Relationships and Physical Contact with Children

Suitable arrangements should exist in all homes for matters relating to physical contact, intimate care, menstruation, enuresis, encopresis and other aspects of children's personal care.

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 that is safe, protective and avoids the arousal of sexual expectations, feelings or in any way which reinforces sexual stereotypes.

Whilst 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.

Also see Lone Working Procedure.

Where staff's daily work brings them into a one to one situation they should remember to inform other staff why this is necessary and where this will be taking place.

Where one to one work is delivered as part of a specialist service or direct work programme this should be identified in the Placement Plan.

Managers will, where it is deemed necessary, ensure a risk assessment is carried out for the delivery of any piece of work that is consistent with the Placement Plan e.g. intimate care – see below, or prolonged periods of lone working.

Consideration should be given to environmental factors e.g. the opening or closing of doors when lone working.

No volunteer should ever be in a one to one situation with a child unless properly vetted, trained and supported through supervision.

Giving first aid or personal care (where deemed necessary on the Placement Plan), should be recorded on the relevant format.

If any member of staff is uneasy about the behaviour of others who are putting himself or herself or the child at risk they must inform the manager of the home.

Where a member of staff feels that the unease is centred on the Registered Manager they must report this to a manager outside of the Line Management of the Home, or to the child's social worker.

Any allegations, suspicions and/or disclosures of abuse should be reported as per Safeguarding Children and Referring Safeguarding Concerns Procedure.

Wherever possible children should be supported and encouraged to undertake bathing, showers and other intimate care routines themselves without relying on staff. Where additional support is necessary, these arrangements must be kept under frequent review to ensure that young people are encouraged to develop age appropriate self-care skills. 

The following are good practice guidelines in relation to children and young people who may require intimate care whilst living in the Caldecott Foundation. However, it is essential that individual plans and arrangements are made for each child based on their own needs. This should include consideration of the young person’s own history and their relationships within the home. Individual plans should give specific details of plans in line with the general principles outlined below.

Prior to staff completing any intimate care placing authorities/parents should be consulted and made aware of how intimate care for their child will be managed. These arrangements must be included in the placement plan and a record kept of all relevant party’s agreement.

These guidelines should be viewed as expectations upon staff, which are designed to protect both children and staff alike. In situations where a member of staff potentially breaches these expectations, other staff should be able to question this in a constructive manner.

Staff are advised that if they are not comfortable with any aspect of the agreed guidelines, they should seek advice from their Registered Manager or supervisor. For example, if they do not wish to conduct intimate care on a 1 to 1 basis, this should be discussed and alternative arrangements considered. For example, it may be possible to have a second member of staff in an adjoining room or nearby so that they are close to hand but do not compromise the child’s sense of privacy.

Guidelines for good practice

These have been adapted from the Kent and Medway Safeguarding Children’s Board own published policies.

Treat every child with dignity and respect and ensure privacy appropriate to the child’s age and the situation. Privacy is an important issue. Much intimate care may be carried out by one staff member alone with one child. Kent and Medway LSCBs believe this practice should be actively supported unless the task requires two people. Having people working alone does increase the opportunity for possible abuse. However, this is balanced by the loss of privacy and lack of trust implied if two people have to be present – quite apart from the practical difficulties. It should also be noted that the presence of two people does not guarantee the safety of the child or young person - organised abuse by several perpetrators can, and does, take place. Therefore, staff should be supported in carrying out the intimate care of children alone unless the task requires the presence of two people or any individual risk assessments highlight this as necessary.

1. Involve the child as far as possible in his or her own intimate care. Try to avoid doing things for a child that s/he can do alone, and if a child is able to help ensure that s/he is given the chance to do so. Support children in doing all that they can themselves. If a child is fully dependent on you, talk with her or him about what you are doing and give choices where possible;
2. Be responsive to a child’s reactions. It is appropriate to "check" your practice by asking the child – "Is it OK to do it this way?"; "Can you wash there?" If a child expresses dislike of a certain person carrying out her or his intimate care, try and find out why. Conversely, if a child has a “grudge” against an individual or dislikes them for some reason, staff should ensure the Registered Manager or a senior member of staff is aware of this;
3. Make sure practice in intimate care is as consistent as possible. Line managers have a responsibility for ensuring their staff have a consistent approach. This does not mean that everyone has to do things in an identical fashion, but it is important that approaches to intimate care are not markedly different between individuals. (e.g. expectations to wear bathing suits, areas to be washed by the young person, use of flannels / sponges in place of bare hands etc.);
4. If staff are concerned that during the intimate care of a child:
   • They accidentally hurt the child;
   • The child seems sore or unusually tender in the genital area;
   • The child appears to be sexually aroused by your actions;
   • The child misunderstands or misinterprets something;
   • The child has a very emotional reaction without apparent cause (sudden crying or shouting).
     
     Report any such incident as soon as possible to another person working with you and record this appropriately (incident report, daily record, health file etc.). 

Additionally, if you are a member of staff who has noticed that a child's demeanour has changed directly following intimate care, e.g. sudden distress or withdrawal, this should be noted in writing and discussed with the Registered Manager or supervisor.

5. Encourage the child to have a positive image of her or his own body. Confident, assertive children who feel their body belongs to them are less vulnerable to abuse. As well as the basics like privacy, the approach you take to a child’s intimate care can convey lots of messages about what her or his body is "worth". Your attitude to the child’s intimate care is important. As far as appropriate and keeping in mind the child’s age, routine care of a child should be enjoyable, relaxed and fun. 
   
   Intimate care is to some extent individually defined, and varies according to personal experience, cultural expectations and gender. Kent and Medway LSCBs recognise that children who experience intimate care may be more vulnerable to abuse:
   • Children with additional needs are sometimes taught to do as they are told to a greater degree than other children. This can continue into later years. Children who are dependent or over-protected may have fewer opportunities to take decisions for themselves and may have limited choices. The child may come to believe they are passive and powerless;
   • Increased numbers of adult carers may increase the vulnerability of the child, either by increasing the possibility of a carer harming them, or by adding to their sense of lack of attachment to a trusted adult;
   • Physical dependency in basic core needs, for example toileting, bathing, dressing, may increase the accessibility and opportunity for some carers to exploit being alone with and justify touching the child inappropriately;
   • Repeated "invasion" of body space for physical or medical care may result in the child feeling ownership of their bodies has been taken from them;
   • Children with additional needs can be isolated from knowledge and information about alternative sources of care and residence. This means, for example, that a child who is physically dependent on daily care may be more reluctant to disclose abuse, since they fear the loss of these needs being met. Their fear may also include who might replace their abusive carer.

The above is taken largely from the publication 'Abuse and children who are disabled: a training and resource pack for trainers in child protection and disability, 1993'.

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

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

Some young people may experience enuresis(involuntary urination) and/or, encopresis (soiling). Where this is the case there should be clear strategies for managing this identified in the placement plan.

It may be appropriate to consult a Continence Nurse or other health professional, who may provide advice on the most appropriate strategy to adopt.

In any case, staff must remain sensitive and caring towards the young person when addressing these issues. Staff must avoid any interactions which may shame the young person. Young people, regardless of age, should be offered appropriate support in relation to personal hygiene and restoring their environment.