Sexual exploitation of children: how to raise concerns
The NSPCC has warned of a rise in cases of child exploitation during the pandemic and the need for early interventions
- The NSPCC has identified that the COVID-19 pandemic may have increased children’s vulnerability to abuse, including sexual exploitation
- Child sexual exploitation can take place online and in person and can involve grooming, threats of violence and trafficking
- How nurses can spot the signs of child sexual exploitation and how to raise concerns when a child is at risk
There are indications that the COVID-19 pandemic has heightened the vulnerability of children and young people to certain types of abuse, including child sexual exploitation (CSE), according to the NSPCC.
Grooming and the methods of abuse
CSE is a form of abuse where a child or young person is typically given things – such as gifts, drugs, money, or even affection and attention – in exchange for sexual activities.
Boys or girls can be targeted and it can take place in person or online, explains the NSPCC.
The child may trust their abuser and not understand that they are being abused; the relationship may be framed as a friendship or a romance or the abuser may have presented themselves as someone the child can look up to.
Often, abusers ‘groom’ the child, tricking them into believing they are in a consensual relationship, or sometimes they use violence and intimidation – perhaps by threatening the child’s family.
A child might be persuaded or forced to send sexually explicit images of themselves, film or stream sexual activities or participate in sexual conversations, for example.
Children can also be trafficked – moved around the country and forced into sexual activity, often with numerous people.
Anyone can be a perpetrator of CSE, no matter their age, gender or race.
Be alert to safeguarding issues
RCN Wales education and lifelong learning adviser Michelle Moseley says child victims of sexual exploitation may present to nurses across different healthcare settings.
‘Nurses might be the first point of contact and we can pick up on something and set in place that early intervention and prevention to support children and young people – or adults – who have been exposed to a safeguarding issue.’
Exploiters groom children and young people by showering them with gifts and attention and trying to separate them from their friends and family, says Ms Moseley, 2018 winner of the RCN Wales Nurse of the Year safeguarding award.
‘The child’s behaviour might change – and then they might be given alcohol and drugs and be manipulated into doing things.’
This can include bringing other children on board to be exploited too, she says.
‘I was groomed, threatened and raped, but my abuse remained hidden’
‘Jade’ was 14 when her father died. She started missing school, her work deteriorated, she became quiet and withdrawn and she was considered ‘difficult’.
Her school thought her behaviour change was caused by grief – but the reality was different.
Jade’s father had been linked to a drug gang and she felt she had to carry on for him. She was taken to so-called ‘cuckoo houses’ where gangs target vulnerable people and use their homes as bases for activities such as drug dealing. Jade was given some of the drugs ‘to try’ and was raped and sexually assaulted.
She was trafficked among men in the gang and their friends and ‘debt-bonded’’ by being told that if she disclosed what was happening, her mother’s house would be burned down and her younger sibling would be raped.
Victims often hide the true picture of their abuse
Jade presented repeatedly at emergency departments, usually with abdominal pain, but would often leave before she got beyond the reception desk. She went to sexual health clinics but used an alias, which meant it was difficult to identify her.
The gang members gave her expensive gifts and took her to exclusive hotels. She felt that they were showing her attention, not realising it was part of the grooming process. Jade would later describe it as the ‘worst time in her life but also some of the best times’.
She described losing her sense of empathy and she recruited friends to join her. She did what she felt she had to do – and what she thought her father would have wanted.
Eventually, with repeated contact with police, social services and health services, the true picture of what was happening to her was recognised and interventions were put in place to keep her safe.
(Based on a case recounted by Birmingham Community Healthcare NHS Trust head of service for safeguarding Claire Capewell with some details changed)
Prevalence of the problem is difficult to gauge
Nurses should be on the alert for signs that a child is being sexually exploited, says Ms Moseley, and they must never ignore a suspicion, no matter how small.
‘You’re trying to build up a picture of the lived experience of that child because that will tell you if the child is being exploited. Professional curiosity has to be uppermost as it might be the only time the child has the confidence to go to a healthcare setting’
Claire Capewell, Birmingham Community Healthcare NHS Trust head of service for safeguarding
‘They cannot not deal with it, because that would be a fitness-to-practise issue,’ she stresses. ‘It can be difficult – especially if you’re a health visitor and have built a relationship with a family – but you have to act.’
The extent of child sexual exploitation in the UK is hard to gauge.
The NSPCC quotes Office for National Statistics figures showing that in 2019-20 the police in England and Wales recorded 1,012 offences of abuse of children through sexual exploitation. However, a further 11,554 offences that might be related to CSE were flagged by police. Similar figures are not available for Scotland or Northern Ireland.
According to Birmingham Community Healthcare NHS Trust head of service for safeguarding Claire Capewell, who has had many years of experience as a CSE nurse specialist, referrals for child sexual exploitation have reduced.
She is convinced that the actual prevalence remains high but that media attention has shifted away since high profile cases such as the Rotherham CSE scandal. Media and policy-makers’ focus is now on child criminal exploitation, including ‘county lines’ gangs that force children to distribute drugs far from their homes.
‘Where we have children at risk of criminal exploitation, we have to think about whether there is a sexual element,’ she says. ‘Just because a girl is being used to transport drugs doesn’t mean she isn’t being raped and sexually exploited at the same time – and it’s the same for boys.’
Red flags for nurses
Look for a general deterioration in health for boys and girls, which can be broken down into physical, emotional, sexual changes – and things like appearance and neglect, says Ms Capewell.
Children might be reluctant to explain injuries or leave if questioning becomes too difficult. Sometimes they are being controlled by an abuser who is listening to the consultation on a mobile phone, and may order the child to leave. One solution here, she adds, is to write ‘Are you alright?’ on a piece of paper and allow the child to write a response.
The most important thing that a nurse can do is listen, notice and then act, she says. ‘You’re trying to build up a picture of the lived experience of that child because that will tell you if the child is being exploited.
Spot the signs of sexual exploitation
Signs of sexual exploitation and grooming may include:
- Unhealthy or inappropriate sexual behaviour
- Being secretive
- Sharp changes in mood and character
- Having money or things they won’t explain
- Physical signs of abuse such as bruises or bleeding in the genital or anal area
- Abdominal pain
- Alcohol or drug misuse
- Sexually transmitted infections; repeated pregnancy tests; repeated requests for emergency contraception
- Pregnancy
- Self-harming, including eating disorders
These signs are not exhaustive and even children who do not show any obvious signs can also be victims.
Source: The NSPCC and interviewees
‘Professional curiosity has to be uppermost as it might be the only time the child has the confidence to go to a healthcare setting.’
Resources and time are always going to be an issue, but that should not stop nurses acting if they suspect something is amiss – it might be a small nugget of information that contributes to a wider multi-agency picture of what’s going on. This can save the child but also bring perpetrators to justice.
‘In a busy ED on a Friday night, it’s difficult and we don’t expect staff to get the whole picture. But use that moment of contact to document what you see and what you hear, and make sure the information is passed on – don’t hold on to it.’
What to do if you suspect a child is being sexually exploited
Speak to your line manager. If a child is at risk of immediate harm if they return to their parent or carer, alert the police or social services. If immediate harm is not deemed a risk, then follow your local child protection/safeguarding procedures.
In England, contact your local safeguarding team, or contact social services if it is out of hours.
In Scotland, contact your local child protection officer who will initiate an inter-agency referral discussion (IRD), usually within 24 hours after an initial concern is raised.
In Wales, there is a statutory duty to report children at risk by making a referral to social services. You can use the Child Sexual Exploitation Risk Questionnaire to inform your decision.
In Northern Ireland, the Safeguarding Board for Northern Ireland says all professionals working with children and their families should be alert for the signs that a child or young person might be experiencing CSE and know who the CSE lead is in their area.
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