Smoking Policy for the Adoption Service and Fostering Service

1. Introduction

Children's Services acting as the corporate parent for Looked After Children has a duty to promote the health and well-being of those children. Many come into the care system with impaired or neglected health as a result of their previous experiences. It is important to place them with carers who will be able to promote their health and model a healthy lifestyle.

Children are particularly vulnerable to the effects of second-hand smoke because:

• They are often unable to remove themselves from a smoky home environment because of their age;
• If children are younger or have a disability, they are likely to spend most of their time in close proximity to a carer or parent;
• The lungs, airways and immune systems of young children are not fully developed and are therefore more susceptible;
• Their respiratory rate is higher than an adult's so they breathe in more harmful chemicals, per pound of body weight, than an adult would in the same period of time.

The Adoption Service and Fostering Service are committed to following a shared policy on the placement of children in smoking households, to ensure that no Looked-After Child will be placed with a smoking family unless exceptional circumstances apply. This means not only following a consistent approach when receiving enquiries from potential foster carers or adopters, but also having an agreed position in terms of existing foster carers and prospective adopters who are smokers.

2. Context

The National Minimum Standards for Fostering Services (England) 2011 emphasise the importance of health promotion awareness for foster carers both in relation to their own health and that of the children in their care.

Adoption agencies are unable to impose "blanket" bans when considering applications from prospective adopters. Nevertheless, it is essential that smoking should be discussed with enquirers and that they should be made aware of the implications of smoking for their own health and that of a child.

Enquirers for both fostering and adoption should be made aware of the limitations that smoking will place on them, particularly in terms of the age of child they might be considered for, but also in relation to certain health needs or disabilities.

3. Policy

Both the Adoption Service and Fostering Service are committed to ensuring that no Looked-After Child, and particularly a child under 5 years, are placed within a smoking household unless exceptional circumstances apply. This also applies to the use of e-cigarettes. Not only will this improve the health of children, but it will also protect agencies from potential legal action in the future. Both the Adoption Service and Fostering Service operate a 'no smoking in the house' policy. If there are smokers in the household, they need to smoke in a designated area away from the home.

"Exceptional circumstances" refers to a situation where the child's other identified needs are well met and there is no alternative family available. A decision to place a child in a smoking household must be ratified by one of the Fostering / Adoption Practice Managers.

The Fostering or Adoption Panel will need to see evidence that a Smoking Agreement has been signed and have confidence that the family will honour the terms contained therein.

Children with respiratory or cardiac conditions, middle ear problems or a disability such as Down's Syndrome or Cystic Fibrosis will not be placed with a smoking family unless there are exceptional circumstances.

All older children, who are able to express a view, must be given a choice to be placed with a non-smoking family wherever possible.

Enquirers for both Fostering and Adoption will be encouraged to consider seeking support via their GP or a smoking cessation programme to stop smoking.

Foster carers and prospective adopters who stop smoking (e.g. in order to be able to consider younger children) will only be regarded as "non-smokers" once they have not smoked for 12 months. This is because relapse rates are high within the first three to six months; lower after six months, but significantly reduced after 12 months.

Where prospective adopters / foster carers have an annual review of approval, health issues (including smoking) will form a part of this.

Children and young people who smoke will be given information about the health risks associated with this and encouraged to access support to stop smoking.

Social workers also act as role models for children and young people in care. They should therefore, carefully consider the importance of promoting non-smoking and the positive messages that they convey to young people.

4. Enquiries and Applications from People who Smoke

All enquirers who contact the Fostering or Adoption Service should be welcomed and treated with courtesy and respect. If, in the course of the initial contact, it becomes clear that the enquirer is a smoker, they should be made aware of the existence of a smoking policy.

It should be made clear to enquirers that although smoking will not automatically bar them from making an application, it may seriously restrict the resource they are able to offer. In particular they will not normally be considered for children under 5 years or children with certain health needs or disabilities. In addition, children who come from non-smoking birth families and children who express a wish to be placed in a non-smoking household will not be placed with them, as far as this is possible to achieve.

The initial visit to potential foster carers or adopters should include a discussion about smoking.

The social worker and manager will need to make a decision about whether or not to invite the enquirer to make a formal application. Whilst a number of factors will be considered, the enquirer's attitude towards smoking and their willingness to address this will be one important element. Adopters / foster carers will need to be advised to buy e-cigarettes only from reputable outlets, only use the correct chargers for the advise and not to leave an e-cigarette charging unattended or overnight. This is because poorly made or counterfeit chargers have caused house fires. Adopters / foster carers will also need to be provided with additional information about the risks of burns and fires from smoking.

Assessment Process

As part of the assessment, smoking habits will be addressed, along with other health issues. Where applicants for fostering or adoption are smokers who are unable or unwilling to stop smoking, or where other members of their household or regular visitors to their home are smokers, a Smoking Agreement must be discussed with them during the assessment process. An agreement should be signed before the application is taken to Fostering or Adoption Panel, and a copy made available to the Panel hearing the application. Agreements will be drawn up on an individual basis to meet the circumstances of the carers. If an adopter / foster carer smokes, the Health and Safety check will need to ensure e-cigarette liquid is always kept out of reach of children as there is a risk of poisoning from e-cigarette liquid as this can be serious if large amounts are swallowed.

When proposing a placement, the supervising (fostering) social worker or adoption social worker should revisit the health and safety check undertaken during the assessment to ensure that any work or changes identified have been implemented.

5. Current Carers or Prospective Adopters who Smoke

Prospective adopters have an annual review up to the point where a child is placed with them. Any changes in their health (including smoking) will form part of this review. Adoption medicals are also updated every two years. Foster carers have an annual review.

6. Children and Young People who Smoke

This section is mainly relevant to foster care, given that children placed for adoption are usually younger and are unlikely to have started smoking. However, on the rare occasions that an older child who smokes is placed for adoption, the following guidance would equally apply.

Where children are already smokers every effort should be made by carers, in liaison with health professionals, to ensure that they are fully aware of the health risks associated with smoking. Carers should be equipped by the agency to offer appropriate advice to children and young people who smoke. The aim should always be to discourage smoking.

Carers must never buy cigarettes or e-cigarettes for children and young people in their care, and cigarettes must never be used as a reward for good behaviour. Carers' household rules should include expectations about smoking and these should be made clear to young people on placement.

7. The Role of Central Bedfordshire Council (CBC)

Professionals act as role models for children and young people in care. They should therefore, carefully consider the importance of promoting non-smoking and the positive messages that they convey to young people. They should support carers in ensuring that young people have access to information and services to help them to stop smoking.

Professionals must never smoke in the presence of, or in view of, children and young people or buy cigarettes or e-cigarettes for them. They should not smoke in a car which will be used later to transport a child or young person. They should not smoke outside Child Protection Conferences or reviews, or before any other meeting or share lighters etc. They should be aware that witnessing cigarette smoking or E-cigarette usage may influence children.

Although there is a Government ban on smoking in public places, smoking in the home has a significant impact on the health of smoking and non-smoking members of the household. Therefore, if anyone in the household does smoke, CBC's policy should be adhered to. Children are particularly vulnerable and the local authority, acting as the corporate parents for children in our care, has a duty to promote every aspect of their welfare, including their health. People who apply to be foster carers or adoptive parents should be fully aware of:

• The risks associated with smoking;
• The position of the local authority; and
• The implications for any application to be considered as a carer for children, whether temporary or permanent.

Some facts about smoking:

• Tobacco smoke contains a mixture of around 4000 chemicals, many of which are poisonous and cause cancer and heart disease;
• Second-hand smoke is even more toxic than the smoke which goes directly into the smoker's lungs;
• If you're breathing second-hand smoke at home or work, your chances of developing asthma are doubled, your risk of developing lung cancer is increased by 24% and the risk of heart disease is increased by 25%;
• Children who live with smokers are much more likely to become smokers themselves.

Our position on smoking:

We are committed to reducing the level of smoking in Central Bedfordshire and protecting non-smokers from the damaging effects of second-hand smoke. One important aspect of this is to encourage and support smokers who want to give up and to promote local "stop smoking" services.

What are the Main Concerns in Relation to Fostering and Adoption?

1. Carers who smoke are damaging their own health and potentially compromising their ability to actively parent the child. This is of particular concern for a limited number of foster carers and all adopters who are providing a permanent home for the child. Children who have experienced many losses in their lives may be faced with the premature loss of another parent figure as a result of smoking related disease, disability or death;
2. Carers who smoke are damaging the health of children in their care. 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 the first year of life;
   • Off sick from school more often;
   • More likely to get more coughs, colds and wheezes;
   • At greater risk of getting "glue ear", which can lead to deafness.
3. Adult carers act as role models for their children. Children who live with smokers are much more likely to become smokers themselves, with all the health risks that this poses. Smoking is a difficult habit to break, so it is important to encourage children never to start.

What if I Only Smoke at Work / in the Car / Outside / in Another Room?

You might think that smoking at work - if you're still allowed to do it! - deals with the second-hand smoking issue. However, the smoke on your clothes that you take back into the home still contains poisonous chemicals which can affect the health of those who breathe it in. The same is true if you smoke in the car, outside or in another room. It is impossible to cancel out the damaging effect of smoke which hangs around on your clothes, or drifts into the house or another room and, of course, in all these situations the risk to your own health is still present.

So Should I Stop Smoking to Foster or Adopt?

Ideally, yes - for your own health's sake and for the welfare of the child who would be placed with you. We will raise this with you at the outset and hope that you will be open with us about your smoking. Government statistics suggest that 70% of smokers wish to give up. If you're one of them, we can point you in the direction of services which might help you achieve this. Your GP is the first port of call. Most people find that it is quite difficult to simply stop smoking, and many are more successful if they have some support and encouragement.

If you are unable to stop smoking or have no wish to stop, this will not mean an automatic ban on becoming foster carers or adopters. We look at many factors, health and other wise.

Realistically, however, smoking will restrict the number of children we could consider placing with you. Because of this we would need to decide whether we were justified in taking up an application from you. Our focus must be on the child and we are legally obliged to make them our first and foremost consideration.

Medical advice is that children under 5 years should not be placed within a smoking household, nor should children who have:

• Asthma or other breathing difficulties;
• Heart conditions;
• Middle ear / glue ear problems;
• A disability such as Down's Syndrome or Cystic Fibrosis;
• Been born prematurely;
• A family history of asthma.

From these examples, you can see that if you are committed to fostering or adoption you would be well advised to first commit yourself to stop smoking. Generally speaking, medical advisers expect to see that applicants have not smoked for at least twelve months before they consider them to be "non-smokers".

The rules outlined above in relation to fostering and adoption will also apply to E-cigarette use for the reasons outlined below:

E-Cigarettes

E-cigarettes are battery-powered products that typically look like real cigarettes; others look like items (e.g. pens and USB memory sticks). Each e-cigarette consists of a cartridge of liquid nicotine, the atomizer (or heating element), a rechargeable battery, and electronics. They turn nicotine, flavour and other chemicals into a vapour that is inhaled by the user. The exhaled vapour can be seen and the tip of the e-cigarette has a light emitting diode (LED) which lights when the user inhales, resembling a real cigarette. Users are therefore modelling smoking to children and young people in much the same way as they would with normal cigarettes.

The latest Public Health England report, which states that "the hazards associated with use of products (e-cigarettes) currently on the market is likely to be extremely low, and certainly much lower than smoking" and as a result BAAF and other organisations are updating their recommendations about e cigarettes.

The Health Group Advisory Committee (HGAC) will be recommending that agencies now consider e-cigarettes as different to tobacco cigarettes.

The welfare of children is our primary concern and the long term impact of e-cigarettes is unknown. Whilst e-cigarette use as a substitute for tobacco smoking is likely to pose a much lower level of risk to the health of the individual who switches, the evidence does not confirm that they are completely safe. We will continue to monitor research into e-cigarettes and will continue reviewing our recommendations in line with latest research.

How to Get Help to Stop Smoking:

If you want to stop smoking it is important that you first seek advice from your GP who will be able to discuss how you might approach this and also give you information about local support groups.

You may also find the following phonelines and websites helpful:

• NHS Smoking Helpline:
  0800 169 0 169 (freephone)
  0800 169 0 171 (textphone)
• NHS Asian Tobacco Helpline:
  0800 169 0 881 (Urdu)
  0800 169 0 882 (Punjabi)
  0800 169 0 883 (Hindi)
  0800 169 0 884 (Gujarati)
  0800 169 0 885 (Bengali)
• Go Smoke Free website;
• Text GIVE UP with your full postcode to: 88088;
• NHS "Stop Smoking" Services across Central Bedfordshire.