Sexual Exploitation of Young People: 3 years experience of using a checklist in sexual health clinics Kate Smith, Clinical Lead Nurse & Dr Louise Cook, Associate Specialist Sexual & Reproductive Health Directorate

Sexual Health in the UK Poor Sexual Health is experienced by young people, particularly in the UK UK Sexually Transmitted Infection (STI) rates and teenage pregnancy rates are the highest in Western Europe NPHS(2010)

Research: Unhealthy Relationships

What is Child Sexual Exploitation? The coercion or manipulation of children and young people into taking part in sexual activities A form of sexual abuse involving an exchange of some kind of payment which can include money, mobile phones and other items, drugs, alcohol, a place to stay, ‘protection’ or affection The vulnerability of the young person and the grooming process employed by the perpetrators renders them powerless to recognise the exploitative nature of relationships and unable to give informed consent.

Consent to Sexual Activity The Sexual Offences Act (SOA) 2003 ‘A person consents if she or he agrees by choice and has the freedom and capacity to make that choice’ (SOA 2003 Section 74) The SOA emphasises that consent to sexual activity is an active act not a passive one

The Grooming Line Exploitative relationships are complex and parallel experiences of victims of domestic abuse Thanks to Barnardo’s for this slide

Which Children are Vulnerable? (Clutton and Coles, 2007)

Barnardos / National Working Group for sexually exploited children and young people

Barnardos / National Working Group for sexually exploited children and young people

Barnardos / National Working Group for sexually exploited children and young people

Ability to recognise those ‘at risk’ Agencies should work within a risk assessment framework Level of risk is identified by considering the number & range of risk indicators present in a child’s life All services should identify a child sexual exploitation lead Key recommendations

WAG Statutory Guidance 2011 Supplements Safeguarding Children: Working Together Under the Children Act (Working Together) 2007 Supports All Wales Protocol: Safeguarding and Promoting the Welfare of Children who are at Risk of Abuse through Sexual Exploitation 2011

Child Sexual Exploitation Research 2005 / 2006 Sexual and Reproductive Health develop Under 16’s clinical history sheet 2005 - Welsh scoping study 184 cases of CSE 2006 - Pilot study in Newport, South Wales 67 children / young people identified at risk CSE

All Wales SERAF: Under-18’s Clinical Sexual Exploitation Risk Assessment Form Implemented in May 2009 Identifies: School Sexual History Sexual Behaviour Vulnerabilities Levels of risk of exploitation: Moderate Risk Significant Risk

Significant Risk Factors Periods of going missing overnight or longer; Older boyfriend/ relationship with controlling adult; Rewarded for having sex; Unexplained amounts of money, expensive clothing or other item; Frequenting areas known for sex work. Action : If 1 or more significant risk indicators above are identified follow child protection procedures and make a Child Protection referral to Social Services

Sexual Exploitation and Young People Case Scenario

Amber's Story In pairs: Practice asking Amber the Clinical SERAF questions One person use the information provided to answer questions Together, consider what referrals you might make.

Amber's Story (group) Sexually active, using condoms How much shall I tell her? Sexually active, using condoms Boyfriend is 17yrs old Recent episodes of Missing school Not returning home till late Cut to right wrist, 5 stitches Previous visits to A&E Overdose of paracetamol Found drunk in the street Anxious about any possibility of referral to Social Services Lives with Mum, step-father and 2 younger siblings Mum is her trusted adult No friends own age Has a worker from YPs support service Withdrawn and quiet - low self-esteem

Is Amber significantly at risk in this relationship?

Think about how you would phrase the following questions History of physical/sexual assault and/or later withdrawal of the allegation? Run away from home or gone missing overnight or longer? Rewarded for having sex? Older ‘boyfriend’/relationship with controlling adult? Posted photographs of yourself, in your underwear, on the internet?

What Amber didn't say Met current boyfriend Liam through ex-boyfriend He's not 17yrs, he’s 24yrs old Liam has sent explicit images he took of Amber to his friend Her recent wrist injury was inflicted by her older ex-boyfriend She is often forced into sexual acts with associates of her boyfriend She’s really scared but doesn’t want her relationship with Liam to end – she loves him…

What happened in A&E? CAMHS referral was made. CPN seeing young person twice weekly because of substance misuse issues and self-harm Referral to Social Services was made. Social worker assessed Amber using a multi-agency SERAF. She was assessed as at significant risk of sexual exploitation Will be identified as a victim of CSE during police operation investigating CSE, in 6 months time

Clinical SERAF What did our Staff initially think of the checklist?

What did staff think of the changes? Before… After… Concerns: Who’s role? Embarrassed Take too long More paper How to ask questions? Put young people off re-attending Benefits: Job satisfaction Communication skills Confidence Understanding of Young People Care of Young People Knowledge & skills

3 years on: clinician feedback Percentage (%)

Clinical SERAF: What do young people think of the assessment? Feedback from 20 young people

20 Young People questioned Did you mind being asked about your home and social life? Why do you think we were asking you these questions? Did social services help with the things you were worried about? Did they put you in touch with anyone else who helped? Have you been back to clinic since? Examples of some of the questions we asked

Overall view of 20 young people 10% 10% 10 have since returned to a SRH clinic 9 had no need to return but would be happy to do so 1 said the experience had put her off returning 40% 50%

Examples of CSE referrals made in SRH 2009 – 2011 (87 = 1% p.a) 13 yr old – taken to St Pauls, Bristol by older males, reporting multiple sexual partners 14 yrs old, has older boyfriend. B/f regularly takes her to hotel for “party’s”. She has had sex with > 100 males in past year at these events 2 x15 year olds identified relationship with older Turkish immigrants (alerted to sex ring by police) Group of 15-17 years olds with multiple partners, STIs, spend nights in cars in s/market car park 14yr old - relationships with controlling older males, history STI / unplanned pregnancy / LAC / signs of physical violence.

What we have to remember is… CSE is a hidden for of abuse – takes place out of sight Disclosure of this form of abuse is rare Vulnerability and risk indicators of CSE are well established Early identification and a timely response is central to effective safeguarding practice It is possible to reduce the risks associated with CSE at all levels of risk

“Sexual assault is the great crime of our time and the silence makes it invidious. It’s the kind of crime that prefers darkness and we need to shine a light on it, and for that we all share a responsibility. Every community worker, professional and neighbour has a duty not to stay silent.” Nazir Afzal, Chief Crown Prosecutor North West England.