Child sexual exploitation: a guide for health practitioners

3. Why Health Practitioners should be aware of child sexual exploitation

Health is a universal provider for children and young people, and practitioners may have opportunities to spot indicators that a young person may be a victim, or at risk of child sexual exploitation. The nature of health service relationships, based on trust and the creation of a safe space, can also provide further opportunity to identify this type of abuse (a patient may choose to disclose information about themselves or another person which may raise a Child Protection concern).

Health practitioners have a duty to respond to concerns about the safety and wellbeing of a child or young person. Local Child Protection procedures will provide further guidance on how to respond meet your duties to keep that child safe. Aspects of that response may include:

• Providing direct support;
• Discussing concerns with a line manager or more experienced colleague;
• Seeking more information from the child or others;
• Recording information about your concerns;
• Making an initial referral to social work or police;
• Participating in a multi-agency response;
• Referring a person to local support services.

When it is recognised that a Child Protection response is required, it is in the best interests of the child or young person that information is shared between agencies (for example other health services, education, police, social work), to enable an appropriate assessment of the situation and a fully informed response. Anyone working with children and young people who have a concern that a child or young person may be at risk of child sexual exploitation must share those concerns in line with their local Child and Adult Protection procedures.

The requirement to share information when a child or young person may be at risk of significant harm will always override a professional or agency requirement to keep information confidential.

If in doubt as to whether sharing information would be in the best interest of the child or others, a discussion should be had with the local Health Board Child Protection Advisor or Child Protection Team.

Confidentiality must be explained properly to young people, including its parameters and the fact that you will need to seek advice if you believe they are at risk of significant harm.

Case Study

A 15 year old attended her local Sexual Health Service several times over three months, receiving screening and treatment for Chlamydia and two negative pregnancy tests. The Sexual Health Service had noted deterioration in her physical appearance and personal hygiene. After several appointments the 15 year old disclosed that she was staying out all night; she was not getting on well with her mum and her older sister had moved out. She went on to disclose that her boyfriend had forced her to have sex with him and wanted her to have sex with his friends.

The Sexual Health Nurse contacted her local Child Protection lead for advice. The Sexual Health Nurse used a CSE screening tool to discuss the situation with the 15 year old, who was then confident in the next steps when the Nurse went on to make a referral to social work.

Case Study

A 16 year old boy attends the Emergency Department with a leg injury he claims came from falling awkwardly getting out of a car. He is accompanied by a male in his mid-20s who insists on being present throughout; the ED staff feel that the boy is very watchful of the older male.

The boy's ED records show he has 12 attendances in three years, with six in the last six months, all for injuries; staff also notice significant bruising on his arms and upper legs. Local health record systems show that he has been in care since he was 12.

The ED staff try unsuccessfully to speak to the boy alone. Still concerned, they seek further information from the local Looked After Children ( LAC) Nurse. The staff record their observations and the information they have gathered, and decide to make a formal referral to Social Work due to concerns about child sexual exploitation.