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Sexual Health & Sexual Exploitation

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1 Sexual Health & Sexual Exploitation
Sue Gilbert Sexual Health Promotion & Network Manager Solent NHS Trust Activity next Consider the impact on young peoples emotional & sexual health Identify resources to support, including local sexual health services

2 Speaking the same language?
8 143 Cu46 DUM GNOC GNRN TDTM Code 9 8 Oral Sex 143 I Love You Cu46 See You For Sex DUM Do You Masturbate? GNOC Get Naked On Cam GNRN Get Naked right Now TDTM Talk Dirty To Me Code 9 Parent / Adult around

3 Definitions of Sexual Health
“The integration of the physical, emotional, intellectual and social aspects of sexual being, in ways that are enriching and that enhance personality communication and love” (World Health Organisation 1975) “The capacity to enjoy and express sexuality without exploitation, oppression, physical or emotional harm” (FPA 2006)

4 Positive sexual health
Emotional health – freedom from fear, shame and guilt, respecting self and others Social health – making informed choices about sex and relationships based on personal beliefs and values Physical health – freedom from infection and unwanted pregnancy Tend to focus on physical health and forget that overall positive sexual health & wellbeing includes emotional & social wellbeing

5 Positive health?

6 The 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 2009 One in four pupils ‘swap porn images of themselves’ Daily Mail 2010

7 Consensual 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 2010 One 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.

8 Who is at risk of sexual ill health?
Regardless of sexuality, gender, race Negative childhood experiences physical and sexual abuse neglect and emotional abuse domestic violence parental drug/alcohol misuse parental mental health problems family breakdown. going missing care or foster placement breakdown disengagement from education drugs/alcohol homelessness peers’ involvement in sexual exploitation, sometimes including prostitution association with ‘risky’ adults sexual identity issues (especially among young men).

9 ALL young people…

10 Common themes Low self esteem Low aspirations Low expectations
High numbers of sexual partners Least access to sexual health services Least confidence in ‘helping’ professionals Higher rates of unplanned pregnancies Higher risk of STI’s Greater risk to psychological well being Barnardos project Southampton 1999 Teen pregnancy next…

11 Teenage Pregnancy Where young people experience multiple risk factors their likelihood of teenage pregnancy increases significantly. A young woman demonstrating five or more risk factors has a 31% probability of becoming a mother under 20, compared with a 1% probability for someone experiencing none of the risk factors. NHS Medway (2007)

12 Complex slide showing strong links

13 Data 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 abortions England % Southampton % Portsmouth % Hampshire % Since 2001 Fareham Gosport Havant 125 – 61 EH 48 – 32 Ports

14 Contraceptive services
Strategic leadership Champions & SRE in schools and out of school settings Contraceptive services Young people friendly and partner agencies to young people Strong messages Workforce training on SRE Strong youth service places to go things to do, Targeted SRE work with young people at risk Strong use of local data and self esteem Building aspirations Supporting parents To discuss sex & relationships

15 STI’s 1 in 14 under 25’s have chlamydia infection Pelvic infection
Infertility Increase in other STI’s

16 Other…..? Self harm Bullying Suicide Substance & alcohol misuse
Eating disorders Isolation from friends & family Homelessness Commercial Sex Working Trafficking FGM

17 Holistic approach – Solent NHS

18 A Holistic Approach YOUNG PERSON YP at the centre. RAT GTBT
Sexual health practitioners Partnership working Risk/Needs assessment Workforce Training Effective SRE Accessible services Safeguarding those at risk YOUNG PERSON YP at the centre. RAT GTBT Early identification of risky sexual behaviours Providing SRE and contraceptive/sexual health advice and support Providing outreach and in-service support to young people’s sexual health services Targeted work with boys and young men Solutions next…

19 Solent Sexual Health Services - accessible to all
Sexual and Reproductive Health & Genito-urinary Medicine HIV Services Unplanned Pregnancy service (Solent & bpas) Psychosexual Medicine Sexual Health Promotion and Chlamydia screening Specialist Outreach Nurse Team Network and Training ALL CONFIDENTIAL

20 Accessible Services Basingstoke Winchester Andover Southampton
Portsmouth Aldershot 20 spokes FE Colleges & Schools

21 Specialist Outreach Services
Referral pathways in to and out of specialist services Specialist 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 adults Partnership work- Barnardo’s (FCASE) and No Limits (Right 2 B Safe)

22 The 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 infection rates of Sexually Transmitted Infections unintended pregnancies psychosexual problems and to facilitate more satisfying, fulfilling and pleasurable relationships Effective Sexual Health Promotion - A Toolkit for Primary Care Trusts and others working in the field of promoting good Sexual Health and HIV Prevention DH 2003 Locality Teams delivering Action Plans Direct client contact Indirect work Condom Distribution & Pregnancy Test Schemes Collaborative community partnerships & networks Campaigns Teenage Pregnancy…next

23 Risk Assessment Tool Identification and assessment is embedded in legislation (Working Together and supplementary guidance ) 4LSCB guidelines Contributes to Common Assessment Framework (CAF) (& SERAF) Meets Information Sharing Protocols Supports appropriate referral to Safeguarding and Child Protection teams in health and social care 1. 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 young person’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/assault 8. (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.

24 12 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 on Mutually 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 appropriate SOA - summary SRE next

25 Sex & 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)’

26 Values Beliefs Attitudes
Effective Sex & Relationships work consists of a balance of elements SELF ESTEEM IDENTITY Values Beliefs Attitudes Knowledge Skills Sex Education Forum, NCB

27 ‘GIRL TALK’ ‘BOY TALK’ Porn Sexual violence
Early id of sexually vulnerable leading to early intervention Linked to HWB, specialist services including outreach Multi agency training and facilitators Target schools in high TP rated wards Compliments curriculum not replaces

28

29 Contact details www.letstalkaboutit.nhs.uk
For clinics, professionals page for referrals and training/conference details how to access our services

30 FCASE Families and Communities Against Sexual Exploitation
Barnardo’s Core Presentation Slide No. 30 Thursday, 06 April 2017 FCASE Families and Communities Against Sexual Exploitation

31 Barnardo’s Core Presentation Slide No. 31
Thursday, 06 April 2017 FCASE – What is FCASE? Two year DfE grant funded project 1st April 2013 – 31st March 2015 Hampshire, Birmingham, Middleborough Contribute to the development of safeguarding services that support and protect children at risk of harm The 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.

32 Barnardo’s Core Presentation Slide No. 32
Thursday, 06 April 2017 FCASE – What is FCASE? Objectives Embed 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).

33 FCASE – Outcomes Enhance 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.

34 Case 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 identified Mother and father allocated a worker Lucy was allocated a different worker

35 Parents Young Person Week 1 –Understanding & Living with Risk
Week 2 – What is CSE? Week 3 –Abusive Relationships & Gooming Week 4: The Internet - how to get help and support? Week 5: Consent Week 6: Review of Learning Young Person Week 1 -Relationships Week 2 – Risk Week 3 – Abusive Relationships Week 4: Grooming in relationships Week 5: Consent, The Law and E-Safety Week 6: Review of Learning

36 What has changed for the Smith Family?
The family has said that this programme has enabled them to: Understand and identify risks Learn and Discuss CSE Maintain consistent boundaries What to do if a child goes missing again Since our intervention: Lucy has not gone missing again Lucy has enrolled at college and has regular attendance Lucy has a clearer understanding of potential risks

37 How to Refer - SERAF - Complete our referral form
- Contact our professionals on

38 Thank you!

39 IP copyright © Barnardo’s 2013 All rights reserved
No part of this material, including images, may be used, reproduced or stored on an authorised retrieval system, or transmitted in any form or by any means, without the express permission of the publisher.  

40 What do Serious Case Reviews Tell us?
Learning Lessons What do Serious Case Reviews Tell us?

41 Learning Lessons Serious 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

42 Learning 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.

43 Learning 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.

44 Learning 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

45 Learning 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.

46 Learning Lessons Key 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.

47 Learning 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.

48 Learning 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?


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