6.1.10 Smoking Policy for Foster Carers and Children and Young People in Care

This chapter was added to the manual in February 2019.

1. Introduction

The health, safety and wellbeing of children and young people are at the heart of policies and practice related to children in care. This includes taking into consideration the effects of smoking on children who are in foster care, and recognising the important role that foster carers and social workers have in protecting all aspects of a child's health while they are in care.

The corporate parent has a responsibility towards looked-after children that has to be balanced against the rights of foster carers to do as they wish in their own homes.

There is a huge body of evidence that demonstrates the negative effects that smoking has on children. 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. A study in the British Medical Journal suggested that the only way of reducing children's exposure to passive smoke is to maintain a smoke-free home (Wang et. al, 2016). Other measures, such as restricting smoking in the vicinity of the child or using fans or open windows to ventilate rooms where smoking has taken place, are ineffective. There are also other health hazards associated with smoking, including poisoning and the increased risk of fire.

Northamptonshire County Council ('the Local Authority') are moving towards a position where children and young people in care are placed in smoke-free homes. It is acknowledged that expecting all foster carers who currently smoke to suddenly give up is not realistic, and it is acknowledge that some foster carers who smoke have recognised sufficiently the needs of the children and young people for whom they care and are already minimising the impact of their smoking on the children that they foster.

The Local Authority will ensure that recruitment and retention processes address the issue of smoking in a robust and open manner. This procedures sets out the action that will be taken to achieve this.

2. Assessment

Smokers should not be denied the opportunity to foster but there can be long-term health and social (and possibly legal) implications for the child or young person in their care who has been exposed to second-hand smoke, or who comes to regard smoking as the norm. 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 some young people from starting smoking. Providing positive non-smoking role models and support to stop smoking can help them quit.

Thus, all new carers and existing carers who smoke must be provided with verbal information and encouraged and supported to give up smoking. There is a range of organisations to which carers can be referred and there is a wealth of guidance about how to minimise children's exposure to smoke.

It follows then that the assessment of new carers who smoke and the supervision of existing smoking carers must take account of their attitude and willingness to work with the agency on this issue. Guidance and support however must be seen as an interim measure as we work towards what BAAF describe as "a position where no more smoking carers are recruited".

3. Policy Statement

Northamptonshire County Council will ensure that recommendations contained in CoramBAAF practice note 68 are fully implemented for all children. Essentially, the main good practice points are:

  • All carers should be encouraged to implement a smoke-free home;
  • Homes should be smoke free;
  • If carers or visitors do smoke, they should do so right away from the house. This includes the use of e-cigarettes;
  • Carers should not smoke in presence of children and should not allow others to do so;
  • Childcare social workers should request that birth family members do not smoke at or immediately prior to contact visits;
  • All children with a disability, respiratory problems such as asthma, and those with heart disease or glue ear should not be placed with smoking families;
  • Children less than five years old will not be placed with carers who smoke;
  • In all long-term fostering placements, the additional health risks to children being placed in a smoking household needs to be carefully balanced against the available benefits of the placement to the child. (This is because the significant risk of exposure to passive smoking increases with time);
  • Carers who have successfully given up smoking should not be allowed to foster those children identified in points 2 and 3 till they have given up smoking for at least 12 months (This is because after 12 months most people with be permanent non-smokers).

A possible exception to these timescales can be made for kinship carers. Kinship carers should be:

  • Advised about the health risks of smoking and second-hand smoking;
  • Encouraged to implement a smoke-free home and car;
  • Encouraged to give up smoking;
  • Signposted to local smoking cessation services and encouraged to use nicotine replacement products;
  • All children and young people who smoke should be provided with support to give up smoking. All carers should be made aware that it is illegal to purchase cigarettes or e-cigarette for under 18 year olds. Cigarettes and e-cigarettes should not be used a reward for good behaviour;
  • The supervising social worker will provide carers who smoke with a copy of the Fire Safety in the Home (fire safety) Guide about the risks fires from smoking
    (A copy of the guide is available from the Local Resources);
  • E-cigarette liquid should always be kept out of reach of children. There is a risk of poising from e-cigarette and this can be serious if large amounts are swallowed;
  • The service believes that a smoking environment should be avoided in the best interests of children who are placed away from home;
  • The service is working towards a position where no looked after child will be living in a smoking household;
  • Smoking habits will be considered in any assessment process, in supervision sessions, and for foster carers, at the annual review of registration and approval. Northamptonshire foster carers will be actively encouraged to engage in a smoking cessation programme, with the aim of giving up smoking within 12 months of their approval;
  • It is illegal to smoke in private vehicles where a person under the age of 18 is present in the vehicle.

Currently approved carers who smoke will be encouraged to create a smoke-free home. Carers will also be advised to restrict their smoking to certain areas of their house and to ensure that children play, eat and sleep in smoke-free rooms and are not exposed to excessive smoking when visiting friends and relatives of the carers, or when smokers visit the home.

4. Supervision of Carers who Smoke

Foster carers' household rules (safer caring policy) should include expectations about smoking and that these should be made clear to children and young people (age appropriately) on placement – see Behaviour Management and Safe Caring Procedure, Minimum House Rules.

Supervision sessions provide a valuable opportunity to reinforce the service's expectations about smoking. It may be that smoking is a response to stress and this will need to be explored. Carers should be supported to manage stress in safer ways such as through relaxation and so on. Thus the service, as well as promoting smoking cessation, should additionally provide a signpost and support to alternative ways of managing stress.

The Smoking Risk Assessment must be completed.

5. Caring for Young People Who Smoke

Foster carers are encouraged to have house rules which actively discourage smoking. It may be helpful to have a house rule of no smoking indoors. This should help restrict smoking without making it a source of conflict in the household. House rules regarding smoking must apply to everyone, including guests. It is important that foster carers are informed of the following:

  1. No child/young person under the age of 18 years old is legally allowed to buy tobacco products in the UK. This restriction applies to e-cigarettes and associated products;
  2. No child/young person under the age of 18 years old is legally allowed to smoke tobacco products. This restriction does not apply to e-cigarettes;
  3. Foster carers caring for a child/young person who smoke under the age of 16 years cannot give permission or condone the action. Carers must actively encourage the child/young person to stop and, where possible, insist that the child/young person smoke away from the property. Carers must inform their Supervising Social Worker and the child's social worker, if social workers are not aware;
  4. Cigarette, tobacco, e-cigarettes and associated products must not be bought or offered to children / young people;
  5. Cigarette, tobacco, e-cigarettes and associated products must not be used as a reward or punishment to children / young people.

Foster carers must advise and inform children/young people of the health risks associated with smoking and other consequences of becoming addicted.

6. Family and Friends Foster Carers

When assessing family and friends as foster carers for a specific child, there are particular issues to consider if the applicants are smokers. As with any potential carers who smoke, every effort should be made to encourage them to give up and to create a smoke free home for the fostered child.

However, any risks to the health of a child resulting from such a placement will need to be weighed against the potential benefits to a child of being placed with people who are part of their family (or friends) and with whom they have a pre-existing bond. Children generally have better outcomes in such placements and an assessment will need to be made in each case as to whether the best interests of an individual child would be served by living with family and friends carers, even where there may be some doubt as to their ability to provide a smoke-free home for that child.

On-going work would be needed to ensure that smoking was restricted as far as possible from the areas of the house that, particularly, a child under the age of five was accessing.

It is illegal to smoke in private vehicles where a person under the age of 18 is present in the vehicle.

Northamptonshire foster carers will be actively encouraged to engage in a smoking cessation programme, with the aim of giving up smoking within 12 months of their approval.

7. Smoking Policy Agreement

All smokers and users of e-cigarettes over the age of 18 years in the household must read and sign (thus agreeing to adhere to) the Family Smoking Policy Agreement prior to placement.

8. Smoking Cessation Advice

Foster carers should be directed to their General Practitioner (GP). Advice and support is also available from the NHS Smoke Free advice line on 0800 022 4332, NHS advice website at www.nhs.uk/smokefree, or a Local Stop Smoking Service.