All professionals need to be confident they have the knowledge and skills to recognise when children might be showing them that something is wrong.

Children may also drop hints and clues that the abuse is happening without revealing it outright.

Children often do not talk about sexual abuse because they think it is their fault or they have been convinced by their abuser that it is normal or a “special secret”.

Children may also be bribed or threatened by their abuser or told they will not be believed.

A child who is being sexually abused may care for their abuser and worry about getting them into trouble.

Different families may use different words for their genital area which may make a disclosure less obvious. It is therefore important to consider the child’s presentation and following signs when a child is speaking about something that may not be clear.

Emotional and behavioural signs may include:

• Avoiding the abuser – the child may dislike or seem afraid of a particular person and try to avoid spending time alone with them;
• Sexually inappropriate behaviour – children who have been abused may behave in sexually inappropriate ways or use sexually explicit language;
• Changes in behaviour – a child may start being aggressive, withdrawn, clingy, have difficulties sleeping, have regular nightmares or start wetting the bed;
• Changes in their mood – feeling irritable and angry, or anything out of the ordinary;
• Changes in eating habits of developing an eating problem;
• Problems at school – an abused child may have difficulty concentrating and learning, and their grades may start to drop;
• Alcohol or drug misuse; and
• Self-harm.

Physical signs may include:

• Bruises;
• Bleeding, discharge, pains or soreness in their genital or anal area;
• Sexually transmitted infections; and
• Pregnancy

Signs of online sexual abuse may include:

• Spending a lot more or a lot less time than usual online, texting, gaming or using social media;·Being distant, upset or angry after using the internet or texting;
• Being secretive about who they’re talking to and what they’re doing online or on their mobile phone;
• Having lots of new phone numbers, texts or email addresses on their mobile phone, laptop or other device.

The Centre of Expertise on Child Sexual Abuse have designed a CSA signs and indicators template to help professionals to gather the signs and indicators of sexual abuse and build a picture of their concerns.

Harmful sexual behaviour (HSB)

Harmful sexual behaviour (HSB) is developmentally inappropriate sexual behaviour which is displayed by children and young people and which may be harmful or abusive (derived from Hackett, 2014). It may also be referred to as sexually harmful behaviour or sexualised behaviour.

HSB encompasses a range of behaviour, which can be displayed towards younger children, peers, older children or adults. It is harmful to the children and young people who display it, as well as the people it is directed towards.’ NSPCC

Signs of HSB

Children and young people demonstrate a range of sexual behaviours as they grow up, and this is not always harmful.

Sexualised behaviour sits on a continuum with five stages:

• Appropriate – the type of sexual behaviour that is considered ‘appropriate’ for a particular child depends on their age and level of development; Inappropriate – this may be displayed in isolated incidents, but is generally consensual and acceptable within a peer group;

• Problematic – this may be socially unexpected, developmentally unusual, and impulsive, but have no element of victimisation;

• Abusive – this often involves manipulation, coercion, or lack of consent;

• Violent – this is very intrusive and may have an element of sadism.

It is not always easy to identify HSB; the NSPCC have created a guide of age-appropriate healthy sexual behaviour that should be considered when assessing whether a child’s behaviour is healthy or harmful: https://learning.nspcc.org.uk/media/1659/responding-harmful-sexual-behaviour.pdf

In the borough of Lewisham, multi-agencies aim to work together to provide a specialist service to children and young people who have engaged in harmful sexual behaviour (HSB). This includes harm to other children, young people, and themselves. You can find further information on HSB including the criteria for referrals to the HSB Consultation Panel.

Questions to ask when considering if a child is displaying HSB include

• Is the behaviour unusual for that particular child or young person?
• Have all the children or young people involved freely given consent?
• Are the other children or young people distressed?
• Is there an imbalance of power?
• Is the behaviour excessive, degrading or threatening?
• Is the behaviour occurring in a public or private space?

Child sexual exploitation (CSE) Is defined by the Department of Education as:

‘Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.’

Signs of CSE

Indicators that a child or young person may be being groomed may include:

• Being secretive about who they are talking to and where they are going;
• Often returning home late or staying out all night;
• Sudden changes in their appearance and wearing more revealing clothes;
• Becoming involved in drugs or alcohol, particularly if you suspect they are being supplied by older men or women;
• Becoming emotionally volatile (mood swings are common in all young people, but more severe changes could indicate that something is wrong);
• Using sexual language that you would not expect them to know;
• Premature sexual behaviour in under 16s;
• Engaging less with their usual friends;
• Appearing controlled by their phone; and
• Switching to a new screen when you come near the computer.

Indicators that an adolescent may be being exploited may include:

• Persistently going missing from school or home and/or being found out-of-area;
• Unexplained acquisition of money, clothes, or mobile phones;
• Excessive receipt of texts/ phone calls and/or having multiples handsets;
• Relationships with controlling/ older individuals or groups;
• Leaving home/ care without explanation;
• Suspicion of physical assault/ unexplained injuries including bruising;
• Suffering from sexually transmitted infections/ pregnancy;
• Parental concerns;
• Carrying weapons;
• Significant decline in school results/ performance;
• Gang association or isolation from peers or social networks;
• Becoming estranged from family;
• Self-harm or significant changes in emotional well-being; and
• Volatility in mood/ mood swings.

Child sexual abuse covers a range of illegal sexual activities, divided into two categories – contact and non-contact abuse.

Contact abuse is where an abuser makes physical contact with a child, and it can include:

• Sexual touching of any part of a child, whether clothed or unclothed;
• Using a body part or object to rape or penetrate a child;
• Forcing a child to take part in sexual activities;
• Making a child undress or touch someone else.

Contact abuse can include touching, kissing and oral sex – sexual abuse is not just penetrative.

Non-contact abuse is where a child is abused without being touched by the abuser. This can be done in person or online and can include:

• Exposing or flashing;
• Showing pornography;
• Engaging in any kind of sexual activity in front of a child, including watching pornography;
• Making a child masturbate;
• Forcing a child to make, view or share child abuse images or videos;
• Forcing a child to take part in sexual activities or conversations online or through a smartphone;
• Possessing images of child pornography;
• Taking, downloading, viewing or distributing sexual images of children; and
• Not taking measures to protect a child from witnessing sexual activity or images.

Sexting

Children and young people who are involved in a sexting incident might have:

• Shared an image of themselves;
• Received an image from someone else;
• Shared an image of someone else more widely;

This may have happened with or without consent of all the people involved, and children may have been coerced or pressured into giving consent. It’s a criminal offence to create or share explicit images of a child, even if the person doing it is a child.

Signs of sexting

Sometimes a child might disclose that they have been involved in sexting, or they might mention something which gives cause for concern. Other times, professionals might notice that a child is behaving differently, being bullied, or overhear a conversation and the sexting might come to light when the professional tries to find out what is going on.

Poly-victimisation

Can be defined as the experience of multiple victimisations of different kinds – in different domains of a child’s environment – such as sexual abuse, physical abuse, bullying in school, witnessing community violence or being exposed to family. The emphasis here is on different kinds of victimisation, rather than multiple episodes of the same kind of victimisation. Research suggests that the greater number of victimisations experienced, the greater the impact on children’s mental health and wellbeing. When a child experiences any type of familial maltreatment, the risk for experiencing any other type of abuse or victimisation.

The concept of poly-victimisation raises the possibility of adopting a ‘contextual safeguarding approach’ in relation to intrafamilial child sexual abuse.

Sometimes an adult may disclose sexual abuse they suffered as a child (which can remain an ongoing traumatic experience), including within public, private, voluntary sectors and family settings. Responses to allegations by an adult of abuse experienced as a child must be at the same high standard of response to current abuse, because:

• There is a significant likelihood that a person who abused a child in the past will have continued and may still be doing so;
• Criminal prosecution may be possible if sufficient evidence can be carefully collated.

The adult who disclosed should be encouraged and supported to report the crime to the Police. If the adult will not report it to the Police, then the worker who the disclosure was made to must make a referral to the Police.

A referral should also be made to Children’s Services where the adult lived as a child and where the perpetrator lives now.

A referral to the Local Authority Designated Officer (LADO) should be made where the perpetrator works with children.

To make a referral to the LADO please email a LADO referral form to LewishamLADO@Lewisham.gov.uk

Barnardos TIGER – Emotional Support Service

The Barnardos Tiger service offers emotional support for children and young people under 18 years old and up to 25 years old with Special Educational Needs where there has been a disclosure of sexual abuse or sexual assault or where the professional believes sexual abuse is likely.

What is TIGER?

• Short-term intervention; up to 15 sessions
• Evidence & trauma-informed approach
• Co-designed intervention plan, led by young person
• Using coaching to re-empower young person

Support offered in South East London:

• 1:1 meetings for young person
• 1-2 sessions of direct work with parent/carers
• Professional collaboration with team around the child
• Support onward referrals
• Training sessions for professionals

Useful information

T: 07519 294000

E: tigerservices@barnardos.org.uk

(Please note this is not a secure email address and should not be used for referrals)

To make a referral please visit: https://www.barnardos.org.uk/get-support/services/london-spa/tiger-referral

South London CSA Services

The South London CSA Services have produced a series of resources as part of NHS England’s ‘Enhancing sexual abuse pathway for CYP in South London’. These resources are available for all professionals working in the field of CSA within and outside of London.

The books are designed to help children (under 8 and 8-12 years old) and their families develop a shared understanding of what might happen after a child has been sexually abused.

• What Happened to Elephant
• What Happened to LJ
• Parent and Caregivers Guide

Supporting survivor-practitioners in the workplace

A best practice guide about supporting practitioners with lived experience of sexual harm.