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Looked after children

Personal Relationships and Sexual Health Policy and Practice Guidelines

1.Introduction
1.1    Worcestershire County Council has a commitment to the provision of high quality services within the context of legislative requirements.

In respect of young people who are ‘looked after’ by the local authority, the need for a policy relating to personal relationships and sexual health is highlighted in the 1989 Children Act:

"The experience of being cared for should also include the sexual education of the young person…  This is absolutely vital since sexuality will be one of the most potent forces affecting any young person in the transition from childhood to adulthood."

Guidance & Regulations also emphasise that the particular needs of different groups of young people must be recognised and approached sympathetically, for instance young people with physical or learning disabilities, young people who have been abused and young gay men and lesbians.

Article 24 of the United Nations’ Convention on the Rights of the Child emphasises the rights of all children to health care services (1989).  This has been reinforced by Human Rights Act, 2000.

The 1994 Audit Commission Report ‘Seen But Not Heard’ identifies the health of children and young people in public care as poorer than that of the general population.

Sir William Utting in ‘People Like Us’ (1997) makes clear the importance of age appropriate sex education and goes on to emphasise that sex education protocols should be drawn up by care agencies.

The Government strategy on reducing teenage pregnancy, has resulted in Worcestershire County Council and Worcestershire Health Authority, producing "Tackling Teenage Pregnancy and Paternity in Worcestershire - A 10 year Strategy".  

Included in this document is a 3-year rolling action plan.  Recognising that children and young people in public care are a vulnerable group who need particular attention, the plan identifies specific tasks, with timescales, that will address their needs.

The Teenage Pregnancy Unit has produced guidelines: ‘Guidance for Field Social Workers, Residential Social Workers and Foster Carers on Providing Information and Referring Young People to Contraceptive and Sexual Health Services’.

Quality Protects sub-objective 4.2 aims to:

"Ensure that children looked after enjoy a standard of health and development as good as all children of the same age living in the same area."

1.2    Many young people looked after will have had inadequate or damaging life experiences.  Such experiences are likely to distort their understanding of personal relationships and sexual behaviour.  Developing appropriate personal relationships, and an understanding of sexual behaviour and sexuality, are fundamental to their maturation and future well being.

This document is intended to support carers when dealing with this complex and sensitive area.

1.3    The policy is the result of collaboration between Children's Services Directorate and Worcestershire NHS.  In addition, information was gathered from young people currently looked after and staff in the County’s Residential Children’s Homes.

1.4    Whilst acknowledging that this policy is intended to support the carers of all children Looked After, work is currently being undertaken to further develop practice guidelines for those carers who assume responsibility for children with disabilities.

1.5    For ease of reference:

‘Carers’ refers to those with day to day responsibility for the young people, primarily Residential Social Workers (RSW&’s) and foster carers.

‘Young People’ include both children and young people who are ‘looked after’ by the local authority.

‘Education’ refers to support, guidance and advice.

2. Aim of the Policy

To enable carers to work effectively with young people on all personal relationship issues.3.

3. Objectives of the Policy

• To contribute towards an integral part of the lifelong process of sexual health and relationships education, which is an entitlement for all children, young people and adults;

• To take a pro-active approach on the provision of information, support and guidance to young people ‘looked after’;

• To respect, promote and support the rights of young people;

• To provide a safe environment for young people to talk with carers about sex and relationships, and to ensure that young people have a balance of accessible information via internal and external agencies;

• To ensure that young people know what information and support they are entitled to receive and make sure they receive it;

• To enable young people to gain skills and confidence in coping with sexual matters;

• To enable young people to make decisions and informed choices, and thereby develop into adults who can enjoy their sexuality;

• To enable young people to access health services, confidential support and advice;

• To ensure that young people’s care plans take into account the understanding of sex and relationships and how it has been, or will be, addressed;

• To provide guidance for carers about age appropriate sex, sexuality and personal relationships, for young people who are ‘looked after’ by the local authority;

• To ensure that carers are aware of and supported in the work they undertake on sex and relationships;

• To clarify for birth parents the role of Children's Services in supporting the sexual health and relationship education for their children;

• To ensure carers receive appropriate training;

• To set out the legal position regarding sex education and sexual activity;

• To promote an anti-discriminatory perspective, challenging oppression and respecting diversities, e.g. race, gender, religion, sexuality;

• To challenge the perpetuation of guilt, shame and prejudice

4. Anti-Discriminatory Practice
A young person’s welfare is paramount when making decisions about their upbringing.  When promoting issues of sexual health, carers must always take into account issues of race, culture, gender, religion, disability, sexuality and HIV status, as they relate to the young person.

It is recognised that carers hold their own cultural, religious and moral beliefs and whilst they will not be expected to alter those beliefs, they should not, however, impose those beliefs on young people, where they differ from the guidance within this policy.

It is acknowledged that stereotypes exist.  When considering personal relationships and sexual health issues therefore, carers will be expected to actively challenge such stereotypes.

Disabled young people and young people with learning difficulties have an equal right to accurate information on personal relationships and sexual health that is appropriate to their age and understanding, and their disability should not preclude them from having fulfilling personal and sexual relationships.

To ensure that information is accessible to young people and their carers it may be necessary to use translation, interpretation, signing and Braille services.

Black young people, young women and lesbian, gay and bisexual young people are particularly vulnerable to sexualised verbal abuse and carers need to be sensitive to young people facing such discrimination.

Young people themselves may also use sexualised language towards their peers which carers will need to challenge.

Sexual health/advice is not just about providing information about sex but also putting this into a context in terms of relationships, emotions, choice and exploitation.  This is particularly important when considering the needs of girls/young women and those young people who have been sexually abused.

In terms of anti-discriminatory practice carers have a responsibility to examine their own beliefs and how that affects the work they carry out.

5. Policy Framework
5.1    Morals and Values
We, as a service, do not believe ignorance protects.  As such our framework of values for sex and relationships education, to which we all subscribe, attempts to foster:

• A respect for self and others;

• Non-exploitation in sexual relationships;

• A culture in which we explore rights, duties and responsibilities in relationships;

• An acknowledgement and understanding of diversity regarding religion, culture, sexual orientation, physical and mental ability and social class;

• Realistic discussion about the effects of early sexual activity and society’s attitude towards this.

This policy is also framed within the context of legislative requirements, and departmental childcare policies and procedures.  ‘Best Practice’ will be achieved through:

• A commitment to the rights of young people;

• Working in partnership with young people and their parents/carers.  In any decision affecting a young person, those with parental responsibility will be consulted, unless the young person specifically requests that this does not happen, and is of sufficient age and understanding to make such an informed decision.  Every attempt will be made to help facilitate a model for parents to talk to young people about sex themselves, as described in the Social Exclusion Unit’s recommendations on reducing the number of teenage pregnancies;

• An acknowledgement that RSWs, foster carers and SWs are often best placed to provide support, advice and information to the young people they look after.  This policy will ensure that they receive the training and support they need, to undertake this area of work;

• A commitment to taking an active role in promoting all aspects of the health of young people ‘looked after’, including personal relationships, contraception, pregnancy, sexually transmitted diseases and HIV/AIDS;

• A recognition that all young people ‘looked after’ should have opportunities to develop caring and fulfilling personal relationships.  It is acknowledged that these relationships may at some stage involve sexual expression.  Providing these are not abusive or coercive, we will respect acceptable expressions by young people ‘looked after’, having due regard to the constraints of individual placement settings;

• A recognition that, despite the advice and guidance offered them, young people may have relationships that are abusive or coercive.  We will always act in accordance with the principle in the Children Act, 1989 that, "the child’s welfare is paramount in deciding all questions about his (or her) upbringing…";

• An acknowledgement that it is our responsibility to safeguard and promote the welfare of young people looked after, even if they are involved in unlawful sexual activity.  We will provide guidance on all aspects of personal relationships/sexual health, together with information on how to access contraception, pregnancy advice and treatment services for sexually transmitted infections;
• The promotion of a multi-disciplinary approach to the provision of services, collaborating with the young person, their parents/carers and other agencies;

• In accordance with the Home Office/Department of Health "Guidance on Children Involved in Prostitution", we will treat children involved in prostitution as victims of abuse, even when they claim to be doing it willingly.  We will regard them as children in need.

6. Legal Framework
Local Authorities’ duties and responsibilities with regard to personal relationships of young people looked after are contained in legislation and case law, the most important statute being the Children Act 1989

6.1    Children Act 1989

• The over-riding principle is the paramountcy of the welfare of the young person;
• Section 22 (3) imposes an obligation on the Local Authority to safeguard and promote the welfare of young people looked after;

• Section 22 (4) imposes a duty on the Local Authority, so far as is reasonably practicable, to ascertain and take into due consideration the wishes and feelings of the young person (according to his/her age and understanding), his/her parents, any other person with parental responsibility and any other person whose wishes and feelings the Authority consider to be relevant;

• Section 22 (5) requires the Local Authority to give due consideration to the young person’s religious persuasion, racial origin and cultural and linguistic background;

• When a young person is subject to an Interim Care Order or Care Order, parental responsibility for that young person is shared between the parents/guardians and the Local Authority.  However, the Care Order gives the Local Authority the power to determine the extent to which a parent or guardian of the young person may meet his or her parental responsibility.  The Local Authority must be satisfied that any proposed action will continue to safeguard or promote the young person’s welfare;

• The Local Authority does not have parental responsibility for young people who are accommodated.  It is only the parents (and the child) who are able to make important decisions about that young person’s life.  However, under Section 3 (5) of the Children Act, the Local Authority may do what is reasonable in the circumstances in order to safeguard or promote a young person’s welfare, subject to the provisions of Section 22.

In relation to sexuality and young people looked after, the Government has issued guidance on the implementation of the Children Act:

• "Those responsible for the sexual education of young people will need to bear in mind the particular needs of different young people… The needs and concerns of gay young men and women must also be recognized and approached sympathetically."

• "Some young people may need considerable counselling before they do come to accept themselves…  Gay young men and women may require very sympathetic carers to enable them to accept their sexuality and to develop their own self identity."

It is a criminal offence for a boy or man to have intercourse of any kind or sexual contact with a girl who is under 16.  It is not an offence for the girl, who is deemed incapable in law of consenting to a sexual act if she is under 16.  Boys as young as 10 can commit offences involving sexual intercourse: s.1 Sexual Offences Act 1993 abolished the legal presumption that a boy under 14 was incapable of achieving sexual intercourse.

In practice prosecution is unlikely for a boy under 17, unless he is considerably older than the girl, or the girl does not consent.  There is a greater likelihood of men over 17 being prosecuted and the penalties they incur are likely to be more severe.  Sexual offences against girls under 13 are considered more serious in law and incur a heavier penalty.

6.2    Lesbian and Gay Sexual Acts

There is no legislation of any kind, which is specifically concerned with sex between women.  However, a woman aged over 16 can be charged with indecent assault for any kind of sexual contact with a girl under 16.  From 2001, the age of consent was equalised at 16, for both heterosexual and homosexual activity.

6.3    Age of Consent to Medical Treatment
The Children Act 1989 Guidance and Regulations, Volume 3 - Family Placements states "Children who are judged able to give consent cannot be medically examined or treated without their consent.  The responsible Authority should draw the child’s attention to his/her right to give or refuse consent to examination or treatment.  The doctor(s) decides whether a young person is capable of giving/witholding consent and understanding the consequences of their action.

6.4    Contraception and Girls under 16
The Gillick Case involved a challenge by Victoria Gillick to guidance issued by the DHSS in 1980 on family planning services for young people.  She objected to the guidance because although it emphasised that doctors should attempt to persuade the young person to involve their parents, it accepted that there were ‘exceptional’ circumstances when confidential advice and treatment could be provided to people under the age of consent.  In 1986 the House of Lords, while emphasising that girls under 16 seeking contraceptive advice should be encouraged to inform their parents, upheld the right of doctors to prescribe contraceptives without parental knowledge or consent.  Guidance to doctors and health professionals is now to be found in the Fraser Guidelines (based on the judgements of Lord Fraser in the Gillick case).

6.5    Implications of the Fraser Guidelines
It is an offence for a person to cause or encourage the commission of unlawful sexual intercourse with a girl under the age of 16 for whom they are responsible.  However "The only situation in which it would be unlawful would be where it could be proved that advice was given to a young person (or an adult) with the intention of facilitating sexual intercourse with a girl under 16.  In such a case the adviser concerned could be charged with being an accessory to the crime of unlawful sexual intercourse."   In practice no such charge has ever occurred.  The Fraser Guidelines have been construed more widely to apply to any medical or dental treatment, or care.  Provision of any medical treatment to a child may be a trespass to the person and constitute an assault in law if consent to such treatment is not obtained.

In the judgement, the House of Lords concluded that the duration of parental rights could not be determined with reference to a child attaining a certain age but upon a judgement of what was best for the welfare of a particular child.  It was concluded that a doctor would be justified in proceeding without the parents’ consent provided they were satisfied of the following:

1. that a young person would understand the advice;
2. that the doctor could not persuade the young person to inform the parents or allow the doctor to inform the parents that they were seeking medical advice;
3. that the young person was very likely to be at risk without medical advice or intervention;
4. that unless the young person received advice or treatment their physical or mental health or both were likely to suffer;
5. that their best interests required the doctor to give advice,  treatment or both without parental consent.

The Fraser Guidelines primarily give guidance to Health professionals.   This states that professionals should take care not to undermine parental responsibility.  Advice may be given without parental consent if the professional is satisfied that:

1. the young person can understand the advice and has sufficient maturity to understand what is involved in terms of the moral, social, and emotional implications;
2. the professional can neither persuade the young person to inform the parents, nor allow him/her to inform them, that advice was being sought;
3. the young person would be very likely to begin to be at risk without medical advice or treatment;
4. without advice the young person’s physical or mental health, or both would be likely to suffer;
5. the young person’s best interests require the professional to give advice without parental consent.

6.6    1987 Local Government Bill (Clause 28)
This legislation, despite popular belief, does not forbid either the provision of information or the counselling of young people who are or who think they may be lesbian or gay.  Discussion of sexuality and sexual feelings is a vital part of education around relationships.

The legislation, which has never been used in court, is due to be repealed.

7. Practice Guidelines
7.1    RSW’s, foster carers, SWs and Family Support workers are highly skilled at developing relationships with young people.  Communication is vital and the best discussions around personal relationships and sexual health often occur informally and spontaneously, e.g. washing up, over a meal, watching TV.  All of these situations offer good opportunities to talk about such diverse subjects as safer sexual practices, love, friendship, child abuse, homophobia, teenage pregnancy, termination of pregnancy etc.  It is at these times that we can discuss important values and information with young people in an open and non-threatening way.

7.2    Young people want the opportunity to talk to adults they know and can trust about relationships and sexual health.  This will not promote sexual activity.  Teenagers who are able to openly discuss sex and relationships are more likely to make informed choices with regard to what they do and do not want from relationships.

7.3    Young people ‘looked after’ must be encouraged to promote their own protection and develop responsibility in the sexual expression of their relationships.  Access to advice services should be proactively sought, rather than as a response to a crisis.  Failure to do this would only serve to endorse the message that sexual health matters are a ‘problem’.

7.4    It is essential that we take account of a young person’s age and understanding and work in partnership with those with parental responsibility.  This can include offering help and advice to parents which can assist them in supporting their child.

7.5    Our own feelings of embarrassment or our beliefs can make it hard to talk to young people.  RSW’s and foster carers who are unable to discuss specific sex and relationship issues with young people, have a responsibility to advise them where to go for help and support.  In some placement settings, e.g. residential homes, there is an expectation that staff members will make known to colleagues any personally held beliefs, which will affect their ability to engage with young people on certain aspects of relationships. In all circumstances, the rights of the child must be paramount.

8. Confidentiality
Carers do not have a duty to inform parents of evidence or suspicion of sexual activity; however, it is a principle of the Children Act that they should work in partnership whenever possible and appropriate.  Clearly, there are some situations where this may not be an appropriate role for a carer, e.g. if a young person becomes pregnant or seeks a termination.  Whenever there is concern for the well-being of a young person, carers should liaise with the young person’s social worker to agree the appropriate course of action.

Information relating to sex, sexuality and personal relationships can often be very sensitive and carers should not divulge such information without the prior knowledge and preferably consent of the young person to whom the information relates.  Information that is recorded should be stored securely so that unauthorised people cannot have easy access to it.  Good practice should involve the routine sharing of information that is recorded with the young person.

As discussions around sexual issues may result in disclosure of abuse, it is essential that young people are aware, from the start, that any such disclosures involving themselves or any other young person will be passed on.  RSW’s and foster carers need to be clear about what constitutes abuse and Children's Services Child Protection Procedures MUST be followed.

9. Application of Policy
9.1    For children under 10 years of age

The work to be done with the young person needs to be identified in the child’s Placement Plan part 2, (health) and section 12 of the Care Plan, which is concerned with the long-term needs of the child.  This will involve giving age appropriate information to help them:

• understand how their body works, and what names are used for different parts of the body;

• develop skills in talking about their bodies, their feelings and relationships;

• know how to nurture self-respect and respect for others;

• have an understanding of appropriate and inappropriate touching;

• know whom to tell if they experience unwanted sexual advances;

• develop good personal hygiene preparing for puberty, understanding the changes that will occur/are occurring in their bodies, e.g. being prepared for wet dreams or how to manage periods.

9.2    For children over 10 years of age
The need for support and advice on personal relationship issues will be identified in the Assessment and Action Records (H16 to H20), the Placement Plan part 2, section 2, (health) and section 4 (identity); as well as section 12 of the Care Plan, which is concerned with the long-term needs of young people.  The expectation would be that areas identified in 8.1 are expanded upon, appropriate to age and understanding, including:

• issues raised by a young person in relation to their emerging sexuality.

• power issues in relationships.

• implications of becoming a young parent.

9.3    Working with Parents
Working in partnership with parents is identified as a key principle of the Children Act.  Consistency and understanding between carers and those who hold parental responsibility will always benefit young people, but particularly in the area of sexual health.

Agreement to discuss relationships and sexual health matters with young people should be sought from those with parental responsibility, prior to the initial planning meeting - consultation should then follow as a matter of course.  However, if the young person does not wish their parents to be consulted, and is of sufficient age and understanding, their wishes should be respected.

Where the young person’s welfare would be prejudiced by informing his/her carers, work can continue without parents/carers having to be informed.  It is important, in this event, that the position should be reviewed regularly.  This responsibility lies with the Child Care Team Manager, through an allocated social worker.

A clear written record of decisions and actions must be kept in the young person’s case file.

Persons with parental responsibility should be given information relating to any sexual health education programmes available to their child.  This will ensure that they have the opportunity to express their concerns or wishes.  Parents often find talking to their children about sex and relationships difficult, and talking to another adult can be beneficial, i.e. Children & Families Social Worker, Residential Social Worker, Family Support Worker, Foster Carer, Teacher, Health Worker.

Some parents may have religious/cultural beliefs that affect their views.  These need to be acknowledged and respected.  Ensuring information/communication is available to parents in an accessible format will increase their confidence and trust in the information given.  (See 9.5).

It is essential to consult with the young person before divulging any information about their sexual activity to their parents.  If there appears to be a child protection issue, departmental guidelines will always be followed.

9.4    Review Process
The health and education of young people are important issues that need to be addressed throughout the review process.  In relation to issues of sexual health and education, the following need to be considered:

• By the first review a person/s should have been identified, who will be responsible for ensuring the provision of advice, support and guidance on personal relationships to the young person.  The young person should have been party to this decision and issues of gender/ethnicity/sexuality, wherever practicable, must be addressed;

• The young person’s social worker will make them aware of their right to make a complaint in respect of the service they receive;

• The Planning & Review Manager will record both the responsible person/s and agreed tasks under Section 10 of the LAC Review Arrangements;

• Sex and sexuality are private and sensitive topics and a review is often not the place to discuss these issues in depth.  It can be an appropriate forum to discuss general issues around sex education and is an effective way of ensuring that the young person is receiving sex education;

• Young people should always be consulted beforehand and have some say in which issues they want discussed in this forum;

• Section H 16 - 20 of LAC: Assessment & Action Record, Aged 15 and over and Section H 16 - 19 of LAC: Assessment and Action Record, Aged 10 - 15 years, which cover sexual health matters, are ideal ‘tools’ to use when working with young people.  They must be given the opportunity to comment on any ‘planned programmes’ that may be in place and should be party to the planning of these.  Their review provides an ideal opportunity for them to voice their comments;

• It is not appropriate for information on personal relationships to be recorded in logbooks.  In the residential service, records that relate to a young person’s sexual health, will be held in the confidential section of their main file.  The young person must be informed of this.  Recording, including foster carer recording, should be completed with the young person in order to ensure that they are fully involved and that any information which is shared, is done so with their consent, except where abuse is disclosed.

9.5    Religion, Culture & Sex Education
Young people ‘looked after’ by the local authority come from a variety of cultural and religious backgrounds.  This may impact on how sex education may be delivered and at what age.  However, this does not mean some young people should be denied the benefits of receiving sex education.  There are several points which will support carers in this task:

• Making links with local places of worship, and community groups will help parents and young people trust the information being delivered;

• Written information should be varied, accessible, culturally and linguistically appropriate and should be translated or interpreted into the parents’/young person’s first languages (avoiding the ‘waiting room’ look);

• Information should also be available via audio cassettes, PC’s etc.

• All materials/information should be selected, bearing in mind the impact of racial, religious or cultural sexual stereotypes;

• It may be appropriate, if group discussions are being considered, to suggest same gender or religion groups;

• The issues of culture and religion should be considered when choosing a carer.  Carers who are not of the same culture or religion need to inform themselves, whilst not making assumptions based on such information.  It is important that the interpretation of information is checked out with the young people and their parents;

• Different cultures and religions have different sexual norms and, as such, it is important to check out views and values held by carers, young people and parents.

9.6    Contraception

• There is no legal definition of what constitutes contraceptive advice.  A carer is not qualified to give medical advice or treatment, nor would this be an appropriate role to take. The decision to prescribe contraception is a matter for a doctor’s or nurse’s clinical judgement.  The provision of contraceptive advice is also, ultimately, the responsibility of health professionals.  Carers can, and should, engage in general discussion and information on matters of sexual health and identify local sources of professional help and information for young people;

• Young people have a right to medical services, including contraceptives, without reference to those with parental responsibility for them.  For young people aged 16 years and over, it may be appropriate for carers to provide condoms directly, where this is considered necessary to safeguard a young person’s welfare.  As some young people will find it difficult to ask for them, consideration must be given to a sensitive and discreet method of provision.

9.7    Sexual Relationships in Placement
Being ‘looked after’ can highlight many feelings and emotions and these can present particular challenges during times of sexual development.  Living away from home could result in young people developing relationships that have a sexual element (Bremner, J & Hillin, A (1993)).

Whilst carers need to recognise and respect young people’s feelings, it is considered unacceptable for sexual activity, involving young people ‘looked after’, to take place within Children's Services community homes.

Family placements may want to consider a range of ‘house rules’ depending on a young person’s age, circumstances, customs and beliefs.  Whatever these are agreed to be, an open discussion amongst carers, social workers, young people, and parents where appropriate, is vital if the young person is to understand what is and what is not acceptable.

There are several points to keep in mind when addressing this issue.

• Young people have a right to, and deserve, respect, confidentiality and privacy when working with their relationship issues;

• Positive relationships between young people in placement should be valued;
• Young people ‘looked after’ have the same rights to sexual information as young people in relationships outside of the placement;

• If two young people are involved in a serious committed relationship in a placement, finding an alternative, local placement for one young person could be an option.  This action, as a support to the continuation of the relationship and not as a sanction, would also demonstrate the level of respect the adults had for the young persons involved;

• Allocated social workers should always be informed if young people are known to be in a sexual relationship;

• Young people should be made aware of the difficulties that can arise from being in a relationship with another young person in the same placement;

• If young people are in a sexual relationship, information should only be shared on a ‘need to know’ basis;

• Adolescence is a time when young people begin to make their own choices, regardless of advice and guidance from adults.  However, this should not prevent adults from expressing their concerns.

9.8    Safer Sex
Information and advice on safer sex, HIV, Hepatitis and other sexually transmitted infections such as Chlamydia is very important.  Carers need accurate and up to date information on local services and how to access them.

Young people have a right to be tested, once they are able to make an informed choice.  The opportunity to discuss this with carers and professional counsellors should be made available.  Carers should advise young people of clinics where anonymity and appropriate pre- and post- testing counselling is available.  Young people should be advised against testing without their having access to appropriate counselling services.  Not all the carers working with a young person need to be informed of their HIV or Hepatitis status, e.g. the whole of the RSW team in a residential unit.  Information relating to a young person’s blood-borne viral status should be shared on a ‘need to know’ basis, and the young person consulted.  No young person will be discriminated against as a result of such a disclosure.  First aid and control of infection practice, should always follow current guidelines and assume that blood spills can be infectious in some circumstances.

9.9    Sexuality
Sexual health information and education should be supportive of and responsive to the needs of all young people being ‘looked after’ including those exploring their sexual identity and/or those identifying themselves as gay, lesbian or bisexual.

This is clearly stated in the Children Act:

"…the needs and concerns of gay young men and women must be recognised and approached sympathetically…"

"…some young people may need considerable counselling before they come to accept themselves…  Gay young men and women may require sympathetic carers to enable them to accept their sexuality and to develop their own self identity."

This policy offers support to young people experiencing discrimination on the basis of their sexuality.  In practice this means that same sex relationships should be acknowledged and valued so that young lesbians, gay men and bisexual young people value themselves and their relationships.

Some points to consider when dealing with this issue are:

• Personal views should not be imposed on young people and care should be taken with language and behaviour;

• Homophobia should be challenged and same sex relationships valued;

• Carers should ensure the safe sexual development of all young people ‘looked after’ and be sensitive to their feelings about same sex relationships;

• Carers need to be aware of organisations that are supportive of young lesbians, gay men and bisexual young people;

• Carers need to be aware of and sensitive to the discrimination faced by these groups of vulnerable young people.

9.10    Pornography
Pornographic material containing sexually explicit images is often degrading and offensive and the department does not support its use or availability.  Pornographic material can only be purchased by adults aged 18 years and over therefore if a young person is found to be in possession of pornographic material, it should be removed from them with sensitivity.  In addition the opportunity should be taken to discuss with them how such material could lead to the development of a distorted view of sexuality and degrade the dignity of the individual.

9.11    Masturbation
Masturbation is part of normal sexual behaviour, particularly for young people who are exploring their emerging sexuality.  Young people should not be made to feel guilty or embarrassed about masturbation or to be prevented from doing it.  It is important however, that young people understand the social conventions associated with sexual behaviour in general and masturbation in particular, in that it is a private activity.

9.12    Pregnancy
Young, pregnant women face many difficulties.  Young pregnant women who are ‘looked after’, face even more.  Isolation from their families often results in a lack of support.  They may face criticism and prejudice about their sexual behaviour.  It is vital that guidance and support is made available to them, to enable them to make informed choices about their future and that of their baby.

The following will assist carers when dealing with this:

• Young women should be assisted in confirming their pregnancy, as soon as possible;

• Information should be made available in relation to the pregnancy, ante-natal care and the care of the baby;
• The young woman should be reassured that she will be supported throughout her pregnancy and afterwards; the nature of the support will vary according to individual need.

• Options should be discussed with a health professional.  If a young woman chooses to have her baby, then support will be made available to her.  Research confirms that many young women fear that the local authority will take their baby away from them;

• Women have the right to have an abortion, provided they satisfy the criteria of the 1967 Abortion Act.  Young women ‘looked after’ have the same right.

• For further guidance, please refer to ‘Tackling Teenage Pregnancy and Paternity in Worcestershire: a 10-Year Strategy’ (April 2001).

10. Children’s Rights
Young People ‘looked after’ have a right to be provided with the same information that is available to young people, of the same age, in the local community.  Carers should ensure that:

• Young people are provided with age appropriate information that is accessible and accurate;

• This information should be provided as a matter of course without the young person having to ask for it;

• Young people are responded to as individuals and their personal relations and sexual health respected;

• Young people are allowed to define their own sexual orientation and to seek advice and support without fear of stigma;

• Young people are allowed to take risks and make mistakes;

• Young people are provided with the information they require, without having to justify their reasons;

• Young people have access to counselling in personal relationships, sexual health and sexuality;

• Young people are allowed to make choices in respect of their personal relationships, even if carers do not support these choices;

• Young people have access to privacy and confidentiality.

11. Information & Advice
Young people who are ‘looked after’ are entitled to receive information and guidance appropriate to their individual needs. This information should include access to information on sexual health services, and the legal framework of sexual activity.

Information should cover a range of issues, not just be based on sexual facts, but should incorporate an understanding of different kinds of relationships, values, attitudes and moral issues.

12. Professional Boundaries & Safe Practice
Maintaining appropriate boundaries between the carer and the young person is particularly important in relation to matters concerning personal relationships.  While carers need to provide young people with opportunities to safely discuss and explore their emerging sexuality and sexual behaviour, this must at all times be undertaken in a professional context.

For further guidance, please refer to ‘Towards Safer Care in Worcestershire’ (February 2000).

Many young people who are ‘looked after’ by the department have had previous experiences of abuse and involvement in high-risk lifestyles.  This may influence their response to work undertaken with them concerning personal relationships and sexuality.  Young people may misinterpret situations and conversations and on occasions make allegations against carers.  Caution must be observed by carers in sharing their own personal life experiences which, however well-intended, may be open to misrepresentation and misunderstanding by the young person.  If in any doubt, carers should discuss with their supervisor the most appropriate means of working with a young person in this area.  

Under no circumstances would it be acceptable for a carer to engage in a sexual relationship with a young person in their care.

13. Support, Supervision & Training
The implementation of this policy relies on carers receiving appropriate support, supervision and training.  To this end, the following points will need to be addressed:

• The department will ensure that all carers responsible for providing sexual health education are given appropriate training;

• Carers must be aware of the relevant departmental policies and procedures, i.e. Child Protection, HIV.

• Support must be available to carers, especially those working in community settings, i.e. foster carers.

14. Dissemination of this Policy
A full copy of this policy and practice guidance will be made available to those Children's services staff employed within Children’s Services, and given to all approved foster carers.

A full copy of this policy can be made available to anyone else who requests it.

A summary of this policy will be made available to young people and their parents, when they become 'looked after'.  This will contain information on how to access a full copy of the policy.

15. Monitoring
It is proposed to monitor the effectiveness of the policy on an annual basis.  This process will include gaining the views of carers and young people and incorporate any changes arising from legislation and good practice.

16. References

• Guidance for Field Social Workers, Residential Social Workers and Foster Carers on Providing Information and Referring Young People to Contraceptive and Sexual Health Services - Teenage Pregnancy Unit, Dept of Health
• Children Act 1989 - Guidance and Regulations, Volume 4 - Residential Care
• Personal Relationships & Sexual Health Policy- Hammersmith & Fulham
• Personal Relationships & Young People Looked After - Bristol City Council
• Quality Protects ‘Framework for Action’ Department of Health, 1998
• William Utting, ‘People Like Us’, 1997
• Working with Young People, Legal Responsibilities and Liabilities - The Children’s Legal Centre
• United Nations Convention on the Rights of the Child
• Children Act 1989, Guidance and Regulations, Volume 3 - Family Placements
• Audit Commission Report ‘Seen But Not Heard’, 1994
• ‘Our Healthier Nation’, 1998
• Teenage Pregnancy - Social Exclusion Unit, 1999
• Bremner, J & Hillin, A (1993)
• Towards Safer Care in Worcestershire (2001)
• Looking After Children Implementation Forms

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Get in touch with our Contact Centre:
Call: 0845 607 2000  or  Email: socialcare@worcestershire.gov.uk
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