15.15 Guidance on Children who present with Harmful Sexual Behaviours

Harmful sexual behvaiours are expressed by children and young people under the age of 18 years old that are developmentally inappropriate, may be harmful towards self or others, or be abusive towards another child, young person or adult. (derived from Hackett, 2014).  It may also be referred to as sexually harmful behaviour or sexualised behaviour.

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 Hackett Continuum  and Excerpted from Harmful Sexual Behaviour Framework, 2nd Ed. 2019, NSPCC, UK

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.

‘child on child abuse' (known previously as 'Peer on Peer’) 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
• No power differential
• Shared decision making

Find out more about what is considered developmentally typical sexual behaviour

It is important to be able to distinguish developmentally typical sexual behaviours from those that may be problematic or harmful, and make sure children get appropriate support. Always consider the child’s holistic needs and safeguarding concerns alongside any sexualised behaviour

The table in the link below sets out behaviours, from developmentally typical to harmful.

This ranges from

• Normal
• Inappropriate
• Problematic
• Abusive 
• Violent 

Responding to children who display sexualised behaviour (nspcc.org.uk)

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). 

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, exchangeb ased 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:               

West sussex have developed Sexual Harm Practice guidance. This is available for west sussex social workers to access through Tri-X. Social workers should refer to this for more information on responding to 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.