Policy and Guidance for Staff, Foster Carers and Children/ Young People on smoking in Foster Care

Introduction

The Government smoking ban, set out in the Health Act 2006, came into effect in England on the 1 July 2007, and made it illegal to smoke in any public place, with exemptions for certain residences, including prisons, care homes and psychiatric units. Under the Act, Children’s Units are considered to be public places.

Although Foster Carer’s homes are not regarded as a workplace it is essential that the rights of carers to smoke are balanced against the rights of children in care to be healthy.

The health risks from smoking and passive smoking are well known, with smoking being the single greatest cause of preventable illness and premature death in the United Kingdom (Appendix I).

Most children will have experimented with tobacco by the age of 16 and this is a key age at which behaviour can be shaped and influenced. Research does suggest that smoke free environments, promoting non smoking as the cultural norm and providing children with information about the dangers of smoking does help to prevent young people from starting to smoke. Providing positive non smoking role models and support to stop smoking can help them to quit.

It is important, that the authority establishes a smoke-free policy which includes residential staff, Foster Carers and the children they care for.

Foster Carers

It is important that Foster Carers understand and are made aware of the detrimental effect of smoking and passive smoking on their health and that of other people in their household.

During the recruitment, assessment and preparation process discussions will take place with applicants regarding the department’s expectations and requirements. Carers will be provided with information as to where they can access help and be supported to reduce or to give up smoking, if they are motivated to do so.

At each stage the department will be clear that any Carer who smokes or lives in a household where people smoke cannot be approved to take a child under the age of five. In addition any child or young person with known middle ear or respiratory tract infections, or who is prone to asthma and bronchitis, will not be placed in a smoking household, although exceptions may be made where it is in the child’s best interests.

The issue will be raised regularly with all approved carers who smoke and reinforced through regular supervision, the safe care plan and the provision of guidance and training on Health & Safety issues and Healthy Care. Support is crucial, particularly as smoking can be a response to stress, and consideration needs to be given to ways of minimising the level of stress experienced.

The supervising Fostering Social Worker will agree a smoke free plan with the carers to include the following:

Carers and other members of the household, including visitors, will not smoke in the company of children of any age, in the home or in the car and will promote non-smoking as the norm
Smoking will take place outside the home or in well ventilated rooms that are not used by children
Tobacco products, matches or lighters will not be left lying around or accessible to children

This will form part of the Safe Care Plan, which is reviewed and updated regularly and for each new placement.

Guidance on Smoking

Staffordshire County Council Fostering Service acknowledges the proven skills and abilities of its carers who smoke, however the overriding priority in fostering is the welfare of the child. Staffordshire County Council always aims to provide a safe, loving and positive environment for the child, helping to improve their chances of being happy and healthy as they grow older. It is therefore in the best interests of all children, to be raised in smoke free homes, ideally by non-smoking carers/adopters.

The service believes that a smoking environment should be avoided in the best interests of children who are placed away from home.
Children, under five years old, will not be placed with carers who smoke 1tobacco-based products.
All children with a disability, with respiratory problems such as asthma, and those with heart disease or glue ear should not be placed with families who smoke
Applications to foster children under 5 years old will not proceed unless the applicants have been tobacco-free for 6 months.
During the recruitment and assessment process discussions about smoking will take place with applicants regarding the agency’s expectations and requirements.
The issue will be raised regularly with all approved foster carers who smoke and reinforced through the annual review, supervision and the Safe Care Plan.

The use of e-cigarettes

BAAF are continuing to monitor research on the use of e-cigarettes and following the Public Health England report (2014) have recommended that agencies consider e-cigarettes as different from tobacco.

Staffordshire County Council recognises the low risk to children and will not see the use of e-cigarettes as a reason to preclude foster carers/adopters, purely on this basis. The applicant’s use of e-cigarettes will be assessed in the initial visit, as well as during the full prospective carer/adopter assessment.
Prospective carers/adopters who use e-cigarettes will need to demonstrate in the Risk Assessment/Health & Safety Plan, what steps they will take to minimise any risk to the child. This should include details about where and how often e-cigarettes are used and how e-cigarettes and their components are stored.
Approved carers/adopters who use e-cigarettes will be encouraged to restrict their usage to outside of their home, and it will be expected not to use e-cigarettes in front of children.
In the best interests of the child, the use of e-cigarettes will be discussed as part of the carer’s/adopter’s personal plan to cease the use of tobacco/nicotine indefinitely.

Children/Young people

It is illegal for retailers to sell any tobacco products to anyone below the age of 18. In the same way foster carers will not be permitted to provide children or young people under 18 with tobacco products.

Some young people may start smoking or be smokers at the point of becoming looked after. It is important to work with young people to actively discourage them from smoking by giving them information about the harmful effects and helping them to access support to reduce or give up smoking. The role of health professionals, including the Looked After Children Designated Nurse, is crucial in addressing this issue through the child or young person’s Initial Health Assessment, Health Plan and reviews. Information about where help can be found is in Appendix I.

The parent or person with parental responsibility for the child or young person will be informed of the department’s policy on smoking and involved in discussions about action that will be taken by the Foster Carer. Any arrangements agreed must be recorded in the Placement Plan and communicated in writing to the parent or person with parental responsibility.

In situations where a child/young person already smokes it is reasonable to expect the Foster Carer to have an agreed place to store any smoking products whilst the child or young person is in the foster home and for the child or young person to hand them over to the carer. This will be explained to the child/young person and their Social Worker and recorded in the child/young person’s individual safe care plan. The child/young person will be expected to comply with the smoke free plan for the foster home.

This arrangement will also apply to smoking products given to the child or young person during contact with the parent or person with parental responsibility. The Child’s Social Worker will discourage the parent or person with parental responsibility from smoking during contact and return any smoking products given to the child or young person to them.

The Statutory 6 monthly review of the child or young person’s care plan will look at any arrangements that are in place in relation to smoking.

This policy and guidance was developed by a small working group made up of young people, foster carers, Looked after Children’s Nurse, Children’s Commissioner, Children’s Voice Project worker and Area and Fostering staff. The policy was widely consulted upon and amended to try to reflect the many views expressed.

It is a working document which will be subject to regular review and revision to ensure that any changes in legislation, regulations or good practice are included.

Staffordshire’s Smoking Policy

1. Introduction:

1.1 The Local Authority has reviewed its existing policy in relation to smoking in light of legislation and national guidance published by BAAF and in response to a joint brief ‘Foster Care, Adoption and Smoking’ – published in July 2014 by the Fostering Network and ASH (Action on Smoking and Health).

1.2 The smoking ban, set out in the Health Act (2006), came into effect in July 2007 and made it illegal to smoke in any public place, with exemptions for certain residences, including prisons, care homes and psychiatric units.

1.3 Although foster carer’s homes are not regarded as a workplace, it is essential that the rights of carers to smoke are balanced against the rights of looked after children to be healthy.

1.4 The health risks from smoking and passive smoking are well known, with smoking being the single, greatest cause of preventable illness and premature death in the UK. (See Appendix A).

1.5 Most children will have experimented with tobacco by the age of 16 and this is a key age at which behaviour can be shaped and influenced. Research suggests that smoke-free environments, promoting non-smoking as the cultural norm and providing children with information about the dangers of smoking, does help to prevent young people from starting to smoke. In addition, providing positive, non-smoking role models and support to stop smoking can help young people to quit.

1.6 It light of the above, it is important that smoking is actively discouraged in all foster placements, including family & friend’s placements.

2. Applicants and Approved carers:

2.1 New applicants should be advised from an early stage that their smoking habits will be considered prior to and during the assessment and these habits will impact on their approval and matching. Placing social workers may be more likely to choose non-smokers for preference.

2.2 Additionally, young people should be able to have the choice of being placed in a non-smoking environment, if consistent with their age and understanding. Birth parents, who request that their child be placed in a non-smoking household should, where possible, also have their wishes adhered to. However, in some situations the wellbeing and health needs of the child may override the wishes of the children/parents.

2.3 It is important that foster carers understand and are made aware of the detrimental effect of smoking and passive smoking on their health and that of other people in their household.

2.4 During the recruitment, assessment and preparation process discussions will take place with applicants regarding the agency’s expectations and requirements. Carers will be provided with information as to where they can access help to give up smoking, if they are motivated to do so.

2.5 Where people inform us they have given up smoking and wish to foster children under the age of 5 years, we would ideally need to ensure that they have given up for at least a year (where possible by being tested at their GP surgery and providing evidence of this). If carers have a child under 5 years placed with them and are subsequently found to be smoking, a risk assessment needs to be carried out outlining the steps the carer will be taking to minimise risk to the child in placement .Once that child has moved on, the carer will need to show they have ceased smoking for a year before children under 5 years can be placed.

2.6 At each stage the agency will be clear that any carer who smokes or lives in a household where people smoke cannot be approved to take a child under the age of 5 except in exceptional circumstances, for example where relatives or friends become carers at short notice. In these circumstances a plan to cease smoking needs to be agreed between the carer and assessing social worker and presented to the Fostering Panel alongside the assessment. The Fostering Panel may recommend it is in the best interests of a child to remain there. In addition, any child or young person with known middle ear or respiratory tract infections, or who is prone to asthma and/or bronchitis, or has heart disease will not be placed in a smoking household, although exceptions may be made where it is in the child’s best interests. Additional consideration needs to be given to long term placements as the risks of exposure to passive smoking increase with time.

2.7 The issue will be raised regularly with all approved carers who smoke and reinforced through the annual review, regular supervision, the Safe Care Plan and the provision of guidance and training on health & safety issues and healthy care. Support is crucial, particularly as smoking can be a response to stress, and consideration needs to be given to ways of minimising the level of stress experienced.

2.8 The supervising Social Worker will agree a smoke free planwith the carers to include the following:

Carers and other members of the household, including visitors, will not smoke in the company of children of any age, in the home or in the car and will promote non-smoking as the norm. Carers should also not expose children to smoking when visiting friends and relatives.
Smoking will take place outside the home.If carers are smoking this should be in an area where children cannot see them.
Tobacco products, matches or lighters will not be left lying around or accessible to children.
This will form part of the Safe Care Plan, which is reviewed and updated regularly, and for each new placement.

3. Children and Young People:

3.1 It is illegal for retailers to sell any tobacco products to anyone below the age of 18. In addition, foster carers are not permitted to provide children or young people under 18 with tobacco products.

3.2 Some young people may start smoking or be smokers at the point of becoming looked after. It is important to work with young people to actively discourage them from smoking by giving them information about the harmful effects and helping them to access support to give up smoking. The role of health professionals, including the Looked after Children Designated Nurse, is crucial in addressing this issue through the child or young person’s Initial Health Assessment, Health Plan and Health Plan Review. Information about where help can be found is in Appendix C.

3.3 The child/young person’s parent or person with parental responsibility will be informed of the local policy on smoking and will be involved in discussions about action that will be taken by the foster carer. Any agreed arrangements must be recorded in the Placement Information Record (Placement Plan), and communicated in writing to the parent or person with parental responsibility.

3.4 In situations where a young person already smokes it is reasonable to expect the foster carer to have an agreed place to store any smoking products while the young person is in the foster home and for the young person to hand them over to the carer. This will be explained to the young person and their social worker and recorded in the Safe Care Plan. The young person will be expected to comply with the smoke free plan for the foster home.

3.5 This arrangement will also apply to smoking products given to the young person during contact with the parent or person with parental responsibility. The child’s social worker will discourage the parent or person with parental responsibility from smoking during contact and return any smoking products given to the young person to them.

3.6 The child’s Statutory Review will look at any arrangements that are in place in relation to smoking.

4. Electronic (e-cigarettes)

A new joint brief has been produced by ASH and the Fostering Network (July 2014) – ‘Foster Care, adoption and electronic cigarettes’ and is endorsed by the Fostering Network. The BAAF advice in regards to e-cigarettes is as follows:

E-cigarettes are not regulated as a tobacco product or as a medicine in the UK. While research evidence suggests that the use of e-cigarettes is effective in helping people to stop using traditional tobacco cigarettes, there is little evidence to suggest that it is encouraging smoking.
The Fostering Network considers the current research evidence provides no compelling reasons for restricting the use of e-cigarettes. Therefore, foster carers should not be prevented from fostering or applying to foster because of their use of e-cigarettes.
However, the Fostering Network also advise that it is good practice not to use e-cigarettes in front of children and young people until more evidence is gained about the role modelling effect of this on the smoking behaviour of children more generally.
Health professionals should not recommend the use of e-cigarettes as a smoking cessation aid or a lower risk option than continuing to smoke due to a lack of evidence of their safety and efficacy

5. Further Information

5.1 For more information about this policy, please contact the Business Improvement and Development Team - 01785 277024 or 01785 278426.

Links to both documents can be found here:

Ash.org.uk - Foster Care, Adoption and Smoking/e-cigarettes

Additional Information

In the UK, 42% of children live in a home where someone smokes. Despite nearly 60% of smokers admitting they disapprove of smoking cigarettes with a child present in a room or car, 28% continue to do so.

What’s wrong with second-hand smoke?

Tobacco smoke contains poisonous gases, tar and thousands of toxic chemicals. These poisons get into the bodies of children who live in smoky atmospheres. As children are more sensitive to smoke than adults, due to their bodies still developing, it is not safe for children to be in a room where someone is smoking, even if the room is odourless and not visibly smoky.

How does second-hand smoke harm children?

Babies and children who are exposed to a smoky atmosphere are:

Twice as likely to have asthma attacks and chest infections
More likely to need hospital care in their first year of life
Off sick from school more often
More likely to get coughs, colds and wheezes.

Medical research also shows they have:

Much higher risk of cot death than the children of non-smokers
Increased risk of meningitis
More chance of getting ‘glue ear’, which can lead to partial deafness.

What can you do to protect babies and children?

You can help protect them by keeping their playing, sleeping and eating areas completely smoke-free.

What can I do if my family and friends are smokers?

Let them know before they visit that you are keeping your home smoke
free for your children’s health
Ask if they would not smoke while visiting you
Explain that children can get ill through second-hand smoke.

Useful tips:

Always smoke outside, well away from children.
When out and about with the family, try to find non-smoking or smoke-free areas.

The benefits of giving up smoking

After 20 Minutes - Blood pressure and pulse return to normal.
Circulation improves, especially to hands and feet.
After 8 Hours - the oxygen level in your blood increases to a
normal level. Chances of a heart attack start to fall.
After 24 Hours - Carbon monoxide leaves the body. The lungs start
to clear out mucus and debris.
After 48 Hours - Nicotine is no longer found in the body. Senses of
taste and smell improve.
After 72 Hours - breathing becomes easier. Energy levels increase.
After 2 to 12 Weeks - Circulation improves throughout the body. Walking and exercise become easier.
After 3 to 9 Months - Breathing problems, coughing, shortness of breath and wheezing improve. Lung efficiency increases by 5-10%
After 4 Years – The risk of having a heart attack falls to about half that of a smoker.
After 10 Years – The risk of lung cancer falls to around half that of a Smoker; the risk of a heart attack also falls to about the same as someone who has never smoked.

Smoking Cessation Services

Talk to your GP or Pharmacist:

Many people don't realise that their GP can help them quit smoking. Your doctor can do a lot, such as enrolling you in a 'stop smoking' clinic and prescribing nicotine replacement therapy such as patches and gum, or prescribe a stop smoking medication such as Champix.

Get a free 'Quit Kit'
This kit is packed with practical tools and advice to help you stop smoking, including a 'tangle' to keep hands busy, a wall chart to keep track of your progress, stress-busting apps, information on medicines that can help you stop smoking and exercises to improve your willpower.

Join an NHS Stop-Smoking Service:

The NHS has stop-smoking services staffed by trained stop smoking advisers all over the country in a range of venues at times to suit you. You can join a group where local smokers meet once a week or have one-to-one support if you prefer. You usually go for a few weeks and work towards a quit date. Find your nearest NHS Stop Smoking Service from the NHS Smoke free website|, or call 0800 022 4332.