Child sexual exploitation and the adoption of public health approaches to prevention: critical reflections on evolving processes and practices

<h3>Background/introduction</h3> We are a community based, multi-disciplinary team providing sexual health care for 8,000 under 20s that attend our service yearly. Child Sexual Exploitation (CSE) is an increasingly recognised problem that affects young vulnerable people across the UK. Information sharing between agencies is an important factor in identifying young people who are involved in CSE and in order to improve our practice, we retrospectively reviewed case notes of those identified as vulnerable to CSE by other agencies. <h3>Aim(s)/objectives</h3> To identify: was information shared when a risk of CSE was identified during the sexual health consultation? What is the prevalence of strong and warning signs of CSE in this population of young people attending sexual health services? <h3>Methods</h3> Retrospective case note review using our health authority tool for identifying CSE risks. <h3>Results</h3> 76 of the136 young people identified had attended our service. 39/76 (51%) had at least one strong indicator for CSE. 36/39 nine were known to social work. 38/39 had documented information sharing. 11/76 (14%) had at least one warning indicator and 26/76 (35%) had no identifiable CSE risk factors. 7/26 had information shared with social work. <h3>Discussion/conclusion</h3> Information sharing occurred for almost all patients identified with a strong risk factor for CSE. 49% of the young people identified by other agencies as at risk did not disclose information that strongly indicated CSE. Incorporation of the BASHH spotting the signs proforma and training to further increase staff awareness is being developed.

Aims Determine how well current Initial Health Assessments (IHA) assess the risk of child sexual exploitation (CSE) in looked after children (LAC) Propose modifications to improve CSE screening Propose methods to improve sexual health promotion Methods IHA reports (1.2.16–31.8.16) in young persons aged >13 years were reviewed for evidence of sexual health promotion and CSE screening using validated tools: BASHH and Brook guidance ‘Spotting the Signs’ (StS), and Barnados’ modified Child Sexual Exploitation Risk Questionnaire (CSERQ4). A focus group of health professionals who carry out IHAs was held to suggest ways to improve CSE screening. Results Age demographics (female/male) 13–14 years: 6/0, 15–16 years: 10/6,>17 years:1/1 Asked relationship history=19/24. 15 (79%) in relationship, 11 (58%) sexually active. StS 7 categories (education, family relationships, friendship, personal relationships, consent, sexual health education, professional analysis). Multiple sub-questions. 0% full compliance. Best performances: Substance use 21 (88%), education history 22 (92%), trusted adult 21 (88%). Particular weaknesses: Confidentiality 0 (0%), self harm 5 (22%), pre-intercourse substance use 2 (18%) STIs 6 (38%), location/nature of intercourse 0 (0%) Focus group (n = 4) Main issues: Time constraints Lack of professional relationship with LAC Intimate questions StS vs: CSERQ: CSERQ4 preferred Conclusion Current IHA process fails to support screening for CSE using either StS or CSERQ4. Screening for CSE needs to be balanced against other health priorities, developing rapport, and time. Ideally CSE screening should be done by a familiar trusted health professional, but this population is particularly vulnerable, making opportunistic IHA screening appropriate. New 2016 CoramBAAF guidance recommends sexual exploitation risk assessments, but without specifying CSE toolkit. CoramBAAF currently does not fulfil either StS or CSERQ criteria. The focus group recommended integration of CSERQ4, with ‘tick box’ reminders into the current IHA, with ongoing training. Written information and local signposting on sexual health promotion should be provided.

Drawing on the knowledge that looked-after children are disproportionately involved in child sexual exploitation, this critical systematic literature review considers the significance of ‘love’, using bell hooks’ ‘love ethic’. This literature review applies a systematic approach to retrieving literature and includes ten peer-reviewed journal articles containing primary research from individuals with lived experience of being a looked-after child and child sexual exploitation, or professionals within the field. Thematic analysis is used to identify the themes of risk, agency and relational practice. Together, these explore how dominant discourses of neoliberalism, patriarchy and capitalism shape modern social work, increase the risk of child sexual exploitation for looked-after children and maintain conditions needed for child sexual exploitation to function. bell hooks’ conceptualisation of the ‘love ethic’ is discussed as a possible framework in meeting the unmet emotional and economic needs of looked-after children through using ‘love as action’. ‘Love’, critical thinking and critical reflection are then recommended for social work.

Background/introduction Identifying and assessing the risk of child sexual exploitation (CSE) in young people is a fundamental role of sexual health clinics. The ‘Spotting the signs’ proforma developed by BASHH recommends assessing all those Aim(s)/objectives The aim of this audit was to review those Methods EPR records for all Results 56 patients identified, 86 attendances. 36/56 (64%) were 16–17 yrs. 48/56 (86%) were female. 23/56 (41%) were seen in the Young Person’s Clinic, the rest seen throughout the service. Concerns included: sexual assault/non-consensual sex 41%, drugs and alcohol 39%, difficulties at home/in care 37%, mental health 37% and partner age/coercion 11%. 20% had concerns in ≥ 3 areas. Interventions: 24/56 (53%) already had social work or other agency involvement, 27% were referred to agencies for the first time as a consequence of their visit to the clinic. Further clinic follow up was arranged in 33/56 (59%). All patients had a clear action plan. Discussion/conclusion This audit suggests that older young people (16–17 yrs) have significant risk factors; the same vigilance accorded to under 16’s needs to be applied to this group. Sexual Health clinics are well placed to both recognise those at risk and provide ongoing support and referral.

Purpose– The purpose of this paper is to explore the links between forced marriage, running away/going missing and child sexual exploitation.Design/methodology/approach– An extensive research review and interviews with experts and practitioners across the three fields identified a total of 22 cases in which young people (aged 18 and under) had experienced some combination of all three issues. Of these, nine case studies involving South Asian young people were explored in depth using a case study methodology.Findings– Through adopting constitutive intersectionality as an analytical framework, the power of “community” emerged as a distinct theme within the cases. Concern about both family and community “honour” impacted young people’s decision making and help seeking processes. “Honour” also impacted parental responses to the young people as well as how they engaged with the professionals seeking to support them.Research limitations/implications– The safety of mothers also emerged as an issue, suggesting that this is an area for further research.Practical implications– Practical implications for practice included: the need to address barriers to young people disclosing abuse and entering into the criminal justice process; difficulties associated with finding safe spaces to work with young people; the need to identify effective ways of working with abused young people who are unable to draw on relational and social support; and dangers associated with accessing support services.Originality/value– An extensive review of the relevant research literature failed to uncover links between forced marriage, going missing and child sexual exploitation. This led the author to assert that the risk of child sexual exploitation as it relates to young South Asian young people who run away from home to escape forced marriage has been both under-acknowledged and under-explored (Sharp, 2013). Empirical research undertaken by the author over a 15-month period confirmed this assertion.

ABSTRACTThe risk of child sexual exploitation is a growing concern, both within community and child care settings. Within community services working with vulnerable young people, the risks of exploitation are pervasive and present a constant management problem for professionals. This makes the need for focused educational interventions within such settings all the more vital. This case study aims to describe the assessment, formulation, intervention, and outcomes of a young female considered to be at risk of sexual exploitation. It was hypothesised that, after completion of a psychoeducational group designed to enhance knowledge and skills around child sexual exploitation, positive outcomes would be seen in psychometric assessment, risk-taking behavior, and risk awareness. Results demonstrated no clinically significant change for measures of impulsivity, resourcefulness, or self-reported difficulties. A significant increase was seen for self-reported self-esteem, and all outcomes revealed a positive direction of change. Observational accounts of behavioral and attitudinal change produced more positive results, revealing an increase in prosocial behaviors and a reduction in risk-taking behaviors. Outcomes are discussed in relation to the individual’s history and the residential care environment. Implications for future research and practice are outlined, and the study limitations are considered.

This article considers the effects of an educational intervention with young people designed to reduce the risk of child sexual exploitation (CSE). Drawing on findings from a qualitative study, we consider processes of engagement with the initiative, the relevance of the strategy adopted by the delivery team and the impacts on the perspectives of young people targeted. Focusing on mutually constitutive problems of context sensitivity, recognition of ambiguity and the silencing of alternative narratives, we raise several critical caveats that should be considered in the design and implementation of future CSE awareness raising initiatives. Overall, we aver that an unstinting focus on individual behaviour management unduly responsibilizes young people and draws inflexible demarcation lines between appropriate and inappropriate sexual conduct.

Driving Improvements in Child Protection and Safeguarding Practice

Background: Youth in foster care are at increased risk for the Commercial Sexual Exploitation of Children (CSEC), however most do not identify themselves as exploited. Mandates in New York State require child welfare workers to screen and classify all foster care youth for CSEC based on specific indicator tools. Despite being co-located with agency social workers, our medical providers may be unaware of a youth’s CSEC risk classification because the database is not integrated with our electronic medical record and cross disciplinary communication may fail to make all team members aware of this risk …

ABSTRACTTools to assess the risk of becoming a victim of child sexual exploitation (CSE) have been developed by UK CSE practitioners based on their professional experiences, with little evidence underpinning their development, and no evaluation/validation. Little is known about how they are used in practice. This paper summarizes two studies. The first study consisted of a rapid review to identify factors associated with increased or decreased risk of vulnerability to becoming a victim of CSE and the assessment of 10 tools being used in the UK. The second study undertook interviews and online survey with professionals across multi-agencies to establish the use of tools. Results illustrate the context and processes in which the tools are being used and identify concerns regarding their ability to identify and protect children.

New Horizons for the Journal: Familiar Landscapes in Child Protection

IntroductionRecognition of CSE is a vital part of our work. We host a monthly multiagency safeguarding meeting (SM), alongside social services, children in care (CIC) team and hospital safeguarding. All children with high risk behaviours/vulnerabilities who have attended in the previous month are discussed including children in care, those current self-harming and those disclosing grooming or sexual assault. We will explore other factors contributing to CSE risk and demonstrate the value of the multiagency SM to care.MethodsReview of records of 90 adolescents 13-17 attending between 01/08/16 – 30/09/16. Demographics, safeguarding concerns and SM outcomes were recorded. Results were analysed using SPSS and Pearsons/Fishers tests.Results84% (76) were female. 13% (12) were aged ≤15. In this group a history of involuntary sex was associated with both the use of recreational drugs (p=0.002) and any diagnosis of a mental health condition (p=0.020). 12 patients were discussed at the SM. New information was shared between partner organisations in 75% (9) cases. Further results for risky behaviours can be seen in Table 1.Abstract P221 Table 1Spotting CSEYes (%)No (%)History of involuntary sex21(25.6)61(74.4)History of grooming1(1.2)82(98.8)Sent/Received sexually explicit photos5(8.8)52(91.2)Met partners on internet/social media6(10.7)50(89.3)Previous or current self-harm33(37.6)53(62.4)Known to Social Services20(22.8)68(77.2)DiscussionDiscussion at the SM improves the care of vulnerable children by identifying those at risk and improving multiagency care planning. Mental health problems or illicit drug use should prompt careful evaluation for CSE risk.

The present study examined police officers' and social workers' experiences of investigating child sexual exploitation (CSE) cases and the impact on their welfare. Semi‐structured interviews were conducted with frontline social workers and law enforcement professionals. Practitioners reported that they seldom reacted emotionally during forensic interviews because they were attending entirely to the victims while gathering evidence. Although some practitioners employed post‐interview stress management techniques, anticipatory coping strategies were seldom adopted, and most coping methods were employed outside of the workplace (e.g., spending time with family). Practitioners focused on the needs of young people, almost to the exclusion of their own. Many did not consider the negative emotional impact of CSE cases on their welfare. These findings have important implications for practitioner wellbeing. Copyright © 2016 John Wiley &amp; Sons, Ltd.‘Examined police officers' and social workers' experiences of investigating child sexual exploitation (CSE) cases and the impact on their welfare’Key Practitioner Messages Practitioners rarely considered the emotional effects that CSE cases might have on them or ways to psychologically prepare themselves before meeting with young people. Practitioners reported a variety of ways they managed the impact of working with CSE which most often occurred outside of the workplace; a number of these ways could be actively promoted and developed within police forces and local authorities, especially preventative coping strategies. ‘Practitioners reported a variety of ways they managed the impact of working with CSE’

Commercial sexual exploitation of children (CSEC) is a critical public safety and health concern in the United States. While evidence exists on the healthcare needs of exploited youth, less is known about the barriers they face accessing care. Discrimination in health care is one barrier reported by exploited youth and can include the perception of being treated differently based on perceived intelligence, engagement in commercial sex, or not feeling heard by nurses or doctors. To explore asa experienced or are at high risk of CSEC. Survey data from a sample of 534 young people aged 13-24 years who experienced or are at risk of CSEC were collected via agency partnership and social media. Ordinary least squares and logistic regression models examined the associations among victimization histories and different perceived discrimination events in healthcare settings. CSEC disclosure is highly associated with discriminatory events in medical settings. Among evaluated victimization histories, CSEC experiences were the most highly associated with an increase in the odds of each discriminatory event in the present measure, compared to other victimization histories that yielded lower associations of discrimination in medical settings. Experiences of discrimination in health care are an underexamined barrier to CSEC victims seeking and engaging with health care. By fostering a supportive, nonjudgmental environment, healthcare providers can improve healthcare experiences for CSEC survivors. Recommendations include enhancing training for healthcare professionals and creating more accessible and supportive healthcare services tailored to the unique needs of these young people.

Sakran, Joseph V MD, MPH, MPA, FACS; Bornstein, Sue S MD, MACP; Dicker, Rochelle MD, FACS; Rivara, Frederick P MD, MPH, FAAP; Campbell, Brendan T MD, MPH, FACS, FAAP; Cunningham, Rebecca M MD, FACEP; Betz, Marian MD, MPH; Hargarten, Stephen MD, MPH; Williams, Ashley MD, FACS; Horwitz, Joshua M JD; Nehra, Deepika MD, FACS; Burstin, Helen MD, MPH, MACP; Sheehan, Karen MD, MPH; Dreier, Fatimah L; James, Thea MD, FACEP; Sathya, Chethan MD, MSCE; Armstrong, John H MD, FACS; Rowhani-Rahbar, Ali MD, MPH, PhD; Charles, Scott MAPP; Goldberg, Amy MD, FACS; Lee, Lois K MD, MPH, FAAP, FACEP; Stewart, Ronald M MD, FACS; Kerby, Jeffrey D MD, PhD, FACS; Turner, Patricia L MD, MBA, FACS; Bulger, Eileen M MD, FACS Author Information