Children being dropped off and picked up by named and unknown persons;
• Children returning under the influence of alcohol or drugs;
• Children returning with new possessions, mobile phones or money from unknown persons;
• Children appearing distressed when observed on return from outings, visits or other or feeling pressurised to go out and meet people;
• Observations of Children placing undue pressure on other children to accompany them when going out unsupervised from the placement.

Carers should do all they can to create an safe environment which encourages children to be open and honest about their past or present attitude/ behaviours and which demonstrates they will be supported from lifestyles that places them at risk.

As we are aware, children need to feel valued, listened to and confident that they will be protected. It is vital that children who have been or are at risk of sexual exploitation are reassured that it is not their fault and helped to develop trust in their carers, alongside concrete practical strategies for ending or preventing the abuse.

Where there is any suspicion that a child is at risk of sexual exploitation it should be addressed in the child's Placement Plan together with the detailed strategies to be used to protect them. In addressing these behaviours there should be a case discussion and 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 Merton Safeguarding Children Partnership, Child Sexual Exploitation Strategy and London Safeguarding Children Procedures.

9. Sexually Transmitted Infections

If it is known or suspected that a child has a sexually transmitted infection (including HIV), foster carers/residential staff should talk to the child about it and listen carefully to their views and wishes. Carers should support the child to access relevant health services, information and treatment and must notify the Supervising Social Worker, or allocated social worker and Team Manager, who will decide what measures to take.

10. Sexual Peer Group Abuse

The possibility of peer sexual 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.

Sexual behaviour between peers is not necessarily a cause for concern unless it is compulsive, coercive, age-inappropriate, involves a significant power imbalance or takes place between children of significantly different ages, maturity or mental ability.

If at any time carers/residential staff suspect children are engaged in abusive or exploitative sexual relationships as perpetrators and/or victims, they must immediately inform their Supervising Social Worker, allocated Social Worker and/or Team Manager.

11. Menstruation

Young women should be supported and encouraged to keep their own supply of sanitary protection without having to request it from carers and provided with separate funds to purchase this and not ne expected to use their pocket money or allowance to purchase these essentials.

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 sensitively, with the child if possible, and strategies adopted for managing it; these strategies should be outlined in the child's Placement Plan.

Foster Carers/residential staff, their supervising managers and the allocated social worker should consider the reasons for enuresis and encopresis. There may be reasons but it is likely that such behaviour is symptomatic of anxiety, worries or about trauma from previous experiences including abuse and neglect In the first instance there can be a discussion with the School Nurse or LAC Nurse prior to referring to a GP.

It may be appropriate that the following should be adopted:

1. Talk to the child alone and allow them to have an open discussion sympathetically. Agree with them how to manage practical arrangements e.g. changing sheets/ clothing in a way which respects their dignity and privacy;
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; encourage or help the child to wash, depending on age and development 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 going to bed, and arrange for the child to use the toilet before going to bed; 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 policy 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 guidance relating to the physical demonstration of affection, acceptance and reassurance.

It is acknowledged that touch raises particular issues for those working with children. Physical affection is a normal part of caring and trusting relationships with children and is important to their wellbeing and development. However, for children who have experienced abusive, exploitative physical touch from others, neglect and a lack of touch, physical contact and the emotions and boundaries associated with it can be confusing and difficult to cope with.

Carers may be anxious about allegations of inappropriate physical contact with children. It is important to be sensitive and responsive to individual children's needs and experiences and to consider 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 care planning process and preparation for the placement plan.

Dependent on the age and level of understanding of the child, s/he should be involved in this assessment and care planning; and they should be encouraged to express what they do and do not feel comfortable with in terms of physical affection.

Children often communicate through body language rather than by explicitly telling carers. Carers should be observant, sensitive and responsive to children's non-verbal communications in reaction to positive physical contact.

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. Foster Carers/residential staff and children should be encouraged to use touch positively and safely and have open lines of communication with each other in case this changes.

It is important for both carers and children to know the boundaries that exist within the placement for children. If there are specific boundaries or expectations for individual children they should be set out clearly in their Care Plan and Placement Plan. If boundaries or expectations exist for the placement, they should be be available for the child, placement officer and social workers to review, as need be.

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

1. Carers should ensure that they help children in their care understand the benefit from touch as a positive and safe;a way of communicating affection, warmth, acceptance and reassurance;
2. 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 and it is crucial that a child feels comfortable with and balanced with the adult's awareness of appropriate boundaries. This will enable a developing relationship in the context of safety between both parties. Adults should consider what they might represent to the child and respect the child's preferences and be mindful of these factors;
3. There are many factors that influence power imbalance in the relationships between adults and children, including gender, race, disability, age, sexual identity and role status;
4. Children from other minority backgrounds may be used to different types of touch as part of their culture but this does not mean that this is acceptable and should be challenged if need be if deemed inappropriate and unsafe;
5. Children who have been subject to physical or sexual abuse may be suspicious or fearful of touch or confused about the boundaries of acceptable touching. This is not to say that children who have experienced abuse should not be touched, they will benefit from adults who show that touch can be safe, positive and non-abusive. Carers should demonstrate what safe affectionate touch is and what the boundaries of acceptable touch are;
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';
7. 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;
8. 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;
9. Also, no part of the body should be touched in a way which appeared patronising or otherwise intrusive;
10. Therefore, the context in which touch takes place is usually a decisive factor in determining the emotional and physical safety for both parties;
11. 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;
12. 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";
13. Where children indicate that touch is unwelcome carers should back off and apologise if necessary;
14. 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;
15. 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;
16. It is also acceptable to talk about how touch feels, about acceptable boundaries and expectations; doing so in 'house meetings' and within key worker sessions;
17. 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 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.

15. Friendship and Support

Good and relationships with significant adults are a fundamental element in good care practices and a children's wellbeing and development. Upon children being placed in either foster or residential care a variety of problems may arise, at times due to stress or unforeseen 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 boundary between healthy and unhealthy, abusive or exploitative relationships is not always clear cut. Carers and practitioners have a professional and ethical obligation to reflect on their own and others relationships with children, to model appropriate boundaries and to raise concerns or seek support if they are worried about a relationship with a child.

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 guidance will have to be drawn up for carers/residential staff. This should be explained to the child and discussed with them, enabling them to express their views, understand the boundaries and how they are intended to help them.

What is important is that carers and residential staff need to be seen to put children's interests first and always considering what is appropriate in any given situation. Decisions should be made on a case by case example and be clearly documented with the strategic measures adopted.

Interaction on a One To One Basis

Carers/residential staff must have prior knowledge and understanding of the child and his or her background, and be able to recognise and respect any emotional barriers' the child has developed.

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.

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.