Family Placement and Smoking Policy

This policy applies to both prospective and existing Foster Carers.

One of the five key outcomes for children and young people is: "Be healthy". The aspiration is that children and young people should develop healthy lifestyles and opportunities to achieve optimum health and well-being within the context of high quality preventive and treatment services. 

There are specific health objectives for children looked after by local authorities. Local authorities and Integrated Care Boards are required to ensure that Children in Care enjoy a standard of health and development as good as all children of the same age living in the same area. 

City of Doncaster Council is committed to achieving these objectives, in partnership with the Integrated Care Board.

The 1989 Children Act requires that the wellbeing of Children in Care is safeguarded and promoted. The physical, emotional and health needs of each child are to be identified and appropriate action taken to secure the medical, dental and other health services needed to meet their needs.

Good practice guidance has outlined the need for clear policy with regard to the issue of smoking in relation to the assessment of potential carers.

It is important that Foster Carers are assessed without prejudice.

Smoking is one of the factors considered within the health report/medical assessment of Foster Carers in Doncaster.

• In view of the risks to health for children aged under 5 years old, for those with physical conditions which adversely affect their breathing, those with glue ear and children with heart disease - such children will not normally be placed with Foster Carers where the carers or other members of their household smoke, other than in exceptional circumstances;
• At all times the welfare of the child or young person is paramount;
• Disabled Children and young people have the same rights as all other children and young people;
• All applications will be treated individually, on a case-by-case basis, regardless of whether or not the applicant/s or carers smoke;
• Children, young people, and their parents have individual values and beliefs and a right to their own views and preferences. These rights are acknowledged and respected within legal and professional boundaries;
• Potential Foster Carers should receive information, advice and counselling about any smoking behaviour at an early stage of an application.

There are well-documented adverse health effects from smoking and these are not only for smokers but for those affected by "passive" smoking. Adverse effects have been known for many years but a number of studies have demonstrated the effects of smoking on young children:

• Compared to those infants whose mothers do not smoke, the infants of smoking mothers have almost 5 times the risk of dying from Sudden Unexpected Death in Infancy (often called 'cot death');
• Lower respiratory tract infections (pneumonia and bronchitis) in pre-school children occur more frequently if a parent smokes; 
• Asthma and respiratory infections in school-age children are more common in a smoking household;
• Parental smoking is responsible for a 20 - 40 percent increased risk of middle-ear disease in children. This is associated with hearing loss, a need for surgery, secondary speech delay, schooling difficulties and social isolation;
• In the UK, 17,000 children under the age of 5 years are admitted to hospital every year with illnesses resulting from passive smoking.

Additionally:

• Children with breathing difficulties and specific medical conditions as a result of an underlying medical condition are more likely to be particularly vulnerable and experience an exacerbation of their condition as a result of exposure to cigarette smoke.

There is, therefore clear evidence that cigarette smoke is harmful to young children, to those with breathing difficulties and other medical conditions.

Additionally, as children copy the behaviour of adults it means that "growing up in a household where adults smoke often means that children perceive smoking as the "norm".

As assessments will be dealt with on a case-by-case basis it is important that each and every prospective assessment is considered on its merits. It is important to balance positive qualities of prospective Foster Carers who smoke against the adverse effects of smoking upon children. Prospective carers should not be given the impression if they smoke that they will automatically be excluded from fostering. Primary consideration will be given to the welfare of the child and smoking, whilst not a debarring factor to fostering, is an important factor which is considered. Smoking should be covered at an early stage with prospective carers. The discussion should centre on the following:

• Doncaster’s policy on smoking states "that unless there are exceptional circumstances a child aged under 5 years of age, children with breathing difficulties and certain medical conditions will not normally be placed with carers who smoke/where others within their household smoke";
• The known effects of smoking on young children, children with breathing difficulties and certain medical conditions; 
• How the effects of smoking on long-term health might influence an assessment and a recommendation for approval as a Foster Carer;
• The need of Children's Services to treat the welfare of each child as paramount and to select the best possible placement available to meet each child's needs. It should be noted that in considering placement of a child, the child's best interest is served throughout life by selecting from available and equally suitable applicants/carers who do not smoke;
• The extent of their smoking/the smoking of others within their household and how it is managed within the home. This should include any arrangements that have been made and family routines, to minimise the risks of passive smoking to other members of the household;
• Their intentions or otherwise regarding stopping smoking. If they wish to stop smoking they should be advised of some of the avenues of support available to them including their GP and Doncaster SmokeFree. Where prospective carers/carers require counselling about their health they should be referred to appropriate health professionals.

Where it appears that a Foster Carer's smoking and the needs of children to be placed are incompatible it may be appropriate for a brief /Foster Carer's report outlining the issue to be placed before the Fostering Panel (as an early consideration item). If this is the case the Social Worker should consult with the Line Manager. It may be appropriate to seek the advice of the Panel's Medical Advisor, Legal Advisor or both.

Subject to subsequent recommendations of the Fostering Panel and Agency Decision Maker's decisions, staff considering potential matches will evaluate all relevant factors when considering which placement can meet a child's needs. An assessment of each child's individual needs will form the basis for such consideration. The potential for harm as a result of exposure to passive smoking will be one of the elements for consideration.

Although children aged under the age of 5, children with breathing difficulties and certain medical conditions will not normally be placed in an environment where they may be exposed to passive smoking, there may be exceptional circumstances which would warrant such a placement. Such situations may include a child being placed with a relative or with siblings.

Where such a child is placed with prospective carers who smoke or where another member of their household smokes, the reason/s for this should be recorded and placed on the child's record. The views of the child's parents must also be sought when making such a placement and their support for such a placement, or otherwise, should be clearly recorded.

Where Foster Carers are subject to review, the implications of the Policy should be discussed with approved carers who smoke or where another member of the household smokes, see Review and Termination of Approval of Foster Carers Procedure. The approved carers will need to understand the significance of the Policy to their approval and have the opportunity to fully explore those matters outlined in Section 4, Advice to Foster Carers.

The outcome of the discussion will inform the report to the Fostering Panel. Where they are currently registered to take children aged less than five years of age the issue should be highlighted within the report for the Fostering Panel.