Around 40 per cent of referrals to council children’s services for sexual abuse in 2021/22 involved harmful sexual behaviour (HSB) by children.
In light of this significant need among children and young people, CYP Now teamed up with Amberleigh Care and Kites Children’s Services to host a webinar to improve practitioners’ knowledge of, and response to, HSB by children. The free webinar, held on 29 November 2023, was attended by a wide range of practitioners working with vulnerable children including social workers, school safeguarding leads, residential and foster care workers, children’s social care commissioners and third sector providers.
Four leading experts shared their experiences and knowledge about a range of issues related to childhood HSB including how to identify it at assessment and start a conversation with parents, what therapeutic responses are available and how to tailor these to different settings, and what outcomes can be achieved and how to measure these.
EXPERT PANEL
Kevin Gallagher is a qualified social worker and managing director of Amberleigh Care which operates two accredited therapeutic communities for boys who have displayed HSB. Founded in 2004, the models and practice at Amberleigh have evolved in keeping with the evidence base and NICE guidance for HSB assessment and intervention.
Pete Thomason is head of therapy at Kites Children’s Services – a role that is primarily about ensuring young people benefit from a high standard of therapy during their placement. Thomason has 25 years’ experience of working with young males who have displayed HSB in a range of roles including as principal therapist at The Lucy Faithfull Foundation.
Marcella Leonard MBE is a qualified social worker and international expert in the fields of sexuality, sexual deviancy and trauma with both victims and perpetrators. As director of Leonard Consultancy, Leonard delivers specialist safeguarding training in a range of settings – this includes assessing and managing sexual and violent risk.
Sharron Wareham is children’s services manager at Barnardo’s Cymru Better Futures Service, in charge of sexual offending programmes and recently led a research team working alongside boys and young men to improve identification, assessment, and intervention. Her research on HSB has helped shape NICE guidelines on working with children and young people who sexually harm.
RISK FACTORS FOR HSB
Sharron Wareham: Through projects like AIM3 we’re now taking a child development perspective to child sexual behaviour and seeing children as distinct to adults.
The majority of children and young people we see have an abuse or trauma history. At my service, Better Futures, about two-thirds of children will come to us with known or suspected multiple harms in their background with their own sexual abuse experience or domestic abuse. As social workers we are often in those family homes but not necessarily spotting harmful sexual behaviours.
When we’re working with a group of children that have come to harm, often in relation to a trusted adult, that harm remains unreconciled and not responded to and we shouldn’t be surprised when those children go on to make mistakes including in their sexual relationships.
Online spaces for children and young people can be really good and positive experiences, but for the children we work with it provides another space where they take those vulnerabilities with them and become vulnerable themselves and so come to harm but also harm others. That’s one of the closest areas of convergence at Better Futures between children who display HSB and are harmed by sexual exploitation – children need support across both of those areas.
Children will be developing sexually in those online spaces too – they will be coming across information they are maybe confused by or curious about and maybe go down rabbit holes we would rather they didn’t go down. As safeguarding professionals, we need to educate ourselves to understand the risks to children in those spaces.
KEY WARNING SIGNS
Marcella Leonard: Social workers are always talking about the emotional regulation of children, never sexual regulation. HSB is a young person struggling to regulate their behaviour and practitioners need to look for the signs of that.
We need to identify the pathways that we know: for example, domestic abuse in the home has a significant impact on role models, and the messages about sexualisation and violence that a young person gets. When working with a family like that we need to be thinking about how the young person is going to manage and deal with that.
Inappropriate behaviour should be an invitation to educate – why wait for the behaviour to become harmful? Think early warning signs: for example, is a child’s verbal language being sexualised? We need to get better at discussing when HSB moves from normal to inappropriate behaviour and practitioners need the confidence to address it early.
Also, lots of young people are getting involved in HSB who are not coming from chaotic families. Sometimes it’s about isolation and loneliness, mental health, or wanting to fit into a peer group.
Norms around sexuality and society are also changing and young people are seeing that. We need to be more proactive that our education system is in line with that. For example, gender identity can be confusing and sometimes children [process] that by engaging in inappropriate behaviour, and get labelled with that.
Practitioners need to think: is their behaviour normal for their age and stage of development, for their IQ level but also for their environment?
TYPES OF INTERVENTIONS
Pete Thomason: Commissioners will want to hear what a good response might look like, how much it will cost and how long it will take? It all depends on where the young person is at [in their behaviour]and I believe it is the practitioners’ responsibility to find the best way for the young person to respond.
There’s a young person we’re working with currently who assaulted his niece and would have done it again.
We’ve used a prevention-based approach which we think is working because he’s responding well – he talks about how he should be able to spend more time unsupervised in the community. That approach might not work with other young people.
We need to use all our experience, skills and knowledge and make that work for the young person. We shouldn’t fool ourselves that there’s a quick fix – I work with young people who abuse power to hurt other people, sometimes sexually. Two years in a residential placement is quite common.
All aspects of the harm and damage that has led the young person to come into care – all the boys we work with have been abused – must be worked through and you can’t do that quickly.
But we need to be accountable: I don’t think we can sit back and say, “it takes a long time”, we have to show why it takes a long time and what we’re doing to help the young person.
USING RESIDENTIAL SETTINGS
Kevin Gallagher: Young people in the looked-after system come with a range of needs. HSB is a dysfunctional response to getting an emotional, sexual or psychological need met. HSB generates huge amounts of anxiety around risk. When considering residential or fostering services, how is normal parenting and nurturing going to be built in and how is their educational and social development going to be upheld? It comes back to assessment: understanding that young person’s functioning, background and what their needs are and matching that to the setting where they are going to be living. It could be fostering in the community is the right setting. But if there’s a young person with additional needs, involved in gangs or self-harming that’s part of the mix that goes into the assessment.
If you build up a young person’s resilience and self-esteem and concentrate on their strengths, then naturally risk will reduce because you’re giving them healthier responses and are less likely to use dysfunctional responses.
It all has to be dynamically assessed, involve the young person and be constantly reviewed and refreshed. You must also keep an optimistic willingness for theoretically informed positive risk taking so young people in care have the same opportunities as their non-care peers.
For commissioners, the kind of system that will accommodate those factors is quite sophisticated. If settings are providing care, their own school provision and clinical services they have got to be systemically integrated around the child.
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The webinar is available to watch at http://tinyurl.com/4sxhkkvp
Definition of HSB
For the webinar, HSB was defined through Hacket’s Continuum of sexualised behaviour in children. This uses a scale to define what is typical, problematic and harmful behaviour. There is a good summary of this on the NSPCC website which describes how HSB presents and offers advice on how to identify it and what action to take.
HSB can affect a diverse group of young people – some may be living in the family home but have come to the attention of services because of a one-off incident, while others will have multiple behaviours that require residential placements to address the wider risks they pose.
