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Intimate Care Policy

Policy details

Date created - 22/07/2025
Date approved by Trust Board- 10/07/2025
Next review date - 10/07/2027
Policy owner - Co-op Academy Brownhill

Rationale

This policy gives clear guidance and support to all staff who may provide intimate care to children and young people on how to provide this care appropriately whilst safeguarding the child or young person, and the staff involved.

Purpose

The purpose of the policy is to:

uphold pupils’ rights to privacy and dignity
identify situations which have elements of close personal/intimate contact
recognise the responsibilities of adults involved and to assure parents and carers that staff are knowledgeable about the needs of their children and that they are taken into account
safeguard pupils and adults
ensure consistency of action whilst being sensitive to individual need
encourage independence and choice for pupils
maximise learning opportunities
ensure that pupils who require intimate care are not discriminated against, in line with the Equality Act 2010
ensure staff carrying out intimate care work do so within guidelines (i.e. health and safety, manual handling, safeguarding protocols awareness) that protect themselves and the pupils involved.

This policy should be read in conjunction with the following policies

Child Protection and Safeguarding Policy
Manual Handling Policy
Staff code of conduct
Guidance for safer working practice
Special Educational Needs & Disability policy
Supporting children with medical needs in school policy
RSE Policy

We are committed to ensuring that all staff responsible for the intimate care of children and young people will undertake their duties in a professional manner at all times. It is acknowledged that these adults are in a position of great trust.

We recognise that there is a need to treat all children and young people, whatever their age, gender, sex, disability, religion, ethnicity or sexual orientation with respect and dignity when intimate care is given. The child’s or young person’s welfare is of paramount importance and their experience of intimate and personal care should be a positive one. It is essential that every child or young person is treated as an individual and that care is given gently and sensitively.

Staff will work in close partnership with parents/carers and other professionals to share information and provide continuity of care.

All children and young people will be supported to achieve the highest level of autonomy and independence that is possible given their age and abilities. Staff will encourage each individual student to do as much for themselves as possible.

Definitions of intimate care and personal care

Intimate care

Intimate care can be defined as care tasks of an intimate nature, associated with bodily functions, bodily products and personal hygiene, which demand direct or indirect contact with, or exposure of, private and personal parts of the body. Help may also be required with changing colostomy or ileostomy bags, managing catheters, stomas or other appliances. In some cases, it may be necessary to administer rectal medication on an emergency basis.

Intimate care tasks include:

Dressing and undressing (underwear)
Helping someone use the toilet
Changing continence pads/nappies (faeces and urine)
Bathing/showering
Washing intimate parts of the body
Changing sanitary wear
Inserting suppositories
Giving enemas
Inserting and monitoring pessaries.

Personal care

Personal care encompasses those areas of physical and medical care that most people carry out for themselves but which some are unable to do because of disability or medical need. Personal care generally carries more positive perceptions than intimate care. Although it may often involve touching another person, the nature of this touching is less intimate, does not involve direct or indirect contact with, or exposure of, the private and personal parts of the body and usually has the function of helping with personal presentation and hence is regarded as social functioning. These tasks do not invade conventional personal, private or social space to the same extent as intimate care.

Personal care tasks include:

Skincare/applying external medication
Feeding
Administering oral medication
Hair care
Dressing and undressing (clothing)
Washing non-intimate body parts
Prompting to go to the toilet.

Vulnerability of children and young people who require intimate care.

By its definition, intimate care may involve touching the private parts of the child or young person’s body, increasing the vulnerability of the child or young person. We recognise that children who experience intimate care may be more vulnerable to abuse:

Children and young people with additional needs are sometimes taught to do as they are told to a greater degree than other children. This can continue into later years. Children and young people who are dependent or over-protected may have fewer opportunities to make decisions for themselves and may have limited choices. The child or young person may come to believe they are passive and powerless.
Increased numbers of adult carers may increase the vulnerability of the child or young person, either by increasing the possibility of a carer harming them, or by adding to their sense of lack of attachment to a trusted adult.
A child or young person’s dependency on adults to meet their basic core needs (for example, toileting, bathing or dressing) may increase their accessibility and the opportunity for some carers to exploit being alone with and justify touching the child or young person inappropriately.
Repeated intimate care may result in the child or young person feeling ownership of their bodies has been taken from them.
Children and young people with additional needs can be isolated from knowledge and information about alternative sources of care and residence. This means, for example, that a child or young person who is physically dependent on daily care may be more reluctant to disclose abuse, since they fear the loss of these needs being met. Their fear may also include who might replace their abusive carer.

It is unrealistic to eliminate all risk, but this vulnerability places an important responsibility on staff to act in accordance with this policy. Where possible and appropriate for children, young people, and parents/carers should be involved in the development of their intimate care plan so they know how and what to expect when intimate care is provided and where it may have been deviated from.

Safeguarding procedures

Safeguarding procedures are supported by rigorous selection and recruitment procedures including DBS checks. No staff member will be permitted to work alone with a child or young person until they have undergone an Enhanced Disclosure and Barring Service (DBS) check, including a Children’s Barred list check, and where appropriate, an Adults Barred list check if providing intimate care to young people 18 years and over.

If a staff member notices any of the following indicators of harm, these must be reported to the Designated Safeguarding Lead or Deputy Safeguarding Lead:

unexplained marks,
the child or young person seems sore or unusually tender in their genital area,
they are sexually aroused by the staff member’s actions,
they misunderstand or misinterpret something,
they have a very emotional reaction without apparent cause (sudden crying or shouting),
the staff member suspects FGM has taken place or there are any other safeguarding concerns.

Inline with the Safeguarding and Child Protection Policy, these concerns should be reported without delay. Concerns must also be reported on CPOMS by the person noticing them as soon as possible. The report must include a description of any marks, including the location, size, and colour. The staff member, where possible, should also ask the child or young person how the mark occurred and record the child’s response as part of the CPOMS concern. Staff who don't have access to CPOMS (e.g supply staff) must complete a Cause for Concern form and hand it to the DSL without delay.

If a member of staff notices that a child’s demeanour has changed directly following intimate care, e.g. sudden distress or withdrawal, this should be recorded in writing and discussed with the Headteacher. The child should be spoken to by a person elected by the Headteacher as soon as possible to ascertain the reason behind the child or young person’s change in demeanour. Any issues/concerns arising from this discussion should be addressed immediately without delay. Parents/carers must be notified of any such issues/concerns in a timely fashion and in line with the Safeguarding and Child Protection policy, and Managing Safeguarding Concerns and Allegations of Abuse

If a member of staff or parent/carer believes that intimate care is not being undertaken with dignity and respect and in line with the school’s Intimate Care Policy or the individual care plan, or a child or young person discloses abuse or harm, they must escalate this to the Headteacher without delay. Procedures detailed in the Managing Safeguarding Concerns and Allegations of Abuse Policy, must be followed, including deciding whether this should be discussed with the Regional Safeguarding Lead and Local Authority Designated Officer.

No member of staff will use a mobile phone, camera, or similar device whilst providing intimate care.

Providing intimate care

An intimate care plan

Intimate care plans should have the child or young person’s safety, privacy and dignity at their centre.

Line managers have a responsibility for ensuring their staff have a “care planned” approach. This means that there is a planned approach to intimate care across the school, but which is also flexible enough to be planned to meet the specific needs (and wishes as appropriate) of individuals. It is important that approaches to intimate care are not markedly different between individuals, but also reflect individual needs and wishes.

The following documents should be used to create an intimate care plan and to monitor the Individual Intimate Care Interventions:

Where schools are supporting children or young people towards independence a Toileting Plan can be used as a method of discussing with parents and the child or young person and agreeing actions.

Appendix 5:Intimate Care Toileting Plan

This should be used in conjunction with the Appendix 4 Individual Intimate Care Intervention Record.

There may be occasions where a child or young person needs intimate care on a one-off basis or infrequently. An intimate care plan is not required on these occasions in order to provide the care required. However if there becomes an increase of incidents this should be reviewed. These instances need to be recorded (Appendix 4).

A copy of the plan will be given to the parents and the child or young person as well as being held within the child’s records.

The school’s intimate care plan will be reviewed regularly (at least annually), and any individual intimate care plans should have an agreed regular review to ensure needs or requests have not changed. Any changes should be communicated to staff, children, young people and parents/carers.

Intimate care plans will be linked (where present) to a child/adolescent’s Education Health Care Plan, Individual Health Care Plan, moving and handling plan, and/or an Individual Pupil Risk Assessment if required.

Planning for pupils who are likely to be resistant to intimate care

The intimate care plan should clearly identify an agreed plan of action between parents/carers and the setting on how to support the child or young person who is likely to be extremely resistant to intimate care. This could include distraction techniques, notifying parents/carers of the situation, and an agreed way forward that is in the best interest of the child or young person, without compromising their safety, dignity, health or causing emotional harm. This could include the name and details of an emergency contact(s) who will be asked to attend without delay. All behaviour should be understood as communication.

Who provides intimate care?

Dignity, respect and privacy must be central to all practices and procedures.

Intimate care plans should have the child or young person’s safety, privacy and dignity at their centre. Where possible, intimate care should be carried out by one staff member alone with one child or young person. This practice should be actively supported unless the task requires two people (for example lifting or moving). However the need for a chaperone should be considered and offered on a case-by-case basis.

Where appropriate, a named member of staff who is familiar to the child or young person should carry out intimate care routines. Wherever possible, the member of staff should be a permanent staff member and/or somebody that the child or young person knows and is familiar with, this is especially important for younger children and children with special needs. There should be a named second person in case of staff absence and to cover breaks. In exceptional circumstances, it may not be possible to have a permanent staff member or someone the child or young person is familiar with to provide intimate care. The need to ensure the child or young person receives intimate care is the priority. Where this is likely to occur, the Headteacher must be involved in the decision-making and assessment to ensure the quality of care does not fall below the expected standards of this policy.

Having people working alone does increase the opportunity for possible abuse. However, this is balanced by the need for privacy and trust, which are increased if only one person is present. It should also be noted that the presence of two people does not guarantee the safety of the child or young person - organised abuse by several perpetrators can, and does, take place. Therefore, staff should be enabled to carry out the intimate care of children or young people alone unless the task requires the presence of two people. We recognise that there are partner agencies that recommend two carers in specific circumstances. Headteachers should consider the implications of using a single named member of staff for all intimate care or a rota system when assessing the risk of abuse.

Where possible, the member of staff carrying out intimate care should be chosen in collaboration with parents/carers and the child or young person.

Intimate examinations or treatment procedures, such as rectal examinations, must only be carried out by nursing or medical staff. They will adhere to the medical agency's chaperone policy. Medical procedures, such as giving rectal valium, suppositories or intermittent catheterisation, must only be carried out by staff who have been formally trained and assessed as competent.

During intimate care

Staff will speak with the child or young person to alert them to what is happening next. If a staff member is not sure how to do something, they should ask for support until they are able and competent. If they need to be shown more than once, they should ask again.

Staff members are not permitted to take personal or work devices, including mobile phone, camera, or similar device into the cubicle, even if this has been provided by the school.

Staff will be aware of the child or young person's behaviour and will be alert to any distress which becomes apparent. In cases where children/adolescents are extremely resistant to intimate care and become distressed or demonstrate they are in discomfort, staff must always use agreed strategies/techniques as outlined in the intimate care plan which will be informed by an understanding of their wider needs and attempt to restart. At no point must staff forcibly hold the child or young person down to undertake intimate care, as this could result in injury/distress/trauma and/or increased anxiety for all parties concerned. In the event that any behaviours are out of the ordinary or if the child or young person displayed ongoing and concerning reactions to intimate care, staff must report this immediately to a member of the Designated safeguarding team.

The school should ensure children and young people receive the highest level of care.

Give sufficient time for the child or young person to achieve, to be aware of expectations and be familiar with the type and frequency of prompts
Give opportunities throughout their school day to communicate not only what they like, but crucially, to communicate that they are rejecting something
Staff will ensure they are aware of how each individual within their class communicates their preferences
Ensure females (and males who catheterise) are cleaned front to back
Creams, etc will only to be used with written permission from parents
Male and female members of staff are trained and, within policy, are able to change any pupils. The school will consider the appropriateness of male/female assistance with boy/girl pupils, taking into account the wishes of the pupil, parents and staff. For older children and young people (eight years and above) it is preferable if the member of staff is the same sex as the young person. However, this is not always possible in practice.
Rooms used for intimate care should only be occupied by the same sex at the same time
Generally any staff, once trained can assist and attend to any child
When referencing genitalia, staff will use the accurate biological terms, for example ‘penis’

Showering/bathing

If a pupil requires showering in the school as part of a hygiene programme or at the request of a social worker/parent/carer, a permission form must be completed for this. The original copy must be signed by the headteacher and stored by the SENCO or the care team to retain in the pupil's records. Children and young people must not be showered without parental permission.

If a child or young person has a continence accident, staff are to wear gloves, aprons, and clean the child or young person with skin cleansing foam/wet wipes. If a child or young person requires a shower in an emergency situation (e.g. soiled themselves) staff must gain headteacher approval for showering the student. Parents must be informed and the incident and actions must be recorded in the child’s records.

Staff must make sure the shower is left clean and tidy and there is a wet floor sign at the door to prevent injury to others.

Additional considerations

There should be sufficient space, heating and ventilation to ensure safety and comfort for staff and child or young person.
There should be facilities with hot and cold running water and anti-bacterial hand wash should be available.
Supplies of suitable cleaning materials should be available. Anti-bacterial spray should be used to clean surfaces.
Items of protective clothing, such as disposable gloves and aprons, should be provided. There must be no re-use of disposable gloves.
Special bins should be provided for the disposal of wet and soiled nappies/pads. Soiled items should be “double-bagged” before placing them in the bin.
Supplies of clean clothes (the child or young person’s own where possible) should be easily to hand to avoid leaving the child unattended while they are located.
Adolescent girls will need arrangements for menstruation in their plan.
Settings should have a supply of sanitary wear which can be provided for girls in a sensitive and discreet way
Seeking advice on general continence issues through the school nurse or health visitor. For specific conditions, the school nurse, health visitor and / or parents / carers should be able to provide links with relevant specialists.

Recording

A record of individual personal care must be completed immediately following each individual intimate care event using Individual Intimate Care Intervention Record (Appendix 4).

Each child must have their own record.

Records must be scanned and uploaded to Arbor each half term (minimum). The original paper copies must then be destroyed. The records uploaded to Arbor must be retained inline with the trust Data Retention Policy.

Involving children, Young people and parents/carers

Parents/carers and the child or young person will be invited to contribute in individual discussions and decisions about how intimate care will be managed in order to draw up an agreed plan.

Staff understand that all of our pupils should be given the opportunity to give consent to the process of intimate care. The school has a Commitment to Communicating Consent Appendix 6 which should be discussed with all children as part of the plan and displayed in the spaces where intimate care occurs.

The wishes and feelings of both the child and the parents/carers, including cultural and religious beliefs, will be sought and plans will be respectful and responsive to these, reflecting, where possible, usual home routines.

The intimate care plan should clearly state what the child or young person can do independently. This will give the child or young person some control over the process and promote the child’s independence. Staff should try to avoid doing things for the child or young person they can do alone, and if the child or young person is able to help, adults will ensure that they are given the chance to do so, including tasks such as removing clothing and washing private parts of their body. Staff should explain to the child or young person the tasks the staff member is undertaking and give choices where possible. Staff should take into consideration the views of the child or young person, offering choices where appropriate. For example, getting changed lying down or standing up, in which cubicle etc.

Staff will ensure that children and young people can communicate wishes/views in a variety of ways including for those who are non-verbal. Where possible, staff will complete personal/intimate care routines at appropriate times to minimise children missing out on social break times. Staff will consider quieter times of day, and a recognised prompt to allow children/adolescents privacy and dignity in this support.

Staff can “check” their practice by asking the child, particularly a child they have not previously cared for, “Is it OK to do it this way?”, “Can you wash there?”, “How does mummy do that?”. If a child expresses dislike of a certain person carrying out her or his intimate care, senior leaders will try to find out why and record this in their notes/care plan.

Senior leaders must ensure that intimate care is as positive an experience for children and young people as possible. Due consideration must be given to the choice of staff undertaking intimate/personal care, i.e., if a child/adolescent is anxious around specific individuals, due to their individual needs/experiences, or if a child/adolescent does not have a positive relationship with a specific individual, staff must address this with a senior lead, and this must not be ignored.

PSHE and the wider curriculum

Confident, assertive children and young people who feel their body belongs to them are less vulnerable to abuse. As well as the basics like privacy, the approach taken to a child’s intimate care can convey lots of messages about what their body is “worth”. It is acknowledged that adults’ attitude to the child or young person’s intimate care is very important.

It is important that the curriculum (at age and/or developmental level) provides children and young people with information about their bodies and also provides them with clear language and vocabulary.

Training

The requirement for staff training in the area of intimate/personal care will vary greatly between schools within our trust and will be largely influenced by the needs of the children/young people for whom staff have responsibility. Senior leaders will consider the need for training on an individual setting basis and for individual staff who may be required to provide specific care for an individual child/young person or small number of children/young people.

All members of staff responsible for intimate care should have appropriate training in Health and Safety practices around hygiene, safeguarding, intimate care training and Manual Handling. Whole staff group training should provide staff with opportunities to work together on the range of issues covered within this document thus enabling the development of a culture of good practice and a whole setting approach to personal/intimate care. Training should include disability awareness, and opportunities for staff to increase their knowledge and enhance their skills.

More individualised training will focus on the specific processes or procedures staff are required to carry out for a specific child or young person. In some cases this may involve basic physical care which might appropriately be provided by a parent or carer. In cases of medical procedures, such as catheterisation, qualified health professionals should be called upon to provide training.

Staff may require training in safe Moving and Handling. This will enable them to feel competent and confident and ensure the safety and well-being of the child/young person.

The school will maintain a dated record of all training undertaken.

For intimate care needs, training and advice should be included for staff on how to deal with sexual arousal in the child or young person, if appropriate.

Co-op Academy Brownhill