Lessons from Serious Case Reviews: Harmful sexual behaviour

Harmful sexual behaviour (HSB) can be a challenging issue for professionals to manage. A child who displays HSB can have a range of behaviours, which need a safeguarding response. HSB has been identified as a significant risk factor in some serious case reviews.

Published case reviews show that professionals can find it difficult to respond to the safeguarding implications of HSB. There may be several children involved, each of whom will have different needs, and minimising the immediate effects of an incident can become a priority. Because of this, professionals can find themselves managing individual episodes rather than looking at the bigger picture.

The learning from these reviews highlights that children who display HSB need support and understanding. HSB should be recognised as a potential indicator of abuse and professionals should work together to look for the reasons behind a child's behaviour and consider appropriate safeguarding responses.

Reasons case reviews were commissioned

This briefing is based on learning from case reviews published between 2010 and February 2017, where HSB was highlighted as a significant issue.

The children in these case reviews faced a complex and wide range of risk factors. They became the subject of reviews following:

• Involvement in sexually harmful behaviour
• Death of a child following a violent incident involving other young people
• Death of a child following a serious head injury
• Suicide of a young person whose issues included displaying HSB.

Risk factors for HSB in case reviews

HSB is not always recognised

• Responding to individual incidents of HSB can become the focus of professionals' attention, rather than looking at patterns of behaviour and the reasons behind it.
• Professionals may not understand the seriousness of such behaviour so they do not always make appropriate referrals or follow-ups.
• Children who display concerning behaviour are not often discussed at multi-agency meetings, so no one gains an overview of the child's situation.
• If HSB is investigated as a criminal offence rather than a safeguarding concern, the child is not always given appropriate support and protection.

Confusion about who needs protection

• HSB can involve several children. Sometimes the needs or behaviour of one child can distract professionals' attention away from the needs of another.
• Sometimes a child's risk to others can overshadow any risks they are being exposed to. This may mean that the child is not supported appropriately.
• Some professionals feel that they only have a responsibility towards a specific group of children, which can mean that the safeguarding needs of other children are overlooked.
• It can be challenging for professionals to establish whether sexual activity has taken place between two children, and whether any of the children involved were coerced or forced into taking part. This makes it difficult to assess the risks to each child and offer the support needed.

Professional attitudes

• Some professionals may not fully understand the underlying risks of HSB and think it isn't serious enough to report or investigate.
• Sometimes professionals can assume that the sexual behaviour between two children is consensual, and believe they should respect the privacy of the children involved. This means that issues are not reported and information is not shared. This is a particular concern if at least one of the children involved is particularly vulnerable, for example if they are much younger or have a disability.
• Some professionals may not understand the reasons why children display HSB, seeing them as predators rather than vulnerable young people.

Capacity of services

Due to lack of resources, it can take time for therapeutic intervention to be offered to a child.

Learning for improved practice

Looking at the wider context

• Professionals should look beyond individual incidents of HSB, focusing instead on the overall patterns that emerge.
• Accurate, detailed records should be kept about incidents. This will help professionals now and in the future to get an overview of what is happening.
• It is important to identify the reasons behind the child's behaviour and take action to address them.
• Professionals should adopt a child-centred approach, working with children to find out what risks they are exposed to and what their needs are.
• Professionals should consider the child's use of social media and whether they are a part of any networks that promote harmful sexual behaviours.
• As long as there is no risk in doing so, professionals should tell parents about any incidents of HSB that their child has been involved in, and help them to support their child appropriately.

Awareness and training

• Organisations should have specific procedures for responding to HSB and safeguarding all the children involved. All staff should be made aware of these and know how to follow them.

Referrals and multi-agency working

• Referrals should be made to social services early on so that any risks to children can be properly identified and ongoing support can be provided.
• Information about children who display HSB should be shared between agencies so that professionals can get an overview of the child's situation and identify any risks they are exposed to.
• Professionals working together need to be clear about their roles and how this contributes to the overall safeguarding of the children involved.

USING THE HARMFUL SEXUAL BEHAVIOUR FRAMEWORK

Published last year, the framework aims to help local areas develop and improve multi-agency responses to children displaying harmful sexual behaviour (HSB). It seeks to provide a co-ordinated and consistent approach to recognising both the risks and the needs of this vulnerable group.

The framework was developed by the NSPCC, Research in Practice and Professor Simon Hackett of Durham University with input from a large number of national organisations, local authorities and subject experts.

What are its aims and who is it for?

The framework aims to support local work with children and young people who have displayed HSB, and their families, by delivering and developing clear policies and procedures, and by refreshing local practice guidelines and assessment tools.

It seeks to provide a more coherent and evidence-informed approach for work with these children and young people, and to better understand how to improve outcomes.

The framework is a systemic tool to help develop a local area response to HSB. To get the most out of it, a range of professionals should be involved in using it, including:

• Staff with a strategic role in co-ordinating child protection and local HSB responses
• Commissioners of local child protection and HSB services
• Those with a wider safeguarding remit and audit responsibility, such as chairs and members of local safeguarding children boards.

What does the framework do?

The framework seeks to:

• Support an integrated understanding of, and response to, HSB
• Identify a continuum of responses to children and young people dependent on levels of risk and need. These will range from early community-based identification and support to assessment, intervention and intensive work
• Promote effective assessment as key to preventing unnecessary use of specialist time and, where appropriate, to support earlier interventions
• Ensure children and families are offered the right level of support by suitably trained and skilled workers
• Promote the advantage of involving frontline agencies and workers, especially education services, in earlier recognition, assessment and intervention
• Encourage inter-agency work to tackle professional isolation and anxiety when making decisions, which can lead to under- and over-estimation of risk
• Promote the use of a shared language, skills and training exchange, and development of appropriate local peer support systems
• Promote the importance of evaluation and monitoring of outcomes for children and young people.

How is the framework organised?

The framework promotes five domains that cover the essential elements of developing and delivering an integrated and effective HSB service for children, young people and their families:

• A continuum of responses to children and young people displaying HSB
• Prevention, identification and early assessment
• Effective assessment and referral pathways
• Interventions
• Workforce development

Each domain includes:

• A summary of the latest evidence to back up practice and local decision making and the key issues being faced
• An audit tool to help local areas assess the current state of their HSB offer and service responses
• Key delivery principles to consider, with practical examples.

How to use the audit tool

Each domain includes an audit tool to enable local areas to assess their practice, processes and leadership against the five key areas.

These tools provide a set of statements, based on research messages, against which a score between nought (never/no evidence) and four (always/strong evidence) should be given.

Using the audit tool should enable local areas to focus their efforts on the domains where improvement is needed most. There are examples and resources which can be used to draft an action plan that reflects local needs and priorities.

The audit should be repeated every six to 12 months to demonstrate progress and to inform any changes or developments required.

The framework should be used alongside the National Institute for Health and Clinical Excellence guidelines on harmful sexual behaviour among young people published in 2016.

The guidelines make recommendations about:

• Roles of universal services
• Early help and risk assessment
• Linking with families pre- and post-intervention
• Key principles and approaches for intervention.

The guidelines aim to ensure that children and young people who display HSB are assessed as soon as possible.

Framework from: https://tinyurl.com/y9edkprj

FURTHER READING

• Harmful Sexual Behaviour Among Children and Young People, Nice, September 2016
• Neglect and its Relationship to Other Forms of Harm, Elly Hanson, Debbie Allnock and Simon Hackett, NSPCC, Action for Children and Research in Practice, July 2016
• Individual, Family and Abuse Characteristics of 700 British Child and Adolescent Sexual Abusers, Hackett, S., Phillips, J., Masson, H. and Balfe, M. Child Abuse Review, 2013