Sexual Health & Sexual Exploitation Sue Gilbert Sexual Health Promotion & Network Manager Solent NHS Trust Speaking the same language? ● 8 ● 143 ● GNRN ● Cu46 ● TDTM ● DUM ● ● GNOC Code 9 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) 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 Positive health? 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 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. Who is at risk of sexual ill health? ALL young people… 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 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) The issue is complex as there are a range of factors that are associated with whether a teenager becomes pregnant Looked after children / young people leaving care Behavioural problems Disengagement from school / poor attendance Poor educational attainment Sexual abuse in childhood Social deprivation Lack of confidence in resisting pressure to have sex Mental health problems Emotional well-being Low aspirations Cultural influence Low self-esteem Peer influence Parental influence Alcohol/substance misuse Teenage Pregnancy More likely to have sex early Teenage mother Poor and inconsistent contraceptive use among Fear of Lack of confidence young people parents/carers in mainstream health finding out Lack of easy services access to Young people lack skills contraception Parents and professionals and confidence to make lack confidence to discuss and carry through sex and relationship issues positive choices with young people Ethnicity Less likely to use contraception Poor knowledge and skills among young people in relation to sex, relationships and sexual health risks Low knowledge levels among boys and young men Data England and local area 2011 (per 1000 women) U18 conceptions rate England Southampton Portsmouth Hampshire 30.9 47.4 33.3 23.3 leading to abortions 48.8% 41.2% 42.0% 49.2% Supporting parents To discuss sex & relationships Building aspirations and self esteem SRE in schools and out of school settings Young people friendly Contraceptive services Strong messages to young people and partner agencies Champions & Strategic leadership Workforce training on SRE Strong use of local data Targeted SRE work with young people at risk Strong youth service things to do, places to go STI’s ● 1 in 14 under 25’s have chlamydia infection ● Pelvic infection ● Infertility ● Increase in other STI’s Other…..? ● ● ● ● ● ● ● ● ● ● Self harm Bullying Suicide Substance & alcohol misuse Eating disorders Isolation from friends & family Homelessness Commercial Sex Working Trafficking FGM A Holistic Approach Sexual health practitioners Safeguarding those at risk Accessible services YOUNG PERSON Effective SRE Partnership working Risk/Needs assessment Workforce Training 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 Accessible Services 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) 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 Risk Assessment Tool ● Identification and assessment is embedded in legislation (Working Together and supplementary guidance - 2009) ● 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 12 years 364 days (and under) Any sexual activity is an offence – unable to consent to sexual activity – Refer on 13 years 14 years 15 years Mutually agreed sexual activity can be consensual but remains an offence… Risks to be assessed and young people vulnerable to abuse / exploitation to be referred on as appropriate 16 years and over Sexual activity is legal in consenting relationship (N.B. still consider risks, coercion & vulnerability up to 18 years as ?offence) 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)’ Effective Sex & Relationships work consists of a balance of elements Skills Knowledge SELF ESTEEM IDENTITY Values Beliefs Attitudes ‘GIRL TALK’ ‘BOY TALK’ www.letstalkaboutit.nhs.uk Contact details www.letstalkaboutit.nhs.uk For clinics, professionals page for referrals and training/conference details www.sshvirtualtour.nhs.uk how to access our services www.4lscb.org.uk email@example.com SNHS.firstname.lastname@example.org SNHS.email@example.com FCASE Families and Communities Against Sexual Exploitation 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. 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). 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. 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 Parents - - - - - - Week 1 –Understanding & Living with Risk Young Person - Week 1 -Relationships - Week 2 – Risk - Week 3 – Abusive Relationships Week 2 – What is CSE? Week 3 –Abusive Relationships & Gooming Week 4: The Internet - how to get help and support? - Week 4: Grooming in relationships - Week 5: Consent, The Law and E-Safety - Week 6: Review of Learning Week 5: Consent Week 6: Review of Learning 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 How to Refer - SERAF - Complete our referral form - Contact our professionals on 01489 796 684 Thank you! 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. What do Serious Case Reviews Tell us? 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 Learning Lessons: The learning about the complexity of the sexual exploitation of children and young people identified that effective multiagency working has a key role to early identification of concerns and to taking action to keep the children and young people safe. 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. 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 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. 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 voluntarysector services. 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. 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?