Protecting Children from the Harmful Effects of Second-hand Smoke (Prospective Adopters)

Children's Services act 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;
• Impact on time missed from school due to ill health,

The Fostering and Adoption Services 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.

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.

The Fostering and Adoption Services 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. Not only will this improve the health of children, but it will also protect agencies from potential legal action in the future.

"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 the relevant Children's Service Manager/Group Head.

The Fostering or Adoption Panel will need to see evidence that the Smoking Exemption has been signed ( the Smoking Exemption can be located on the case file and is a Mosaic episode) 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 sent a leaflet about smoking in the information pack and will be encouraged to consider seeking support via their GP or a smoking cessation programme to stop smoking.

The Declaration of Health used by both Fostering and Adoption includes a smoking questionnaire to seek information about the smoking behaviour of the applicants, other household members and regular visitors to the home.

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.

At enquiry stage all prospective foster carers and adopters will be provided with a copy of a leaflet entitled 'Top Fire Safety Tips'. This will be discussed as part of the health and safety check.

Foster carers will complete an annual Declaration of Health (including the smoking questionnaire) and their smoking habits will be considered at their annual review of registration.

The Smoking Exemption will be incorporated into the Foster Carer Agreement, which is signed annually.

Where prospective adopters 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.

All enquirers who contact the Fostering and Adoption Services 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. They should also be informed that:

• A leaflet about smoking is included in the information pack sent to all enquirers;
• A smoking questionnaire forms part of the Declaration of Health;
• If their application is accepted, they will be required to sign a Smoking Exemption if they are unable or unwilling to stop smoking, or another household member or regular visitor to their home is a smoker.

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.

An information pack will be sent to enquirers. The inclusion of a smoking leaflet entitled 'Smoking advice for prospective foster carers and adopters' (see Appendix B) in every pack avoids discrimination and also covers situations where enquirers themselves may not be smokers, but other members of the household, or regular visitors to their home do smoke.

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.

The Smoking Exemption will be incorporated into the Foster Carer Agreement, which is signed annually.

Foster carers complete a Declaration of Health each year as part of their annual review of registration. Any changes in smoking behaviour or health should be considered at the review.

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.

Please refer to Appendix 1: Copy of Leaflet 'Smoking advice for prospective foster carers and adopters'

The use of electronic cigarettes (e-cigarettes) is now a growing phenomenon. These are battery operated devices that provide a nicotine delivery system which does not contain tobacco. The most recent evidence suggests that they are effective in helping people to stop smoking, and that they are unlikely to be taken up by those who are non-smokers.

Electronic cigarettes produce a vapour, but there is no evidence to date that second hand vapour is harmful to human health. E-cigarettes play a role in reducing tobacco smoking levels nationally, and they could be a useful aid to foster carers who may wish to use them to cut down or stop tobacco smoking. The use of e-cigarettes imitates smoking behaviour by mimicking the sensation and appearance of smoking a cigarette for the user and for those around them. There are some concerns that this may ‘normalise’ smoking behaviour, making it more acceptable especially to children and young people.

Whilst current research evidence suggests that the use of electronic cigarettes is effective in helping people to stop using traditional tobacco cigarettes, there is little to suggest that it is encouraging smoking. The Fostering and Adoption services are therefore following The Fostering Network’s guidance, which 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 we advise it is good practice not to use them 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. We endorse the content of the briefing paper produced by ASH (Action on Smoking and Health) and the Fostering Network (July 2014) Foster Care, adoption and electronic cigarettes which gives a comprehensive overview of the topic and is an aid to policy development.

In addition, as a general rule we will not place children under 5 years old with carers who use E-cigarettes.

Please refer to:

• Appendix 2: Copy of Fostering Network Position Statement on Smoking and the use of E-cigarettes;
• Appendix 3: Copy of ASH Foster Care Briefing Paper.

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.

No child/young person under the age of 18 years is legally allowed to buy tobacco products (UK law) or legally allowed to smoke tobacco products (UK law).

Carers must never buy 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.

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.

They should support carers in ensuring that young people have access to information and services to help them to stop smoking.

social workers must never smoke in the presence of, or in view of, children and young people or buy 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 case conferences or reviews.

Appendix 1: Copy of Leaflet 'Smoking advice for prospective foster carers and adopters'

Appendix 2: Copy of Fostering Network Position Statement on Smoking and the use of E-cigarettes

Appendix 3: Copy of ASH Foster Care Briefing Paper