Guidelines for Staff who provide Intimate Care for Children and Young People with Disabilities

1. INTRODUCTION

The purpose of these guidelines is to set out a framework within which staff who provide intimate care to children with special needs can offer a service and an approach which acknowledge the responsibilities and protect the rights of everyone involved. The children's special needs might arise for a variety of reasons including learning disabilities, physical, visual, hearing or speech and communication impairments. These children will be found in all settings: pre-5 centres, primary and secondary schools in addition to special schools, classes and units.

Definition of Intimate Care

Intimate care encompasses areas of personal care which most people usually carry out for themselves but some are unable to do so because of impairment or disability.

Children and young people with disabilities might require help with eating and drinking and all aspects of personal care such as washing, dressing and toileting. Help may also be required, for example, with changing colostomy or ileostomy bags, managing catheters or with other appliances. In some cases it may be necessary to administer rectal medication.

The guidance contained in this document is not prescriptive, but offers advice for good practice based on the practical experience of intimate care and the value base of those who have been involved and consulted in its preparation. Staff should be aware of these guidelines and encouraged to follow them for their own protection as well as for the protection of children. Staff should also have a good knowledge of the school's/local authority's Allegations Against Staff policy and procedures which should be in place as part of Child Protection advice to safeguard adults and children.

Vulnerability to abuse

It has become increasingly apparent from research studies on child protection that children with disabilities are particularly vulnerable to all kinds of abuse.

Factors which contribute to this increased vulnerability include the following:

• children with disabilities often have little control over their lives;
• lack of sex education leads to difficulties for them in recognising abusive behaviour and finding the right words or way to communicate what is happening;
• frequent hospitalisation and/or placements in residential care with multiple carers;
• denial by carers that the abuse of children with disabilities takes place so that signs of abuse are not recognised;
• differences in appearance or behaviour may be attributed to the child's disability and not to the possibility of abuse; and
• discrimination and prejudice against disabled children (and adults) in society.

From a child protection perspective, intimate care involves risks both for children and adults as it may involve the adult touching the private parts of the child's body. It may be unrealistic to expect to eliminate these risks completely. However, by acknowledging them, we create an awareness of the importance of maximising safety for all concerned and promoting the best interests of the child. It is also important that staff are supported and trained so that they feel confident in their practice.

Partnership and participation

Partnership with parents is an important principle in any educational setting and is particularly necessary in relation to children with disabilities. Much of the information required by the school to make the process of intimate care as comfortable as possible for the child is available from the parents. They should be closely involved in the preparation of Individualised Educational Programmes (IEPs) which may include intimate care arrangements. The importance of regular consultation and information sharing is emphasised throughout this document.

Disabled children and young people should be able to participate in all aspects of life in the community and it may be necessary for intimate care procedures to be carried out in a variety of settings and by a variety of carers, such as teachers and support staff in schools, escorts, residential social workers or health professionals. Children requiring intimate care will vary in age, background, ethnicity, level of dependency and communication skills. They may have physical disabilities, learning difficulties or sensory impairment or a combination of these conditions.

What they have in common, however, is the right to be treated with sensitivity and respect, and in such a way that their experience of intimate care is a positive one.