8.13 Guidance on Children who present with Harmful Sexual Behaviours

Harmful sexual behaviour (HSB) is the umbrella term for those actions that are either:

• Sexually abusive, where there is an element of manipulation, force or coercion or where the subject of the behaviour is unable to give informed consent, or

• Sexually problematic, where there may not be an element of victimisation but where the behaviours may interfere with the development of the child demonstrating the behaviour or which might provoke rejection, cause distress or increase the risk of victimisation of the child.

Children’s sexual behaviour should be thought about as being on a continuum, ranging from healthy to violent.  Read more about Hackett’s continuum https://www.icmec.org/wp-content/uploads/2019/07/Hackett-Continuum-of-Harmful-Behavior-Excerpted.pdf

Defining what behaviours fit where on the continuum can be a difficult task and should be thought about within the context of the child's behaviour itself and the child's developmental situation. A particular behaviour in one circumstance could be harmful, whilst in another, it may not.

HSB is harmful to the children who display it as well as the people subjected to it.

Technology assisted HSB is problematic and abusive sexualised behaviour which children or young people engage in using the internet or technology such as mobile phones and tablets.

This might include:

• developmentally inappropriate use of pornography
• sexual harassment
• grooming
• sending sexual texts, including sexting without images
• exposing other children and young people to pornography
• Viewing and distribution of Indecent Images of children and extreme pornography
• Voyeurism, e.g. recording an individual(s) in a state of undress or engaging in sexual activity without their knowledge or consent.

‘Peer on Peer abuse’ is defined by Farrer & Co’s (2019) as:

 any form of physical, sexual, emotional and financial abuse, and coercive control exercised between children, and within children’s relationships (both intimate and non-intimate), friendships, and wider peer associations.

Some suggestions about features of behaviour are given below as prompts.

Healthy Sexual Behaviours:

• Age-appropriate
• Mutual
• Consensual
• Exploratory
• No intent to cause harm
• Fun
• No power differential
• Shared decision making

Problematic

• Not age-appropriate
• One-off incidents or low key, such as touching over clothing
• Peer pressure
• Spontaneous rather than planned
• Self-directed, e.g. public masturbation
• Other balancing factors, e.g. lack of intent to cause harm or level of understanding, or acceptance of responsibility
• Other children irritated or uncomfortable but not scared; they feel free to tell someone
• Other factors such as parents/carers are concerned and supportive.

Abusive

• Not age-appropriate
• Elements of planning, secrecy, force or coercion or lack of consent
• Power differentials, e.g. age, size, status, strength
• The response of others, e.g. fear, anxiety, discomfort
• The response of the child, e.g. fear, anger, aggression
• The child blames others and takes no responsibility
• Frequent incidents or increasing in frequency and disproportionate to other aspects of their lives
• Not easily distracted, compulsive despite intervention
• Other difficult behaviours, conduct disorders, anger, poor peer relationships etc.
• May include elements of expressive violence

Violent

• Physically violent sexual abuse
• Highly intrusive
• Instrumental violence which is physiologically and/or sexually arousing to the perpetrator
• Sadism

Assessments of children and young people who have displayed HSB need to take account of the child’s developmental and family circumstances (including own abuse and/or trauma victimisation, and other behavioural issues), along with their educational and social situation, and should look to balance concerns and strengths.

Unstructured clinical judgements have been shown to be unhelpful in assessing this cohort of children and young people. 

The level of response to the harmful sexual behaviour displayed by a child or young person will differ case by case and should take into account the seriousness of the behaviour, the needs of the child and their family, the impact on the child(ren) who have been harmed and any other identified risks. In some cases, a structured risk assessment tool may be used to assist trained professionals when intervening with young people who have displayed harmful sexual behaviour. Interventions need to be holistic and child-focused, and involve families.

A number of checklists and risk assessment tools  are available within the nice guidance which can assist in considering children and young people's sexual behaviour https://www.nice.org.uk/guidance/ng55

Children and young people’s use of IT equipment and social media is now widespread. The above prompts can also be used in connection with such behaviour.  Accessing pornography may be problematic for children and could lead to them acting in abusive ways to others.  Social networking and exchanging personal information and images with other children, young people and/or adults could expose the child to abuse and/or precipitate their own harmful behaviour.  Again the specifics of the child/young person’s behaviour and its context will be important in determining what action to take.

Evidence shows that own victimisation by sexual abuse is a poor single explanation for why children/young people may present with HSB. The younger the child, with more serious/abusive behaviours, the more likely they have witnessed or experienced highly sexualised environments or actual abuse.  However, even in these situations, it is not always the case.

Other forms of victimisation – neglect, physical abuse – are as significant, as is witnessing domestic violence. However, the possibility of child sexual abuse MUST be thoroughly and robustly investigated and the child given appropriate opportunities to discuss such a possibility.

Professionals should be open to the idea that disadvantage and/or traumatic experiences may impact the child/young person’s behaviour, and this may not necessarily be due to their own sexual abuse.

Child Sexual Exploitation (CSE) and HSB are seen as separate yet interlinked phenomena, with some distinct elements but the potential for overlap.

CSE is more likely to be represented by sexual violence towards teenagers, often in a relational context, and frequently where young people are sexually exploited by either individuals or group offenders (other young people or adults). HSB is envisaged as abuse that more often involves young people harming younger pre-pubescent victims of all genders in family or community contexts.

Young people who sexually abuse other young people within the context of relationships, often described as ‘peer-on-peer’ abuse (Firmin, 2015), fit the definitions of both HSB as sexual behaviour which victimises others and CSE as exploitative, exchangebased abuse. Hackett et al (2016) therefore argue that it is appropriate to view HSB and CSE as distinct but overlapping forms of sexual abuse, as both share the elements of coercion, misuse of power, violence and lack of consent and choice.

If you are concerned that a child/young person is presenting with HSB, then speak to your manager or designated child protection lead. Action should be taken in accordance with child protection procedures: Making a Referral.  Ultimately what action is taken to help the child should depend on, and be proportionate to, the type of behaviour being demonstrated and the child’s developmental stage and needs.  These decisions should be taken in collaboration with the child/young person’s parents/carers.

Consideration should also be given to safeguarding children in contact with the child /young person who may be demonstrating harmful sexual behaviour, including siblings. See the procedure on Children who Harm other children

Brighton and Hove:

The Partners in Change hub has a team (TACT) which works with children and young people who display harmful sexual behaviour. A consultation from TACT/Partners in Change should be considered when there is concern about a pattern of problematic sexual behaviour, the behaviour is abusive, or when it is believed that a specific intervention is required.

West Sussex:                  

Assessment and Treatment Service (ATS): The ATS is a joint agency team which is based within the West Sussex Children and young people’s services (ChYPS), provided by Sussex Partnership NHS Foundation Trust. The Service is commissioned to work with young people under 18 with harmful sexual behaviours, working with young people who have convictions and those who do not. To meet ATS referral criteria the young person must be under 18, have a West Sussex Social Worker and be presenting with harmful sexual behaviour towards others.

Pathway to service

• All young people/children require a Social Worker for the duration of the time that they are under the service.
• ATS require that the referral must be made by a Social Worker. If the young person is a child who is looked after a referral would be accepted from any professional involved in their care.

 To contact the ATS to discuss a referral please call 01403 223 268.

ATS have devised a checklist for social workers to use in the early stages of the children and families assessment. This is designed as a tool to guide thinking and aid the gathering of important information to inform an initial multi-agency risk assessment, and risk management plan. The checklist can also be used by other professionals to guide thinking when working with children and young people who display HSB.

East Sussex

In East Sussex the SWIFT Service works with harmful sexual behaviour:

Any concerns about a child or young person not already known to Children's Services should be reported via SPOA (Single Point of Access) 01323 464222 0-19.SPOA@eastsussex.gov.uk

 SWIFT Specialist Family Service includes a multi-disciplinary team of workers who work with children, young people and families where there are concerns about sexual abuse, whether this relates to a young person with harmful sexual behaviour or an adult perpetrator.  The service for children and young people with harmful sexual behaviours incorporates consultation, assessment and intervention.  Interventions include individual and family work and support for the professional network in managing the child/young person.  A consultation from SWIFT (sexual risk) should be considered when there is concern about a pattern of problematic behaviour, the behaviour is abusive, or when it is believed that a specific intervention is required.