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We owe our children, the most vulnerable citizens in our society, a life free of violence and fear

Nelson Mandela

Table of Contents

Section One

Introduction

The last four decades have been witness to a changing landscape of language and framings for Child Sexual Abuse (CSA) – from incest in the 1970s, through a number of other terms, to the current distinction of Child Sexual Exploitation (CSE) and Female Genital Mutilation (FGM) being a category within CSA. Each shift has meant that different forms and/or contexts of abuse have been recognised, which also opens up space for survivors to speak and for agencies to listen and hear.

The shift in language and perceptions should not be seen as a pendulum effect. It is more of a clock face on which some parts are highlighted and others in shadow: holding all forms of and contexts for CSA in view at the same time has been elusive for research, policy and practice.

The Cambridgeshire and Peterborough Safeguarding Children Partnership Board (CPSCPB) recognise the need for cases of CSA to be recognised and addressed. The CPSCPB has the following aim –

To ensure that there is recognition of child sexual abuse cases in Cambridgeshire and Peterborough and that from early help to statutory intervention there should be appropriate, consistent and timely responses across all agencies”

To achieve its aim CPSCPB, will seek to ensure that all partner agencies work together so that anyone who comes into contact with children and young people is able to recognise, understand and know how to respond to cases where a child or young person may be at risk of harm from CSA.

This strategy seeks to explain;

  • What is child sexual abuse
  • How agencies in Cambridgeshire and Peterborough recognise and respond to child sexual abuse
  • What this means for people and organisations and how they exercise their duties and responsibilities to protect children and young people

The CPSCPB recognises that this task is particularly difficult when signs and indicators of CSA are not always easy to spot and the consequences of action or inaction may have great significance for the child, young person, their family and those involved with them.

This strategy has been created to help improve the ways in which needs and risks are understood, recognised and responded to at all stages of the “child’s journey”. It is not a “stand alone” document and should be considered alongside a number of other strategies, including the CPSCPB Effective Support document, CSE Strategy and Harmful Sexual Behaviour Strategies, Online safeguarding strategy and information regarding FGM. Together these reflect the many different aspects of CSA and priority concerns of organisations and professionals.

Over time those responsible for ensuring the safety and protection will be supported to evidence how they are implementing this strategy through the CPSCPB section 11 (Children Act 2004) self-assessment and their own governance and accountability structures and processes.

The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing

Albert Einstein

Definition of Child Sexual Abuse

Working Together 2018 defines child sexual abuse as;

Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening.

The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing.

They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse Sexual abuse can take place online, and technology can be used to facilitate offline abuse.

Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.”

Whilst it is recognised that there are many definitions of CSA, the Working Together definition will be used for the purposes of this Strategy.

CSA includes many areas, the following discusses some of these areas but is not exhaustive.

Child sexual exploitation (CSE)

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 in exchange for (a) something the victim wants, and/or (b) the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if sexual activity appears consensual. Child sexual exploitation does not always include physical contact; it can also occur through use of technology’.

Online abuse

Online Safeguarding’, ‘eSafeguarding’, ‘Internet Safety’, ‘eSafety’, ‘Digital Safeguarding’ and ‘Online Safety’ are all interchangeable terms used to varying extents. However, regardless of the term used, all should relate to ensuring children and adults using technologies both now and in the future do so safely and responsibly.

Individuals often associate online safeguarding with online grooming, cyberbullying or inappropriate images/video. However, there is also a much broader and developing agenda particularly in relation to the growth of social media including information privacy, sexting, gambling, radicalisation, self-generated content, revenge porn and numerous other risk areas. In line with this, online safeguarding is an increasingly common thread running across a number of related and already embedded areas such as child exploitation including Child Sexual Exploitation (CSE) and Child Criminal Exploitation (CCE), anti-bullying, anti-social behaviour and the radicalisation of young people amongst others. If we are to be effective in our approach, it is essential that colleagues across all related agendas work together cohesively to ensure a common and collaborative approach and ensure the online aspects are appropriately reflected in related risk areas.

The prevalence of online messaging, social networking and mobile technology effectively means that children can always be ‘online’. Their social lives, and therefore their emotional development, are bound up in the use of these technologies. We can no longer adequately consider the safeguarding or wellbeing of our children and young people without considering their relationship to technology – we can no longer seek to support and protect them without addressing the potential risks which the use of these technologies poses. One of these risks revolves around sexual offending and sexual abuse.

Agencies are working together to ensure that the profile of “online” abuse is recognised and responded to. For further information regarding Online abuse please see the CPSCB Online safeguarding strategy.

(https://safeguardingcambspeterborough.org.uk/children-board/professionals/procedures/online-safeguarding-strategy-2021-2023/ )

Female Genital Mutilation (FGM)

Female Genital Mutilation (FGM) involves the partial or total removal of external female genitalia for non-medical reasons and is a form of CSA and violence against women and girls, as well as being a violation of their human rights.

The term FGM covers all harmful procedures to the female genitalia for non-medical purposes. There are 4 types – all are illegal and have serious health risks.

FGM is also known as female circumcision, cutting or sunna and is practiced by families and communities for a variety of complex reasons including religious or cultural reasons but often it is believed that it is beneficial for the girl or woman. However, FGM has no health benefits, it is dangerous, a criminal offence and causes harm to girls and women in many ways.

The age at which girls undergo FGM varies enormously according to different communities. The procedure may be carried out when a girl is new born, during childhood or adolescence, just before marriage or during the first pregnancy. However, the majority of cases of FGM are thought to take place between the ages of 5 and 8 and therefore girls within that age bracket are at a higher risk.

Recent epidemiological study by British Paediatric Surveillance Unit on cases from Nov 2015- Nov 2017 showed much lower number of children presenting with FGM then were estimated- 103 reported cases only. The possibility of abandonment of the practice after migration needs to be considered.

Hodes D et al Archives of Disease in \childhood 2021; 106: 372-376

FGM related legislation

FGM is illegal. Under the FGM Act 2003, a person is guilty of an offence if they excise, infibulate or otherwise mutilate the whole or any part of a girl’s or woman’s labia majora, labia minora or clitoris, except for necessary operations performed by a registered medical professional on complex physical and mental health grounds.

It is also an offence to assist a girl to perform FGM on herself. Any person found guilty of an offence under the Act will be liable to a maximum penalty of 14 years imprisonment or/and a fine.

For further guidance and resources regarding recognising and responding to cases of FGM please see the CPSCB FGM resource pack. https://safeguardingcambspeterborough.org.uk/children-board/professionals/fgm-2/

Harmful sexual behaviour (HSB)  

Primarily considered a behaviour associated with adolescents, services are increasingly seeing younger children referred whose sexual behaviour is considered to be problematic or harmful. These are behaviours that can cause concern for parents, family and professionals working with the child. The numbers of children being referred to specialist services are increasing, and this is in part due to an increased awareness of the subject in professional groups but also to the impact of the use of new technologies on harmful sexual behaviour. Children as young as five and six are being referred to services for behaviours influenced by their use of the internet. This is known as technology-assisted harmful sexual behaviour (TA HSB).   

The Hackett Sexual Behaviour Continuum (2010) provides an overview of sexual behaviours across a range which supports professionals to consider whether the behaviour can be identified as normal, inappropriate, problematic, abusive and violent (Aim Assessment Models for Children under 12 years old with Problematic or Harmful Sexual Behaviours 3rd Edition 2019).    

It is important to apply an understanding of the cognitive ability of the child when assessing sexual behaviours as this will impact on their capacity to understand their own sexual behaviour. Developmentally appropriate responses need to be applied whilst using a trauma informed approach. This supports professionals to consider adverse childhood experiences defined as highly stressful events or situations that occur during childhood and adolescence. These events and experiences can be traumatic and cause lifelong impact on the child’s development including their physical and mental health. For some children maladaptive coping techniques help them to make sense of the experiences they have faced.  

The National Institute for Health and Care Excellence (NICE) 2016 published their first public health guidance on assessment and intervention responses for children and young people displaying harmful sexual behaviours. Within the recommendations, NICE recommends that practitioners consider the use of the AIM3 assessment model as part of a holistic response to harmful sexual behaviour (HSB).   

Examples of harmful sexual behaviour include;  

  • Inappropriate touching  
  • Using sexually explicit words and phrases  
  • Using sexual violence or threats  
  • Penetrative sex with other children or adults  

A study by Hackett et al (2013) of children and young people with HSB suggested that two thirds had experienced some type of abuse, trauma or neglect themselves.  This included physical abuse, emotional abuse, sexual abuse, severe neglect, parental rejection, family breakdown, domestic violence, and parental drug and alcohol abuse. Around half of them had experienced sexual abuse.   

Taking this into account, it is increasingly accepted that adolescents who engage in HSB are a heterogeneous population (Hackett 2007; Leversee 2007) who span a range of characteristics, including types of offending behaviours, extent of sexual knowledge, cognitive functioning, mental health issues, degree of social isolation and background experiences (Vizard, Monck and Misch 1995). In addition, the risk factors that have commonly been recognised when considering adult sexual offenders (e.g. deviant sexual arousal, lack of victim empathy) cannot easily be extrapolated to an adolescent population.   

There is no standard intervention for young people who display HSB, but there is a growing recognition that interventions should be based on a developmental and contextual understanding of young people (Ryan 1999; Hackett 2007) rather than based on models of adult sexual offending. There is also increasing consensus that interventions should not just be offence specific, but should be holistic, focusing on the range of needs of the young person with the aim of enabling the young person to become a confident healthy adult with a meaningful role in society (Potter and Reeves 2015).   

For further information regarding recognising and responding to children who display harmful sexual behaviour please refer to the Harmful Sexual Behaviour Policy https://www.safeguardingcambspeterborough.org.uk/children-board/professionals/procedures/shb/

Professionals are able to contact Trudy Potter: Manager Cambridgeshire Sexual Behaviour Service, email – Trudy.potter@cambridgeshire.gov.uk to discuss referrals or signposting for appropriate services.

Key themes and issues

It is recognised that there is a lack of national research into prevalence and causes of CSA. The most recent research and statistics have identified the following:

  • The data suggests that at least 15% of females and 5% of males in England and Wales experience sexual abuse before the age of 16.
  • In surveys, girls are at least three times as likely as boys to describe experiences of CSA
  • most CSA remains hidden and is never reported to, or uncovered by, an official agency – or is not reported until the victim is an adult
  • Offences against children accounted for more than half of all sexual offences recorded by the police: in 2019/20, 48% of sexual offences against females were committed against children under 18, and 65% of sexual offences against males were perpetrated against under-18s.
  • Between 2019/20 and 2020/21, the NSPCC’s helpline for adults concerned about children received 44% more contacts regarding online sexual abuse and 2% more regarding contact sexual abuse.

https://www.csacentre.org.uk/documents/scale-nature-review-evidence-0621/ June 2021 

  • Over 90% of sexually abused children were abused by someone they knew
  • Around a third of sexual abuse is committed by other children and young people

https://learning.nspcc.org.uk/media/1710/statistics-briefing-child-sexual-abuse.pdf

  • Disabled children are over 3 times more likely to be abused than non-disabled children

https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/childsexualabuseinenglandandwales/yearendingmarch2019

  • There were 1,550 individual women and girls who had an attendance where FGM was identified in the period January 2021 to March 2021. These accounted for 2,530 attendances reported at NHS trusts and GP practices where FGM was identified.

www.digital.nhs.uk Female Genital Mutilation (FGM) Enhanced Dataset January 2021 to March 2021, England, experimental statistics Published 27 May 2021

Why is child sexual abuse difficult to identify?

CSA can be difficult to identify for numerous reasons: 

  • Children may not recognise they are being sexually abused
  • Children often don’t 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 won’t be believed.
  • A child who is being sexually abused may care for their abuser and worry about getting them into trouble.
  • Children and young people may be exploring their sexuality and become victims of CSA and are unsure about how to disclose

Young people disclose for a variety of reasons including:

  • not being able to cope with the abuse any longer
  • abuse getting worse
  • wanting to protect others from abuse
  • seeking justice

Reasons for not disclosing include:

  • having no one to turn to
  • not understanding they were being abused
  • being ashamed or embarrassed
  • being afraid of the consequences of speaking out
  • abuse is historical and they think they have left it too late to tell people
  • confusion around sexual identity

Disclosing abuse is a difficult journey and an estimated 90% of young people have had negative experiences at some point.  This was mainly as a result of agencies responding poorly to the disclosure.

In a recent local survey of CSA the young people said they wanted:

  • someone to notice that something was wrong;
  • to be asked direct questions;
  • professionals to investigate sensitively but thoroughly;
  • to be kept informed about what was happening.

I didn’t know I was sexually abused until I found out what is was

Quote from a young person

Identifying child sexual abuse:

Potential signs and indicators of sexual abuse in children, young people and their families

A child may show no signs at all that they are being sexually abused, or they may show many.  They may show signs that could be indicative of sexual abuse, but may actually be as a result of other factors in their lives.  Furthermore, some factors may be a stronger indicator of sexual abuse than others.  This information is therefore not for ‘risk assessment’, it is designed to support practice, and can be used:

  • as information to consider the potential indicators that abuse is taking place
  • as information to explore a hypothesis of sexual abuse in supervision, case discussion or individual casework
  • to identify factors that can be used to record concerns

Historical child sexual abuse

We are aware that a significant number of children and young people across the UK will be the victims of historical sexual abuse. Practitioners should be mindful that this may impact on the indicators and behaviours detailed above. Cases of suspected historical child abuse must be taken seriously by agencies and appropriately investigated.

EmotionalBehaviouralPhysicalAbusive BehaviourFamily Vulnerabilities
  • Nightmares or sleeping difficulties without explanation
  • Mood swings including fear, insecurity or withdrawal
  • Developing new or unusual fears of certain people or places
  • Distracted and distant at odd times
  • Fear of intimacy or closeness
  • Eating disorders
  • Substance or alcohol misuse
  • Self harm
  • Suicidal thoughts or actions
  • Depression and anxiety
  • Regression to younger behaviour (e.g. bedwetting or thumb sucking)
  • Other mental health difficulties
  • Disassociation
  • Post-traumatic stress disorder (PTSD)
  • Thinks of self or body as repulsive or bad
  • Psychosomatic symptoms e.g. tummy ache
  • Disclosure
  • Asks another child to behave sexually or play sexualised games
  • Sexually uninhibited/inappropriate behaviour towards adults
  • Mimics sexualised behaviour with animals or toys
  • Inserting objects into vagina or anus
  • Compulsive masturbation or self-soothing behaviour
  • Writes, draws, plays or dreams of sexual or frightening images
  • Change in eating habits, e.g. refuses to eat or overeats
  • Unusual personal hygiene (none or overly)
  • Resists removing clothes at appropriate times (e.g. bath, bed or toileting)
  • Running away from home
  • Wetting and soiling accidents unrelated to toilet training
  • Sexual ‘promiscuity’
  • Leaving clues that seem likely to provoke discussion about sexual issues
  • Talks about a new older friend
  • Suddenly has money, toys, or gifts without reason
  • Uses new words for sex or genitals
  • Aggression or violence to others
  • Fear of dentistry
  • Bruising or marks in unusual places
  • Persistent or reoccurring pain during urination and bowel movements
  • Repeated urinary tract infections
  • Discolouration, bleeding or discharge in genitals, anus or mouth
  • Tears to anus or vagina
  • STDs including genital warts
  • Pregnancy
  • Evidence of self harming behaviour
  • Significant weight gain or loss
  • Difficulty swallowing when eating
  • Buying a child gifts
  • Singling out a child either to favour them or bully them
  • Wanting to spend more time with the child than the parent
  • Offering to babysit
  • Play fighting/tickling
  • Encouraging a child to engage in ‘grown up’ activities
  • Encouraging a child to dress provocatively
  • Leaves bedroom and bathroom door open
  • Undermining the other parent
  • Putting the other parent down
  • Interrupting the relationship between parent and child
  • Gets involved in personal care of the child
  • Encouraging nudity in the home
  • Behaving secretively
  • Wears inappropriate clothing around the house
  • Talks about sex, makes sexual jokes
  • Wants to be left alone with children
  • Changes in sexual behaviour
  • Seems to be behaving more like a child
  • Mood swings and erratic behaviour
  • Complains of not being trusted
  • Poor attachment
  • Poor mental health
  • Substance and alcohol misuse
  • Parental absence through work commitments
  • History of maternal sexual abuse
  • Children or adults with disabilities
  • Poor communication
  • Lack of sex education
  • Domestic abuse – current and previous
  • Previous sexual offending
  • Social isolation

Table 1 Centre of Expertise on Child Sexual Abuse 2020

Tools to help assess cases of CSA

Cambridgeshire and Peterborough CSA Tool:

NICE guidance for Harmful Sexual Behaviour among Children and Young people (NICE guideline [NG55]) states

the use of a locally agreed tool … that accounts for the severity of the behaviour, to avoid unnecessary and potentially stigmatising referrals.

Models that place a child or young person’s sexual behaviour on a continuum indicating various levels of seriousness, such as Hackett’s model[2].

Professionals who work with children and young people often struggle to identify which sexual behaviours are potentially harmful and which represent healthy sexual development.

Cambridgeshire and Peterborough Safeguarding Children Partnership Board have developed a local CSA assessment tool to support professionals. The tool can be used to help identify and respond appropriately to sexual behaviours. To ensure a consistent approach to assessing possible CSA cases, partnership agencies have agreed that this tool will be used by all practitioners. A link to the tool can be found here. https://safeguardingcambspeterborough.org.uk/wp-content/uploads/2021/06/Child-Sexual-Abuse-Assessment-Tool.pdf

The tool uses a system to categorise the sexual behaviours of young people and is designed to help professionals:

  • Make decisions about safeguarding children and young people
  • Assess and respond appropriately to sexual behaviour in children and young people
  • Understand healthy sexual development and distinguish it from harmful behaviour

By categorising sexual behaviours professionals across different agencies can work to the same standardised criteria when making decisions and can protect children and young people with a unified approach.

How children seek help

Research is clearer about why children do not seek out help than how they do. However, children often develop their own methods of communicating a problem or concern with which the professional needs to become attuned.

Gorin (2004) identified the reasons for children not seeking help as including fear of the abuser, fear of the consequences, fear of not being believed, and fear of loss of control. The behaviours associated with these fears and designed perhaps as coping mechanisms are likely to include avoidance, inaction, confrontation, risk taking, recourse to informal support.

A key message for professionals here is that children are more likely to speak to adults in whom they have confidence and who care about them. It is important that the adult is able to listen and take a measured response based on presenting risk and bearing in mind the reasons why children don’t seek help. The importance of establishing a strong, respectful and approachable relationship with the child is of paramount significance particularly as children tend to choose who they talk too.

I used to talk to my dog and it helped me

Quote from young person

How parents seek help

The blocks for parents seeking help are strikingly similar to the reasons why children don’t seek out help. However when parents do ask for help it appears that many don’t receive it.

The key message for professionals is the need to be proactive in seeking support for families who are struggling and not to shy away from engaging such families in constructive dialogue about ways in which help can be provided. Equally important is the role that fathers play in caring for their children. Fathers tend to be excluded from such conversations and as a result their role may be ignored or not fully understood within the dynamics of the family’s functioning.

Prevention of CSA

The following tools/ information/ agencies are available to help talk to children/ young people, families and carers about CSA. Please note that the following information is not exhaustive but is a selection of help and support that is available.

NSPCC – Underwear rule –

The NSPCC has developed a campaign with 5 easy rules to keep children to stay safe;

  • Privates are Private – Your underwear covers up your private parts and no one should ask to see or touch them. Sometimes a doctor, nurse or family members might have to. But they should always explain why, and ask you if it’s OK first. Remember, what’s in your pants belongs only to you
  • Always remember your body belongs to you – No one should ever make you do things that make you feel embarrassed or uncomfortable. If someone asks to see or tries to touch you underneath your underwear say ‘NO’ – and tell someone you trust and like to speak to.
  • No means No – You always have the right to say ‘no’ – even to a family member or someone you love. You’re in control of your body and the most important thing is how YOU feel. If you want to say ‘No’, it’s your choice.
  • Talk about secrets that upset you – There are good secrets and bad secrets. If a secret makes you feel sad or worried, it’s bad – and you should tell an adult you trust about it straight away
  • Speak up, someone can help you – It’s always good to talk about stuff that makes you upset. If you’re worried, go and tell a grown up you trust – like a family member, teacher or one of your friend’s parents. They’ll say well done for speaking out and help make everything OK. You can also call Childline on 0800 1111 and someone will always be there to listen

The “PANTS” information on the NSPCC website contains useful information for both professionals and parents about how to talk to children about CSA. There are a number of helpful resources to available, including resources aimed at children with disabilities. Available are lesson plans, teaching guidance, a PANTS presentation, leaflets and guidance – including the underwear rule in five languages. For further information visit https://www.nspcc.org.uk/preventing-abuse/keeping-children-safe/underwear-rule/

Recognising and responding to abuse

Research/evidence briefings

  • NSPCC helplines report: peer sexual abuse – “Is this sexual abuse?” is a report into the concerns being raised to the NSPCC helpline and Childline about peer sexual abuse; how it takes place, the impact it has, and how to best provide support.
  • Harmful sexual behaviour: learning from case reviews – Lessons from case reviews published since 2010, where harmful sexual behaviour was highlighted as a significant issue.
  • Harmful sexual behaviour: statistics briefing – Briefing on the data available about harmful sexual behaviour (HSB), including scale of the issue, technology-assisted HSB and characteristics of young people who display HSB.
  • Harmful sexual behaviour: research briefing – A summary of messages from research into Harmful sexual behaviour published in 2016 and 2017.

Information for parents –

The NSPCC has lots of information for parents. It contains useful advice about signs and symptoms of CSA.

Find out more: https://www.nspcc.org.uk/keeping-children-safe/sex-relationships/sexual-behaviour-children/

The Lucy Faithful Foundation is a charity dedicated solely to preventing CSA. They have developed a series of short films to inform adults about how and why child sexual abuse happens, how to prevent harm from happening in the first place, and where to get help if something has already happened.

The films cover topics such as ‘Understanding child sexual abuse, ‘The effects of sexual abuse on children’, ‘Why children don’t tell about abuse and ‘What to do if you suspect abuse. There’s also information on the warning signs of abuse in both children and adults, and how to make a family safety plan.The links to the films can be found here https://www.parentsprotect.co.uk/sexual-abuse-learning-programme.htm

Section Two

Principles

To ensure that child sexual abuse is addressed consistently and effectively all agencies interventions whether early help or statutory intervention should work to the following principles:

  1. The child is at the heart of what we do. This means that we need to take account of the child’s views and feelings and understand the impact on them and their family.
  2. All professionals have a responsibility to identify needs and concerns in relation to children and take action to ensure those needs and concerns are addressed at the appropriate level of intervention. This should always be at the lowest possible level to address the issues.
  3. Interventions will be conducted openly and honestly with children and families and all agencies will strive to work in partnership with children, parents and carers.
  4. Assessments will be holistic, taking account of all views including parents that do not live with their children. Assessments will be evidence based and identify strengths as well as areas of concern. Assessments will focus explicitly on each child in the family.
  5. Plans will be clear and directly related to the strengths and concerns identified in the assessment. All plans will have clear timescales that will be reviewed regularly
  6. Parents/carers will be expected to take responsibility for making the required changes to address the identified concerns. Professionals will be expected to be clear with parents/ carers about what those changes need to be and the support they will offer to help achieve them.
  7. All agencies will work together positively to address the identified needs and risks for the child and their family. Any concerns about the effectiveness of the interventions with the child should be raised as possible in a constructive way to enable progress to be made.
  8. Agencies will support information sharing that is in the best interests of the child.
  9. Areas of disagreement will be taken seriously and considered with the family. The child and family will have information that tells them how to make a complaint.

Early help and statutory joint working interventions will often be triggered by concerns about signs of CSA so it is important that assessment and interventions to help and protect children reflect this.

Assessment

CSA is a damaging form of child abuse. The signs of CSA may not be immediately obvious to the professional and are often part of a complex family picture that can on occasions be explained away or that simply overwhelm the professional. Some children and young people may be the victims of historical CSA, this may impact on possible signs and indicators that the child/ young person may display.

Protecting children and young people involves professionals in the difficult task of analysing complex information about human behaviour and risk. It is rarely straightforward and responses should be based on robust assessment, sound professional judgement and where appropriate statutory guidance.

Early help assessment

Working Together 2018 emphasises the importance of local agencies working together to help children who may benefit from early help services. Early help assessments should identify what help the child and family might need to reduce the likelihood of an escalation of needs to the level that will require interventions through a statutory assessment conducted under the Children Act 1989.

Professionals should work within the guidance contained in the Cambridgeshire CPSCPB Effective Support Document when undertaking an Early Help Assessment or Joint Referral Form to Cambridgeshire and Peterborough Social Care

Where possible early help needs are identified, Cambridgeshire and Peterborough promotes the use of the Early Help Assessment (previously known as a CAF or Family CAF) as the tool for recording the family’s unmet needs. Any professional who knows the child can carry out the assessment and liaise with other professionals who might need to be involved. A lead professional, who knows the child and can coordinate the delivery of services, should be identified.

This could be a G.P, teacher, health visitor – the decision should be made on a case by case basis and be informed by the views of the child and family concerned.

An Early Help Assessment must only be undertaken with the agreement of the child and / or family and requires honesty about the reasons for completing the assessment as well as clarity about the presenting concerns. Further information on the consent process is available in the Effective Support Document.

Should the child or family decline the offer of an assessment, the professional who identified the concerns should reconsider the needs of the family and discuss the case with their Designated Safeguarding Lead using the Effective Support Document as a guide. A family’s refusal to complete an EHA does not mean that specialist safeguarding services will become involved, except where there is a risk of significant harm to the person concerned, or where they may present a significant risk to others. The information should be logged by the agency and may form pattern of behaviours that could mean consideration for Social Care intervention is needed in the future.

The lead professional should ensure that the circumstances of the child improve as a result of coordinating the delivery of services. Where improvements do not occur, in a timescale appropriate for the child, a referral to Children’s Social Care should be considered.

Where the situation is judged to be within the definition of a ‘child in need’ or the child has suffered or is likely to suffer significant harm, a referral should be made to Children’s Social Care immediately.

Parental Consent

The clear expectation is that all professionals will discuss their concerns openly and honestly with the child, where appropriate, and their family.

Where a practitioner is requesting support of services on behalf of a child or family, they require consent beforehand – this is regardless of whether they are seeking support from Early Help Services or from Children’s Social Care for child in need services.

An Early Help Assessment must only be undertaken with the agreement of the child and / or family using the EHA Privacy Notice to explain to a family how their information will be shared and stored.  

Where the referral relates to immediate safeguarding concerns, and professionals are concerned that seeking consent may place the child at risk of significant harm, consent is not required and contact should be made with Children’s Social Care as soon as possible. The reason for not informing the parents or carers of the referral should be clearly recorded by the professional.

Agency and professional responsibilities:

Responsibility of all agencies

No one agency is able to address the complex elements of CSA on its own, largely because a child’s and family’s needs cannot always be met by a single agency. Effective interventions, whether early help, child in need or child protection  depend on professionals developing working relationships which are sympathetic to each other’s legal responsibilities, agency’s purpose and procedures respective roles and agencies capacities.

All agencies represented on the Cambridgeshire and Peterborough Safeguarding Children Partnership Board have a responsibility to contribute to the safeguarding of children across Cambridgeshire and Peterborough. Roles and responsibilities are clearly defined in both statutory guidance and the CPSCPB Procedures and include the following:

  • To view the safety and wellbeing of children as paramount.
  • To ensure that achieving the best outcomes for the child is the primary focus when working with CSA.
  • To ensure that their workforce understand the significance of all types of CSA on children and equip their workforce to work effectively in situations where CSA is a feature. This includes staff understanding the links of CSA with other types of abuse (particularly neglect) and links with missing from home.
  • To share relevant information and collaborate with other agencies and work together to ensure accurate assessments and the early identification of needs.
  • To harness and develop resources to ensure that interventions are proportionate, effective, and delivered sufficiently early so as to reduce the likelihood of any escalation of adversity for the child.
  • To ensure that staff attend the CPSCPB training on all elements of CSA and that the training is embedded in practice.

Responsibility of Health

Health is a universal service that is accessed by individuals from all of the communities across Cambridgeshire and Peterborough. Health professionals are involved with children and families throughout their lives and as a consequence they get to know families in more detail than other statutory agencies. Health professionals in Primary care, Acute Hospitals and Community Services particularly midwives, health visitors, school nurses, Emergency Medicine staff and specialist paediatric staff, spend time with children, young people and their families either in people’s homes or other establishments (schools/ hospitals) and are very well-placed to identify cases of CSA. It is important that health professionals are alert to the signs of all types of sexual abuse in children and young people and attend the numerous safeguarding training opportunities that are available to them. The nature and impact of sexual abuse is corrosive and cumulative so it is essential that all health professionals maintain accurate, detailed and contemporaneous records that help to form a “picture” of the abuse. When a practitioner identifies concerns regarding sexual abuse in a family they should speak to a member of the Health Safeguarding Children team to determine what the next steps to take are.

Responsibility of Children’s Services

Children’s Services are responsible for co-ordinating Early Help and statutory assessments of children’s needs which include the parent’s capacity to meet those needs. The assessment may result in the provision of services designed to address the identified needs of the child through a child in need plan. Where a child is assessed as having suffered, or being at risk of, significant harm Children’s services will convene an initial child protection conference to consider the risks on a multi-agency basis. This may result in the child becoming subject of a child protection plan under the category of sexual abuse. Children’s Social Care has the statutory responsibility for child protection cases but it will work with other agencies to develop, implement and monitor a plan (Child in Need or Child Protection) to help the child and their family and stop the abuse.

Responsibility of Adult Services

Children may be at greater risk when they live with parents or carers who have complex physical and mental health needs, have problems with alcohol and drug misuse, are in violent relationships or have learning difficulties. Professionals working with adults who have these difficulties and have children should be particularly alert to how these may impact on the care they give their children. It is important that professionals from the adult workforce attend safeguarding training so that they are aware of the signs of abuse and neglect and know the pathway to follow if they have concerns.

Adults with responsibilities for disabled children have a right to a separate carer’s assessment. The outcome of this assessment should be taken into account when deciding what services, if any, will be provided under the Children Act 1989.

Responsibility of Police

The police have a duty to protect all members of the community and to bring offenders to justice. The welfare of children is a priority for the service, and all officers are responsible for identifying and referring children who are at risk or in need. Any officer can utilise emergency powers to ensure immediate protection of children believed to be at immediate risk of suffering significant harm (this is a very draconian step and should only be utilised in exceptional cases). In these circumstances the police should contact either the early help team or Children’s social care during office hours & the Emergency Duty Team (EDT) out of hours. It is important that Police officers attend safeguarding training so that they are aware of the signs of all types of abuse and neglect and know the pathway to follow if they have concerns.

Responsibility of Education

All schools play an important role in the prevention and identification of all types of abuse and neglect. Schools are a universal service that often provide a safe environment for children. Due to the amount of time that school staff spend with children (and their families) they often know the child and their circumstances better than other agencies. Schools provide an essential educative environment for the next generation of parents. All education staff have a crucial role in identifying the early indicators of sexual abuse, the early help agenda and in contributing to child in need and child protection cases involving sexual abuse. The teaching of Health Education is now a statutory requirement for schools including the teaching of Relationship and Sex Education in Secondary Schools and Relationship Education in Primary Schools. This will include looking at healthy, respectful relationships, how to keep themselves safe including online and introducing knowledge about intimate relationships and sex.

Responsibility of Housing

The Housing Departments/ providers may have important information about families, identifying cases of abuse or contributing information to assessments. The Housing Departments/providers have a critical role in cases of poor home conditions, social isolation, and domestic abuse. Staff have an important part to play in reporting concerns where they believe that a child may be in need of support through early help or in need of statutory intervention. It is important that housing professionals attend safeguarding training so that they are aware of the signs of all types of abuse and neglect and know the pathway to follow if they have concerns.

Responsibility of Probation Services

In discharging its statutory responsibility, the Probation Service, through its work with offenders (particularly sexual offenders) and their families, may become aware of children who are at risk of sexual abuse. All Probation staff have a responsibility to be aware of the signs of all types of child abuse and to refer appropriate cases to early help or Children’s Social Care. Probation staff will work in collaboration with other agencies in contributing to assessments and will follow all relevant child protection policies, procedures and protocols.

Responsibility of Youth Offending Service

The Youth Offending Service is responsible for completing assessments, plans and interventions for children/young people aged 10 – 17 who are at risk of offending, those subject to Out of Court Disposals and Court Disposal supervision. All YOS staff have a responsibility to be alert to safeguarding issues in their work with children/young people and their wider families. All YOS staff have the responsibility to be aware of the signs of child sexual abuse and safeguarding referral processes. Where concerns are identified through a recognised YOS assessment, intervention or involvement these should be raised with a manager and where appropriate will be referred to Children’s Social Care using the Joint Referral Form.

Responsibility of the Voluntary and Community Sector (VCS)

The VCS undertake a range of programmes around early help, some of which are designed to assist parents in their parenting role. The VCS are therefore well-placed to identify early concerns that relate to abuse and to work with the family in addressing issues quickly. In some cases improvement may not be achieved in sufficient time for the child, or the situation may be judged sufficiently chronic in nature to warrant a referral to Children’s Social Care.

Responsibility to share information

Information sharing is essential to enable early intervention and preventative work, for safeguarding and promoting welfare and for wider public protection.

It is important that practitioners can share information appropriately as part of their day-to-day practice and do so confidently.

It is important to remember there can be significant consequences to not sharing information as there can be to sharing information. You must use your professional judgement to decide whether to share or not, and what information is appropriate to share. 

Data protection law reinforces common sense rules of information handling. It is there to ensure personal information is managed in a sensible way.

It helps agencies and organisations to strike a balance between the many benefits of public organisations sharing information, and maintaining and strengthening safeguards and privacy of the individual.

It also helps agencies and organisations to balance the need to preserve a trusted relationship between practitioner and child and their family with the need to share information to benefit and improve the life chances of the child.

Please see the Cambridgeshire and Peterborough Safeguarding Children Partnership Board Threshold Document for more information.

Strategic Aims and Objectives

To support the implementation of this strategy and to ensure that child sexual abuse is widely understood and responded to in joint working arrangements, the CPSCPB undertakes to deliver the following objectives:

  1. To ensure that all CPSCPB partners understand the threshold for intervention in situations where sexual abuse is a feature by:
    • Highlighting childhood sexual abuse within the early help offer
    • Ensuring thresholds for intervention are implicitly covered in CPSCPB training.
  2. To ensure services are delivered in a meaningful and timely fashion for children who are experiencing sexual abuse so as to avoid the need for statutory intervention where possible by developing performance and Quality assurance systems and mechanisms that enable the CPSCPB to judge the effectiveness of early help.
  3. Raise awareness of child sexual abuse through our website and newsletters and will seek to be involved in and support events and initiatives that will contribute to this.

Performance and Quality Assurance framework

The CPSCPB is responsible for scrutinising multi-agency performance data. To assess the impact of this strategy the CPSCB will regularly monitor the following multi-agency quality assurance information:

  • What children, young people and their families tell us
  • Thematic case audits (both single and multi-agency)

Governance

Governance is provided by the CPSCPB and scrutiny of progress against the strategic aims and objectives and performance management indicators will be undertaken through the CPSCB Quality and Effectiveness Sub Group.

All Partnership Board members are responsible for implementing and embedding this strategy within their own agency and the CPSCPB will hold members to account over this.

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