What can prevent professionals from recognising the signs of CSE

Child Sexual Exploitation (CSE) traps children in a world of misery – but every time an exploited child comes into contact with a professional, there’s an opportunity for someone to notice something, say something, do something…

Exploited children come into contact with doctors, nurses, sexual health practitioners, social workers, teachers and youth workers. When children who had experienced CSE were interviewed  was found that:

  • All of them had been subjected to physical violence – and 48% had visited A&E because of their injuries.
  • 85% had self-harmed or attempted suicide
  • 75% had received treatment for sexually-transmitted infections including chlamydia, herpes and gonorrhoea . Pregnancy, miscarriages and terminations were also common.

from “I thought I was the only one.” The Office of the Children’s Commissioner for their Inquiry into Child Sexual Exploitation in Gangs and Groups Interim report November 2012:

If you work with children in a hospital, clinic, health centre, A&E or any other area, you are in a unique position to notice the signs of CSE and help end the nightmare. But only if you know what to look for.

What is CSE?

CSE – Child Sexual Exploitation – is when a child (any girl or boy under age 18) is forced or manipulated into sexual activity in return for affection, gifts, money, drugs or alcohol.

CSE can be carried out by individuals, by street gangs or by groups. It happens in the real world and online. It can be motivated by money or by sexual gratification. But in all cases, there is an imbalance of power – vulnerable children are controlled and abused by adults or by other children.

Perpetrators gain control over children by grooming them, offering excitement, drugs, alcohol, gifts and affection. As the exploitation gets worse, terrifying threats and violence may be used to keep children compliant. They are sexually exploited not just by the original perpetrators but often by many other abusers.

Exploited children are trapped because they often believe the abuse is their own fault – they fear they will be blamed or punished if they tell anyone what is happening. They are ashamed of what they are forced to do and are scared they will not be believed.

In many cases, children believe they are in a loving relationship with their exploiter. What’s more the perpetrator will do everything they can to isolate children further by convincing them that no-one cares about them, and that professionals are to be feared and avoided.

Read more about the signs of CSE or book a place on our multi-agency training course Preventing & Disrupting the Sexual Exploitation of Children & Young People

What could prevent you from recognising the signs of CSE?

There are a number of assumptions, myths and misunderstandings that can lead even vigilant professionals to miss the signs of CSE. Professionals need to be clear about the key issues:

Consent

Exploited children almost invariably believe they are in a consensual relationship, voluntarily engaging in sexual activity with the person who is exploiting them. But a child cannot by law consent to being sexually exploited

Age

The fact that a child is 16 or 17 years old and has reached the legal age of being able to consent to sex does not mean that they are not being sexually exploited.

Labels

Giving children labels (such as ‘promiscuous’ or ‘engaging in risky behaviour’ or ‘a danger to themselves’) implies that they are complicit in the exploitation and somehow therefore responsible for their own abuse. But for exploited children, saying ‘no’ isn’t an option – failure to comply with demands for sex are likely to result in serious harm to them and/or their family. Professionals need to consider the possibility of coercion.

Boys

Boys can be victims of CSE too – and they are most often identified by services due to their criminal behaviour. So professionals need to look at criminal behaviour as a possible indicator of underlying problems or risk of CSE – just as it would be for girls. Going missing and having an older ‘girlfriend’ are also often missed as indicators of a boy being at risk of CSE.

Challenging vs vulnerable

Children who are being sexually exploited may appear abusive and anti-social and may become involved in bullying and exploitative activities towards others. This can make it hard for professionals to recognise and respond to the young people’s vulnerability.

Online

60% of CSE happens online. Professionals need know how to monitor online spaces and request access reports where they have suspicions that a child is being groomed online, for example, at school, youth groups or in libraries.

What to do if you suspect CSE

Call the Multi-Agency Safeguarding Hub (MASH) on 01273 290400

If you believe a child is, or could be, in immediate danger, call 999

If you have concerns that a child might be at risk of CSE, call Sussex Police on 101

Do not confront the alleged abuser – this could place the child in greater physical danger and may give the abuser time threaten them into silence.

Try to speak to the child alone, ask questions.

If a child tells you they are being sexually exploited, listen to them, believe them, and reassure them that you will take action to keep them safe.

Make sure you know who the child protection lead is in your workplace and that you are aware of the procedure to follow if you have concerns about a child.

Further guidance can be found in ‘Safeguarding Children and Young People from Sexual Exploitation www.education.gov.uk/publications/standard/publicationdetail/page1/DCSF-00689-2009

There are many resources available online for professionals, many of which are free to use.

www.brook.org.uk/our-work/cse-e-learning-tool – an online course designed to help health professionals identify children who are at risk of or have been sexually abused.

www.thinkuknow.co.uk/Teachers/KCSO/ – an e-learning tool for professionals on how to keep children safe online

www.barnardos.org.uk/what_we_do/our_work/sexual_exploitation/cse-professionals/wud-u-app.htm – a useful app from Barnardo’s that you can download. Wud U? is a free educational tool that aims to show young people the behaviours that could put them at risk of being sexually exploited, through illustrated, interactive stories.

  • 1. Universal

    Has needs met within universal provision. May need limited intervention within the setting to avoid needs arising.

  • 2. Early Help

    Has additional needs identified within the setting that can be met within identified resources through a single agency response and partnership working.

  • 3. Early Help Partnership Plus

    Has multiple needs requiring a multi-agency coordinated response.

  • 4. Specialist Services to address Acute & Chronic need

    Has a high level of unmet & complex needs, or is in need of protection.

  • Child developmental needs
    • Good attendance (above 90%)
    • ×

      Good attendance (above 90%)

      ×

      Good attendance (above 90%)

    • Meeting developmental & learning milestones
    • ×

      Meeting developmental & learning milestones

      ×

      Meeting developmental & learning milestones

    • Has emotional well-being
    • ×

      Has emotional well-being

      ×

      Has emotional well-being

    • Ability to protect self and be protected
    • ×

      Ability to protect self and be protected

      ×

      Ability to protect self and be protected

    • Resilient and able to adapt to change
    • ×

      Resilient and able to adapt to change

      ×

      Resilient and able to adapt to change

    • Physically healthy
    • ×

      Physically healthy

      ×

      Physically healthy

    • Age-appropriate self care & independence skills
    • ×

      Age-appropriate self care & independence skills

      ×

      Age-appropriate self care & independence skills

    • Ability to express needs
    • ×

      Ability to express needs

      ×

      Ability to express needs

  • Child developmental needs
    • Absence/truancy from school    
    • ×

      Absence/truancy from school

      ×

      Absence/truancy from school

    • Incidence of absence/missing from home    
    • ×

      Incidence of absence/missing from home

    • Persistent poor behaviour in school  
    • ×

      Persistent poor behaviour in school

      ×

      Persistent poor behaviour in school

    • Risk of social exclusion    
    • ×

      Risk of social exclusion

      ×

      Risk of social exclusion

    • Poor relationships  
    • ×

      Poor relationships

      ×

      Poor relationships

    • Language and communication difficulties  
    • ×

      Language and communication difficulties

      ×

      Language and communication difficulties

    • Disability or additional special educational needs    
    • ×

      Disability or additional special educational needs

      ×

      Disability or additional special educational needs

    • Difficulty in achieving in education  
    • ×

      Difficulty in achieving in education

      ×

      Difficulty in achieving in education

    • Potential for becoming Not in Education, Employment or Training (NEET)    
    • ×

      Potential for becoming Not in Education, Employment or Training (NEET)

      ×

      Potential for becoming Not in Education, Employment or Training (NEET)

    • Slow in meeting developmental milestones    
    • ×

      Slow in meeting developmental milestones

      ×

      Slow in meeting developmental milestones

    • Missing health checks/immunisations    
    • ×

      Missing health checks/immunisations

    • Minor health problems  
    • ×

      Minor health problems

      ×

      Minor health problems

    • Early signs of offending/anti-social behaviour  
    • ×

      Early signs of offending/anti-social behaviour

      ×

      Early signs of offending/anti-social behaviour

    • Underage sexual activity    
    • ×

      Underage sexual activity

    • Early signs of drug/alcohol misuse    
    • ×

      Early signs of drug/alcohol misuse

    • Poor self-esteem    
    • ×

      Poor self-esteem

    • Low level emotional & behavioural issues that may be linked to attachment and/or emotional development delay    
    • ×

      Low level emotional & behavioural issues that may be linked to attachment and/or emotional development delay

    • Young carers    
    • ×

      Young carers

    • Bullying    
    • ×

      Bullying

      ×

      Bullying

    • Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.  
    • ×

      Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.

      ×

      Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.

  • Child developmental needs
    Despite intervention at 2, there is evidence of continuing and escalating need:
    • Persistent absence from school    
    • ×

      Persistent absence from school

      ×

      Persistent absence from school

    • Missing from school/ home regularly with no explanation    
    • ×

      Missing from school/ home regularly with no explanation

    • Fixed Term exclusions/no school place  
    • ×

      Fixed Term exclusions/no school place

      ×

      Fixed Term exclusions/no school place

    • Social exclusion    
    • ×

      Social exclusion

      ×

      Social exclusion

    • Poor relationships  
    • ×

      Poor relationships

      ×

      Poor relationships

    • No access to universal services / “Hidden Children”    
    • ×

      No access to universal services / “Hidden Children”

      ×

      No access to universal services / “Hidden Children”

    • Significant disabilities    
    • ×

      Significant disabilities

    • NEET (Not in Education, Employment or Training)    
    • ×

      NEET (Not in Education, Employment or Training)

      ×

      NEET (Not in Education, Employment or Training)

    • Developmental milestones not being met due to persistent parental failure/inability    
    • ×

      Developmental milestones not being met due to persistent parental failure/inability

      ×

      Developmental milestones not being met due to persistent parental failure/inability

    • Chronic/recurring health problems    
    • ×

      Chronic/recurring health problems

      ×

      Chronic/recurring health problems

    • Regular missed appointments affecting developmental progress    
    • ×

      Regular missed appointments affecting developmental progress

      ×

      Regular missed appointments affecting developmental progress

    • Teenage pregnancy    
    • ×

      Teenage pregnancy

    • Drug/alcohol misuse impacting negatively    
    • ×

      Drug/alcohol misuse impacting negatively

    • Risky sexual behaviour (e.g. unprotected sex)    
    • ×

      Risky sexual behaviour (e.g. unprotected sex)

    • Offending / anti-social behaviour resulting in risk of entering Youth Justice System  
    • ×

      Offending / anti-social behaviour resulting in risk of entering Youth Justice System

      ×

      Offending / anti-social behaviour resulting in risk of entering Youth Justice System

    • Emotional / mental health issues    
    • ×

      Emotional / mental health issues

      ×

      Emotional / mental health issues

  • Child developmental needs
    Persistent/continued/severe:
    • Chronic persistent absence, permanent exclusions or no school place that risks entry to the care system  
    • ×

      Chronic persistent absence, permanent exclusions or no school place that risks entry to the care system

      ×

      Chronic persistent absence, permanent exclusions or no school place that risks entry to the care system

    • Persistent social exclusion    
    • ×

      Persistent social exclusion

      ×

      Persistent social exclusion

    • Poor relationships  
    • ×

      Poor relationships

      ×

      Poor relationships

    • Complex / multiple disabilities    
    • ×

      Complex / multiple disabilities

    • Complex mental health issues affecting development needs, including self harm    
    • ×

      Complex mental health issues affecting development needs, including self harm

      ×

      Complex mental health issues affecting development needs, including self harm

    • High level emotional health issues and very low self-esteem    
    • ×

      High level emotional health issues and very low self-esteem

    • Non-organic failure to thrive  
    • ×

      Non-organic failure to thrive

      ×

      Non-organic failure to thrive

    • Inappropriate sexual knowledge / sexualised behaviour for age.    
    • ×

      Inappropriate sexual knowledge / sexualised behaviour for age.

      ×

      Inappropriate sexual knowledge / sexualised behaviour for age.

    • Harmful Sexual Behaviour / Peer on Peer Abuse    
    • ×

      Harmful Sexual Behaviour / Peer on Peer Abuse

    • Teenage parent/pregnancy under the age of 13    
    • ×

      Teenage parent/pregnancy under the age of 13

    • Concerns about exploitation (including sexual exploitation/ abuse, radicalisation; criminal exploitation; gang affiliation)    
    • ×

      Concerns about exploitation (including sexual exploitation/ abuse, radicalisation; criminal exploitation; gang affiliation)

    • Child victims of modern slavery or human trafficking    
    • ×

      Child victims of modern slavery or human trafficking

      ×

      Child victims of modern slavery or human trafficking

    • Unaccompanied minors    
    • ×

      Unaccompanied minors

    • Drug/alcohol use severely impairing development    
    • ×

      Drug/alcohol use severely impairing development

    • Frequently missing from home resulting in self-neglect    
    • ×

      Frequently missing from home resulting in self-neglect

    • Relationship breakdown between child & parent    
    • ×

      Relationship breakdown between child & parent

    • Offending and in the criminal justice system    
    • ×

      Offending and in the criminal justice system

      ×

      Offending and in the criminal justice system

    • Unexplained / suspicious injury    
    • ×

      Unexplained / suspicious injury

  • Family & Environment
    • Positive relationship between parents
    • ×

      Positive relationship between parents

      ×

      Positive relationship between parents

    • Stable & affectionate relationships with caregivers
    • ×

      Stable & affectionate relationships with caregivers

      ×

      Stable & affectionate relationships with caregivers

    • Housed, good diet and kept healthy
    • ×

      Housed, good diet and kept healthy

      ×

      Housed, good diet and kept healthy

    • Supportive networks
    • ×

      Supportive networks

      ×

      Supportive networks

    • Access to positive activities
    • ×

      Access to positive activities

      ×

      Access to positive activities

    • Positive sense of self and abilities
    • ×

      Positive sense of self and abilities

      ×

      Positive sense of self and abilities

  • Family & Environment
    • Children of prisoners/ parents subject to community orders    
    • ×

      Children of prisoners/ parents subject to community orders

    • Low income affects achievement    
    • ×

      Low income affects achievement

    • Parental conflict and risk of relationship breakdown    
    • ×

      Parental conflict and risk of relationship breakdown

    • Concerns about possible domestic abuse    
    • ×

      Concerns about possible domestic abuse

  • Family & Environment
    • Housing tenancy at risk    
    • ×

      Housing tenancy at risk

      ×

      Housing tenancy at risk

    • Harmful parental conflict and/or relationship breakdown    
    • ×

      Harmful parental conflict and/or relationship breakdown

      ×

      Harmful parental conflict and/or relationship breakdown

    • Transient families  
    • ×

      Transient families

      ×

      Transient families

    • Domestic abuse & coercive control    
    • ×

      Domestic abuse & coercive control

    • No recourse to public funds    
    • ×

      No recourse to public funds

  • Family & Environment
    • Significantly harmful parental conflict and/or relationship breakdown    
    • ×

      Significantly harmful parental conflict and/or relationship breakdown

      ×

      Significantly harmful parental conflict and/or relationship breakdown

    • Suspicion of physical, emotional or sexual abuse or neglect    
    • ×

      Suspicion of physical, emotional or sexual abuse or neglect

      ×

      Suspicion of physical, emotional or sexual abuse or neglect

    • Domestic abuse resulting in child being at risk of significant harm    
    • ×

      Domestic abuse resulting in child being at risk of significant harm

    • Homeless Child/Young Person    
    • ×

      Homeless Child/Young Person

    • Family intentionally homeless    
    • ×

      Family intentionally homeless

    • Extreme poverty affecting child well-being    
    • ×

      Extreme poverty affecting child well-being

      ×

      Extreme poverty affecting child well-being

    • Forced Marriage, Honour Based Violence, Female Genital Mutilation    
    • ×

      Forced Marriage, Honour Based Violence, Female Genital Mutilation

  • Parents & Carers
    • Protected by carers
    • ×

      Protected by carers

      ×

      Protected by carers

    • Secure and caring home
    • ×

      Secure and caring home

      ×

      Secure and caring home

    • Receive and act on information, advice and guidance
    • ×

      Receive and act on information, advice and guidance

      ×

      Receive and act on information, advice and guidance

    • Appropriate boundaries maintained
    • ×

      Appropriate boundaries maintained

      ×

      Appropriate boundaries maintained

  • Parents & Carers
    • Inconsistent care arrangements  
    • ×

      Inconsistent care arrangements

      ×

      Inconsistent care arrangements

    • Poor supervision by parent/carer    
    • ×

      Poor supervision by parent/carer

      ×

      Poor supervision by parent/carer

    • Poor response to child’s physical, emotional or health needs    
    • ×

      Poor response to child’s physical, emotional or health needs

      ×

      Poor response to child’s physical, emotional or health needs

    • Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences (ACEs)  
    • ×

      Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences (ACEs)

      ×

      Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences (ACEs)

  • Parents & Carers
    • Parental learning or physical disability, substance misuse, or mental health impacts on parenting    
    • ×

      Parental learning or physical disability, substance misuse, or mental health impacts on parenting

    • Inconsistent care arrangements  
    • ×

      Inconsistent care arrangements

      ×

      Inconsistent care arrangements

    • Poor supervision by parent/carer  
    • ×

      Poor supervision by parent/carer

      ×

      Poor supervision by parent/carer

    • Poor response to identified needs    
    • ×

      Poor response to identified needs

      ×

      Poor response to identified needs

    • Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences  
    • ×

      Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences

      ×

      Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences

  • Parents & Carers
    • Edge of care  
    • ×

      Edge of care

      ×

      Edge of care

    • Parental encouragement of abusive/offending behaviour
    • ×

      Parental encouragement of abusive/offending behaviour

      ×

      Parental encouragement of abusive/offending behaviour

    • Continuing poor supervision in the home    
    • ×

      Continuing poor supervision in the home

    • Parental non-compliance / superficial co-operation    
    • ×

      Parental non-compliance / superficial co-operation

    • Inconsistent parenting affects child’s developmental progress  
    • ×

      Inconsistent parenting affects child’s developmental progress

      ×

      Inconsistent parenting affects child’s developmental progress

    • Private fostering    
    • ×

      Private fostering

  • Level of assessment
    No formal assessment
  • Level of assessment
    Consider commencement of Early Help Assessment / Pastoral Support Plan
  • Level of assessment
    Strengthening Families Early Help Assessment and Plan
  • Level of assessment
    Strengthening Families > Child in Need Plan or Child Protection Conference
  • Go direct to Service or search the Family Service Directory for the Local Offer, or call the Family Information Service on 01273 293545
  • Early Help Strengthening Families Assessment & Plan. If you require advice or guidance in respect of the child needs contact the Front Door For Families on 01273 290400
  • Contact Front Door For Families on 01273 290400 or if the child is at immediate risk call the Police on 999