8.1 Relationships and Personal Care

RELEVANT PROCEDURE

This Chapter should be read in conjunction with Privacy, Intimate and Personal Care Procedure

Relationships with Children
Appropriate Language
Friendship and Support
Touch

1. Relationships with Children

Relationships between Staff and children are based on mutual respect and understanding with clear professional and personal boundaries which are effective for both children, Staff and the group as a whole.

Equality

Everybody has an equal opportunity to partake in resources.
Everybody has an equal right to time and attention.
Everybody has an equal right to make complaints and be made aware of the procedures
Everybody has an equal right to be heard and listened to
All children are children first. Any physical or learning disability should be considered, but not allowed to dominate the manner of care.
Children and children's religion and cultural origins/persuasions and disabilities should be acknowledged and fostered. Where at all possible, opportunities should be provided for everyone to experience and practice their cultural and religious route.
Participation in groups in accordance with age and understanding is encouraged.

Individuality

All children are entitled to a Care Package geared to their individual needs (i.e. Care Plan and Placement Plan.
Every child has the right to individual privacy.
Opportunities for individual pursuits and interests should be fostered and participation in group activities should be voluntary.
Every child has the right to individual attention.
Every child has the right to express themselves as a unique individual.

Caring

The Home should aim to provide a safe, caring environment.
Every child has the right to experience being part of a caring environment.
Every child has the right to have their needs identified.
Every child has the right to change their levels of care where able.
All children and young people should be encouraged to be involved in planning their own care and be informed of areas/agencies that can assist them where appropriate.
Staff should receive clear instructions with regard to contact with adults in order to help protect children from threats/abuse.
Staff should receive clear instructions with regards to handling difficult situations/Sanctions in order to protect the rights and physical safety of children in residence.

Assessment and Planning

There should be a detailed assessment of needs of every child and information regarding placement objectives, Staff role with regards to health needs/promotion, care needs, safeguarding and promoting welfare, physical and emotional needs, educational needs and attainment targets, cultural, religious, language and racial needs and how these are met; leisure needs and contact arrangements.
It is the primary Carer or Keyworker's role to ensure implementation, guidance and support.
Child's wishes should be taken into account in the selection or change of primary Carer or Keyworkers.
Children know content of Care Plan and Placement Plan, which is developmentally appropriate.
Views of children, Parents and other significant people are taken into account in initiating any changes to the plan.

Reviews

Staff should contribute to all reviews and ensure children's participation, before, during and after a review.
The recommendations should be reflected in the child's day-to-day care.
Reviews should be recorded and those responsible for pursuing actions should be clearly identified.
The child's primary Carer Keyworker should contribute to reviews, attend meetings, highlight achievements.
Written copies of reviews should be made available to children, help with understanding and stored safety.

Contact

Children are provided with practical support for constructive contact with Parents, family and other significant people and encouraged to maintain contact. This is discussed at admission or detailed in the child's Placement Plan.
There should be written guidance for Staff which includes the rights of children, Parents and others to maintain contact, where necessary, to supervise visits in order to safeguard the child, when and how to encourage Parents, relatives and friends to take part in activities in the Home.

Choice

Children should have the opportunity to present their case (with support) in written or spoken form to reviews or any other meetings that might influence their future, with the confidence that theirs views will be carefully considered
Clear, realistic boundaries whilst in the unit, must be explained in a manner that is appropriate to the age and understanding of the child concerned.
The opportunity to participate in the daily running of the Home should be encouraged through personal suggestions and group meetings.
Every child should be given realistic choices to progress, grow and develop at their own pace.
Every child should be able to review the choice of their primary Carer Keyworker with their Social Worker.
Every child should have the choice as to whether they engage in activities or not
Children should be encouraged and supported in making their own choices
Every child should have the right to choose where possible their own personal toiletries, belongings, etc.

Continuity

Children should be enabled to maintain contact with their family, relatives, friends etc.
In order to maintain as much continuity between past experiences and the current environment within the Home, Staff should consult with Carers over issues such as past setting of boundaries, limits, routines, etc.
Wherever possible children should be enabled to maintain links with workers, environments, personal belongings.
Staff should make every effort to work closely with other Carers (e.g. school/Parents etc.) in order to facilitate continuity of care.
Clear procedures should be used by Staff to promote continuity of care between shifts within the units.
Every child should be given the opportunity to make a significant record of life experiences which they can keep.
Menus, rotas, plans for activities etc., should be available for viewing by children at all times.

Change

Care Package/Care Plans should be realistic in their goals.
Planned or encouraged change should be appropriate and suitable to the individual concerned.
Children should be involved in consultation about changes to their environment.
Children should have the right to change their mind.
Care Plans and Care Packages should be understood and implemented by all concerned and regularly reviewed.
Individual programmes should be structured in such a way that highlights the child's strengths
Care Plans and Placement Plans should be changed as needs modify.

2. Appropriate Language

It is essential that all 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/Staff relationship and lead to an escalation of disruptive and challenging behaviour.

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

3. Friendship and Support

Confidence in and good rapport with particular adults is a fundamental element in good care practices. Whilst children are in the care of Staff 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 each Homes particular ethos.

What is important is that Staff need to be putting the children's interests first and always considering what is appropriate in any given situation with a particular child.

Staff relationships also need to be sufficiently open and confident to allow discussion with one another and to provide opportunities for joint consideration of each other's actions.

Interaction on a One to One Basis

Staff must have knowledge and understanding of the child and his or her background, and be able to recognise and respect any emotional 'barriers' the child has 'erected'.

Staff need to be aware of their own feelings. They may believe they are the best person to care for, Keywork, or support a particular child in a confidential, one to one situation but they should discuss this with supervisors.

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 peoples 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 Staff member involved should discuss the matter with other Staff in order to understand their concerns and to explain their own perspectives.

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

Each child should have an Independent Visitor (Advocate, Children's Right Officer, Adult Family Member or Mentor).

Appropriate support is provided for children who are refugees or asylum seekers.

Support for disabled children with communication difficulties, communication barriers - access to interpreters/BSL.

All children are given individualised support in line with needs and those children identified as needing help, guidance and support, receive it.

It is not a matter of Staff never becoming involved in close one to one relationships with a child, it is a vital part of the 'caring' task, however, Staff must be aware of the dangers, which this type of work can bring and be clear where the boundaries in such relationships lie.

One of the prime tasks for a residential worker is to work with the children to maximise opportunities for forming and benefiting from such relationships with adults.

Where it is known that a child has been a victim of sexual abuse and it is likely he or she will behave towards Staffers in a sexual manner, particular rules will have to be drawn up for Staff. 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. Due to the current rota systems and shift patterns which some children may find bewildering, Staff can help by explaining their own movements and make sure the children know who will be with them and who will be available for support or advice.

There are clear boundaries that Staff should not break when working with children and young people. Staff must ensure that children do not have access to their personal addresses, and private phone numbers. If this information is gained by the child then their Line Manager should be informed.

There should be no arrangements made between Staff and children to meet socially unless part of an agreed plan made in conjunction with the child's Social Worker and the Homes Manager. Any meeting that may take place by chance or in unexpected circumstances should be reported immediately to the Home Manager.

There is provision for individual personal health, social, sex, relationship and education for each child.

4. Touch

The following guidance has been written with substantial extracts from a practice guide produced by the Social Care Association: 'Touch, A Discussion Paper for Developing a Positive Management Strategy'.

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 Staff to demonstrate affection, acceptance and reassurance.

This chapter provides guidance on the latter, relating to the demonstration of affection, acceptance and reassurance.

It is acknowledged that touch raises particular issues for those working with children. Views about applying a 'hands off or hands on' policy with children result from scandals of child abuse, or fear of violence from children. Staff may be anxious about allegations of inappropriate physical contact with children.

However, touch is acceptable; but Staff should consider the following:

Children's background and plans

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 Staff 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 Culture, the Boundaries

The culture or values of the Home should be such that touch is encouraged; as a positive and safe way of communicating affection, warmth, acceptance and reassurance.

Staff and children should be encouraged to use touch, positively and safely.

But it is important for Staff 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, Placement Plan or other relevant Plan.

If boundaries or expectations exist for the Home, applying to groups of Staff and children, they should be clear. For example, if Staff 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:

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. In normal circumstances, it may be appropriate to touch other parts of the body e.g. for washing children with disabilities, this would be outlined in the child's own plan or in the homes Statement of Purpose
Therefore, it may be appropriate to touch a child's back or stroke their hair - 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 patronizing 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 make them feel uncomfortable or even cause distress. Staff/ 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 Staff should back off and apologise if necessary.
Staff 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.
Touch of an equally positive and safe nature is acceptable between Staff; demonstrating positive role models for children. Showing that adults can get along and use touch in non abusive or threatening ways
It is also acceptable to talk about how touch feels, about acceptable boundaries and expectations, doing so in 'resident's meetings' or primary Carer Keyworker sessions.
Play fighting is no alternative for this. It is unacceptable.
The key is for Staff to help children experience and benefit from touch, positively and safely, as a way of communicating affection, warmth, acceptance and reassurance.

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