SUPPORTING DOCUMENT – 13
Sexual Health of Children and Young People Looked After
The following information is copied from:
“Torbay Council, Children’s Services Sexual Health of Children and Young People Practice
Guidance” - updated November 2006.
“Sexuality is one of the ways we experience ourselves as female and male and how we relate
to others. It includes our self esteem; the roles we are given or take on; the way we
communicate with others; our bodies – how they work and how we use them, and our
relationships, including sexual relationships.” (H. Dixon and G Mullinar, Taught not Caught,
1987).
In accordance with the wishes of accommodated children and young people in Torbay, this
document will refer to children and young people looked after as accommodated children and
young people, other than when reference is made to Government documents.
Accommodated children in this document are therefore:
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Children who are accommodated by the local authority under a voluntary agreement with
their parents (under section 20 Children Act)
Children subject to a care order
Children who are compulsorily accommodated by the courts to the care of the Local
Authority
Unaccompanied Asylum Seekers
Children/Child relates to anyone under the age of 18 years unless otherwise stated.
Torbay Council has worked with Torbay Care Trust in producing this guidance.
Several other local authorities were happy to share their policies with us and their help is
gratefully acknowledged.
The documents listed below have underpinned the writing of this policy.
Enabling young people to access contraceptive and sexual health information and advice:
Legal and Policy Framework for Social Workers,
Foster carers and other Social Care
Practitioners DfES 2004; Sexual Offences Act 2003 the Stationery Office; Children Act HMSO
1989; Consent – what you have a right to expect, a guide for children and young people DH
2001; Consent – what you have a right to expect, a guide for parents DH 2001; Seeking
consent – working with children DH 2001; Promoting the Health of Looked After Children DH
2002; Human Rights Act HMSO 1998; Data Protection Act HMSO 1998.
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BACKGROUND
Why do we need a Sexual Health Policy?
All Social Services Departments are being asked to develop sexual health policies for
accommodated children and young people. This is because:
 Accommodated children and young people may miss out on the sex education, advice and
support that other children and young people get through parents and/or school1
 Young people are becoming sexually active at a younger age2
 There are far more young people who have been accommodated very recently among
teenage mothers and fathers that people haven’t been accommodated3. Lots (not all) of
these teenage mothers and fathers did not mean to become parents so soon.
 Research has shown that many young people feel that their sex and relationships
education was too little, too late and too biological4
Who is the policy for?
The policy is intended to help accommodated children and young people.
It is for the children and young people themselves, for their parents, their foster carers or
respite carers, the people who work with them such as social workers, school nurses, and
youth workers, but also available for anyone who feels it would be useful to them in their work
with an accommodated young person.
It is also intended to help accommodated young people and the people who work with them
know what is expected.
KEY PRINCIPLES OF THE POLICY
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Good sexual health is part – a very important part – of how we feel about ourselves.
Helping children and young people develop and enjoy good sexual health goes hand in
hand with helping them feel good about themselves in general and their place in the world;
valuing themselves and having respect for themselves and other people.
Accommodated children and young people are entitled to the same privacy about their
developing sexuality and experimentation as any other child or young person, unless (like
any other young person) there behaviour puts them or someone else at risk.
The primary duty of carers and professionals alike is to promote and ensure the welfare
and safety of the children and young people in the local authority’s care.
We all approach sexual health issues in our own way, depending on our knowledge,
experience, background and upbringing and we need to be aware of how this affects what
we do and say.
We need to acknowledge that for accommodated children and young people this can be a
very sensitive area indeed. One accommodated young person from another area said:
1
This is because accommodated children and young people may have moved school a lot and/or had
erratic attendance. This may also have had difficult relationships with birth parents.
2 Wellings K et al., Sexual Behaviour in Britain: The national survey of sexual attitudes and lifestyles,
Penguin 1994.
3 Biehal W et al: Prepared for living? A survey of young people leaving the care of local authorities.
National Children’s Bureau, 1992
4 Allen I: Education in Sex and Personal Relationships, Policy Studies Institute. 1987.
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“Your sexuality is the one thing you manage to keep secret, the one thing you hang on
to, you feel it’s the only place you have control. If they do find out they want to take
control, it’s the one thing they can’t change.
DEFINITIONS, DESCRIPTIONS AND NEEDS – WHAT ARE WE TALKING ABOUT?
What do we mean by sexuality?
For sexuality to be a positive part of life, all children and young people need and have a right
to:
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Feel good about themselves and their bodies
Know how to avoid being sexually abused or exploited
Know how to avoid sexually abusing or exploiting others
Understand what kind of sexual behaviour is legal and illegal
Get appropriate support, including support around their sexual choices and sexuality
Behave responsibly towards themselves and to others
Understand about roles and stereotypes and how these impact on relationships
Receive information appropriate to their age, needs and sexual orientation so that they
can safeguard themselves and enjoy good sexual heath.5
What is sexual health?
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Sexual expression and enjoyment without exploitation, oppression or abuse of themselves
or other people.
Control of fertility and avoidance of unwanted pregnancy
The absence and avoidance of sexually transmitted infections (STIs)
How do we learn about sexuality and having good sexual health?
We learn, to name a few, from:
 Parents
 Schools
 TV/Radio
 Pop music
 Books - both story books and information books
 Magazines - teenage and adult
 Adult friends or relatives
 Professionals such as doctors, family planning staff, school nurses, social workers, youth
workers, religious teachers and leaders
 Friends – though their information may not always be accurate or complete and may need
checking out.
When do we learn?
We learn all the time – even as adults – but we start learning very early in our lives, whether
it’s about what is acceptable in public, how to wash and look after our bodies properly, how to
get on with people, or about what we do and don’t like. We all go on learning and we may not
always get it right or get the correct information.
How and why is it different for accommodated children and young people?
5
Bradford Social Services Sexuality and Relationships Policy
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It may not be different for accommodated children and young people. But it may be harder for
some to get the right advice, information and support because:
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They may not have a close relationship with their parent or parents
They may not have the opportunity to discuss sex and sex education with their own
families
They may have moved around a lot, changed schools, changed foster carers etc and
missed sex and relationships education in school.
They may be struggling with their reading, which makes getting information from books
and leaflets harder.
They may be worried about talking to the adults around them in case they don’t keep the
information confidential.
Adults around them may think that someone else has talked to the child or young person
about growing up, bodies changing, sex education etc.
They may not know who to turn to
They may have been sexually abused earlier in their lives and feel very confused or
frightened about sex as a result.
They have a disability and people around them may feel that they aren’t able to
understand
That they don’t need information and guidance about sexual matters.
What else can get in the way of young people getting information, advice and guidance
about sexual health and sexuality?
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Lots of people find it embarrassing talking about sex (especially adults talking to children
and young people) and therefore avoid it.
Lots of people feel they don’t know how to talk about sex and sexuality, and they may not
have the correct information or knowledge themselves.
Some adults disapprove of young people’s sexual behaviour or find it hard to think of their
little girl/boy becoming a sexual person.
People like foster carers and social workers may not be sure what is OK to talk to young
people about. This can be a real concern if a young person is having under-age sex
(he/she is under 16 and/or has a sexual partner who is under 16).
WHAT DO WE NEED TO DO TO ENSURE THE POLICY IS IN PLACE?
Accommodated children and young people need and have a right to:
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Information, guidance and advice on sexual health from:
o Supportive, non judgmental, well informed adults
o Books, leaflets, videos, CD-ROMs, websites etc appropriate for their age and
understanding
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Access to detailed information, guidance and advice from appropriate professionals
if/when they need it.
The opportunity to say who they feel most comfortable talking to about these issues. Their
views need to be respected, providing that the person they prefer is a source of
appropriate and reliable support and information.
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Birth parents need:
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To be aware that appropriate sex and relationships education will be part of the parenting
their children receive while they are accommodated.
The opportunity to discuss particular concerns they have about this (e.g. how their cultural
differences, religious beliefs will be respected and reflected.)
Usually, with full and open discussion it will be possible to gain the support of the birth
parents. Where this is not possible, however, the welfare and safely of accommodated
children and young people must come first.
Foster and respite carers should:
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Be aware that Social Services sees sex and relationships education as part of the
parenting role they take on as foster carers.
Be aware that this part of parenting starts very early in terms of helping children develop
skills in caring for themselves, keeping themselves safe, starting to understand how their
bodies work and, as they get older, what changes take place.
Be sensitive to the concerns that birth parents will naturally have.
Understand that even children and young people having respite care (short term breaks)
with them may turn to them for sex and relationships advice and information if they feel
more comfortable with them than other people.
Assume that children and young people have not had sex and relationships education
already. We know that large groups of young people, boys and young men, black and
ethnic minority young people, gay, lesbian and bisexual young people and disabled young
people, tend to miss out on advice and information for a number of reasons. It may be
useful to support them in finding people who are knowledgeable and comfortable talking
about any issues they are concerned about.
Torbay Children’s Services will:
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Ensure that foster carers and respite carers are well-informed and trained to do this work.
Acknowledge that this area of work can be a very stressful and worrying part of supporting
fostered teenagers
Ensure that foster carers are appropriately supported to do this work
Ensure that if, after undertaking training, individual foster carers still feel they cannot take
on this role, then sex and relationships education is provided for any child or young person
they care for in another way.
Accept that individual children’s problems will need individual solutions, but that the sexual
health and welfare of the young person takes precedence.
Social workers will:
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Ensure that children and young people accommodated by the local authority receive
appropriate sex and relationships education and appropriate support.
Be able to support a young person in obtaining advice e.g. by accompanying them to an
appropriate clinic, even if they are under 16.
Be aware that the need for advice and support applies as much to boys and young men as
girls and young women.
Work on the basis that children and young people becoming looked after have not had
sex and relationships education already.
Where necessary, take a lead in putting a young person in touch with people who are
knowledgeable and comfortable talking about any issues they are concerned about e.g.
services specifically for boys and young men, black and ethnic minority young people, gay,
lesbian and bisexual young people or disabled young people.
Take responsibility for ensuring that issues around contraception, STIs etc are taken up
with the young person if he/she is taking sexual risks.
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Independent reviewing officers /chairs of reviews must:
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Be aware that the sexual health of accommodated children and young people should be
reviewed as part of children and young people’s health needs. It is the Chair of the
Review’s responsibility to ensure that this is done both sensitively and with regard to
confidentiality.
Ensure that someone in the child or young person’s life is taking responsibility for their sex
and relationship education.
Be aware that it is acceptable for a review to check whether a child or young person is
getting sex and relationships education and support. It is not acceptable to discuss
specific details about the child or young person’s sexual health behaviour in the review.
Ensure that any young person newly accommodated between the ages of 13 and 16 has
received or will shortly receive their “13th birthday pack” of health information.
Ensure that already accommodated young people have received their 13th “birthday pack”
once they reach 13.
What are the laws about sexual activity?
The situation may change with guidance or case law following implementation of the Sexual
Offences Act 2003 in May 2004, so it may be necessary to check as time goes on. Currently,
a sexual act is only legal if:
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It takes place in a private place (‘private’ may be open to interpretation).
Each person gives consent (‘agrees by choice and has the freedom and capacity to make
that choice’)6
Each person is legally able to give consent. A person under 16 is not seen by the law to
give consent.7
Consent to sexual activity: Current laws
For vaginal and anal sex between:
 A male and female or between two males: minimum age 16 years 8
 Sex acts between two women: no age limit (although it could be indecent assault if a girl
is under 16).
There are various crimes which people commit if these rules are broken: rape, indecent
assault, unlawful sexual intercourse etc, some of which carry very stiff penalties, and young
people need to be made aware of this.
The Sexual Offences Act 2003 (which became law in 2004) includes:
‘a number of new offences criminalising sexual activity between under 18s and under
16s.
However, this will not lead to the prosecution of the mutually agreed sexual
activity within normal adolescent behaviour where there is no evidence of
6
Sexual Offences Act 2003, s74
See also DOH Guidance leaflets about consent, 2001
8 Reduced from 18 years for anal sex and homosexual activity, by legislation in 2000
7
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exploitations. [The legislation will enable the prosecution of abusive and exploitative
sexual activity].’9 (See appendix 2).
What about difficult areas, things that the adults around young people worry about?
It is not unusual for accommodated young people to seek early sexual relationships and/or to
confuse sexual attention from other people with love. This might be because they feel
deprived of love and attention from their birth families or because they had confusing and
abusive early sexual experiences. They may therefore need help and advice from foster
carers and/or their social workers, in managing sexual relationships positively and safely,
particularly if they are under 16. This may include:
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Helping them to get contraceptive advice, including emergency contraception.
Advice and guidance about sexually transmitted infections (STIs) and safer sex
Support in coming to terms with and positively expressing their sexual orientation
Information about how to get further advice, help and support.
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16-18 year-olds can give consent, for example to medical treatment, to being medically
examined, being given contraceptive advice or contraceptives by a health professional,
without the knowledge of a parent, including social services where parental responsibilities
are shared. Health professionals are not allowed to share this information with anyone
unless the young person or someone else is at risk of serious harm.
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If a young person under 16 is sexually active, it is important that he/she is given
appropriate advice and support. At present, a person under 16 can consent to treatment
and be given contraceptive advice and contraceptives by health workers, without the
agreement or knowledge of a parent (including Social Services where parental
responsibilities are shared) where the health worker is of the opinion that the person
‘has sufficient understanding and intelligence to enable him or her to fully
understand what is proposed’.
This is sometimes called Gillick competence (named after a famous court case), now
summarised in the DH Fraser Guidelines. It has allowed health workers to make this
judgment, but not social workers or other professionals. However they could still discuss the
issues with the young person, and put any young person under 16 in touch with appropriate
health workers, for them to decide whether the young person was competent.
Of course workers would usually encourage the young person to share the information with
their parent/carer as appropriate, but if they still did not wish to, the information would be kept
confidential.
The Sexual Offences Act 2003 now takes this further:
The Act will not prevent the provision of confidential advice and treatment to young people
under 16, including those under 13. An exception has been made in statute to make it
clear that a person does not commit an offence if he acts for the purpose of:
a)
b)
c)
d)
9
protecting the child from a sexually transmitted infection or
protecting the physical safety of the child or
preventing the child from becoming pregnant or
promoting the child’s emotional well-being by the giving of advice
Sexual Offences Act 2003, key messages, Teenage Pregnancy Unit, DOH November 2003
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‘as long as he does not act for the purpose of causing or encouraging the activity constituting
an offence or the child’s participation in it. Nor does it apply if the person is acting for the
purpose of obtaining sexual gratification.’
The exception covers not only health professionals, but also anyone who acts to protect a
child.
This is a significant step forward from the current position of Gillick which as case law only
related to health professionals.
Those providing contraceptive treatment to under 16s will continue to assess competence on
a case by case basis and work within the Frazer Guidelines. The Act does not change the
fact that young people under 16, including those under 13, have the same right to
confidentiality as adults.10 (see Appendix 2)
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If there are issues about the young person’s welfare, e.g. that a young person under
16 is taking risks sexually, this should be discussed in the first instance with the young
person, to support them in getting help and advice. If the young person, or someone else,
is at risk of serious harm, it will need to be raised with the young person’s social worker,
and/or the social worker’s line manager under Child Protection Guidelines. This is
especially the case if the young person is under 13.
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If an accommodated young woman becomes pregnant, it is important that, as soon as
possible, she has the opportunity to discuss her options with an appropriate health
professional. If she is over 16 she can make her own decision about abortion. If she is
under 16, some doctors will not agree to abortion at all or without the consent of parents
(or those with parental responsibility) for their own ethical reasons and therefore she will
need to contact another doctor quickly. Other doctors will make a decision based on the
Fraser guidelines, as above.
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If there are concerns that a young person is being sexually exploited, this information
should be shared with the foster carer, the young person’s social worker and his/her line
manager to get guidance. It may need to be taken forward as a child protection issue,
taking account of any risks the young person might be exposed to as a result, e.g. threat
from pimps. There is a specific protocol under child protection dealing with sexual
exploitation which should be used. There may also be issues of criminal behaviour under
the new Sexual Offences Act.
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Where there are issues for a young person about their sexuality/sexual orientation,
professionals have sometimes been concerned about breaking the law if they advise or
support these young people. The law in question (Section 28 of the Local Government Act
1988) did not prevent people talking to young people about lesbian or gay issues, unless it
was a deliberate attempt to persuade a young person to get involved in a gay or lesbian
relationship. However, the law was abolished in November 2003.
IMPELMENTING THE POLICY SECTION 1
There are several areas of work which will need to be carried out at an early stage:
Training
This will be necessary:
10
Sexual Offences Act 2003, key messages, Teenage Pregnancy Unit, DOH, November 2003.
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To help foster carers and social work staff work comfortably, effectively and positively with
children and young people on issues around sex education, sexuality and developing and
maintaining sexual health.
To raise their awareness of and help them understand the very wide range of so-called
‘normal’ sexual behaviours
To ensure consistency and best practice across the department
This will be necessary for:
 Existing foster carers, giving priority to those caring for adolescents
 Existing social work staff who work with accommodated children and young people or with
their carers
 Team manager
Thereafter a rolling programme will be necessary for:
 Newly recruited foster carers
 Foster carers beginning to care for adolescents
 Newly recruited social work staff, including social work team managers.
 All staff and foster carers are also encouraged to attend the generic sexual health training
programme.
Modifying existing policies and documentation
It will be necessary to make some modifications to take account of the policy to:
 The Health of Looked After Children Policy
 The Torbay agreement with parents documentation
 The foster carer agreement
 Any guidelines used by independent reviewing officers in carrying out their tasks.
Resource packs for social workers and foster carers
Whilst social work staff have identified a need for an information pack to pull together the
information currently held informally, it is very difficult to keep such packs up-to-date. It is
more useful for them to know who and how to access current information via websites,
organisations etc, and this information is in the Guidelines.
Resource packs for children and young people
All young people in Torbay reaching the age of 13 will receive the ‘13th Birthday pack’ of health
information from their Social Worker. If it is likely that some accommodated young people will
miss this however, or mislay it in their moves. It will therefore need to be provided to:
 All newly accommodated young people between the ages of 13 and 16 by the time of their
first review
 All already accommodated young people once they reach 13
 All currently accommodated young people between 13 and 16
An information pack will be available to all foster carers, which will include basic sexual health
information for children and young people.
Audit of the current needs of accommodated children and young people’s needs with
regard to their sexual health and sex and relationships education.
It will be necessary to carry out an audit of what current accommodated children and young
people have already received and what they need in terms of sex and relationships education,
to establish a baseline, extent of gaps etc.
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GUIDELINES FOR FOSTER CARERS AND SOCIAL WORK STAFF IMPLEMENTING THE
POLICY
THE CONTEXT
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Accommodated children and young people may miss out on the sex education, advice and
support that other children and young people get through parents and/or school. 11
Young people are becoming sexually active at a younger age. 12
There are far more young people who have been accommodated very recently among
teenage mothers and fathers than people who haven’t been accommodated. 13
Research has shown that many young people feel that their sex and relationships
education was too little, too late and too biological. 14
The overall duty to provide sex and relationships education to accommodated children and
young people is enshrined in the Children Act 1989 (Appendix 1).
THE THREE ELEMENTS OF SEX AND RELATIONSHIPS EDUCATION IN RELATION TO
ACCOMMODATED CHILDREN AND YOUNG PEOPLE
1. WORKING WITH BIRTH PARENTS
Children and young people benefit most when birth parents, social workers and carers can
work together with them. Therefore it is important for workers if possible to gain the support of
birth parents for the sex and relationships education their child will receive while
accommodated.
What are the birth parents’ views likely to be?
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Many parents (not just the parents of accommodated children) are likely to be relieved if
someone reliable and appropriate is giving their children sex and relationships education
(SRE).
Very few parents withdraw their children from the SRE provided in schools.
It is unlikely that parents will object to their accommodated child being given SRE by
carers or professionals if they have all the information. (They may have a general anxiety
about what will happen to their child once accommodated, which may include worries
about sex and relationships, who they’ll be mixing with etc.)
How can birth parents be supported?
Birth parents will need to be kept up to date where possible and be reassured that:
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Sex and relationships education will be given appropriately and responsibly
Will take account of their child’s age and maturity
Will build on what children have already learned as they have been growing up, and
provide what they need to know as they get older.
11
This is because accommodated children and young people may have moved school a lot and/or had
erratic attendance. They may also have had difficult relationships with birth parents.
12 Wellings, K et al: Sexual Behaviour in Britain; The national survey of sexual attitudes and lifestyles,
Penguin 1994.
13 Biehal W et al: Prepared for living? A survey of young people leaving the care of local authorities,
National Children’s Bureau, 1992
14 Allen I: Education in Sex and Personal Relationships, Policy Studies Institute, 1987.
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Will be provided according to a similar framework to that used in schools, though more
informally of course.
Will be provided by people (carers and professionals) who have had special training to do
this.
Birth parents who have a particular cultural background or religious beliefs will need to
be reassured that their views and beliefs will be respected as far as possible. However, it is
also the authority’s responsibility to make sure that accommodated children have the
knowledge and support to make informed choices about their sexual health and sexual
behaviour.
Where a parent has been involved in the sexual abuse of the child or young person,
workers will need to exercise discretion as to how much is shared with that parent.
A young person’s behaviour may be outside the norms or beliefs of their birth family or
a young person’s sexuality may be unacceptable to them. It is important neither to
condone nor judge. They key principle here is to be sure that the young person has the
information and support to make well-informed decisions, to keep safe, and that he/she
understands the implications of his/her decisions and/or behaviour. His/her safety and welfare
remain paramount.
Any decision to withhold information from a parent should not be made by a carer or
social worker alone, but in discussion with the line manager. Reasons should be
recorded.
WORKING WITH CHILDREN AND YOUNG PEOPLE
It is very important for accommodated children and young people that:
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They feel that they can trust their carers and social workers
They can confide in them without fear of being laughed at or judged
Adults working with them create a safe space where they can talk to them privately and in
confidence
It is equally important, however, that children and young people know that there are also limits
to confidentiality.
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If their carer or social worker has reason to believe that there is a risk of significant harm to
the child/young person or to someone else, they will need to act on this information and
share it.
What do young people need to know?
Children need a balance of simple, accessible information, the chance to learn social and
personal skills, as well as the opportunity to think through and talk about moral issues and
dilemmas. Both informal and formal discussions need to take place in a safe, antidiscriminatory environment, and take into account the young people’s religious and cultural
values.
Children under 11 will need opportunities to:
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Talk about and name feelings and emotions
Know the names of parts of the body and how they work
Talk about relationships
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Prepare for puberty, understand body changes and be able to manage periods
Have misunderstandings corrected
Be able to ask for help and support
Understand appropriate and inappropriate touching
Learn how to handle abusive situations.
Children over 11 and young people will need opportunities to:
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Develop interpersonal skills such as listening, asking questions and making decisions.
Receive accurate, easy to understand information about sexual development, sexuality,
sexual response and desire, reproduction, birth, contraception, abortion, sexually
transmitted infections (STIs), including HIV and AIDS, and safer sex.
Be able to express and manage their emotions
Understand the importance of personal relationships and respect for self and others within
relationships
Explore their own attitudes to themselves and others, and develop a values and moral
framework.
Understand the effect of sex and gender roles
Learn how to avoid and resist unwanted sexual pressures
Know how to access confidential information and advice about sexual health and
person/emotional issues. 15
It is better for foster carers and social workers to assume that a newly accommodated
child/young person has not received appropriate sex and relationship education in school or at
home. Their level of understanding and knowledge will become clearer through the normal
exchanges with foster parents and through more formal ongoing assessments.
Assessment and planning
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The child or young person’s needs in terms of sex education will need to be identified in
consultation with the foster carers, the birth parents if appropriate, through the health
assessment of the young person, and possibly taking into account input from other
sources (e.g. concerns from school). They will need to be broadly identified (without
breaching confidentiality) in the child or young person’s care or health plan.
If there are urgent concerns about sexual health risks when the young person becomes
accommodated, it is better to over – rather than under – inform the young person in order
to help them manage risks more effectively.
Who takes responsibility for meeting the child or young person’s sex education needs will
need to be clarified by the social worker as soon as possible, and also be identified in the
child or young person’s care plan or health plan that is being carried out (but not the
details of what exactly) and/or that new needs are being addressed will need to be
checked out at each review by the Independent Reviewing Officers.
Carrying out sex and relationship education
Some of it may be carried out already by foster carers in the normal course of foster caring,
supported by their link worker and/or the child/young person’s social worker, some of it may
need to be initiated. There may be occasions/situations, however, when foster carer or
child/young person is not comfortable with this. In this case another professional should be
identified as soon as possible in consultation with the child/young person.
15
Patel-Kanwal and Lenderyou: Let’s talk about sex and relationships, Sex Education Forum, 1998
SD 13 - SRE Guidance for CYP 2009
Page 12 of 22
Foster parents are encouraged to make a resource pack freely available to the children/young
people in their care. Easy availability of age appropriate information in the foster home is the
first step in gaining the child/ young person’s confidence.
Social workers and foster carers may find it useful to build on the young person’s 13th Birthday
pack (provided to all accommodated children of 13 or as soon after as they become
accommodated). This should accompany the young person throughout their time of being
accommodated, whatever placement changes may take place.
COMMON CONCERNS
Masturbation
Masturbation is a part of normal sexual behaviour, especially for young people growing up and
exploring their sexuality.
It’s completely harmless, no matter how you do it or how often. It won’t make you go blind or
mad, and you won’t get hair on the palms of your hands. Several times a day is not unusual,
nor is less often. It helps you to know your body better, and what you like and don’t like. But
you don’t have to do it … there is no way you can ‘lose energy’ this way … or your virginity.16
But many religions and cultures teach that people should not masturbate and this can lead to
guilt and embarrassment. However, it is important to acknowledge young people’s or their
family’s beliefs. Young people mostly need reassurance that it is an ok, enjoyable sexual
activity. Some may need reminding that it is also a private activity. Of course, mutual
masturbation can also be a useful alternative to intercourse – and much safer.
Pornography
Definitions and opinions of pornography (“indecent images”) vary widely
Material that gives a stereotyped, distorted, or exploitative view of sexuality is widely available
in newspapers and magazines, on DVDs and on the internet and is commonly purchased or
viewed. It is more that likely, therefore, that many children or young people will get access to
such material, particularly via the internet, either deliberately or by accident. But at best it can
give unhelpful or misleading messages to young people and may be particularly damaging to
young people who have been sexually abused. Generally it presents poor images and role
models of women and men in society.
If a young person is found in possession of material perceived to be pornographic, or found
viewing it on the internet, they should not be told off. It should be explained to them that many
people find this sort of material distasteful and why. It may be appropriate to have a further
discussion about pornography and explore the young person’s feelings and attitudes towards
it. It may reflect the fact that they do not have access to information from more appropriate
sources.
Further action will depend on the age and maturity of he child or young person in question, the
other children around etc.
16
fpa, 4 boys and 4 girls 2004.
SD 13 - SRE Guidance for CYP 2009
Page 13 of 22
Legally, the onus is on publishers of magazines, websites etc to ensure they comply with the
law. The only offence that a young person could commit would be downloading indecent
pictures of children or young people under 18 years of age. 17
The internet (including mobile phones)
Some 12% of internet sites are pornographic. Sometimes they hide behind innocent-sounding
names such as ‘Barbie’, and sometimes they ‘invade’ other innocent sites. The Home Office
now advises parents and carers to learn how to monitor the use of the internet effectively,
even where parental controls are in place 18
Carers and young people need to be aware that adults can use the internet and chat rooms in
particular, to entice children and young people into paedophile activity and prostitution.
Current information is that one in five children who use chat rooms have been approached by
paedophiles
online.19
Online
safety
advice
is
also
available
via
www.parentsonline.gov.uk/safety. Furthermore anyone who has concerns about a particular
website, can forward details to the Internet Watch Foundation, at www.jwf.org.uk who will
investigate fully.
3. MANAGING RISK
In an ideal world, carers, social workers and young people work together to help the young
person manage successfully their sexual development and the potential risks to their sexual
health. But it is not unusual for young people to engage in risky behaviour, or to find that their
risk management strategy has failed, e.g. because they were drunk or on drugs.
Accommodated young people are even more vulnerable. This can make caring for a young
person very anxiety provoking, stressful and challenging.
Each accommodated young person will require an individual response, based on a broader
understanding of the young person’s needs and difficulties. Some young people will welcome
being able to confide in a trusted adult, others will find this very difficult to accept. Carers,
social workers and other professionals need to work with the young person to find a solution
and/or a trusted adult that he/she finds acceptable. Carers in particular will also need to
decide (as with other behaviours) what is acceptable within their own homes.
If there are issues about the young person’s welfare, e.g. that a young person under 16 is
taking risks sexually, this should be discussed in the first instance with the young person, to
support them in getting help and advice. If the young person, or someone else, is at risk of
serious harm, it will need to be raised with the young person’s social worker, and/or the social
worker’s line manager. This is especially the case with young people under 13 years.
If there are concerns that a young person is being sexually exploited, this information
should be shared between the foster carer, the young person’s social worker and his/her line
manger to get guidance. It may need to be taken forward as a child protection issue, taking
account of any risks the young person might be exposed to as a result, e.g. threat from
pimps. There may also be issues of criminal behaviour under the new Sexual Offences Act.
It is never possible to manage all the risks; young people have got to have the chance to
make mistakes just as we all do. We need to ensure thought, that they are supported in
dealing with any consequences.
17
Age changed from 16 years in Sexual Offences Act 2003.
Home office: Keep your child safe on the internet. 2004, free leaflet available from Home Office
Publications or on www.THINKUKNOW.co.uk
19 Community Care, 15-21 January 2004.
18
SD 13 - SRE Guidance for CYP 2009
Page 14 of 22
ACCESS TO CONTRACEPTION AND SEXUAL HEALTH SERVICES
The most comprehensive guidance for social workers and foster carers specifically around
young people and contraceptive and sexual health services are the following 2 documents,
both are available to download.
Guidance for Field Social Workers, Residential Social Workers and Foster Carers on
Providing information and Referring Young People to Contraceptive and Sexual
Health Services. (Download available from www.everychildmatters.gov.uk )
Enabling young people to access contraceptive and sexual health information and
advice: Legal and Policy Framework for Social Workers, Residential Social Workers,
Foster Carers and other Social Care Practitioners. (Download available from
www.DH.gov.uk )
Social workers, foster carers and all social care practitioners caring for adolescents are
strongly advised to be familiar with these documents. They include a number of helpful
responses to frequently asked questions and have been updated to take account of the
Sexual Offences Act 2003.
Key Information
They specifically refer to contraception but the principles also apply to other treatments,
including abortion. They refer to doctors, but also apply equally to other health professionals
in England and Wales including school nurses, sexual health outreach workers etc. They are
sometimes referred to as Gillick competence, both names deriving from Lord Fraser and Lord
Scarman’s ruling in the Gillick case.
Giving contraceptive advice and treatment to young people under 16 without parental
consent
Provided the health professional is satisfied that the young person is competent to understand
fully the implications of any treatment and to make a choice of the treatment proposed. The
health professionals must establish that all of the following criteria are met:





The young person understands the doctor’s advice;
The doctor cannot persuade the young person to inform his or her parents or allow the
doctor to inform the parents that he or she is seeking contraceptive advice;
The young person is very likely to begin or continue having intercourse with or without
contraceptive treatment;
Unless he or she receives contraceptive advice or treatment, the young person’s physical
or mental health or both are likely to suffer;
The young person’s best interests require the doctor to give contraceptive advice,
treatment or both without parental consent.
Contraception
Field social workers, residential social workers and foster carers can and should give young
people, including under 16s, information on sexual health and contraception and details of
where and how to access local services.
SD 13 - SRE Guidance for CYP 2009
Page 15 of 22
If they believe a young person is likely to start a sexual relationship, they should actively
encourage them to visit a local contraceptive and sexual health service or their school nurse
to help minimise any risk taking.
The duty of field social workers, residential social workers and foster carers, irrespective of
their personal views, is to promote and safeguard the health and welfare of young people. In
addition to providing information about services, they should offer young people support in
developing assertiveness and negotiating skills to help them resist peer pressure to have early
and unwanted sex. This is particularly important for vulnerable young people who, through
lack of self-esteem, may feel less able to make their own choices.
The parents of a looked after child or young person may express wishes about the sex and
relationship education or contraceptive advice they want provided. Whilst every effort should
be made to respect these wishes wherever possible, the overriding principle for the field social
worker, residential social worker and foster carer is to safeguard the health and welfare of the
young people in their care.
For example, if a young person discloses that they have had unprotected sex, the parents’
views should not be a barrier to immediate referral to a health professional for discussion
about emergency contraception.
Young people under care orders have the same right to confidentiality and treatment from
health professionals as other young people.
This means they can ask for and access
contraceptive advice from health professionals with the same degree of assurance about
confidentiality as a young person who is not subject to a care order.
If a health professional does not consider them competent to understand and made a choice
of the treatment proposed, either the local authority or the person with parental responsibility
could give consent to medical treatment including contraception.
Children subject to Care Orders
Section 33(3) 9b) of the Children Act gives parental responsibility to Councils within Social
Services Responsibilities (CSSR) for any young person in respect of whom it has a care
order. In relation to such as young person, the CSSR could decide to agree to medical
treatment, including contraception, without the consent of the parent. In these circumstances
they would normally inform the parents of the decision, unless to do so would not be in the
young person’s best interests.
The Sexual Offences Act 2003 now takes this further:
The Sexual Offences Act (2003) does not affect the ability of health professionals and others
working with young people to provide confidential and sexual health advice and treatment to
young people under 16, including those under 13.
Section 14 (2) and (3) of the Sexual Offences Act makes clear that a person does not commit
the offence of arranging or facilitating commission of a child sex offence if they act to:
a) protect the child from a sexually transmitted infection
b) protect the physical safety of the child
c) prevent the child from becoming pregnant
d) promote the child’s emotional well-being by giving of advice
Provided it is not done for the purpose of obtaining sexual gratification or for the purpose of
causing or encouraging the sexual activity.
The exception covers not only health
SD 13 - SRE Guidance for CYP 2009
Page 16 of 22
professionals, but also anyone who acts to protect a child, including parents, social care
practitioners, teachers, youth workers and Connexions Personal Advisors.
This is a significant step forward from the current position of “Gillick” which is case law which
only relates to health professionals.
Those providing contraceptive treatment to under 16s will continue to assess competence on
a case by case basis and work within the Fraser Guidelines. The Act does not change the
fact that young people, including those under 13, have the same right to confidentiality as
adults20.
However an accommodated young person under 13, having or planning to have sex, should
be seen as a child protection issue and taken forward accordingly. This should also apply to
any young person for who there is concern re. significant harm.
In brief:
Accommodated young people of 16 or over:




can be sexually active whether gay or straight
can organise their own contraceptive and sexual health advice, confidentially, though they
may need help with this, to know where to go and who to see. They may also need
support in doing it.
Health professionals may encourage the young person to share some information, but
Social Services and foster carers have no right to the information, including information on
the young person’s HIV status.
If an accommodated young person volunteers or wants to discuss very personal
information it should be recorded in general not specific terms (e.g. discuss health
worry/plan).
Accommodated young people under 16 (including those under 13):





Need access to information they can understand, to know they can ask for more
information, who they can go to for further information and how to get there.
Can go to a health adviser, nurse or doctor in confidence
A health professional may need to assess them (see Fraser Guidelines)
Having been assessed and supplied with contraception by a health professional, foster
carers could then continue to do this.
Having assessed them as competent, health professionals may encourage the young
person to share some information, but Social Services and foster carers have no right to
the information, including information on the young person’s HIV status.
Young people in both age groups may need age appropriate support, advice and
information on:


20
Issues and concerns about their sexual identity
Dealing with abusive or coercive relationships
Sexual Offences Act 2003, key messages, Teenage Pregnancy Unit, DOH, November 2003
SD 13 - SRE Guidance for CYP 2009
Page 17 of 22
Particular groups of young people
Boys and Young men
Carers and social workers need to be aware of the needs of boys and young men who
currently miss out on both formal and informal sex education. They will need to be proactively
engaged, and this may involve putting them in touch with services specifically for them.
Young People from Black and Minority Ethnic Groups, Young People with Disabilities
and Gay Young Men and Women.
Carers and social workers need to be aware that young people in any of these groups may
miss out on or switch off from both formal and informal sex education. This may be because it
does not seem to be appropriate to their needs or because adults, including professionals, are
ill informed, or make assumptions about what they do or don’t need. This can be a particular
problem for young people with disabilities who are often stereotyped as people with no
sexuality at all.
Individuals from any of these groups may need special help in challenging and dealing with
stereotyping, prejudice, abusive remarks and behaviour. They may also need to be put in
touch with services specifically for them.
PREGNANCY
If an accommodated young woman becomes pregnant, it is important that, as soon as
possible, she has the opportunity to discuss her options with an appropriate health
professional. It is also important that, in consultation with the young person, a key worker
is identified. This need not be the young person’s social worker, thought they would continue
to hold the case responsibility. If the young person is over 16 she can make her own decision
about abortion but may need additional support do this. If she is under 16, some doctors will
not agree to abortion without the consent of parents (or those will parental responsibility).
Other doctors will make a decision based on the young person’s competency in line with the
Frazer guidelines.
If the young person decides to continue with the pregnancy they are to be advised, supported
and encouraged to make contact with their GP who will organise a midwife to support them
throughout the pregnancy.
SEXUALLY TRANSMITTED INFECTIONS (STIs)
The most common STIs are Chlamydia, non specific urethritis (NSU) and wart virus infections,
though almost all STIs are becoming more common. Chlamydia rates doubled in the 1990s
and rates are especially high among men and women under 20.
Anyone engaging in intimate sexual activity can get an STI, but STI figures are higher for
young people, women, gay men and some ethnic minority groups.
Some STIs can be readily treated; some like AIDS can only be managed. Untreated STIs can
lead to long term serious health problems (eg. infertility in the case of Chlamydia). It is
important therefore for young people to be aware that:




Not all STIs show symptoms at first
Some STIs carry very serious health risks
Safer sex using condoms is the best protection
Even safer sex does not provide total protection from STIs
SD 13 - SRE Guidance for CYP 2009
Page 18 of 22
Where there are symptoms, or any concerns, medical advice should be sought as soon as
possible. Again all young people should be given information about where to go for advice,
treatment or check-ups and should be reassured that the advice and treatment is confidential.
FINALLY, none of us have all the answers all the time. We need to be comfortable saying to
a child or young person ‘I don’t know the answer to your question – but I know how we can
find out’. Not only is this honest, but it also provides an opportunity for the child or young
person to learn more about how to go about finding out the appropriate information.
For useful contacts and services in Torbay see a copy of The Guide – Sexual Health Advice in
Torbay or contact your local Teenage Pregnancy Strategy Manager on 01803 208903.
RESOURCES
There are many books, leaflets, videos, DVDs and CDs aimed at professionals, children and
young people, but they can quickly change and develop so are not quoted here. The website
is one of the best ways that young people can obtain up to date information and listed below
you’ll find some of the recommended sites along with contact details.
Local contacts and services are also listed along with details of where to obtain sexual health
resources in Torbay.
LOCAL CONTACTS
E mail or other information
Contacts
Telephone
Designated Nurse for Children 01803 208500
and Young People Looked or
After
07754 446278
Contraceptive
and
Sexual 01803 656500
Health Services
Resources available at The 01803 308692
Eddystone Trust, Torquay
Teenage Pregnancy Strategy 01803 208903
Manager
Lesley.harris@torbay.gov.uk
Contraceptive and sexual
health services (including
testing for STIs) provided by
the NHS
Some
sexual
health
resources
available
for
collection. Telephone before
hand to ensure staff are
available.
Kim.flemming@torbay.gov.uk
NATIONAL ORGANISATIONS
Telephone
Comments
Sexwise
0800 28 29 30
Confidential. Clear and user
friendly website on anything
to do with sex, relationships
and contraception.
Details
Website
www.ruthinking.co.uk
SD 13 - SRE Guidance for CYP 2009
Page 19 of 22
www.brook.org.uk
0800 0185 023
www.fpa.org.uk
0845 3101334
www.playingsafely.co.uk
0800 567123
www.parentlineplus.org.uk
0808 800 2222
www.nat.org.uk
0800 567123
www.talkadoption.org.uk
0808 808 1234
www.childline.org.uk
0800 1111
www.queery.org
020 7837 7324
www.ncb.org.uk
020 7843 6056
www.likeitis.org.uk
(Part of Marie Stopes)
www.teenagehealthfreak.org.uk
www.wiredforhealth.gov.uk
SD 13 - SRE Guidance for CYP 2009
of local services.
Clear and user friendly.
Confidential advice on sex
and contraception.
Leaflets and confidential
information on contraception
and sexual health.
Sexual
health
and
information advice line
Offer support to anyone
parenting a child
Confidential helpline on all
aspects of HIV/AIDS
National helpline for young
people
Free and confidential, 24
hour helpline for children and
young people
Lesbian
and
Gay
switchboard
Sex Education Forum –
provides information and
resources for children and
young people
Everything about sex and
teenage life exactly as it is –
no frills – no holds barred.
Cool site with clear advice on
wide range of health issues
for teenagers.
Information and resources for
professionals
promoting
health with young people
including young people sites.
Page 20 of 22
APPENDICES TO SD 13
Appendix 1 TO SD 13
CHILDREN ACT 1989 GUIDANCE
Enabling young people to build and maintain relationships with others:
Sexual Relationships (Vol 3, p 97)
The experience of being in care should also include the sexual education of the young person.
This may be provided by the young person’s school, but if it is not the SSD or other caring
agency responsible for the young person should provide sexual education for him. This is
absolutely vital since sexuality will be one of the most potent forces affecting any young
person in the transition from childhood to adulthood.
Sexual education will need to cover practical issues such as contraception, particularly in view
of the spread of AIDS. However, it must include the emotional aspects of sexuality, such as
the part that sexuality plays in the young person’s sense of identity; the emotional implications
of entering into a sexual relationship with another person, and the need to treat sexual
partners with consideration and not as objects to be used. The emotional and practical
implications of becoming a parent also need to be explained in some detail.
Those responsibilities for the sexual education of young people will need to bear in mind the
particular needs of different young people; the fact that young people with mental or physical
disabilities have sexual needs should be acknowledged, for instance. And young people who
may have been abused, or have been in touch with abused young people, may need special
counselling if they are not to regard sexual feelings as a matter for shame or to regard sexual
relationships as impersonal and exploitative. The needs and concerns of gay young men and
women must also be recognised and approached sympathetically.
Principles underlying preparation for leaving care (Vol 4, p101)
…… in helping young people to develop socially and culturally, carers must be prepared to
take some risks and to take responsibility for doing so; to let young people take some risks,
eg. In attempting relationships that do not work; and to take responsibility for supporting young
people through breakdowns in relationships.
SD 13 - SRE Guidance for CYP 2009
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Appendix 2 TO SD 13
Sexual Offences Act 2003: Key Messages
The Sexual Offences Act 2003 received Royal Assent on Thursday 20 November and became
law in May 2004.
Does the Sexual Offences Act 2003 allow health professionals and others working with
young people to provide confidential sexual health advice and treatment?
Yes. Government has committed to ensure the Act will not prevent the provision of
confidential advice and treatment to young people under 16, including those under 13. In light
of concerns that were raised about the implications of the Act for those who provide health
care and advice to young people, an exception has been introduced, in statute, to make it
clear that a person does not commit an offence if he acts for the purpose of:
(a)
(b)
(c)
(d)
protecting the child from sexually transmitted infection, or
protecting the physical safety of the child, or
preventing the child from becoming pregnant, or
promoting the child’s emotional well-being by the giving of advice
as long as he does not act for the purpose of causing or encouraging the activity constituting
an offence or the child’s participation in it. Nor does it apply if the person is acting for the
purpose of obtaining sexual gratification.
The exception covers not only health professionals, but also anyone who acts to protect the
child, for example, teachers, Connexions Personal Advisers, teenage magazine advice
columnists, parents, other relatives and friends. This is a significant step forward from the
current position of Gillick which is case law which related to health professionals.
Those providing contraceptive treatment to under 16s without parental consent will continue to
assess competence on a case by case basis and work within the Frazer Guidelines.
SD 13 - SRE Guidance for CYP 2009
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