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

4. GOOD PRACTICE IN INTIMATE CARE

In many schools and other establishments staff are involved on a daily basis in providing personal and intimate care to children and young people with special educational needs arising from learning difficulties, sensory impairments and physical disabilities.

In so doing staff are placed in a position of great trust and responsibility. They are required to attend to the safety and comfort of the children and to ensure that they are treated with dignity and respect.

Activities related to intimate care often occupy substantial periods of time and they should therefore be enjoyable experiences which offer opportunities for personal development and choice. Even the youngest children can be encouraged to become aware of and value their own bodies and extend their personal skills and communication. Conversely, if such opportunities are denied them they will not learn to distinguish between appropriate and inappropriate. 'Confident and assertive children who feel that their bodies belong to them are less vulnerable to sexual abuse' (Tayside Regional Council Education Department Child Protection Guidelines and Procedures, 1995). Children with special needs are often neither confident nor assertive. Raising their self-esteem should be addressed through the school's personal, social and health education programme.

Where ever possible, staff should work with children of the same sex in providing intimate care and be mindful of and respect the personal dignity of the children at all times. Except in life-threatening and emergency situations, and particularly where adolescent girls are involved, male members of staff should not normally be involved, and certainly not acting on their own or with another male adult, in providing routine intimate care for girls, for example bathing, changing and toileting. These precautions are necessary to ensure child protection and to safeguard male staff from possible allegations of abuse. The religious views and cultural values of families should also be taken into account. These might preclude having female staff provide intimate care to boys, particularly those in their teenage years. Accordingly, it is vital that schools seek to engage with parents, and children, prior to enrolment, to discuss the normal routines of the school and staff most likely to be involved in delivering aspects of intimate care.

Examples of positive approaches to intimate care which ensure a safe and comfortable experience for the child

The following assist in promoting positive attitudes to intimate care:

• Get to know the child beforehand in other contexts to gain an appreciation of his/her moods and verbal and non-verbal communication;
• Have a knowledge and understanding of any religious and/or cultural sensitivities related to aspects of intimate care related to this individual child and take full account of these;
• Speak to the child personally by name so that he/she is aware of being the focus of the activity;
• Give explanations of what is happening in a straightforward and reassuring way;
• Enable the child to be prepared for and to anticipate events whilst demonstrating respect for his/her body eg by giving a strong sensory clue such as using a sponge or pad to signal intention to wash or change;
• When washing, always use a sponge or flannel and where possible encourage the child to attempt to wash private parts of the body him/herself;
• Provide facilities which afford privacy and modesty eg separate toileting and changing for boys and girls or at least adequate screening; bathing/changing children one at a time;
• Respect a child's preference for a particular carer and sequence of care;
• Keep records which note responses to intimate care and any changes in behaviour;
• Agree appropriate terminology for private parts of the body and functions to be used by staff and encourage children to use these terms as appropriate; and
• Speak to older children in a way that reflects their age.

Practical considerations for mangers of schools and establishments to ensure the health and safety of staff and children

Staff should receive training in good working practices which comply with health and safety regulations such as the wearing of rubber gloves for certain procedures and methods for dealing with body fluid spillages and manual handling.

• There should be sufficient space, heating and ventilation to ensure the child's safety and comfort.
• More than one member of staff should be available if a child is difficult to move or handle.
• Hoists should be provided for staff moving heavier children.
• There should be a suitable changing table.

• There should be a disabled toilet and/or appropriate toilet seats for children who require them.
• Items of protective clothing, such as gloves and disposable aprons, should be provided and readily accessible.
• Special bins should be provided for the disposal of wet or soiled pads.
• There should be special arrangements for the disposal of any contaminated waste/clinical materials eg through the Schools Medical Service.
• Supplies of suitable cleaning materials should be provided for cleaning and disinfecting changing surfaces.
• Supplies of fresh clothes should be easily to hand so that the child is not left unattended whilst they are found.
• Checks should be made beforehand to ensure that there are suitable facilities for intimate care available on excursions and residential experiences.

The use of toilets

Staff should promote appropriate use of toilets and associated skills in private and public settings. Parents should be encouraged to train their children at home as part of their daily routine, and schools and residential facilities should reinforce these routines whilst avoiding any unnecessary physical contact. Where possible, staff should work with children of the same sex and be mindful of and respect the personal dignity of the pupils when supervising, teaching or reinforcing toileting skills.

The use of public toilets should be introduced as part of a Personal and Social Development programme, emphasising the following points:

• find an empty cubicle;
• follow an established sequence;
• be aware of hygiene issues; and
• be aware of personal safety issues.

Appendix 7 provides examples of good practice and training in manual handling.