The purpose of this document is to provide guidance to practitioners who are concerned that a child or young person with whom they are working is displaying harmful sexual behaviour, or is at risk of doing so. This protocol explains local authority processes and should be considered alongside the Effective Support for Children and Families Procedures http://www.safeguardingcambspeterborough.org.uk/wp-content/uploads/2018/11/Effective-Support-for-Children-and-Families-Thresholds-Document.pdf and Safeguarding Board Child Sexual Abuse Strategy. http://www.safeguardingcambspeterborough.org.uk/wp-content/uploads/2018/06/CSA-Strategy-2018-20.pdf
‘Sexual behaviours 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’. (Hackett 2014 Children and Young People with Harmful Sexual Behaviours)
…Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse Sexual abuse can take place online, and technology can be used to facilitate offline abuse. (Working Together 2018).
However, there appears to be little consensus with respect to the appropriate terminology to describe young people who sexually abuse. UK polices include ‘young people who display harmful sexual behaviour (HM Government 2013) and ‘young people who sexually abuse’ (YJB 2008). Rich (2011) uses ‘juvenile sexual offender’, ‘sexually abusive youth’ and ‘sexually troubled youth’ interchangeably. It is not technically appropriate to use the term ‘juvenile sexual offender’ until the young person has been found guilty in a court of law (Ryan, Hunter and Murrie 2012). For the purposes of this document we choose to use the term ‘young people who display harmful sexual behaviour’, as this separates the young person from their behaviour and promotes a whole-person focus.
Background and Context
At least a third of all sexual offences against children in the UK involve other children as the perpetrators (Hackett et al., 2016). Since much abuse is unreported or unrecognised, official statistics are only able to reveal a small proportion of actual incidence but evidence suggests that children and young people who are sexually abusive towards others are likely to have experienced considerable disruption in their own lives (AIM Project). They may have been exposed to domestic violence, have witnessed or been subjected to physical or sexual assault, have problems with their educational development and are likely to be involved in a range of offending behaviours and pro- criminal networks. While it is fair to say that most children and young people who abuse or are abused do not go on to become adult abusers, many adult abusers when interviewed, claim to have started their abusive behaviours in childhood.
The impact of childhood sexual abuse is known to lead to costly (both in the human and financial sense) long term mental health difficulties including anxiety, depression, post-traumatic stress disorder, psychosis, substance abuse, eating disorders, self-harm and suicide (Briere &Runtz 1988; Polusny & Follette 1995; McGee et al 2002; Spataro et al 2004). There are also adverse health effects from childhood sexual abuse, including higher rates of health risk behaviours such as smoking, alcohol and drug misuse, risky sexual behaviour (including prostitution), sexually transmitted infection and gynaecological problems (Nurse et al 2005).
What has been acknowledged (Working Together 2018) is that children and young people who have been involved in harmful sexual behaviour require a multi-disciplinary and multi-agency co-ordinated response to identify the problem, assess risk and put in place an effective management plan.
The causes of child/adolescent harmful sexual behaviours are multi-factorial involving socio-cultural, environmental, familial, interpersonal and developmental factors. These are unique in every case. Where a concern exists about sexualised behaviour in children or young people it is important that this is looked at within a holistic context and that staff are able to access appropriate case discussion from a specialist worker, and if necessary assessment interventions, quickly and efficiently. This includes the need to actively consider whether the child or young person displaying the behaviour needs safeguarding themselves.
When exploring harmful sexual behaviour risks it is important to consider that:
- Two thirds of contact sexual abuse is committed by peers;
- History of abuse, especially sexual abuse, can contribute to a child displaying harmful sexual behaviour;
- All children, including the instigator of the behaviour, need to be viewed as victims;
- Children have greater access to information about sex through technology and this has had an impact on their attitudes to sex and sexual behaviour;
- Children with harmful sexual behaviours who receive adequate treatment are less likely to go on to commit abuse as an adult compared to children who receive no support;
- Incidents of harmful sexual behaviour should be dealt with under the specific child protection procedures which recognise the child protection and potentially criminal element to the behaviour. There should be a coordinated approach between the agencies;
- The needs of the children and young people should be considered separately from the needs of their victims;
- An assessment should recognise that areas of unmet developmental needs, attachment problems, special educational needs and disabilities may all be relevant in understanding the onset and development of abusive behaviour;
- The family context is also relevant in understanding behaviour and assessing risk.
Indication and Identification of Harmful Sexual Behaviour
In considering the question of harm, practitioners must also consider harm to the child or young person displaying the behaviour themselves as well as to the alleged/perceived “victim”. If there is felt to be a significant risk to the child or young person themselves from their own behaviour then consideration must be given to Local Safeguarding Board Procedures.
There are no diagnostic indicators in personal or family functioning that indicate a pre-disposition towards sexual offending, although the following have been found to be indicators of young people who sexually offend:
- Attachment disorders – poor nurturing and parental guidance;
- Domestic violence and abuse;
- Previous sexual victimisation – a younger age at the onset of the abuse is more likely to lead to sexualised behaviour;
- Social rejection and loneliness;
- Poor empathy skills.
Many of these factors exist alongside typical family environments where other forms of abuse are present. There is a significant minority of young people who display this behaviour who have a level of learning need – up to 40% in some studies. Their needs must be carefully assessed as some assessment tools are not suitable. Also, the intervention may need to be extended and involve a high degree of coordination between agencies.
It is important to be aware that behaviours may present themselves in young people when there has been a family history of sexual abuse and that young people may themselves be both a victim and perpetrator.
It can be useful to think of sexual behaviour as a range or continuum from those behaviours that are developmentally and socially accepted to those that are violently abusive (see Children and Young People with Harmful Sexual Behaviours (Research in Practice).
Professionals should use the Brook Traffic Light Tool to identify whether or not the behaviour identified can be categorised as Green [safe and healthy], Amber [behaviours that have the potential to be outside of safe and healthy development] or Red [behaviours that are outside of safe and healthy development]. https://www.brook.org.uk/training/wider-professional-training/sexual-behaviours-traffic-light-tool/
The traffic light tool indicates whether identified behaviours for children and young people of varying age groups can be seen as ‘Green’, ‘Amber’ or ‘Red’. This is designed to help those working with children and young people identify the response to sexual behaviour that is likely to be most appropriate. The tool allows behaviour to be considered in the following age categories: age 0-5, age 5-9, age 9-13 and age 13-17.
An example of the Brook Traffic Light Tool rating for 13 – 17 year olds can be seen below, but professionals must follow the link above and consider the tool in full when considering presenting behaviours.
Healthy sexual behaviours are
Problematic sexual behaviours are
Harmful sexual behaviours are
Concerns about problematic and complex harmful sexual behaviour and the welfare and safety of the child/ren should be referred to the Children’s Social Care Customer Service Centre as set out in the Effective Support for Children and Families procedures.
Where behaviours are identified that are significant and are likely to become harmful or have already caused harm and require a higher level response, a professionals meeting or Strategy Discussion is required involving both Social Care, the Police and Harmful Sexual Behaviour (HSB)/YOS Service.
If the case is not open to Early Help, YOS or Children’s Social Care then a referral should be made through the Customer Service Centre using a multi-agency referral form in line with Cambridgeshire and Peterborough Local Safeguarding Procedures and a Child and Family Assessment will be completed and/or a Strategy Discussion will be convened.
The Professionals Meeting/Strategy Discussion is a forum for analysing risk, sharing background information on the young people and planning further action. In addition to the agencies above schools or any other agency with significant contact to any of the young people should also be invited to the meeting where appropriate.
The Professionals Meeting/Strategy Discussion should consider:
- Issues of child and public protection, including a clear understanding and description of any alleged incident;
- An assessment of the child/young person’s needs, and the need for further specialist assessment;
- The roles and responsibilities of child welfare and criminal justice agencies;
- Any on-going safety issues for all of the young people involved.
The context of the behaviour and background of the young people and their family are important factors in determining next steps. The decision on how to proceed is made after a Professionals Meeting or initial Strategy Discussion:
- Into a child protection/child in need route;
- Into a criminal justice route;
- Sometimes both pathways will be running in conjunction with each other.
There are occasions when behaviours are thought to be complex, but not serious enough to warrant Social Care intervention. Therefore the matter may be dealt with through:
- Early Help Assessment and Team Around the Child route
- Out of Court Disposal, criminal justice route;
- Sometimes both pathways will be running in conjunction with each other.
These decisions should not be taken lightly and as a general rule of thumb the behaviours should be considered symptomatic of un-met need in a child or young person.
It is important that complex behaviour should always be reported into Customer Service Centre so that a record is made. If an assessment is required a referral for Early Help and specialist support will be processed. In such cases it is still important to convene a multi-agency planning meeting to consider the needs of the children or young people involved.
Where there are concerns that inappropriate and harmful behaviour has or is likely to take place the lead professional should consider making a referral for a further specialist HSB assessment and intervention from the HSB Service using the attached form in Appendix 1.
Harmful Sexual Behaviour Service Definition
The Harmful Sexual Behaviour (HSB) Service is a local authority service that provides specialist advice, assessment and support to other Local Authority Services such as Education, Early Help, Children’s Social Care and YOS teams and professional. The team includes professionals who have undertaken specialist training in understanding harmful sexual behaviour, conducting assessment and interventions.
The Harmful Sexual Behaviour Workers will provide advice and guidance to lead professionals to inform their own agency assessments and plans for children and young people. In addition where children and young people are assessed as presenting with potential or significant levels of concern the team may complete specialist HSB assessments and interventions alongside the multi-agency partnership. The service will work with young people aged 8 – 18 across Cambridgeshire and Peterborough. For younger age children the HSB service may be able to offer advice and guidance and/or signpost to other services.
Definitions in the context of harmful sexual behaviour can be difficult. In Cambridgeshire and Peterborough the Sexual Behaviours Traffic Light Tool (adapted for use in the UK by Brook) provides professionals across organisations with a framework for identifying whether behaviour is part of healthy development or a cause for concern. The tool also provides guidance on when to safeguard and/or signpost to internal or external support.
The HSB Service will work alongside children/young people who are open to Early Help, YOS and Social Care where a lead professional is identified.
Assessment and Intervention
Cambridgeshire and Peterborough Youth Support are committed to shared partnership working using appropriate models of assessment and intervention for young people who demonstrate harmful sexual behaviour. What has been acknowledged (Working Together 2018) is that children and young people who have been involved in harmful sexual behaviour require a multi-disciplinary and multi-agency co-ordinated response to identify the problem, assess risk and put in place an effective management plan.
At the referral stage it would be expected that the referring agency would provide their own assessment of risk for children and young people displaying harmful sexual behaviour according to their own policies and procedures. This should take into account incident reports of any behaviour that is causing concern and may involve accessing the young person’s social care history, educational, health, police and youth justice records.
The HSB service will then work together with the referring agency to determine the most appropriate level of assessment and intervention. It is expected that most referrals will not result in a formal intervention assessment, as the harmful behaviours may be modified through multi agency working, safety planning and psychosexual education. However where behaviours are assessed as persistent, resistant to change, increasing in frequency and severity, causing distress to the young person and concern for professionals, a more formal assessment of the behaviour and an intervention plan such as an AIM assessment may be completed.
The AIM (Assessment Intervention and Moving on) Model of Assessment is designed to provide practitioners with a structured framework to assist in analysing Harmful Sexual Behaviour (HSB) in the overall context of the young person. The AIM Project uses HSB as an umbrella, shorthand term for sexual behaviours of concern, but acknowledges that within this, there is a range of behaviours including problematic, abusive or violent behaviours. These behaviours will all cause varying levels of concern for professionals.
AIM is designed to be used with young people aged 12-18 years who have committed, or there is strong professional evidence or belief, they have exhibited harmful sexual behaviour. For those children under the age of 12 years, practitioners are directed to utilise the AIM Under 12s Assessment Model (Carson, 2019). For those young people whose behaviour is online the Technology Assisted Harmful Sexual Behaviour (TA-HSB) has been developed to specifically assess internet, image sharing or image-creating HSB
It is likely that most AIM assessments will be undertaken with the Youth Offending service where an offence has been committed and a full assessment may inform the Pre-sentence report and intervention plan. It should be noted that it is not appropriate to complete a full AIM Assessment until a young person has taken some responsibility for their behaviour and accepted an Out of Court disposal or entered a guilty plea if the case is following a criminal process.
The Aim Intervention Framework is not a manualised approach, instead it uses information from the assessment to determine the level and type of intervention required to facilitate change. The intervention framework offers a four stage approach, Preparation, engagement and motivation, Building resilience Sex education and relationships and harmful sexual behaviours.
The benefit of the four stage approach recognises the influence systemic response and the impact of adults on the young person’s progress. This provides a framework to prioritise work, develop a safeguarding/risk management plan and can support the identification of areas of concern in the adult network that might impact on the young person’s ability to engage in interventions.
Staff in the HSB Service and both Cambridgeshire and Peterborough YOS have access to and are trained in AIM assessments. There is also a small resource within the YOS Psychology Team for additional risk based assessments such as the Juvenile Sex Offender Assessment Protocol (JSOAP), Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR). These assessments are only validated for use on males and the ERASOR is only for those who have been convicted of an offence. These assessments may be used as part of a wider psychological risk formulation.
Any agreed HSB plan of intervention will be shared with the lead professional and multi-agency group as appropriate. A proposed number of sessions will be agreed with reviews and/or end summaries provided to the lead professional with an agreed time frame. All interventions will be accompanied by an end summary recorded on the appropriate system within two weeks of the intervention ending. HSB workers will contribute to multi-agency professional meeting such as Team Around the Child, Child in Need Meetings, Child Protection Meetings, Child in Care Reviews and YOS Risk and Vulnerability Meetings.
All HSB referrals, assessments and interventions will be recorded as voluntary interventions on the Child View Youth Justice data base in Cambridgeshire and CAPITA YOS data base in Peterborough.
Multi-Agency Understanding Harmful Sexual Behaviour training is available through the Education Child Protection Training Program and the Children’s Safeguarding Board Multi-Agency Professional Training Program. This Safeguarding Board Training will be supported by the Harmful Sexual Behaviour Team. HSB training will be identified as mandatory for some professionals working with vulnerable children and young people.
Agencies can also access and commission specific team HSB training from other providers such as the NSPCC and Dhiverse.
Department for Education (DfE) (2018 ) Sexual violence and sexual harassment between children in schools and colleges: advice for governing bodies, proprietors, headteachers, principals, senior leadership teams and designated safeguarding leads (PDF). [London]: Department for Education (DfE).