For prospective and approved foster carers
Promoting positive good health for children, young people and their carers
1. Introduction
1.1 Coventry City Council has a duty to ensure positive health outcomes of all looked after children and their carers and in doing so must continue to keep the welfare of the child as paramount. We aim to provide a safe, loving and positive environment for all children and young people in our fostering placements.
1.2 The adverse effects of smoking on health are now widely known and acknowledged. There is now clear evidence of the link between secondhand or passive smoking and diseases in children such as cot death, middle ear disease and asthma.
1.3 The Coventry City Council Fostering Service provides the following policy and guidance for foster carers on tobacco and e-cigarette/vape smoking and related health issues in relation to the care of Looked after Children and Young People.
1.4 The Service is looking to ensure that fostered children are provided with a healthy, nurturing and safe environment where the risks associated with smoking are minimised. The aim is that every child is placed in a smoke free home, regardless of whether the foster carer is a smoker or non-smoker.
1.5 The aim is to promote the health and wellbeing of children and young people who are Looked After and accommodated, whilst at the same time ensuring that as a wide a choice of placement, as possible, is available to meet the needs of children and young people from 0 – 18 years.
1.6 Children under 5 and children with conditions that are negatively impacted by smoking will not be placed with foster carers who smoke, unless there are over-riding circumstances related to the child’s interest. If this is the case, the reasons must be clearly recorded in the placement plan 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.
1.7 For connected persons carers the health risk posed to the child should be balanced with the potential benefits of being placed with a family member or friend.
1.8 This policy is to be shared with approved foster carers and applicants who wish to be assessed to foster for Coventry City Council. The policy and its expectations will be monitored during supervision sessions by the foster carer’s Supervising Social Worker.
2. Approval of Foster carers who smoke
2.1 Coventry City Council will not recruit any new foster carers who smoke or live in a smoking household for children under the age of 5 years, or children with conditions that are exaggerated by a smoking environment. A smoking household is a household where any member of the household smokes.
2.2 Household members will need to have stopped smoking for a period of 12 months before they can be considered as a non smoker.
2.3 Carers who smoke will be encouraged to create a smoke-free home. Carers will be advised to smoke only in outdoor areas of their home and to ensure that children play, eat and sleep in smoke-free rooms. Carers will also be advised to avoid children being exposed to passive smoking when outside the home and to ask visitors to their home to smoke outdoors.
2.4 Carers who smoke will be advised of measures to further reduce the risks of passive smoking for younger children and those with particular health conditions e.g. reducing contact with clothing which has been worn whilst smoking and washing hands after smoking.
2.5 All prospective and approved foster carers will be provided with information as to where they can access help and support to reduce or give up smoking.
2.6 It is strongly advised that carers do not smoke in front of children and young people.
2.7 Carers will be expected not to advocate smoking for children, for example, by ensuring that they do not provide cigarettes or tobacco and ensuring that any cigarettes and lighters are kept securely away from children. Carers need to be mindful that their behaviour provides a role model for the children in their care and to consider the effect of smoking on children.
2.8 Foster carers must not smoke in their car prior to, or when transporting looked after children. It is illegal to smoke in private vehicles which are carrying someone under 18 years of age.
2.9 When a prospective carer who smokes applies to foster, the assessment will include focus on what changes can and will be made as part of this process and the outcome recorded. This information will be presented to and considered by the fostering panel as part of the approval process.
2.10 Smoking will be considered in any future assessment processes, during supervision sessions and at the carers’ yearly review of registration and approval.
2.11 If foster carers do not adhere to this smoking policy, Coventry City Council’s procedure for dealing with; ‘standards of care’ will be followed.
3. Use of E-cigarettes/vapes
3.1 E-cigarettes/vapes are not tobacco cigarettes. The use of them has become more widespread in recent years and can provide a route for smokers to help them reduce or give up smoking. Such products have been developed more recently and due to this the evidence about their use in terms of effects of health continues to evolve. Public Health England reports, published in 2015 and updated in 2018, concluded that e-cigarettes are significantly less harmful than tobacco, whilst acknowledging that they are not completely risk-free products (McNeill et al (2015, 2018) cited in Coram BAAF Practice note 68). This is also stated by NICE (National Institute for health and Care Excellence) in 2018, who add that the evidence in this area is still developing including evidence on the long-term health impact of users.
3.2 There is relatively limited evidence about the potential of e-cigarettes/vapes and the toxins that may pollute the air. More studies are needed to understand the impact of exposure of e-cigarette/vapes vapour, particularly in the long-term for both users and bystanders (See Cancer Research UK – Smoking facts).
3.3 As a result of the limited research, the use of e-cigarettes/vapes will be in line with Coventry City Council’s current smoking policy (see above).
3.4 The fostering service will raise the issue of the use of electronic cigarettes with all applicants who wish to foster as part of their assessment and preparation training. This is to ensure they understand the impact of smoking behaviour on children and young people and the expectations of the fostering service.
3.5 The fostering service will raise the issue of the use of electronic cigarettes with approved foster carers who use these devices at every yearly review.
3.6 E-cigarettes could be a useful aid to foster carers who wish to cut down or stop smoking.
3.7 Foster carers need to adhere to health and safety protocols around the safe storage of nicotine containing products e.g. cigarettes, electronic cigarettes, e-liquids, gum, tablets, patches and sprays to remove any risk of exposure to children.
4. Young people in care
4.1 In line with the Law, the minimum age for smoking is 18 years. No young person under the age of 18 years should be permitted to smoke.
4.2 Not all young people will smoke, and some may have a period of just trying it but they can quite quickly become reliant on cigarettes. This guidance applies to the use of tobacco as well as e-cigarettes/vapes.
4.3 Where young people who already smoke come into foster care, they will not be permitted to smoke in the carer’s home. Smoking by young people will be restricted to the garden or outside areas. Rules about when, where and by who smoking is allowed should be made clear by the carer.
4.4 Foster carers must not purchase cigarettes or tobacco for the young person. It is illegal; for retailers to sell e-cigarettes/vapes or e-liquids to someone under the age of 18 years; for adults to buy (or try to buy) tobacco products or e-cigarettes/vapes for someone under 18. Foster carers must never buy cigarettes or materials used for smoking for children/young people in their care and cigarettes must never be used as a reward for good behaviour.
4.5 Children and young people should be supported to make healthy choices in how they live their lives. Foster carers should always advise and inform the young person of the health risks associated with smoking.
4.6 It is good practice not to use e-cigarettes/vapes 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 and on the impact of e-cigarettes/vapes on health.
4.7 If a young person in their care needs support to reduce or stop smoking this should be raised with either the fostering social worker or the young person’s social worker or during their health assessment, where the young person can be signposted to the relevant health services and advice.
5. Supervision of Foster Carers who smoke
5.1 The Fostering Network advises that foster carers' household rules (safer caring statement) should include expectations about smoking and that these should be made clear to children and young people (age appropriately) in their care.
5.2 Supervision sessions provide a valuable opportunity to reinforce the fostering 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.
6. Further help
References and useful websites - links to key documents and references:
- ASH: Second Hand Smoke (Feb 2014)
- ASH: Second-Hand Smoke - The impact on children (Mar 2014)
- ASH & The Fostering Network: Foster care, adoption and smoking (Jul 2014)
- ASH & The Fostering Network: Foster care, adoption and electronic cigarettes (Jul 2014)
- Borland, R: Electronic cigarettes as a method of tobacco control, British Medical Journal 2011; 343
- BMA: Breaking the cycle of children’s exposure to tobacco smoke (2007)
- BMA Board of Science: Growing Up in the UK - Ensuring a healthy future for our children (May 2013)
- Children and Families Act (2014)
- Children Act 1989 Guidance and Regulations Volume 4: Fostering Services (2011)
- Children and Families Act 2014 – Part 5 (91,92) Tobacco, nicotine products and smoking
- Department of Health Guidance - New rules about tobacco, ecigarettes and smoking: 1 October 2015 (July 2015)
- Fostering Regulations (England) (2011)
- Fostering Services: National Minimum Standards (2011)
- Health Act 2006
- Public Health England: Electronic cigarettes (2014)
- Public Health England: E-cigarettes - an evidence update (Aug 2015)
- Royal College of Physicians: Passive smoking and children. London, RCP (2010)
- The Smoke-free (Premises and Enforcement) Regulations 2006
- Wagener, T. Siegel, M. & Borrelli, B. Electronic cigarettes: Achieving a balanced perspective. Addiction, 2012; 107: 1245–1548