Effective approaches to community awareness raising of child sexual exploitation: a review of the literature on raising awareness of sensitive social issues Dr Lisa Bostock February 2015 Summary • C ommunity awareness raising of child sexual exploitation (CSE) is an active and growing area of policy and practice. Yet, no published evaluations exist of CSE community awareness activities, making it difficult to assess what works best. • T he purpose of community awareness raising depends who is undertaking awareness raising and the population being targeted. From the perspective of professionals, its purpose can be grouped into the following categories: prevention, identification and early intervention and access to advice and support. • W hat is less well understood is what children, young people, parents, carers and the wider community want from CSE awareness raising activities. • E vidence from the wider literature on effective methods of awareness raising on sensitive social issues suggests awareness raising models can be effective but have differential impact on different groups. Targeted outreach work such as community events, appear to work well to promote knowledge and understanding with those ‘harder-to-reach’, including fathers and minority ethnic groups. • M odels of awareness raising fall into the following four categories: multi-media campaigns; outreach via community events; peer educator programmes; and multi-modal activities that adopt a variety of awareness raising techniques. • T he factors that promote effective community awareness raising include: having clear aims and objectives; understanding the needs of the target audience; engagement with wider stakeholders; and use of designated workers to promote awareness and access to services. • T his suggests that to have the most effect, it is important to understand the nature and extent of young peoples’, carers’ and wider community’s awareness of CSE. By doing so, awareness raising initiatives can be tailored to address any knowledge gaps and activities developed in line with needs and preferences. • R ecent research shows that the majority of parents have at least heard of CSE via media reporting, but revealed mixed knowledge concerning signs and indicators and risk factors of vulnerability. • S potting the signs of CSE is difficult without disclosure from children and young people. Children and young people are reluctant to disclose exploitative experiences due to lack of appropriate responses from services, and normalisation of sexual violence, reflecting attitudes in wider society. • N evertheless, young people identified a desire for more openness about sexual exploitation and the development of trusting relationships and discussion with peers who had experience of sexual violence. • T here are few examples of CSE awareness raising with the wider community. New but unevaluated initiatives are working with local faith and community leaders to develop, appropriate, sensitive CSE awareness raising strategies. • U nderstanding effective methods of CSE community awareness raising is in its infancy. This is a significant gap in the knowledge base and clearly, an area that warrants further investigation to ensure future effectiveness of such activities. 2 Contents 1 Introduction................................................................................................................... 4 1.1 Families and Communities Against Sexual Exploitation (FCASE).......................... 4 1.2 Research review questions.................................................................................... 4 1.3 Methods................................................................................................................. 5 1.4 Definitions.............................................................................................................. 6 1.5 Purpose of CSE community awareness raising..................................................... 6 1.6 What are the issues?............................................................................................. 7 1.7 Barriers to effective CSE awareness raising.......................................................... 9 2 Different models of awareness raising......................................................................... 10 2.1 Multi-media campaigns.......................................................................................... 10 2.2 Community events................................................................................................. 11 2.3 Peer educator programmes................................................................................... 11 2.4 Multi-model activities............................................................................................. 11 2.5 Effectiveness of awareness raising models.......................................................... 13 3 Factors promoting and hindering the success of models............................................. 16 3.1 Aims and objectives............................................................................................... 16 3.2 Understanding the needs of the target audience.................................................. 16 3.3 Engaging with wider stakeholders......................................................................... 18 3.4 Designated inclusion workers................................................................................ 18 4Young people, parents and wider community views on CSE and CSE awareness raising................................................................................................. 18 4.1 Parental perspectives awareness on CSE............................................................. 18 4.2 Children and young peoples’ perspectives on CSE............................................... 20 4.3 Wider community views on CSE........................................................................... 22 5 Conclusions and recommendations.............................................................................. 22 Suggested reading........................................................................................................ 24 Useful websites............................................................................................................ 24 References.................................................................................................................... 25 Appendix A: Full search strategy and review methods................................................. 28 3 1 Introduction It is widely assumed by policy-makers and campaigners that community raising awareness of child sexual exploitation (CSE) is a ‘good thing’. Yet, awareness raising has been subject to criticism, with insufficient emphasis placed on its importance by agencies charged with the responsibilities of safeguarding children[1]. But what is community awareness raising? How is it conducted and how do we know that it makes a difference? What do children, young people and their families and carers as well as the wider community want from CSE awareness raising? If we agree that awareness raising is ‘crucial [to] ‘preventing sexual exploitation taking place’[2], answering such questions is essential if we are to get community awareness right for children, young people, their carers and wider community. This research review reports evidence on effective approaches to community awareness raising of sensitive social issues. Community awareness raising of CSE is a new phenomena, hence is an area where practice is ahead of the research and current initiatives unevaluated. In order to develop the evidence base in this area, the review is part of a wider evaluation undertaken by the School of Applied Social Studies, University of Bedfordshire of Barnardo’s Families and Communities Against Sexual Exploitation (FCASE) project.* *See http://www.beds.ac.uk/intcent/publications for all FCASE reports. 1.1 Families and Communities Against Sexual Exploitation (FCASE) FCASE aims to: • Develop community understandings of the signs and indicators of CSE. • Enhance relationships with parents/carers and children and young people. • Reduce the levels of risk for children and young people. • E mpower children and young people make healthier and safer sex and relationship choices. • P rovide support and strategies to enable parents/carers to keep the child or young person safe. Additionally, FCASE community events aim to highlight the existence of the project, and encourage children and young people, parents, carers and local professionals such as youth workers to make contact with FCASE as necessary. 1.2 Research review questions In order support development of University of Bedfordshire’s evaluation of FCASE, this review explores effective approaches to community awareness raising of sensitive social issues. It aims to identify and describe: 1 different models of community awareness raising; 2 evidence of their effectiveness, with focus on outcomes achieved; 3 factors promoting and hindering the success of these models; 4 the perspectives of children, young people, parents/carers and the wider community. When identifying and describing the above the review pays particular attention to awareness raising with Black and Minority Ethnic (BME) groups as well as examples of user-led initiatives that promote public awareness raising. 4 1.3 Methods The methods used to identify and organise material in this review were developed by the Social Care Institute for Excellence (SCIE)[3]. In total, 69 items were identified of which 20 met criteria for inclusion for review. Almost all items report the ‘grey literature’ including research reports (15); independent and voluntary sector reports (3). Just two items peer reviewed (see appendix A for full search strategy write up). Consultation with the project team identified the lack of evaluations of CSE community awareness raising activities. This meant undertaking searches on topics beyond raising awareness of CSE within the community to capture learning from the wider literature on awareness raising on sensitive social issues. In agreement with the commissioners of the review, topics included: 1 Child protection, including children at risk of online grooming. 2 National evaluation of Sure Start (NESS). 3 H ealth promotion initiatives including improving take up of chlamydia testing; and increasing organ donation registry among BME groups. 4 Community-led community safety awareness raising initiatives e.g. gun and knife crime. These topics are necessarily diverse focused on areas that are directly relevant to CSE awareness raising e.g. child protection issues but also areas where evaluations have taken place that affect young people e.g. improving uptake of chlamydia testing or BME groups e.g. improving organ donation registry. NESS was included because it was known to have included evaluation of promotional activities, including use of community events. Raising awareness of gun and knife crime was identified as an area where community-led initiatives were known to have been developed, particularly by mothers whose families had been affected. Although, subsequent searches revealed such initiatives have gone largely unevaluated. In order to be included for full review, items had to an evaluation study. Studies reporting the views of children, young people, parents/carers and the wider community were also included. This reflects the aims of the review to understand their perspectives on CSE and effective awareness strategies; evidence unlikely to be identified via a focus on evaluation studies only. Research types included research reports, independent and voluntary sector reports and peer reviewed papers. Due to time and budget constraints, only UK-based studies are included for review. The majority of the items (18) identified are linked. Eight items refer to the National Evaluation of Sure Start[4-11]; four items are part of the Office of the Children’s Commissioner (OCC)’s Inquiry into Inquiry into Child Sexual Exploitation in Gangs and Groups (CSEGG)[12-15]; two items refer to the evaluation of the awareness raising campaign to increase chlamydia testing[16, 17]; and two items are part of the European Commission Safer Internet Plus project on improving online safety of children and young people[18, 19]. 5 1.4 Definitions In line with Government policy, the review uses the definition of CSE as developed by the National Working Group for Sexually Exploited Children and Young People (NWG)1: ‘Sexual exploitation of children and young people under 18 involves exploitative situations, contexts and relationships where young people (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities. Child sexual exploitation can occur through the use of technology without the child’s immediate recognition; for example being persuaded to post sexual images on the Internet/mobile phones without immediate payment or gain. In all cases, those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources. Violence, coercion and intimidation are common, involvement in exploitative relationships being characterised in the main by the child or young person’s limited availability of choice resulting from their social/ economic and/or emotional vulnerability’[20]. Community awareness raising is more difficult to define, with limited explanations of what is meant by awareness raising available in the literature. For the purposes of this review, community awareness raising refers to activities that promote understanding of CSE with children, young people, their families and carers and wider community e.g. members of the general public. Activities include: multimedia campaigns, such as advertising campaigns on television, radio, national and local press and social media; informal outreach activities such as community-based events and formalised outreach through home visiting; publicity leaflets and postcards; plays and performances; films; and targeted work with specific groups such as leaders of local faith communities. The definition does not include awareness raising among professionals, such as the police, health and social care staff or youth workers; this is beyond the scope of this review. 1.5 Purpose of CSE community awareness raising The purpose of community awareness raising depends who is undertaking awareness raising and the population being targeted. From the perspective of professionals, the purpose of awareness raising can be grouped into the following categories: prevention, identification and early intervention and access to advice and support. Professionally-led awareness raising activities with young people are focused on supporting young people stay safe, make positive choices in relationships and resist unwanted sexual experiences. For parents, carers and the wider community, awareness raising is focused on increased understanding of the signs and indicators of CSE. These include: going missing from home or care; receipt of gifts from unknown sources; involvement in offending; drug or alcohol misuse; poor mental health, self harm, thoughts or 1 he National Working Group is a support group for individuals and service providers working with children and young people who are at risk of T or who experience sexual exploitation. The Group’s membership covers voluntary and statutory services including health, education and social services. 6 attempts at suicide; and repeat sexually-transmitted infections, pregnancy and terminations[20]. What is less well understood is what children, young people, parents, carers and the wider community want from awareness raising activities, discussed in sections 4-4.3. 1.6 What are the issues? A series of high profile court cases, research into the impact of gang-associated sexual violence on women and girls alongside national campaigns such as Puppet on a String by Barnardo’s have fuelled public awareness of CSE[12, 15, 21-23]. The scale of the problem is significant with many thousands of children and young confirmed as victims of CSE or at high risk of sexual exploitation[14]. Child and young people from a range of ages, ethnicities and sexual orientation as well as some disabled young people are victims of CSE. The majority live at home, although a disproportionate number live in residential care. Girls and young women are more likely to victims but a significant minority are boys and young men. While the profile of perpetuators is more difficult to identify, the majority are White males. Men loosely recorded or reported as ‘Asian’ are the second largest category of perpetrators. There is also overlap with a small minority of victims who are also reported as perpetuators of abuse[14, 24, 25]. Increased understanding and awareness has meant that CSE has moved up the policy and practice agenda[2, 13-15, 20, 26-29]. In 2009, the then Department for Children, Schools and Families issued supplementary guidance to Working Together to Safeguard Children focused specifically on CSE[20]; with new statutory guidance also issued by the Welsh Assembly Government[28]. In Scotland and Northern Ireland, CSE policy and practice is currently subject to enquiry and review[23, 30]. In 2011, the UK government issued an action plan on tackling sexual exploitation[2]. This outlined a series of actions including increasing awareness of CSE among young people, parents and carers and professionals. In relation to their raising awareness function, the guidance states that Local Safeguarding Children Boards (LSCBs) should identify any issues around sexual exploitation, including those arising from the views and experiences of children and young people in their area. This should include: awareness raising activities focused on young people; publicity for sources of help for victims; how and where to report concerns about victims and offenders; and public awareness campaigns more generally[20]. For children and young people, the guidance emphasises the importance of sex and relationship education (SRE) to raise awareness about CSE and support children and young people make safe and healthy choices about relationships. Specialist education programmes such as Barnardo’s Bwise2 Sexual Exploitation aim to raise awareness of the rights, risks and responsibilities that equip young people to stay safe as well as promote young people’s confidence to resist unwanted sexual experiences[31]. 7 In terms of ‘targeted prevention’ for parents and carers, the guidance states that agencies should consider how best to inform them about patterns of grooming, indicators of risk of sexual exploitation and the impact of sexual exploitation on children, young people and families as well as where to access advice and support. Local Authorities (LA’s) should work specifically with foster carers and staff in children’s homes to raise awareness of CSE[20]. In their review of policy and practice in LSCBs in England, Jago et al’s (2011) found the impact of the supplementary guidance as ‘limited’, with targeted awareness raising aimed at young people, their families and carers occurring in less than half of the country[1]. A finding mirrored by research undertaken in Wales, where a review of local CSE protocols found awareness of such protocols to be limited to a few key professionals (Clutton and Coles, 2009). Since publication of the two reviews above, the OCC’s Inquiry into CSEGG has produced a series of reports[13-15]. A comparison of data collected from LSCBs by the Inquiry and that gathered by the Jago et al. (2011), indicates that progress has been made with 68 per cent running awareness-raising programmes[15]. The Inquiry found that 38% of LSCBs have or plan to run awareness-raising programmes for parents and carers on how to spot the early signs of child sexual exploitation; 46% have carried out awareness-raising activity directed at young people; and 78% have delivered awareness-raising programmes for professionals, although it is not clear what percentage are foster carers or staff in children’s homes. The need to achieve greater awareness of CSE to aid prevention and early intervention not only among professionals, but also the wider public is recognised by the Local Government Association (LGA). In February 2013, the LGA launched an eight week ‘National Conversation’ exercise that posed a series of questions on promoting best practice in awareness raising of CSE[27]. Responses from local LA’s, the voluntary and community sector and health professionals suggested the following community-led activities: • t raining community based mentors to deliver workshops in CSE, using an area wide training scheme and utilising voluntary agencies; • h aving CSE stalls with leaflets and trained CSE workers at community events such as fetes and markets; • m aking sure that where CSE is publicised in communities there is follow up with staff that have a good knowledge and can give well informed advice; • h olding safeguarding forums within the community; • s etting up one-to-one sessions with young people affected and developing peer-topeer support systems; • inviting professionals to community meetings to speak about CSE and answer any questions people may have[27]. Responses have informed development of online resource to support councils in raising awareness of CSE[32]. As part of the resource, the LGA has published case studies from six LA’s showing how they are tackling awareness raising with partner agencies, young people, parents, faith groups and local media. All six areas have engaged in schools-based 8 awareness raising activity, including Kent’s work with Barnardo’s to embed awareness of CSE within its wider safeguarding children’s policy. Of the other areas, three are actively engaged in wider community-awareness raising: Rochdale is developing awareness-raising for the Muslim community; Rotherham has targeted local taxi drivers as well as producing leaflets for children and young people, parents and carers, and ensuring clear information on the council website; whereas Blackpool’s ‘Buzz Bus’ travels to communities providing advice, information and support on a range of health and wellbeing topics, including CSE[33]. 1.7 Barriers to effective CSE awareness raising The LGA also identifies a series of barriers to raising CSE within local communities, including: stereotypes about the type of person who commits CSE, with some communities finding it difficult to accept that people within their group could commit CSE; focus on particular models such as the ‘boyfriend model’ or the ‘gang model’ meaning that other vulnerable groups, such as young men or victims of peer-on-peer violence can be overlooked; wider societal perceptions that ‘blame’ the victim for repeatedly returning to perpetrators; or the view that CSE only happens to children with bad parents leading some people to mistakenly believe that their child is not at risk. In addition, funding, difficulties with inter-agency working, offering CSE education to younger children within an already packed curriculum as well as uncertainty about how to engage with some communities were all identified as barriers faced by council-led awareness raising activities. Importantly, lack of evaluation remains a barrier to improving the effectiveness of CSE awareness raising. Beckett et al. in their review of current responses to CSE for the London Councils and London Children’s Safeguarding Board, found that while awareness raising was taking place with parents/carers and children and young people (in around 50% of Boroughs who responded to this question), very few London Boroughs had undertaken awareness raising with the wider community. Activities largely focused on written materials, such as posters and leaflets with some online materials and training courses. However, the impact of such awareness raising activities was rarely evaluated: just two Boroughs, for example, had evaluated any aspect of their awareness raising work with children and young people[34]. Becket et al. also found that the education sector was engaged in multi- agency partnerships, and were a source of CSE referrals, a number of interviewees and survey respondents highlighted inadequate engagement on the part of schools as a barrier to awareness-raising with young people. They state that while some schools were positively engaged in referring children into CSE systems where they have concerns, they were not always positively engaged with preventative and awareness-raising CSE activities. Only 17 of the 30 survey respondents reporting awareness of any school-based initiatives in relation to CSE in their area[34]. 9 2 Different models of awareness raising Given CSE awareness raising is a new area for policy and practice, the current review looked to the wider literature on effective approaches to awareness raising on sensitive social issues to derive relevant learning. The review identified four areas where evaluation research on the impact of awareness raising had taken place: child protection; National evaluation of Sure Start (NESS); health promotion including: improving take up of chlamydia testing and increasing organ donation registry among BME groups. Review of this literature identified four UK-based models of awareness raising. These models fall into the following categories: • M ulti-media campaigns e.g. advertising campaigns on TV, radio, national and local press and social media • Community events e.g. outreach via community-based events • P eer educator programmes e.g. trainer educators from target populations to improve awareness of an issue • M ulti-model activities e.g. informal outreach such as social events and organised outreach via home visiting as well as wider publicity materials such as leaflets and merchandise. 2.1 Multi-media campaigns This model of awareness raising cover a range of advertising activity on TV, radio, national and local press and use of social media such as Facebook. Two linked studies looked at the national campaign to increase uptake of chlamydia screening among 15–24 year olds in England called “Chlamydia: Worth talking about”[16, 17]. The campaign ran between February and March 2010, on national TV, radio and included online and poster advertising as well as leaflets, posters and access to logos for local campaigns. The campaign sought to normalise conversations about the transmission of chlamydia, raise awareness of the risk of untreated infection and explain the process of diagnosis and treatment among a group at high risk of infection. The uptake of screening among 15–24 year olds was identified by the campaign developers as a key indicator to evaluate the campaign[16]. In February 2005, the Scottish Executive introduced a protecting children and young people pilot campaign in Aberdeen City, Aberdeenshire and Moray[35]. The campaign was non TVbased, consisting of local radio, inserts into local newspapers, outdoor advertising including posters and bus headliners and posters for the police, GP surgeries and schools. The campaign was targeted at the Scottish adult population and aimed to: raise public awareness of child protection issues and the fact that not all children at risk are easy to recognise; increase public attentiveness to the ‘early signs’ of neglect or harm in children and young people; emphasise individual and community responsibility in relation to child protection; and provide a mechanism for people concerned about a child or young person to make contact with the authorities. The research evaluated both how effective the pilot campaign had been in terms of communicating its key messages as well as examining wider attitudes across Scotland toward protecting children and young people. 10 2.2 Community events Outreach work via community events to raise awareness can be both targeted at particular population groups or may take place within wider community events. As part of a smallscale study on perceptions and beliefs about organ donation in African, Caribbean and Asian communities, Clarke-Swaby[36] organised an event to increase awareness of organ donation, diabetes and kidney disease. The event was held at a local Church Centre and attended by 100 members of the local community. Various health professionals and key public figures gave presentations on national projects to raise awareness of organ donation and blood transfusion, high blood pressure and diabetes and their implications for kidney disease; organ donation and transplantation and barriers impacting the uptake of organ donation. Donors and recipients also shared personal accounts of giving and receiving a kidney. In order to measure the success of the event, data on numbers of signed organ donation registration forms and post event feedback were collected from participants. 2.3 Peer educator programmes As part of Kidney Research UK’s ABLE (A better life through education and empowerment) programme, a Peer Educator programme was piloted. The aim of the pilot was to improve understanding of organ donation among BME communities and to increase the number of BME organ donors[37]. Peer Educators for the pilot were drawn from BME communities employed by the local NHS Trust. Peer Educators were given two days training, detailing the extent of the problem faced by BME groups in relation to both their high risk of requiring donated organs and the severe shortage of BME donors. Following training, Peer Educators targeted specific community events such as the East London Mela in Barking Park to maximise engagement with BME groups. The evaluation had two phases: one looking at the appropriateness of the model as a way of engaging with BME communities; and phase two collected feedback from attendees at Peer Educator information stands as well as data on numbers signing the organ donation register on the day of the event. Interviews were also conducted with those expressing inclination to sign. 2.4 Multi-model activities A multi-modal approach to awareness raising was adopted by Sure Start Local Programmes (SSLPs) to raise awareness of their services to all local households with children under 4 years and increase service uptake[4-11]. Activities included: informal outreach such as social events; organised outreach via home visiting; press coverage, including advertising and local radio; distributing Sure Start merchandise such as pens and t-shirts; written materials in public places; publicity in religious venues; attending local voluntary organisations and support groups; newsletters; door-to-door leafleting; translating material into different languages; information sessions for local professionals; surveys and parent/carer consultations. NESS studied numbers of awareness activities used, extent of reach to households with children under 4, and use of specific activities with hard-to-reach groups. Table 3 provides a matrix of the four models identified covering: author, topic area, aims of awareness raising, method of evaluation and outcomes achieved. 11 Table 1 Matrix of models Author of Topic area evaluation Awareness raising activity Aims of awareness raising Evaluation method Outcomes achieved Scottish Executive[35] Child protection Multi-media campaign Raise awareness of: • child protection issues; • warning signs and indicators; • how to contact authorities with concerns. Quantitative survey with general population comparison Increased awareness and understanding of: • child protection issues, particularly among women with children in the household. • difficulties of recognising when child at risk, although only half agreed with this. • who to contact, although many remained confused about who contact with concerns. NESS[4-11] NESS Multi-model incl: To identify and raise Mixed methods: • Informal outreach: awareness of SSLP with qualitative and Social events all families with children quantitative • Organised outreach under 4 years within SSLP via home visiting locality and promote • Press coverage use of services • Written materials • Parental/carer consultation • Publicity in religious venues • Merchandising Clarke- Health promotion: Community event plus BME organ donation TV interview Swaby[36] Increase: Post event feedback. • awareness of need for BME organ donation • numbers on organ donation register • On average, SSLPs used 15+ methods of awareness raising • In rounds 1 and 2, 54% and 43% respectively of families were seen at least once by SSLP • Three quarters of managers recognise as yet not reaching whole community • Of families seen, three quarters of parents felt SSLP well advertised but just under ¼ felt that there was a lack of information • Targeted work such dedicated key workers and targeted social events worked best with hardto-reach groups e.g. men and BME communities. Following the event: • 30/100 signed the register In addition: • Two more people signed a fter the TV interview • Five more following attendance at related-Expo. Health promotion: Peer educator programme: Increase: Process evaluation Increased awareness of BME Buffin et al.[37] BME organ donation ABLE • awareness of need for with peer evaluators organ donation: BME organ donation (n=15) • 13% immediately signed register • numbers on organ donation Post event • a further 12% showed ‘strong register. questionnaires with inclination’ attendees (n=800) • 18% wanted more time to Interviews (n=54) ‘think about it’. Interviews revealed non-registered due to religious consideration but need for BME organ registration widely accepted. TNS-BMRB[17] Health promotion: Sexual health Multi-media campaign: Worth talking about To measure awareness of: • Chlamydia and contraceptive choice • message take-out and reactions to it; • impact on attitudes, behaviour and actions. Non randomised: Before and after study with 700+ CYP and 300+ parents • Overall no change in awareness pre and post campaign, although increased awareness among parents. • Already high levels of sex and relationship advertising, although that were aware of the campaign had levels of recall of messages. However, over two fifths of CYP aged 16-24 interviewed felt that the campaign was not relevant to them. Gobin et al.[16] Health promotion: Sexual health promotion Multi-media campaign: Worth talking about Increase uptake of Chlamydia screening among 15–24 year olds Non randomised: Interrupted time series analysis of 1,555,139 records • No overall increased uptake of testing, but increased testing of men and Asian groups. • However, the increases in testing in these groups were not sustained after the campaign. 12 2.5 Effectiveness of awareness raising models Assessing the effectiveness of different models of awareness raising should be approached with caution due to the variety of topics identified and use of diverse evaluation designs. Having said this, the evidence presented suggests that awareness-raising techniques appear to have differential impact on different groups, with some methods such as outreach via community events providing valuable data that is relevant the current review. Evidence from multi-media campaigns suggest a mixed picture of effectiveness. Campaigns to increase awareness of chlamydia testing found no overall increase in uptake of testing, although there was increased testing of men and people of Asian ethnicity; an increase that was not sustained following cessation of the campaign[16]. Interviews with children, young people pre and post campaign showed no difference in advertising awareness, with a high proportion of respondents already aware of advertising or publicity about sex and relationships generally. Among parents, awareness was increased significantly (from 57% to 81% post campaign) including high levels taking or intending to take action as a result of seeing or hearing the advertising. However, among the core target of 16-24s, over two fifths felt the advertising was not relevant for them[17]. Gobin et al. suggest that this may explain the differential effects of the campaign on coverage and positivity in the various sociodemographic groups[16]. The impact of pre-existing knowledge and differences between population groups of campaign awareness was also observed in the Scottish Executive’s evaluation of its nonTV, radio and poster child protection campaign. The study highlights that sometimes poster and radio advertising can be confused with television advertising such as high profile TV campaigns by the NSPCC. However, non-television campaigns can also reach people. When shown the advertising, half of respondents in the pilot area recognised some part of the campaign. Women, those with children present in the household and those who had contact with children at work were all more likely to recognise some aspect of the campaign. The strongest spontaneously mentioned message was to be observant and look out for children at risk and to be aware of child abuse and neglect[35]. The evaluation’s wider study of attitudes toward child protection issues showed that all adults in Scotland (97%) agreed that everyone had a responsibility to help protect children and young people, with the majority agreeing that it was difficult to know whether a child or young person may be at risk of, or suffering from, neglect or abuse. Four-fifths (80%) agreed that if they had concerns that a child or young person was at risk of neglect or abuse they would know who to contact. However, those who had seen the campaign, were less likely than other respondents to know who to contact. The campaign had made people reassess what they thought they knew about who to contact if they believed that a child was at risk of neglect or abuse. The authors note that further qualitative research would be needed to explore these issues in more depth, in particular to explore how people would react to real life child protection situations[35]. 13 In order to assess the effectiveness of the implementation of Sure Start, national surveys were conducted and supplemented by case study data. Data from the National Survey (2001, 2002) showed that a majority of SSLPs were implementing a wide range of strategies for promoting programme activities. On average, programmes were using 15 different methods to ‘get the word out’, with the most popular being home visiting schemes, written publicity in public places (e.g. libraries) and door-to- door leafleting as well as social events and parent networking[9]. Authors conclude that all programmes had made considerable efforts to publicise the planned programme with evidence that partnerships in the later rounds — 3 and 4 — had learned from the experience of earlier rounds that community events with entertainment and publicity, were an effective way to raise awareness[7]. However, challenges remained in reaching all families with children under 4 years, with three quarters of all SSLP managers recognising that their programme was as yet to reach the whole target community[8]. Of families seen, three quarters of parents felt SSLP well advertised but just under ¼ felt that there was a lack of information. On-going outreach was considered key to securing both initial access to families as well as their continuous engagement. Formal outreach via referrals from their home visitor (e.g. midwife, health visitor or family support worker) appeared to be appreciated by families. While informal ‘one off’ community events, such as ‘fun days’ (e.g. Easter egg hunts, ‘balloon days’, picnics, Christmas parties and summer ‘beach’ parties) were also popular with families and as a way to make contact with hard-to- reach groups. Such events afforded parents who had not previously heard of or used Sure Start, an opportunity to see how it worked in an informal setting, ‘no strings attached’ setting[9]. The ‘standard’ methods adopted by SSLPs to attract parents who may have been more easily engaged by the programme were supplemented by activities targeted at ‘hard-toreach’ groups. This task was complicated by difficulties in defining which groups were ‘hardto-reach’. While the general identity of these groups could be predicted on a national basis, in reality, their identity, prevalence and location varied from SSLP to SSLP. Such groups included: parents/carers with drug and/or alcohol problems; families experiencing some form of domestic violence; families with children who have special needs; asylum seekers and refugees; mothers experiencing post-natal depression; fathers/male carers; families with special cultural requirements; and teenage parents. Implementation data showed that some groups were more difficult to reach than others and needed extra encouragement to access services, including fathers and families from minority ethnic groups. Low levels of involvement of fathers/male carers meant many SSLPs made considerable effort to encourage their participation. NESS’s study on the nature and extent of men’s and fathers’ involvement in Sure Start identified fathers’ preference for fun and active sessions over discussion-based ones with staff indicating it was easier to involve fathers in outdoor, active, fun day-type activities rather than in indoor sessions with children or in sessions related to parenting skills[5]. 14 Addressing the needs of minority ethnic groups posed similar challenges. Some programmes appointed inclusion workers with direct responsibility for targeting specific populations. Language was one issue that SSLPs addressed, with most programmes providing interpreters as needed, particularly where there was a ‘critical mass’ of specific population groups e.g. such as people who spoke Urdu or Bengali. In other programmes, however, diversity of languages was such that engaging a variety of interpreters was not feasible to fund with relatives used to facilitate communication[11]. Engaging creatively with minority ethnic groups extended beyond language. In one SSLP, the community development worker established links with the local mosque to encourage use of Sure Start activities. This link was developed following recognition that women from this particular ethnic minority required approval from their husbands and/or mothers-in-law to take up activities. In addition, mothers-in-law as key players within family life within this ethnic group were also encouraged to make use of SSLP services[9]. Outreach was also a feature of awareness raising activities designed to increase organ donor registration among BME groups. Following an awareness-raising event held in a Church Centre aimed at the local BME community, 30/100 attendees signed up to the organ donation register. Two more people signed following a TV interview with the organiser of the event and five more following attendance at a local Expo that the organiser attended. Those that signed were mostly African and Caribbean reflecting audience attendance; just six people from Asian communities attended the event. While data is minimal on why people decided to sign the register, Clarke-Swaby concludes that community events are key awareness activities that speak directly to communities affected and offer an opportunity to educate and empower BME people to become organ donors[36]. Evaluation of the Peer Educator project initiated by Kidney Research UK, found that outreach at community events had significantly increased awareness of organ donation among attendees[37]. Of the 800 attendees that completed questionnaires, two-thirds (75%) felt that they had learned more about organ donation, that their attitudes had changed (55%) and that they felt more able to talk to family about the issue (58%). 13% registered on the organ donor register immediately. 12% expressed a strong inclination to do so in the near future and 18% indicated that they may do so after they had had time to think. However, virtually no respondents registered subsequently, suggesting that increases in organ donor registration are most likely to be achieved immediately, with little impact being achieved after events. Buffin et al. conclude that use of peer educators from similar backgrounds to event attendees appears to ease discussion of religious and cultural barriers, facilitating access to events that hitherto may have been inaccessible[37]. 15 3 F actors promoting and hindering the success of models Understanding the factors that promote or hinder the success of community awareness raising is hampered by the type of the data collected. Quantitative evaluation designs can describe impact on attitudes and behaviour and but provide limited information on why attitudes and behaviour may have changed due to awareness activities[16, 17, 35]. Even studies that were qualitative in nature, often did not collect data on what was it was about the awareness raising activities that encouraged people to change their thinking and act on the information provided[36]. Nor are the specifics of awareness raising activities always well described, making it difficult to assess what it is about particular activities that users liked best[9]. Nevertheless, both NESS and Buffin et al. provide nuanced information on what works when it comes to awareness raising with specific target populations: men and minority ethnic groups[5, 11, 37]. These can be grouped as: having clear aims and objectives; understanding the needs of the target audience; engagement with wider stakeholders; and use of designated workers to promote awareness and access to services. 3.1 Aims and objectives Ensuring clear aims and objectives are crucial to awareness raising initiatives. Each model identified has well articulated aims and objectives, with some targeted at specific population groups or taking additional steps to increase awareness among ‘harder-to-reach’ groups. In the child welfare context, fathers are traditionally regarded as a ‘hard-to-reach’ group. Father/ male carer involvement in SSLPs has been a key area of focus for Sure Start policy. SSLPs have had to make a considerable effort to engage fathers/male carers, as the programmes themselves have been seen to be predominantly female-orientated and hence off-putting to men. In addition, the majority of SSLPs inherited very low levels of father-orientated provision in the form of parenting groups or other services related to child rearing, and therefore few areas had already developed a ‘culture’ of father involvement[4]. A themed study on fathers in Sure Start found that programmes with clear aims to engage fathers and proactive strategies to increase their involvement, reported higher levels of engagement than programmes where fathers had not been prioritised[5]. 3.2 Understanding the needs of the target audience Community consultation is a requirement of SSLPs as a means to understand the relationship between individual and family need and use of services. It is not only a mechanism for parents to suggest ways that their needs can be met but also widely used an awareness raising strategy to promote the Sure Start initiative itself. Methods included parent satisfaction surveys, outreach workers such as health visitors consulting parents during the course of their work, open morning and special consultation events. No one method worked in isolation, with best results from SSLPs who had a ‘rolling programme’ of consultation that recognised the different access needs within the community. Parents were, in general, happy with the level of consultation they received. Many had attended ‘parent meetings’ feeding back their views and needs, while some parents had become parent representatives to the Sure Start management board. One parent 16 commented: “I am a parent member on the board and all our ideas and questions are listened to and answered fully. We are all important to the programme and always being told this[9]. Fathers were less likely to be involved at board level, however, with engagement centered around and often limited to certain types of activities[5]. The themed study about fathers in Sure Start identified a recurrent theme in staff interviews, concerning fathers’ preference for outdoor, active, Funday-type activities rather than in indoor sessions with children or in sessions related to parenting skills. Alongside other strategies, such activities were viewed as an effective method of increasing awareness of Sure Start and led to greater engagement by fathers with services, including promoting involvement in parent forums and board meetings. For example one programme manager said: ‘When we run fundays or have big family trips, big events, dads like to get involved in helping with that... they like to be the ones going up the ladders and putting the posters up. But they’re not so keen on being the ones who were sat on the floor reading to the children.’[5] As Sure Start local programmes often scheduled one-off fun events and trips at weekends or evenings, fathers’ apparent preference for these types of activities may also be related to activities being provided outside ‘traditional’ working hours, making them more accessible to working men. Garbers et al. argue that labeling groups as ‘hard to reach’ can both prioritise their needs but also be used as means of avoiding and confronting the tasks necessary to promote awareness and access to services. They state that it is essential that the tasks of awareness raising and access facilitation are made within the context of parental expectation and preferences[4]. Understanding the needs and preferences of the target population is also a theme within the evaluations on increasing organ donation within BME groups. In order to explore understandings and cultural beliefs around organ donation, Clark-Swaby conducted a focus group with Black African, Caribbean and Asian participants. Feedback from the focus group on the lack of awareness of the increased risk of needing a donated organ among BME groups and severe shortage of BME donors, led to an event held in a local Church Centre. The event included personal stories from people both donating and receiving an organ, something that Clark-Swaby argues helped promote ownership of this issue as one that directly affects BME groups and helped empower participants to sign up to the organ donation registry[36]. Adopting a grassroots, community networking approach to increasing awareness of the need for BME organ donors was also seen as central to the success of Kidney Research UK’s Peer Educator programme. Peer Educators were drawn from the local BME community and proved resourceful, in terms of using their initiative, networking skills and contacts to secure more events. Their use of ‘real’ people who had experience of organ donation also increased the impact of the programme: ‘I had asked a family friend who has had a kidney transplant last year. A large number of people wanted to talk to her and ask her questions and she could answer them there and then’ (Peer Educator). Use of a quiz as an ice-breaker to help promote discussion, was also reported by Peer Educators as an important tool of engagement[37]. 17 3.3 Engaging with wider stakeholders Working with local community leaders was another method considered crucial to awareness raising with BME groups. While none of the major religions in the UK expressly prohibits organ donation, research has shown that some groups, particularly Muslims often feel uncertain and wished for guidance from religious scholars. Peer Educators confirmed the importance of engaging with community leaders and recognising their influence on beliefs and behaviour. One Peer Educator commented that they had been: ‘...working more slowly with community leaders to get them on board, they may not always be a religious leader but they will be the person who is coordinating the group, and so work with them, get them on board, so it is almost like you have to do a presentation to them first, then you have to do it to the whole group’[37]. 3.4 Designated inclusion workers Designated inclusion workers were reported within the NESS evaluation reports as having a positive impact on awareness raising and improving access to the services. Garbers et al. highlight the helpfulness of having of a designated worker specialising in making contact with and/or addressing the issues of some ‘hard-to-reach’ groups. Across the study areas, there was considerable variation in the appointment of such dedicated workers. Where they were not appointed, then an existing staff member might be trained more broadly in ‘general issues’ related to specific ‘hard-to-reach’ or special-needs groups[4]. However, while such workers could work well to promote access with minority ethnic groups, for example, their efforts needed to be jointly owned by the team. One social worker commented: ‘ethnic minority workers are left to “deal” with families from different cultures, rather than more joint working with team members where inclusion is everyone’s responsibility’[8]. 4 Y oung people, parents and wider community views on CSE and CSE awareness raising For awareness raising activities to have the most effect, it is important to understand the nature and extent of young peoples’, carers’ and wider community’s awareness of CSE. By doing so, awareness raising initiatives can be tailored to address any knowledge gaps or myths. This section presents data on knowledge and awareness of CSE among young people, parents and wider community. It is limited by lack of research in this area, undermining an assessment of what works best from the perspective of people who are targeted by community CSE awareness raising initiatives. 4.1 Parental perspectives awareness on CSE In Autumn 2013, Parents Against Child Sexual Exploitation (Pace) in partnership with Virtual College’s Safeguarding Children e-Academy commissioned two YouGov surveys of parents and professionals. YouGov surveyed 750 parents and 945 professionals made up of 510 teachers, 209 police officers and 226 social workers to assess parental and professional understanding, experience, opinions and knowledge of CSE in England. There was a particular focus on the role of parents and the impact of CSE on families[38]. 18 Most parents (63%) and professionals (60%) agreed that UK society acknowledges CSE but it should be more openly discussed. The majority of parents (93%) had heard the term CSE, with 55% of parents reporting they have heard about CSE from TV. Six out of ten parents know ‘something’ about CSE and would most likely turn first to the police for support and advice. While it appears some parents are aware of sexual exploitation, over half (53%) of professionals think that parents do not understand what CSE is. This professional concern is supported by the fact that 40% of parents stated that they would not be confident in recognising the difference between indicators of CSE and normal challenging adolescent behaviour[38]. Using a prompted list, parents and professionals were asked to identify signs of CSE. The list included: mood swings; changes in academic performance; receipt of gifts from unknown sources; self harming; drug and alcohol misuse; going missing from home or care; and changes in physical appearance. Both parents (70%) and teachers (68%) are more likely to mention things they would spot more easily such as mood swings and changes in academic performance than police/social workers. All three groups think that the receipt of gifts from unknown sources is a key sign that a child is a victim of CSE[38]. Those with more direct experience of CSE, the police and social workers (76%) were much more likely to mention that drug or alcohol abuse is a key sign of CSE than parents (45%) and teachers (55%). While only 50% of parents and 57% of teachers identified going missing from home or care as an indicator of CSE, compared with 74% of police and social workers. YouGov also conducted online focus groups with one parent commenting: ‘A change of attitude in the child, the behaviour towards people or situations in particular. They usually become more withdrawn and burdened, and therefore are less interactive’[38]. Parents and professionals identified low self-esteem or low self-confidence as the most important factor that places a child at a higher risk of being sexually exploited. Other factors consistently identified through the OCC’s Inquiry into CSEGG such as ‘loss through bereavement’ and living in ‘gang-affected neighbourhoods’ were barely recognised by parents or professionals, prompting the authors to call for further work to address this discrepancy. Parents and professionals also identified that some types of families were more likely than others to have children affected by CSE, focusing on low income, poor educational achievement and lower social status of families as risk factors. While the authors agree that a chaotic or dysfunctional home environment is associated with CSE, this is not the case for all families affected and hence, further work is needed to dispel such myths. However, one myth seems to be almost dispelled with professionals and parents in strong disagreement with the assertion that sexual exploitation only happens to girls, with 96% of professionals and 95% of parents in disagreement. 19 Parents were open to participating in awareness raising activities, although mothers (76%) were significantly more likely than fathers (63%) to indicate that they would attend a presentation on CSE. There is also a relationship between current awareness of the issues of CSE and gaining further information, with those who are currently more aware (75%) significantly more likely to indicate they would attend a presentation than those who are currently less aware (67%). At least 70% of the parents interviewed said they would attend such a briefing at their child’s school. However, it should be noted that attendance at other methods of awareness raising such as outreach via community events was not asked in the survey[38]. 4.2 Children and young peoples’ perspectives on CSE Despite positive messages on increased awareness of CSE among parents and professionals identified above, the OCC’s Inquiry into CSEGG found that children and young people remain ‘invisible’ to services. The Inquiry’s final report identified a significant difference between children and young people’s views of their needs and what would help them as victims of CSE, and professionals understanding of what would help. In particular, the Inquiry continued to references to children ‘putting themselves at risk’, rather than the perpetrators being the risk to children[14]. Understanding what children and young people already know about CSE more generally and what they would find helpful in terms of awareness raising is problematic. There is no known research that is equivalent to YouGov’s research survey of parents and professionals that would help understandings of children and young peoples’ experiences, opinions and knowledge of CSE, nor what kinds of awareness raising activities they would find most valuable. This clearly an area that warrants further research. Beckett et al.’s research into the scale and nature of gang-related sexual violence is revealing insofar that they too, found a propensity to ‘victim blame’, with young women held responsible for the harm that they experienced and a resignation among young women that such violence is ‘normal’ and to be expected. Beckett et al. argue that such responses should be understood within the context of wider patterns of sexual violence and gender inequality in general society[12, 13]. Resistance to what constitutions sexual violence and resignation that sexual violence is normal, combined with a lack of faith in services’ ability to protect them from retaliation and/or respond appropriately, explained young peoples’ low levels of reporting and support seeking. Nevertheless, interviews with young people affected by gang-related sexual violence, did identify a desire for more openness about sexual exploitation and that young people would welcome mentoring and discussion with peers who had experience of sexual violence. Beckett et al. conclude that further work is needed to promote understanding of healthy relationships, the concept of consent and the harm caused by rape and sexual assault, particularly with young men[13]. Like the work with BME groups on improving understanding of the need for organ donation, use of personal stories and developing personal relationships with young people, may be a key to increased awareness of CSE and exploitation more generally. 20 This theme is reflected in work on young peoples’ understanding of online grooming, with peer education and internet safety training provided by someone that they could relate to welcomed by UK-based young people[19]. The European Online Grooming Project commissioned by the European Commission Safer Internet Plus programme and conducted by a collaboration of European academics found that the word ‘groomer’ was in some cases, unfamiliar. When definitions were established, descriptions of online groomers tended to be stereotypical depictions of old, unattractive or ‘sick’ people. The authors argue that more needs to be done to support young people understand the diverse profile of online groomers, with such attitudes open to abuse by groomers who can present themselves attractively[18, 19]. Focus groups with young people in Belgium, Italy and the UK revealed them to be better informed about the type and style of approach that groomers make, including via chat rooms and images, identity deception, information seeking and asking to meet. Despite this, the research identified some key gaps in young peoples’ knowledge and understanding of online grooming including: limited awareness of how some groomers can scan the online environment for information before making contact e.g. via Facebook profile pages; no awareness of the role of mobile phones in the grooming process; and a focus on meetings as an outcome at the expense of understanding continuation of online abuse via image collection[19]. The research also found an unwillingness to report inappropriate contact, with young people preferring to deal with things alone, particularly boys. Girls were more likely to share their experiences but this tended to with friends rather than parents and professionals. This seems to be linked with fear of negative sanctions, specifically that home computer privileges would be revoked. Hence, the authors argue that punitive, fear-based approaches to cyber-safety are ineffective rather balanced, informative approaches are more likely to empower and engage young people and encourage disclosure. Parents and carers have a key role to play in providing compelling, balanced information about online risks but are struggling with their evolving roles as parents in the face of rapid advancements in digital technologies[19]. Given differential awareness and responses according to gender, the authors argue that online safety awareness needs to target girls and boys differently. They also highlight that some groups of young people are more likely to be vulnerable to online grooming. Such children and young people have fewer sources of protection against cyber-risks through family, peers, neighbours and school setting. In addition, they have psychological profiles likely to attract predators who operate in the digital world. However, authors state that the mechanisms by which such children may become trapped in abusive online contact, or the situational constraints on their help-seeking, clearly has other contextual elements that are not well documented and needs further investigation. This means that training and intervention packages for vulnerable children and young people and professionals working with them, have not yet been developed to the same extent as awareness raising and educational materials with wider, normative populations[19]. 21 4.3 Wider community views on CSE There is no research exploring wider community views on CSE. What exists is neither evaluated nor formally researched and hence not included for current review. Beckett et al. in their review of current responses to CSE for the London Councils and London Children’s Safeguarding Board, found that very few London Boroughs had undertaken awareness raising with the wider community. Where such activities had been undertaken, they tended to be in the form of written materials, such as leaflets with only two Boroughs offering these in a language other than English. No attempt had been made to evaluate CSE awareness raising initiatives with the wider community[34]. Given lack of information in this area, it is apposite to drawn attention to Community Alliance Against Sexual Exploitation (CAASE). Set up in response to high profile court cases where perpetuators have been largely from an Asian/Muslim background, CAASE is led by the Islamic Society of Britain and HOPE not hate[39]. It adopts a grassroots approach, working with national and local faith organisations and wider communities to raise awareness of CSE, encourage reporting and promote services to young people. CAASE aims to develop a crosscommunity response, recognising that the victims and perpetrators of CSE come from all backgrounds, including producing ‘myth-busting’ material to counter extremist groups who might attempt to exploit the issue in order to divide communities and stir up hatred[39]. CAASE also produces materials for faith and community leaders, so they can speak out with knowledge and confidence. Working with CAASE, Together against Grooming (TAG) has been engaging with Mosques to devote sermons to CSE awareness raising as part of their campaign, 28/6 KHUTBA AGAINST GROOMING[40]. Christian groups could deliver a similar message in Churches. While not evaluated, such initiatives underline the importance of understanding the needs of local communities, as determined by the communities themselves and adopting awareness raising activities that are sensitive to how best to engage with people locally. 5 Conclusions and recommendations While there is growing awareness of CSE, further investigation is needed to understand what works best to promote awareness of CSE in the community. Awareness raising is viewed as a key means for preventing CSE, achieving early intervention and support for children and young people vulnerable to exploitation. To be effective, it is important to understand the nature and extent of young peoples’, carers’ and wider community’s awareness of CSE. By doing so, awareness raising initiatives can be tailored to address any knowledge gaps or myths. YouGov’s survey shows that the majority of parents have at least heard of CSE via media reporting, but revealed mixed knowledge concerning signs and indicators and risk factors of vulnerability. There is limited information on what young people know about CSE and what they would welcome from awareness raising activities. What knowledge exists comes from young people affected by sexual exploitation, suggesting that such exploitation is normalised, reflecting wider structures of sexual violence in society. Nevertheless, young people 22 identified a desire for more openness about sexual exploitation and the development of trusting relationships and discussion with peers who had experience of sexual violence. Use of peer relationships to raise awareness of online grooming was also identified within a major European study of young peoples’ attitudes to online safety. This demonstrated reluctance to disclosure inappropriate contact online, with young people fearing punitive action by parents, hence their preference for balanced, informative and peer-based exchanges of online safety messages. The lack of evaluated of CSE community awareness raising initiatives, prompted the current review to explore the wider evaluation literature on approaches to raising awareness of sensitive social issues. This revealed that awareness raising can be effective, particularly where work is undertaken to understand and involve the local community and activities undertaken sensitive to their needs. Awareness raising activities fall into four categories: multi-media campaigns; outreach via community events; use of Peer educators; and multimodal approaches that include both informal outreach such as Fundays and formalised outreach via home visiting. Awareness activities appear to have differential impact on different groups, with women for example, with children in their household more likely to recognise child protection campaigns. A finding confirmed by YouGov’s survey, whereby mothers’ reported higher levels of awareness of CSE and a greater desire than fathers to attend awareness raising activities to learn more information. The factors that promote effective community awareness raising include: having clear aims and objectives; understanding the needs of the target audience; engagement with wider stakeholders; and use of designated workers to promote awareness and access to services. All models identified have well articulated aims and objectives, with some targeted at specific population groups or taking additional steps to increase awareness among ‘harderto-reach’ groups. In the child welfare context, fathers are traditionally regarded as a ‘hardto-reach’ group. SSLPs that identified fathers as a priority were more likely to have higher involvement from fathers, promoted via an understanding of their preference for outdoor, active, Funday-type activities. Raising awareness with BME groups was dependent on engagement with local community leaders and adopting a grass-roots approach to activities. Use of community events to raise awareness of the need to increase organ donation among BME groups worked well, with Peer Educators from similar backgrounds to event attendees appearing to ease discussion of religious and cultural barriers and increasing organ donation registry. Adopting an approach sensitive to community needs is a central tenant of work undertaken by CAASE. While unevaluated, such an initiative demonstrates the importance of engaging with faith and community leaders, highlighting use of trusted sources such as sermons as one method of sensitive CSE awareness raising. Understanding effective methods of CSE community awareness raising is in its infancy. From the perspective of professionals, the main purposes of community awareness raising are prevention, identification, early intervention and advice and support. There is almost no information on what children, young people, parents and carers or the wider community wants from CSE awareness raising. Where CSE awareness raising activities have been 23 undertaken with these groups, it is almost entirely unevaluated. This is a significant gap in the knowledge base and clearly, an area that warrants further investigation to ensure future effectiveness of such activities. Nevertheless, evidence from the wider evidence base on effective approaches to community awareness raising of sensitive social issues, demonstrates positive impact, particularly where the needs of different groups are understood and awareness raising strategies targeted accordingly. Suggested reading Beckett, H., C. Firmin, P. Hynes and P. J (2013). Tackling Child Sexual Exploitation: A Study of Current Practice in London. Luton: University of Bedfordshire. The Scottish Government (2005). Protecting Children and Young People 2005: Pilot Campaign Evaluation. Retrieved 09.12.13, from http://www.scotland.gov.uk/ Publications/2005/10/11155156/51562. YouGov (2013). Are parents in the picture? Professional and parental perspectives of child sexual exploitation. London: YouGov. Useful websites The Local Government Association (LGA) have developed a CSE awareness raising resource that includes a comprehensive round up of materials, such as Barnardo’s jointly produced guidance on effective responses to CSE and their ‘Spot the Signs’ leaflet for professionals as well as materials on engaging the wider community, accessible via the following link http://www.local.gov.uk/children-and-young-people//journal_content/56/10180/3790391/ ARTICLE Pace and Virtual College’s Safeguarding Children e-Academy has launched an e-learning course for parents on the signs of CSE which is free to access and can be found at http://keepthemsafe.safeguardingchildrenea.co.uk 24 References 1 J ago, S., et al., What’s going on to safeguard children and young people from sexual exploitation? How local partnerships respond to child sexual exploitation. 2011, University of Bedfordshire: Luton. 2 D epartment for Education, Tackling child sexual exploitation action plan. 2011. 3 R utter, D., et al., SCIE systematic research reviews: guidelines (2nd edition), in SCIE Research resource 1. 2010: London 4 G arbers, C., et al., Facilitating Access to Services for Children & Families: Lessons from Sure Start Local Programmes. Child and Family Social Work, 2006. 11(4): p. 287-96. 5 L loyd, N., M. O’Brien, and C. Lewis, Fathers in Sure Start. 2003: London. 6 N ational Evaluation of Sure Start, Early Experiences of Implementing Sure Start, in Report 01. 2002: Nottingham. 7 N ational Evaluation of Sure Start, Getting Sure Start Started, in Report 02. 2002: Nottingham. 8 N ational Evaluation of Sure Start, Implementing Sure Start Local Programmes: An In-Depth Study. 2005: Nottingham. 9 N ational Evaluation of Sure Start, Implementing Sure Start Local Programmes: An Integrated Overview of the First Four Years, in Report 10. 2005: Nottingham. 10 N ational Evaluation of Sure Start, Outreach and Home Visiting Services in Sure Start Local Programmes, in Report 17. 2006: Nottingham. 11 N ational Evaluation of Sure Start, Sure Start and Black and Minority Ethnic Populations, in Report 20. 2007: Nottingham. 12 B eckett, H., et al., Research into gang associated sexual exploitation and sexual violence: interim report. 2012. 13 B eckett, H., et al., It’s wrong... but you get used to it” A qualitative study of gang-associated sexual violence towards, and exploitation of, young people in England. 2013: London. 14 B erelowitz, S., ‘I thought I was the only one. The only one in the world’: the Office of the Children’s Commissioner’s inquiry into child sexual exploitation in gangs and groups: interim report. 2012, Office Of The Children’s Commissioner: London. 15 B erelowitz, S., et al., “If only someone had listened” Office of the Children’s Commissioner’s Inquiry into Child Sexual Exploitation in Gangs and Groups: Final Report. 2013: London. 16 G obin, M., et al., Do sexual health campaigns work? An outcome evaluation of a media campaign to increase chlamydia testing among young people aged 15–24 in England. BMC Public Health, 2013. 13: p. pp.1-11. 17 T NS-BMRB, Worth Talking About’ Campaign Evaluation 2010 / 2011: Central Office of Information (COI) Research Management Summary on behalf of the Department of Health. ND: London. 18 Davidson, J., et al., Online Abuse: Literature Review and Policy Context. 2011: London. 19 W ebster, S., et al., European Online Grooming Project: Final Report. 2012: London. 25 20 D epartment for Education, Safeguarding children and young people from sexual exploitation: Supplementary guidance to working together to safeguard children. 2009, Department for Education: London. 21 B arnardo’s, Puppet on a string: the urgent need to cut children free from sexual exploitation. 2011, Barnardo’s: London. 22 B arnardo’s, Cutting them free: how is the UK progressing in protecting its children from sexual exploitation? 2012, Barnardo’s: London. 23 B eckett, H., Not a world away’ The sexual exploitation of children and young people in Northern Ireland. 2011: Belfast. 24 C hild Exploitation and Online Protection Centre, Threat assessment of child sexual exploitation and abuse. 2011, Child Exploitation and Online Protection Centre: London. 25 C hild Exploitation and Online Protection Centre, Out of mind, out of sight: breaking down the barriers to understanding child sexual exploitation. 2011: London. 26 D epartment for Education, Tackling child sexual exploitation action plan: Progress report – July 2012. 2012. 27 L ocal Government Association, National conversation on child sexual exploitation: summary report of responses. 2013: London. 28 W elsh Assembly Government, Safeguarding children and young people from sexual exploitation: supplementary guidance to Safeguarding children: working together under the Children Act 2004. 2011, Welsh Assembly Government. 29 A ll Wales Child Protection Procedures Review Group, Safeguarding and promoting the welfare of children who are at risk of abuse through sexual exploitation: all Wales protocol. 2008, Children Wales. 30 B rodie, I. and J. Pearce, Exploring the Scale and Nature of Child Sexual Exploitation in Scotland. 2011: Edinburgh. 31 S kidmore, P. and B. Robinson, It Could be Anyone - Evaluation of London Prevention Education Programme (Child Sexual Exploitation). 2007: London. 32 L ocal Government Association. Local Government Association: Child sexual exploitation toolkit. 2013 12.01.14]; Available from: http://www.local.gov.uk/web/guest/safeguarding-children/-/ journal_content/56/10180/3790391/ARTICLE. 33 L ocal Government Association, How councils are raising awareness of child sexual exploitation: case study report. 2013: London. 34 B eckett, H., et al., Tackling Child Sexual Exploitation: A Study of Current Practice in London. 2013: Luton. 35 T he Scottish Government. Protecting Children and Young People 2005: Pilot Campaign Evaluation. 2005 09.12.13]; Available from: http://www.scotland.gov.uk/ Publications/2005/10/11155156/51562. 36 C larke-Swaby, C., Exploring the understanding and beliefs surrounding organ donation amongst Black African Carribean and Asian Populations affected with Kidney disease in Lambeth, Southwark and Lewisham. 2010: London. 37 B uffin, J., et al., Evaluation of the Kidney Research UK Peer Educator Programme to improve understanding of organ donation amongst Black and minority ethnic communities and to increase the number of Black and minority ethnic organ donors. 2011: Bolton. 26 38 Y ouGov, Are parents in the picture? Professional and parental perspectives of child sexual exploitation. 2013: London. 39 C ommunity alliance against sexual exploitation (CAASE). Community Alliance Against Sexual Exploitation. 2013 08.02.14]; Available from: http://www.caase.org.uk. 40 T ogether against grooming (TAG). Together against grooming (TAG). 2013 08.02.14]; Available from: http://www.taguk.org. 41 Department of Health, Child protection: Messages from research. 1995: London. 27 Appendix A: Search strategy Methods The methods used to identify and organise material in this research review were developed by the Social Care Institute for Excellence (SCIE)[3]. These involved identifying a clear research question, undertaking systematic and reproducible searches of the key evidence sources and identifying relevant research studies for review. Due to time and budget constraints, no systematic attempt has been made to assess the quality of evidence. Searches were conducted between November 2013 and January 2014. Review question The research review addresses aims to identify and describe: 1 different models of community awareness raising; 2 evidence of their effectiveness, with focus on outcomes achieved; 3 factors promoting and hindering the success of these models; 4 the perspectives of children, young people, parents/carers and the wider community. Search strategy Consultation with the project team identified this as an area where practice was likely to be ahead of the research. This meant undertaking searches on topics beyond the CSE community awareness raising initiatives to capture learning from the wider literature on awareness raising on sensitive social issues. In agreement with the commissioners of the review, topics included: 5 Child protection, including children at risk of online grooming; 6 National evaluation of Sure Start (NESS); 7 H ealth promotion including improving take up of chlamydia testing; and increasing organ donation registry among BME groups. 8 Community-led community safety awareness raising initiatives e.g. gun and knife crime. These topics are necessarily diverse focused on areas that are directly relevant to CSE awareness raising e.g. child protection issues but also areas where evaluations have taken place that affect young people e.g. improving uptake of chlamydia testing or BME groups e.g. improving organ donation registry. NESS was included because it was known to have included evaluation of promotional activities, including use of community events. Raising awareness of gun and knife crime was identified as an area where community-led initiatives were known to have been developed, particularly by mothers whose families had been affected. Although, subsequent searches revealed such initiatives have gone largely unevaluated. Searches also sought to identify current policy and practice guidance on CSE community awareness raising, such items were identified as background information rather than included for full review. 28 Where the material was found Bibliographic databases: ASSIA, Discover, Google, Google Scholar, and Social Care Online, including Beta version. Existing database created by the reviewer: CSE victims’ experiences of the criminal justice system Expert recommendations: Supplied by Dr Isabelle Brodie. Academic and organisational websites: 30 sites were searched. Database keywords The diverse focus of studies for the current involved different search terms depending on the topic. Keywords included: CSE: child sexual exploitation, awareness raising, evaluation and UK. Child protection: awareness raising, raising awareness, public awareness, child protection, child abuse, child neglect, online grooming; evaluation, UK. Health promotion to increase chlamydia testing: awareness raising, raising awareness, public awareness, chlamydia testing, evaluations and UK. Health promotion to increase BME organ donation: awareness raising, raise awareness, public awareness, BME; organ donation, increase organ donation, evaluation and UK. Community-led safety initiatives concerning gun and knife crime: community-led, awareness raising, gun crime, knife crime, mothers against gun violence, evaluation and UK. NESS provides a comprehensive database of all publications, hence further database searches were not undertaken, having identified eight relevant items via the NESS website. Websites In total, 30 websites were searched. They include: Africans Unite Against Child Abuse (Afuca); Ashoka Changemakers; Barnardos; BLAST; Centre for Europe’s Children; Childline; Chlamydia Basic Research Society; Communities against gun and knife crime (CAGK); Council of Europe; Department of Applied Social Studies, University of Bedfordshire; Department for Education; European Online Grooming Project; Lifestyle Elf blog; Local Government Association (LGA); Mothers against Murder and Aggression (MAMMA); Mothers against Violence UK; National Chlamydia Screening Programme; National Evaluation of Sure Start (NESS); National Working Group for Sexually Exploited Children and Young People; NHS Blood and Transplant; NPSCC Inform; Office for the Children’s Commissioner; Parents Against Sexual Exploitation (PACE); Parents Protect; Policy Research Institute for Ageing and Ethnicity (PRIAE), University of Central Lancashire; Royal Pharmaceutical Society; Safe Network UK; Sex education forum; Stop it Now UK; Scottish Executive. 29 Eligibility criteria In order to be included for full review, items had to an evaluation study. Studies reporting the views of children, young people, parents/carers and the wider community were also included. This reflects the aims of the review to understand their perspectives on CSE and effective awareness strategies; evidence unlikely to be identified via a focus on evaluation studies only. Research types included research reports, independent and voluntary sector reports and peer reviewed papers. Due to time and budget constraints, only UK-based studies are included for review. Different dates limits were set to reflect different literatures identified for inclusion. Items after 2008 were included to reflect changing policy definitions, with the introduction of new, nationally agreed definitions of CSE[20]. In order to capture data from NESS, this date limit was extended to 2002. Following discussion on evaluations of awareness raising concerning child protection issues, date limits were set at 1995, beginning with major change in policy and practice resulting from introduction of what was colloquially known as the Blue Book, Child Protection: Messages from Research[41]. Data management All references identified from the searches are stored on EndnoteTM Bibliographic software. Almost all items have a document or weblink. Screening All abstracts were screened against inclusion criteria, see end of appendix for completed inclusion/exclusion template. Items included for review In total, 69 items were identified. 20 items were included for final review. Almost all items report the ‘grey literature’ including research reports (15); three items from the independent and voluntary sector, including two from the Office for the Children’s Commission and one voluntary sector report (PACE). Just two items peer reviewed. Table 1: Map of included items by type of evidence Type of evidence Number References Research reports 17 [5-13, 17-19, 35-37] Independent and voluntary sector reports 03 [38] Peer reviewed papers 02 [4, 16] The majority of the items (18) identified are linked. Eight items refer to the National Evaluation of Sure Start[4-11]; four items are part of the OCC’s Inquiry into CSEGG[12-15]; two items refer to the evaluation of the awareness raising campaign to increase chlamydia testing[16, 17]; and two items are part of the European Commission Safer Internet Plus project on improving online safety of children and young people[18, 19]. 30 Source of includes The majority of includes were identified via website searches (18), with just two items identified via database searches, both of which were identified via a database created by the reviewer on CSE victims’ experience of the criminal justice system. This reflects the nature of the evidence in this area, with almost all items identified from the ‘grey literature’. 31 Inclusion/exclusion criteria template2 Inclusion / Guidance exclusion criteria Comments and queries 1 EXCLUDE 2008 Date of publication before Exception: 1 NESS pre-dates 2007, include 2002 2 CP awareness raising, include 1995 2 EXCLUDE language Not English e.g. not English 3 EXCLUDE Publication Exclude books, dissertation type e.g. not journal or abstracts, trade magazines research report (e.g. Community Care), policy and guidance 4 EXCLUDE Location Not UK e.g. not UK 5 EXCLUDE Population e.g. not young people Exception: 1 Books on local evaluations of Sure Start 2 Updating policy literature on awareness raising/ CSE 3 Includes YP and carers views Include CYP, parents, carers, wider community 6 EXCLUDE Scope Not about models of Include studies about community awareness raising. effectiveness. Include service user, carer and wider community perspectives. 7 EXCLUDE: Research type Not academic research report, Include research and peer review or voluntary sector voluntary sector evaluation reportevaluations Include literature reviews 8 EXCLUDE: insufficient details to identify reference or no abstract to screen 9 QUERY 10 INCLUDE 2 Not sure if able to include, query with IB This is based on the Social Care Institute for Excellence (SCIE’s) inclusion/exclusion criteria template. 32 References 1 R utter, D., et al., SCIE systematic research reviews: guidelines (2nd edition), in SCIE Research resource 1. 2010: London 2 D epartment for Education, Safeguarding children and young people from sexual exploitation: Supplementary guidance to working together to safeguard children. 2009, Department for Education: London. 3 D epartment of Health, Child protection: Messages from research. 1995: London. 4 B eckett, H., et al., Research into gang associated sexual exploitation and sexual violence: interim report. 2012. 5 B eckett, H., et al., It’s wrong... but you get used to it” A qualitative study of gang-associated sexual violence towards, and exploitation of, young people in England. 2013: London. 6 B uffin, J., et al., Evaluation of the Kidney Research UK Peer Educator Programme to improve understanding of organ donation amongst Black and minority ethnic communities and to increase the number of Black and minority ethnic organ donors. 2011: Bolton. 7 C larke-Swaby, C., Exploring the understanding and beliefs surrounding organ donation amongst Black African Carribean and Asian Populations affected with Kidney disease in Lambeth, Southwark and Lewisham. 2010: London. 8 D avidson, J., et al., Online Abuse: Literature Review and Policy Context. 2011: London. 9 L loyd, N., M. O’Brien, and C. Lewis, Fathers in Sure Start. 2003: London. 10 N ational Evaluation of Sure Start, Early Experiences of Implementing Sure Start, in Report 01. 2002: Nottingham. 11 N ational Evaluation of Sure Start, Getting Sure Start Started, in Report 02. 2002: Nottingham. 12 N ational Evaluation of Sure Start, Implementing Sure Start Local Programmes: An In-Depth Study. 2005: Nottingham. 13 N ational Evaluation of Sure Start, Implementing Sure Start Local Programmes: An Integrated Overview of the First Four Years, in Report 10. 2005: Nottingham. 14 N ational Evaluation of Sure Start, Outreach and Home Visiting Services in Sure Start Local Programmes, in Report 17. 2006: Nottingham. 15 N ational Evaluation of Sure Start, Sure Start and Black and Minority Ethnic Populations, in Report 20. 2007: Nottingham. 16 T he Scottish Government. Protecting Children and Young People 2005: Pilot Campaign Evaluation. 2005 09.12.13]; Available from: http://www.scotland.gov.uk/Publications/2005/ 10/11155156/51562. 17 T NS-BMRB, Worth Talking About’ Campaign Evaluation 2010 / 2011: Central Office of Information (COI) Research Management Summary on behalf of the Department of Health. ND: London. 18 W ebster, S., et al., European Online Grooming Project: Final Report. 2012: London. 19 Y ouGov, Are parents in the picture? Professional and parental perspectives of child sexual exploitation. 2013. 33 20 G arbers, C., et al., Facilitating Access to Services for Children & Families: Lessons from Sure Start Local Programmes. Child and Family Social Work, 2006. 11(4): p. 287-96. 21 G obin, M., et al., Do sexual health campaigns work? An outcome evaluation of a media campaign to increase chlamydia testing among young people aged 15–24 in England. BMC Public Health, 2013. 13: p. pp.1-11. 22 B erelowitz, S., ‘I thought I was the only one. The only one in the world’: the Office of the Children’s Commissioner’s inquiry into child sexual exploitation in gangs and groups: interim report. 2012, Office Of The Children’s Commissioner: London. 23 B erelowitz, S., et al., “If only someone had listened” Office of the Children’s Commissioner’s Inquiry into Child Sexual Exploitation in Gangs and Groups: Final Report. 2013: London. 34