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, through problematic, to abusive.

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.

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
• 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.

A number of checklists 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.

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 sexually harmful behaviour or an adult perpetrator.  The service for children and young people with sexually harmful 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.