Presentation on theme: "Sexual Health & Sexual Exploitation"— Presentation transcript:
1Sexual Health & Sexual Exploitation Sue GilbertSexual Health Promotion & Network ManagerSolent NHS TrustActivity nextConsider the impact on young peoples emotional & sexual healthIdentify resources to support, including local sexual health services
2Speaking the same language? 8143Cu46DUMGNOCGNRNTDTMCode 98 Oral Sex143 I Love YouCu46 See You For SexDUM Do You Masturbate?GNOC Get Naked On CamGNRN Get Naked right NowTDTM Talk Dirty To MeCode 9 Parent / Adult around
3Definitions of Sexual Health “The integration of the physical, emotional, intellectual and social aspects ofsexual being, in ways that are enriching and that enhance personalitycommunication and love” (World Health Organisation 1975)“The capacity to enjoy and express sexuality without exploitation, oppression,physical or emotional harm” (FPA 2006)
4Positive sexual health Emotional health – freedom from fear, shame and guilt, respecting self and othersSocial health – making informed choices about sex and relationships based on personal beliefs and valuesPhysical health – freedom from infection and unwanted pregnancyTend to focus on physical health and forget that overall positive sexual health & wellbeing includes emotional & social wellbeing
6The Headlines…‘Many girls’ abused by boyfriends-BBC News 1st September 2010‘Teenager commits suicide after ‘sexting’ a nude photo to her boyfriend made her life a misery’Daily Mail 2009‘Generation Sexting – what teenage girls really get up to on the internet should chill every parent’Daily Mail 2009One in four pupils ‘swap porn images of themselves’Daily Mail 2010
7Consensual sex?A third of teenage girls suffer sexual abuse in a relationship and a quarter suffer violence at the hands of their boyfriends.Nearly 90% of 1,400 girls aged 13 to 17 had been in intimate relationships.Source: NSPCC and University of Bristol 2010One in six said they had been pressured into sexual intercourse and one in 16 said they had been raped.One in three said their boyfriends had tried to pressurise them into unwanted sexual activity by using physical force or emotional bullying.
8Who is at risk of sexual ill health? Regardless of sexuality, gender, raceNegative childhood experiencesphysical and sexual abuseneglect and emotional abusedomestic violenceparental drug/alcohol misuseparental mental health problemsfamily breakdown.going missingcare or foster placement breakdowndisengagement from educationdrugs/alcoholhomelessnesspeers’ involvement in sexualexploitation, sometimes includingprostitutionassociation with ‘risky’ adultssexual identity issues (especiallyamong young men).
10Common themes Low self esteem Low aspirations Low expectations High numbers of sexual partnersLeast access to sexual health servicesLeast confidence in ‘helping’ professionalsHigher rates of unplanned pregnanciesHigher risk of STI’sGreater risk to psychological well beingBarnardos project Southampton 1999Teen pregnancy next…
11Teenage PregnancyWhere young people experience multiple risk factors theirlikelihood of teenage pregnancy increases significantly. Ayoung woman demonstrating five or more risk factorshas a 31% probability of becoming a mother under 20,compared with a 1% probability for someoneexperiencing none of the risk factors.NHS Medway (2007)
13Data England 30.9 48.8% Southampton 47.4 41.2% Portsmouth 33.3 42.0% England and local area 2011 (per 1000 women)U18 conceptions rate leading to abortionsEngland %Southampton %Portsmouth %Hampshire %Since 2001FarehamGosportHavant 125 – 61EH 48 – 32Ports
14Contraceptive services Strategic leadershipChampions &SRE in schoolsand out of schoolsettingsContraceptive servicesYoung people friendlyand partner agenciesto young peopleStrong messagesWorkforce trainingon SREStrong youth serviceplaces to gothings to do,Targeted SRE workwith young peopleat riskStrong use oflocal dataand self esteemBuilding aspirationsSupporting parentsTo discuss sex &relationships
15STI’s 1 in 14 under 25’s have chlamydia infection Pelvic infection InfertilityIncrease in other STI’s
16Other…..? Self harm Bullying Suicide Substance & alcohol misuse Eating disordersIsolation from friends & familyHomelessnessCommercial Sex WorkingTraffickingFGM
18A Holistic Approach YOUNG PERSON YP at the centre. RAT GTBT Sexual healthpractitionersPartnershipworkingRisk/NeedsassessmentWorkforceTrainingEffectiveSREAccessibleservicesSafeguardingthose at riskYOUNGPERSONYP at the centre.RATGTBTEarly identification of risky sexual behavioursProviding SRE and contraceptive/sexual health advice and supportProviding outreach and in-service support to young people’s sexual health servicesTargeted work with boys and young menSolutions next…
19Solent Sexual Health Services - accessible to all Sexual and Reproductive Health & Genito-urinary MedicineHIV ServicesUnplanned Pregnancy service (Solent & bpas)Psychosexual MedicineSexual Health Promotion and Chlamydia screeningSpecialist Outreach Nurse TeamNetwork and TrainingALL CONFIDENTIAL
21Specialist Outreach Services Referral pathways in to and out of specialist servicesSpecialist Sexual Health Nurse (1-1 RAT, consultation, contraception, safeguarding)Sexual Health Promotion Practitioner ( RAT,1-1 targeted SRE, behaviour change work, GTBT targeted group SRE, safeguarding)Professionals Training – RAT, vulnerable adultsPartnership work- Barnardo’s (FCASE) and No Limits (Right 2 B Safe)
22The aim of Sexual Health Promotion “To improve the positive sexual health of the general population and to reduce inequalities in sexual health”.Specific aims include reducing:rates of new and undiagnosed HIV infectionrates of Sexually Transmitted Infectionsunintended pregnanciespsychosexual problems and to facilitate more satisfying, fulfilling and pleasurable relationshipsEffective Sexual Health Promotion -A Toolkit for Primary Care Trusts and others working in the field of promoting good Sexual Health and HIV Prevention DH 2003Locality Teams delivering Action PlansDirect client contactIndirect workCondom Distribution & Pregnancy Test SchemesCollaborative community partnerships & networksCampaignsTeenage Pregnancy…next
23Risk Assessment ToolIdentification and assessment is embedded in legislation(Working Together and supplementary guidance )4LSCB guidelinesContributes to Common Assessment Framework (CAF) (& SERAF)Meets Information Sharing ProtocolsSupports appropriate referral to Safeguarding and Child Protection teams in health and social care1. Information will be shared appropriately with Health Care professionals in Sexual Health to ensure that further sexual health information, advice, treatment and support can be offered.Only if there is considered to be a risk of significant harm to the young person will information then be shared outside of Health.2. Emergency treatment may still be given if considered to be in the youngperson’s best interests.3. Consider the nature of the relationship between them. Aim to see the young person alone to exclude exploitation. Are they living at home?4. Suggest they talk to a parent. Reassure that a parent will not be informed (unless at risk).5. Assess their level of understanding and explain the health information as appropriate to their needs. Greater repetition may be required. Consider the risk of exploitation/abuse.6. Are they able to ‘say no’ to unwanted sex. Did they give consent?7. Consider the risk of exploitation/abuse/assault8. (if more than 5 years consider risk of exploitation).9. Young people are more vulnerable if out of education due to lack of sex and relationships education and the risk of being exploited through alcohol/drugs misuse.10. Young people in Care or identified by agencies as ‘children in need’ are known to be particularly sexually vulnerable and will often access different services for sexual health treatment.11. Young people who are not using contraception regularly/effectively are at risk of an unplanned pregnancy or sexually transmitted infection and need health education and appropriate advice.
2412 years 364 days (and under) 13 years 14 15 16 years and over Any sexual activity is an offence – unable to consent to sexual activity – Refer onMutually agreed sexual activity can be consensual but remains an offence…Sexual activity is legal in consenting relationship (N.B. still consider risks, coercion & vulnerability up to 18 years as ?offence)Risks to be assessed and young people vulnerable to abuse / exploitation to be referred on as appropriateSOA - summarySRE next
25Sex & Relationships Education ‘SRE has more impact on reducing sexual risky behaviour if it is taught through small group work with a focus on skills and attitudes (rather than knowledge) (Trivedi et al, 2007)’
26Values Beliefs Attitudes Effective Sex & Relationships work consists of a balance of elementsSELF ESTEEMIDENTITYValuesBeliefsAttitudesKnowledgeSkillsSex Education Forum, NCB
27‘GIRL TALK’ ‘BOY TALK’ Porn Sexual violence Early id of sexually vulnerable leading to early interventionLinked to HWB, specialist services including outreachMulti agency training and facilitatorsTarget schools in high TP rated wardsCompliments curriculum not replaces
29Contact details www.letstalkaboutit.nhs.uk For clinics, professionals page for referrals and training/conference detailshow to access our services
30FCASE Families and Communities Against Sexual Exploitation Barnardo’s Core PresentationSlide No. 30Thursday, 06 April 2017FCASE Families and Communities Against Sexual Exploitation
31Barnardo’s Core Presentation Slide No. 31 Thursday, 06 April 2017FCASE – What is FCASE?Two year DfE grant funded project1st April 2013 – 31st March 2015Hampshire, Birmingham, MiddleboroughContribute to the development of safeguarding services that support and protect children at risk of harmThe aim of Families and Communities Against Sexual Exploitation (FCASE) is to embed more effective practice on safeguarding children and young people, including those in foster care, from sexual exploitation, through harnessing the protective factors within a child’s family and/or foster home; and the wider community.
32Barnardo’s Core Presentation Slide No. 32 Thursday, 06 April 2017FCASE – What is FCASE?ObjectivesEmbed FCASE methodology alongside a Safer You Plan, ensuring early identification of children vulnerable to CSE.Engage 210 children/young people (70 in Hampshire) and their parent/carers to recognise CSE and reduce risk.Provide awareness training to 1800 professionals (600 in Hampshire) working with children across three areas to recognise CSE risk indicators.Provide support/information to communities to understand CSE and strategies to keep children safer through 36 events (12 in Hampshire).Provide independent evaluation and resources to inform and disseminate national practice, by the end of year 2 (Toolkit).
33FCASE – OutcomesEnhance parent/carer – child/young person relationships.Reduction in family conflict.Reduction in the level of risk/harm for children/young people.Stable and secure accommodation.Children/parents/carers contribute to planning and decisions.Adults/children to identify abusive/exploitative behaviour.
34Case Study- The Smith family Mother, father 2 daughters (Mary 23 and Lucy 16) and son aged 12.Daughter identified trough our missing service and offered FCASE as low risks of CSE were identifiedMother and father allocated a workerLucy was allocated a different worker
35Parents Young Person Week 1 –Understanding & Living with Risk Week 2 – What is CSE?Week 3 –Abusive Relationships & GoomingWeek 4: The Internet - how to get help and support?Week 5: ConsentWeek 6: Review of LearningYoung PersonWeek 1 -RelationshipsWeek 2 – RiskWeek 3 – Abusive RelationshipsWeek 4: Grooming in relationshipsWeek 5: Consent, The Law and E-SafetyWeek 6: Review of Learning
36What has changed for the Smith Family? The family has said that this programme has enabled them to:Understand and identify risksLearn and Discuss CSEMaintain consistent boundariesWhat to do if a child goes missing againSince our intervention:Lucy has not gone missing againLucy has enrolled at college and has regular attendanceLucy has a clearer understanding of potential risks
37How to Refer - SERAF - Complete our referral form - Contact our professionals on
40What do Serious Case Reviews Tell us? Learning LessonsWhat do Serious Case Reviews Tell us?
41Learning LessonsSerious Case reviews recommendations have led to the development of multi agency Child Exploitation Strategies being devised by many Local Authorities. A specialist Child Protection Manager (Sexual Exploitation) has in many cases been appointed as the single point of contact on CSE matters. Their job is to manage the Strategy and assist the co-ordination of the multi-agency responses to individual cases
42Learning Lessons:The learning about the complexity of the sexual exploitation of children and young people identified that effective multi- agency working has a key role to early identification of concerns and to taking action to keep the children and young people safe.
43Learning Lessons:Missing children arrangements have been strengthened.The Safeguarding Children Procedures have been updated.New information sharing tools and risk assessment tools have been developed to enable agencies to share information about concerns regarding sexual exploitation.
44Learning Lessons:A training strategy has been implemented to take forward the training and development of staff in CSE across all relevant agencies.CSE Champions have been identified to provide advice and support to staff on the identification of signs and symptoms of CSE and undertaking risk assessments
45Learning Lessons: Aims: Child-centred prevention, identification, support and prosecution.Strategies will have three core aims:Prevention, Identification and Support.Good practice areas also aim to improve action against perpetrators, through disruption and prosecution.
46Learning LessonsKey agencies include: a minimum of police, social care, health, education and education welfare; plus if possible, youth offending, probation, housing, youth service and voluntary- sector services.
47Learning Lessons:It is critical there are multi agency meetings where intelligence is shared, strategies devised to identify : those at risk, possible perpetrators and links within counties and across boundaries.Where clear interventions are agreed and agencies co-ordinate a response to:Prevent the behaviour where possible.To disrupt the behaviours .To support the victim and protect.To prosecute and prevent others being harmed.
48Learning Lessons:Exercise: Within your groups please consider the case study presented. Using the plan format you have decide what are the key risk factors for this child. What needs to happen and who needs to do what ? What responses could agencies give and how well placed is your agency to respond currently? What does your agency need to do to ensure it has an effective CSE strategy in place? How will you take your learning from today back into your work places?