Policy Procedures

Practice Guidance for Family Time

Version	Date	Reviewer	Changes made
1	17-11-20

Practice Direction regarding: COVID-19 (Coronavirus) guidance on arrangements for Family Time.

Date of implementation: 05th November 2020

Review Date: January 2021

Overview: This practice direction is issued following the government announcing further national lockdown restrictions. Full details of the current government guidance/restrictions can be found here: https://www.gov.uk/coronavirus

Change/Actions required: This practice direction sets out the expectations in regards to ‘family time’ arrangements in acknowledgement of changes in the government restrictions. Since July our approach to family time has been to ensure that wherever possible and safe to do so, face to face family time should be promoted and family time not taking place should very much be an exception. Our direction at this time remains the same in this respect. There have however been some minor changes in the wording of the Practice Direction in order for it to better reflect the current situation.

When considering Family Time arrangements practitioners should adhere to the following principles:

1.1	Arrangements should be made to enable face to face family time between children and their parents to take place except in exceptional circumstances. Exceptional circumstances may include but are not limited to; a child, parent or carer showing symptoms or testing positive for Covid-19 or a child , carer or parents having been told to self-isolate via ‘tack and trace’.

1.2	Where practical and safe, family time should continue to take place outdoors with practitioners maintaining social distancing. Outdoor family time is encouraged as the risk of infection is reported to be lower when meeting outdoors. It is recognised however that as we enter the winter month’s options to facilitate family time outside will be significantly reduced.

1.3	Where it is not possible for family time to take place outdoors for safety or practical reasons (including poor weather), then arrangements should be made to enable this to place inside. Practitioners should maintain social distancing when facilitating family time.

1.4	When family time is to take place inside then the following precautions should be taken:

Rooms should be set up in advance to enable social distancing.

Doors should be pinned open prior to family time to reduce the risk of cross contamination on door handles.

Hand sanitizer should be available outside of the family time room and used by all prior to entry.

Only one or two toys/books/activities should be left in the room in order for these to be thoroughly cleaned (with anti-bacterial spray) following the family time session.

Windows should remain open throughout family time sessions and families advised of this prior to the session so they can bring adequate clothing if they become cold.

Use of the toilet for parents/carers should be avoided wherever possible (with parents/carers advised of this in advance).

Rooms used for family time should not be used again until they have been thoroughly cleaned. A notice should be placed outside the room advising the room is out of use until it has been cleaned.

Practitioners supervising family time should wear PPE (face mask, gloves and apron) where it deemed possible that social distancing may not be maintained by the child/parent/carer.

The option to wear PPE during family time is available to all practitioners who choose to even when social distancing can be maintained.

1.5	For family time continuing to take place outdoors, consideration will need to be given as to how to manage issues of confidentiality during the session and what would happen should concerns arise (contingency planning using your pre-existing knowledge of the family).

1.6	It is likely that children and their parents will want to have some form of physical contact during their family time. This should be promoted in a way that minimises risk, whilst enabling this physical contact and its role in maintaining relationships and expressing emotion.

A family time risk assessment needs to consider the risk of the potential spread of Covid-19 to the child, parent, foster carer/carer and the person facilitating the family time. It is important to remember that parents hold parental responsibility jointly with the local authority and therefore their wishes should be respected where deemed safe to do so. The risk assessment should take into account the views of all those potentially impacted by family time and also consider the potential risks, particularly to those identified as being more at risk from Covid-19 (including ‘working age males’, those from Black and Minority Ethnic groups, older practitioners (particularly those aged 70+) and those with additional health needs).

Further details of people at higher risk can be found using the following links: https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/whos-at-higher-risk-from-coronavirus/

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/889861/disparities_review.pdf

South Gloucestershire’s Coronavirus (COVID-19): Vulnerable worker assessment can be accessed here:

http://intranet/content/CEandCR/Sections/HealthSafety/new/Managing%20People%20-%20Yellow/New%20Risk%20Assessment%202012/Vulnrable%20persons%20risk%20assessment.htm

1.7	When considering physical contact between children and their parents, practitioners should remain mindful of the government guidance on visiting arrangements for parents who share custody of their children. This guidance does not stipulate a need for such parents to maintain social distancing between the parents and their child.

Physical contact between the child and the parent will need to be managed proportionately in order to reduce the risk of cross contamination i.e. agreeing a hug at the start and end of the family time session but discouraging children sitting on a parents lap throughout the duration of the session.

Where someone in the child’s network has additional vulnerabilities (i.e. health needs) then the risk assessment will need to consider the use of PEE (i.e. face masks) during any physical contact.

1.8	Prior to facilitating any face to face family time (whether inside or outside), practitioners should discuss and agree with parents/carers their expectations for the family time session (including social distancing measures) and set this out clearly in writing for all involved parties.

1.9	The ‘rule of six’.

https://www.gov.uk/government/news/rule-of-six-comes-into-effect-to-tackle-coronavirus

Recent government guidance places a limit of up to six people gathering at one time.

In recognition of the importance of maintaining contact between children and their siblings/parents, and in line with the exemption for shared parental care, our view is that sibling/parent family time should continue to take place.

An additional risk assessment should be completed where children from more than one household are meeting for the purpose of family time. The risk assessment should consider how risk of infection can be minimised during the planned family time. It should also factor in any additional risk factors which may make someone more vulnerable or at risk from Covid-19.

1.10	If, in exceptional circumstances (such as those mentioned in point 1.1) it is not assessed to be safe or possible for face to face family time to be arranged then this should take place virtually. This can be either via telephone, WhatsApp, MS Teams. Equipment can be made available to families in order to enable virtual contact to take place. Please discuss any specific needs with your Team manager /Service manager. Family time taking place solely via virtual means should be an exception.

Any decision made not to continue with face to face family time following the risk assessment, should be signed off by a Service Manager and the rationale and risk assessment clearly recorded

1.11	It is anticipated that there may need to be some reduction in the frequency of face to face family time in order to manage this safely (including the spaces that family time takes place in). Frequency of face to face family time should be considered alongside the likely impact on the child of reduced face to face family time. It is anticipated that for a number of children the time they have with their families will be facilitated via a combination of direct and virtual family time.

1.12	It is more difficult to establish meaningful family time with babies and young children virtually so where this is to continue (due to exceptional circumstances) there needs to be additional considerations. Consideration should be given to increasing the frequency of family time but reducing the length of time.

*See Appendix 1 for more information on virtual family time for babies and young children

1.13	Risk assessment of family time arrangements is the responsibility of the allocated social worker and their line manager. Whenever possible the risk assessment should be completed in collaboration with the family, foster carer and person who will be supervising the family time. Decisions made about family time arrangements must be clearly recorded on the child’s record with a rationale as to how the decision was made.

1.14	For those children in our care long term who were having unsupervised family time prior to the restrictions, arrangements should be made for this family time to continue wherever possible. These arrangements would be in line with government guidance regarding children of separated parents to continue to have family time with both parents and can move between houses for that purpose. These arrangements need to take into consideration any vulnerable people in each home.

Transport arrangements

2.1	Wherever possible any need to take a child in a car should be facilitated by someone in the household of the child (usually the foster carer) as this reduces the risk of infection.

2.2	Where this is not possible, transport arrangements should be risk assessed in line with current government guidance: https://www.gov.uk/guidance/coronavirus-covid-19-safer-travel-guidance-for-passengers#private-cars-and-other-vehicles

3. Breastfeeding

3.1	If parents wish to continue to provide breast milk for their baby, efforts will be made to enable this to occur if practically possible. There is currently no evidence of the virus being found in breastmilk (although the studies are very small) and the benefits of breast milk are felt to outweigh the risk. Frozen milk can be used although its nutritional value does decrease if kept for a long time (up to 6 months).

3.2	Prior to the birth the social worker should arrange a consultation with a specialist infant feeding midwife or infant feeding key worker to develop a plan of support. A written individualised plan setting out actions and recommendations to support feeding will be requested from the health professional that offers the consultation. This should be completed with sufficient time to allow for the purchase of equipment and any training and support required by the mother or the carer to take place.

Immediately following birth, mother and baby should have skin to skin time to establish bonding and breastfeeding. Mother should be encouraged to express regularly (at least 8 times in 24 hours) in order to maintain a good milk supply, and keep breastfeeding options open.

3.3	The plan for expressing milk, storage and transport to the carer and the feeding pattern will be detailed in the hospital discharge plan and shared with the relevant people required to make the plan effective.

Things to consider:

How to express. Will mother need any equipment?

How to store and transport the milk.

What type of support does mother need?

*See Appendix 2 for more resources on supporting breast feeding

4. Monitoring arrangements

4.1	It is important that family time arrangements are kept under constant review and considered on an individual child basis. In order to assess and review family time the following questions could be considered:

Whether children/parents/foster carers/other children in placement are considered medically vulnerable.

Whether any of the above are self-isolating having shown symptoms.

How are these arrangements working for all concerned but particularly the children?

4.2	If parents of children currently subject of Pre/Care Proceedings are not in agreement with family time arrangements they should be advised to discuss this with their legal representative.

Practitioners must remain aware of local lock-down processes and adapt or revise their family time arrangements based on this local guidance.

4.3	In all circumstances, the social work team must ensure that there is adequate supervision of Family Time arrangements in line with current supervisory requirements.

4.4	This amended family time guidance has been discussed and agreed by Public Health England

Appendix 1: Virtual family time ideas

All ages: A photo of the parent/s for the child to have near i.e. on bedroom wall or have their own photo album and parent/s to receive regular photos of the children. - Foster carers could write a communication book which could be shared with the parent/s on a regular basis and they could also write messages back if internet was a problem.

Children could draw, paint, and make models, sticking pictures to send to parent/s

For new-born babies, photographs can be taken of baby and parents/family members in hospital, for both children to have and parent to take home.

Try recording parent’s voice or a short video, personal message, singing nursery rhymes, telling or reading a story that can repeatedly played to the baby and encourage parent to do this during virtual family time.

Objects can be used to provide a familiar smell for the baby such as a soft toy, blanket or pillow case. For new-born babies this could be considered prior to birth so the smell of Mother transfers and is familiar to the baby. As Covid 19 can be carried on objects it is best that items are left for 72 hours before given to the baby or handled by the foster carer. Ideally items should be washed but that will defeat the purpose of linking it to the parents smell. One option could be to suggest using the washing powder / conditioner/ perfumes etc. the parents use.

Appendix 2: Supporting breast feeding

Storage of Expressed Milk

This table aims to provide a guide to how long you can store breastmilk for a full term baby with no additional health concerns.

MILK	PLACE	MAXIMUM TIME
Fresh breastmilk including colostrum	Normal room temperature	6 hours
Fridge: 5 to 10°C	3 days
Fridge: 4°C or lower	5 days*
(*if temperature rises above 4°C after 3 days, use within 6 hours or throw away)
Frozen breastmilk	Freezer: -18°C or lower	6 months
Defrosting breastmilk	When defrosting in fridge	Usually takes 12 hours to defrost, then use as soon as fully defrosted
When defrosting milk outside fridge	Use as soon as fully defrosted
Milk can be transported within the safe storage times, provided storage temperatures are maintained. Note previously frozen milk must be used immediately when fully defrosted. Fresh milk can be transported within 24 hours, provided fridge temperatures are maintained using an insulated box & deep frozen ice-packs, and total storage & transportation times do not exceed the recommended storage times. If no ice-packs are used when transporting, use within 4 hours.

Resources - Expressing

Information on expressing: https://abm.me.uk/breastfeeding-information/expressing-breast-milk/

Using a pump: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/hand-expression-video/

Type of pump: plenty of hand pumps available to buy, or mum may prefer to hire: https://www.ardobreastpumps.co.uk/shop/carum-breastpump-hire/ It would be worth someone ringing ahead to explain the situation and see if they will hire at a reduced rate.

Storing and transporting expressed milk: https://www.breastfeedingnetwork.org.uk/breastfeeding-help/expressing-storing/