5.10 Sexually Active Young People under the Age of 18 in Knowsley
SCOPE OF THIS CHAPTER
The Knowsley Council and Knowsley Safeguarding Children Board guidance provides information with regards to safeguarding children who are under 18 years of age and are sexually active, it sets out the roles and responsibilities of organisations and the procedures practitioners should follow to ensure the safety and wellbeing of children who may be at risk of abuse and /or exploitation.
Department of Health (2004) Best Practice Guidance for Doctors and other Health Professionals on the provision of Advice and Treatment to Young People Under 16 On Contraception, Sexual, and Reproductive Health.
This protocol has been reviewed and updated in July 2017 by the members of the Knowsley Safeguarding Children Board Health Sub Group, the Multi Agency Safeguarding Hub and the Police Protection Unit. The term young people have been removed and all under 18 year olds are referred to as children in line with the KSCP recommendations. All sections of the policy have been reviewed and updated in line with recent local changes, for example the development of the Multi Agency Safeguarding Hub (MASH) and recent updates in practice guidance, for example Department of Health Information Sharing guidance. An assessment tool has been added for consideration when assessing the under 18's who are sexually active.
This protocol applies to any professional working in Knowsley who comes into contact with a child who is sexually active and under 18.Please refer to Appendix 2: Guidance Note re: Flowchart for professionals working with sexually active under 18 year olds and Appendix 3: Working with Sexually Active under 18's flow chart who may be at risk of abuse and or exploitation when working with children who are under 18 and are sexually active.
|1.2||This protocol has been devised and adapted with the understanding that most children under the age of 18 will have an interest in sex and sexual relationships.|
|1.3||It is designed to assist those working with children to identify where these relationships may be abusive and/or exploitive the children may need the provision of protection or additional services.|
|1.4||It is based on the core principle that the welfare of the child is paramount, and emphasises the need for professionals to work together in accurately assessing the risk of Significant Harm when a child engaged in sexual activity.|
|1.5||All agencies that have contact with children should use this protocol to develop and implement local guidance for their own staff.|
It is the responsibility of each organisation to develop and implement an appropriate assessment tool to use alongside this guidance.
|1.7||The sexual offences act 2003 aims to protect the safety and rights of children and make it easier to prosecute people who pressure or force others into having sex they do not consent to.|
Although the age of consent remains 16 years, it is not intended that the law should be used to prosecute mutually agreed sexual activity between two children of similar age, except where it involves abuse or exploitation.The act still allows children under 16 the right to confidential advice on contraception, condoms, pregnancy and abortion.
All children, regardless of gender, or sexual orientation who are believed to be engaged in, or planning to be engaged in, sexual activity must have their needs for health education, support and/or protection assessed by the agency involved. This assessment must be carried out in accordance with information and guidance set out in;
|2.2||The professional needs to utilise a degree of professional curiosity and not merely accept what is said by the child as fully factual. Please refer to Appendix 4: Children and Young People's Information Systems. An example of a pro forma used in Knowsley when assessing sexually active children who are under 18 years who may be at risk of abusive and/or exploitive relationships. This pro forma is designed to support professionals when undertaking an assessment, enabling the professional to collate a baseline of information and an understanding of the child's circumstances.|
|2.3||It is good practice to undertake a baseline assessment and for it to be reviewed at every attendance, taking into consideration any changes in presentation or further information which would cause suspicion that child may be at risk of harm.|
|2.4||In assessing the nature of any particular behaviour, it is essential to look at the facts of the actual relationship between those involved. Power imbalances are very important and can occur through differences in size, age and development and where gender, sexuality, race and levels of sexual knowledge are used to exert such power. (Of these, age may be a key indicator, e.g. a 15 year old girl and a 25 year old man). There may also be an imbalance of power if the child's sexual partner is in a position of trust in relation to them e.g. teacher, youth worker, carer, including interfamilial abuse, etc.|
Risk Indicators - In order to determine whether the relationship presents a risk to the child, the following factors should be considered. This list is not exhaustive and other factors may be needed to be taken into account; clearly the more factors present will increase the level of risk for the child concerned:
It is considered good practice for workers to follow Fraser guidelines when discussing contraceptive advice and treatment with children under 16 years of age without parental consent providing certain criteria are met:
|3.1||In working with children, it must always be made clear to them that absolute confidentiality cannot be guaranteed, and that there will be some circumstances where the needs of the child can only be safeguarded by sharing information with others.|
|3.2||With regards to safeguarding assessment of the child and their circumstances must be made at each contact, taking into account any changes in presentation or any information disclosed that would cause suspicion the child is at risk of harm.|
|3.3||If you have concerns that the child may be at risk of harm, contact the Knowsley Multi Agency Safeguarding Hub (MASH) on 0151 443 2600 to discuss with a member of staff and follow up with a Knowsley MASH (Multi-Agency Referral Form).|
|3.4||The Multi-Agency Referral Form can be used for access to services for children who need to be protected or require the provision of early help. Please refer to Early Help Assessment Framework in Knowsley of these procedures and Knowsley Helping Children Thrive.|
If you have concerns a child is at risk of sexual exploitation, please complete a CSE 1 and a Multi Agency Referral Form (MARF) and send this to the MASH who will undertake appropriate and propionate screening which will include discussion with the SHIELD Team. This will determine if this meets criteria for intervention from the SHIELD Team.
See Multi Agency Safeguarding Hub (MASH). This is Knowsley's children's social care 'front door'.
When a contact is received in the MASH a MASH Social Worker will screen the contact which includes contacting partner agencies, parents and checking relevant systems. A decision regarding threshold will be made in line with the Knowsley Threshold of Need Document.
Should it be considered that a child is at risk of significant harm, then a Strategy Meeting will be convened.
Please reference Part 4 of this manual - Managing individual cases where there are concerns about a child's safety and welfare. This discussion should be informed by the assessment undertaken using these protocols and, in the majority of cases, may be largely for the purposes of consultation and information sharing.In many cases, it will not be in the best interests of the young person for criminal or civil proceedings to be instigated. However, Police, Children's Social Care and other agencies may hold vital information that will assist in any clear assessment of risk.
Following any referral to the MASH a decision will be made in line with the Knowsley Threshold of Need Guidance.
There may be one of the following responses:
|3.8||Any girl, either under or over the age of 13, who is pregnant, must be offered specialist support and guidance by the relevant services. These services will also be a part of the assessment of the girl's circumstances, and must be included within local guidance.|
|3.9||Although the age of consent remains at 16, the law is not intended to prosecute mutually agreed children who are of similar age participating in sexual activities, unless it involves exploitation. Children including those under the age of 13 will continue to have the right to confidential advice on contraception, condoms, pregnancy and abortion.|
4. Children Aged Under 13
Under the Sexual Offences Act 2003, a child does not, under any circumstances have the legal capacity to consent to sexual activity, and any sexual activity will be considered an offence.The police must be notified as soon as possible when a criminal offence has been committed or is suspected of having been committed against a child.
|4.2||In all cases where the sexually active young person is under the age of 13 each case must be assessed individually and a full assessment must be undertaken and a safeguarding referral to be made to the MASH - in accordance with Part 4 of this manual - Managing individual cases where there are concerns about a child's safety and welfare. In order for this to be meaningful, the child will need to be identified, as will their sexual partner if details are known.|
|4.3||The professional and agency concerned is fully accountable for the decisions made and a good standard of record keeping must always be maintained.|
|4.4||When a girl under 13 is found to be pregnant, a referral to the MASH must be made and a Strategy Discussion will be held the police and/or other agencies. At this stage a multi-agency support package should be formulated.|
5. Children Aged between 13 and 16
|5.1||The Sexual Offences Act 2003 reinforces that children aged between 13 and 16 years of age cannot legally consent to sexual activity although it is recognised that teenagers of a similar age may mutually agree to sexual activity, the age of consent should still remain at 16. This acknowledges that this group of children are still vulnerable and maybe at risk, even when they do not view themselves as such.|
|5.2||The key question is a matter of whether consent was obtained through coercion within an exploitive context or where drugs or alcohol are involved. Where this is the case any consent given by the child will be disregarded. Sexually active children in this age group will still have to have their needs assessed using this protocol. A discussion or a referral to the MASH may be required this will depend on the level of risk/need assessed by those working with the young person. Please refer to the Knowsley Threshold of needs protocol.|
This difference in procedure reflects the position that, whilst sexual activity under 16 remains illegal, children under the age of 13 are not capable and have not got the legal capacity to consent to sexual activity under any circumstances.The police must be notified as soon as possible when a criminal offence has been committed or is suspected of having been committed against a child.
6. Children between 16 and 17
Although children aged 16-17 can consent to sexual activity, children under the age of 18 are still offered protection under the Children Act 1989 and the Sexual Offences Act 2003.The police must be notified as soon as possible when a criminal offence has been committed or is suspected of having been committed against a child.
|6.2||Consideration still needs to be given to issues of sexual exploitation between the ages of 16 and 17 as they can still be subject to offences of rape and assault An offence will be committed where there is an imbalance of power due to a disparity in ages, where there is an element of duress, abuse or exploitation or where there is an abuse of power or trust or a family member as defined by the Sexual Offences Act 2003.|
|6.3||A discussion or a referral to the MASH may be required this will depend on the level of risk/need assessed by those working with the young person. Please refer to the Knowsley Threshold of needs protocol.|
7. Confidentiality and Information Sharing
|7.1||Information sharing is vital to safeguarding and promoting the welfare of children. A key factor identified in many Serious Case Reviews has been a failure by practitioners to record information, to share it, to understand its significance and then to take the appropriate action.|
Confidentiality is an important principle of any service delivery and maintaining a high level of confidentiality is especially important to ensure children continue to engage with services.However, confidentiality is not an absolute principle and professionals need to be aware of the circumstances under which confidentiality cannot be granted.
|7.3||For example, relevant information must be shared with other agencies where children may be at risk of Significant Harm. The Children Act (1989) states the welfare of a child is paramount, and this needs to be made clear to children at each consultation.|
|7.4||Professionals must always consider the safety and the welfare of a child when making a decision and whether to share information about the child. Where there are concerns that a child may be suffering or likely to suffer significant harm, the child's safety and welfare must be the overriding consideration.|
|7.5||Professionals should, were possible, respect the wishes of children who do not consent to share confidential information. However, they may still share the information if in their judgement there is significant need to override the lack of consent.|
|7.6||Professionals should seek advice where they are in doubt, especially where the doubt related to a concern regarding possible significant harm to a child or potential serious harm to others.|
|7.7||Professionals should ensure that the information they share is accurate and up to date, necessary for the purpose for which they are sharing it and shared only with those who need to see it. It is a requirement that all confidential information will be shared securely.|
|7.8||Professionals should always keep a record of the decision making process with regards to sharing the information or not. If you share information then you must record what you have shared with whom and for what purpose.|
|7.9||Sharing Information with Parents and Carers: Decisions to share information with parents and carers will be taken using professional judgement, and consideration of the Fraser guidelines and in consultation with the Safeguarding Children Procedures. Decisions will be based on the child's age, maturity and ability to appreciate what is involved in terms of the implications and risks to themselves. This should be coupled with the parents' and carers' ability and commitment to protect the child. Given the responsibility that parents have for the conduct and welfare of their children, professionals should encourage the young person, at all points, to share information with their parents and carers wherever safe to do so.|
|7.10||This protocol is written on the understanding that those working with this vulnerable group of children will naturally want to do as much as they can to provide a safe, accessible and confidential service whilst remaining aware of their duty of care to safeguard them and promote their wellbeing.|
|7.11||For further information go to the Department for Education (DfE) website and search – 'Information Sharing'.|
It is intended that this protocol will be reviewed 12 months after adoption or following changes in legislation and/or a change in national guidance.This guidance has been reviewed and updated by the members of the Knowsley Safeguarding Children Board Health Sub Group, the public protection Unit and frontline practitioners from Health organisations. The responsible Author is the Chair of the Health Sub Group and is endorsed by the KSCP.
If there is a complaint to be made against a worker it is the responsibility of the complainant to request a copy of the agency complaints procedure and progress accordingly.
Appendix 1: Additional Information
Section 15 of the Sexual Offences Act 2003 makes it an offence for a person (A) aged 18 or over to meet intentionally, or to travel with the intention of meeting a child under 16 in any part of the world, if he has met or communicated with that child on at least two earlier occasions, and intends to commit a "relevant offence" against that child either at the time of the meeting or on a subsequent occasion. An offence is not committed if (A) reasonably believes the child to be 16 or over.
The section is intended to cover situations where an adult (A) establishes contact with a child through for example, meetings, conversations or communications on the internet and gains the child's trust and confidence so that he can arrange to meet the child for the purpose of committing a "relevant offence" against the child.
The course of conduct prior to the meeting that triggers the offence may have an explicitly sexual content, such as (A) entering into conversations with the child about sexual acts he wants to engage him/her in when they meet, or sending images of adult pornography. However, the prior meetings or communication need not have an explicitly sexual content and could for example simply be (A) giving swimming lessons or meeting him/her incidentally through a friend.
The offence will be complete either when, following the earlier communications, (A) meets the child or travels to meet the child with the intent to commit a relevant offence against the child. The intended offence does not have to take place.
The evidence of (A's) intent to commit an offence may be drawn from the communications between (A) and the child before the meeting or may be drawn from other circumstances, for example if (A) travels to the meeting with ropes, condoms and lubricants.Subsection (2)(a) provides that (A's) previous meetings or communications with the child can have taken place in or across any part of the world. This would cover for example (A) emailing the child from abroad (A) and the child speaking on the telephone abroad, or (A) meeting the child abroad. The travel to the meeting itself must at least partly take place in England or Wales or Northern Ireland.
The Sexual Offences Act 2003
Protecting People with a mental disorder
The act has created three new categories of offences to provide additional protection with a mental disorder.
- The Act covers offences committed against those who, because of a profound mental disorder, lack the capacity to consent to sexual activity;
- The Act covers offences where a person with a mental disorder is induced, threatened or deceived into sexual activity;
- The Act makes it an offence for people providing care, assistance or services to someone in connection with a mental disorder to engage in sexual activity with that person
Appendix 2: Guidance Note re: Flowchart for Professionals working with sexually active under 18's
|1.||This process applies to any professionals (including voluntary or agency workers) working in Knowsley who come into contact with a child who is sexually active and under 18, including requests in non-NHS settings for emergency contraception; Chlamydia screening or repeat issuing of condoms. It does not apply to condom distribution campaigns where there is no one-to-one consultation, nor does it apply to the sale of condoms.|
|2.||The Note and Flowchart have been recently reviewed by a wide range of statutory agencies. It is aimed at providing staff with guidance on how contact with sexually active under 18s should be managed. Its use MUST be in conjunction with local Safeguarding Children Procedures.|
|3.||In designing the flow chart, the agencies are clear that at the centre of our contact with the child is their health and well-being. We have a duty to ensure that we work together to minimise risks to potentially vulnerable children and in so doing, we must respect an individual's legal rights to privacy and confidentiality.|
|4.||The decision making process must consider the relationship between the professional and the child, and seek to build trust as far as possible. The amount of information that will be forthcoming will vary from one setting to another, and will be affected by whether the professional has any prior knowledge of the child. Therefore, a pharmacist issuing emergency contraception as a one-off will probably only gain some of the answers to the questions or prompts the guidance proposes. As a result, the threshold for discussions with designated staff, the MASH or the police, may be lower than for a GP who is more confident they will see the child again.|
|5.||Some of the answers to these questions may be gained over the course of several consultations. It is up to the professional to use their judgement as to how much information they can seek each time.|
|6.||Where a professional worker expects to discuss a case with Named/Designated staff, and/or also with their line manager or to have an informal conversation outside the NHS thus breaching confidentiality, then this should be done in consultation with the child, except where the professional believes it is not in their best interests to be informed.|
|7.||Where a serious crime is suspected, advice should be sought from the police at the earliest opportunity to safeguard the child and minimise the risk of any evidence, such as e-mails or pictures, being destroyed before they can begin their investigation. All staff must be aware that the police must formally record contact made by an agency. An incident will be recorded as a crime where on the balance of probability an offence defined by law has been committed and there is no evidence to the contrary.|
|8.||Any referral or potential referral should be discussed in the first instance with the young person. The organisation making the referral then has a Duty of Care to the individual to secure their physical and mental well-being and offer support during that time.|
|9.||Under the Sexual Offences Act 2003, a child under 13 does not have legal capacity to consent to sexual activity and any sexual activity will be considered an offence. The police must be notified as soon as possible when a criminal offence has been committed or is suspected of having been committed against a child.|
|10.||The degree to which a child is regarded as Fraser Competent needs to be assessed on an individual basis and documented. This will vary with age, maturity and with the implications of the treatment or advice they are seeking. Children under 16 years who are Fraser competent can consent to treatment. A child can say they wish to withhold consent to their information being shared with another agency. A professional, however, may override this if they are of the firm view that not to do so may jeopardise the safety and welfare of the child|
|11.||In all cases where the sexually active young person is under the age of 13 each case must be assessed individually and a full assessment must be undertaken and a safeguarding referral to be made to the MASH. The actions taken by the professional MUST BE RECORDED and the rationale for these actions clearly given.|
|12.||Throughout the process it will be important to remember the perpetrator of abuse might be: the patient; male or female; of the same sex; in a caring role for the individual. Similarly not all abuse is recognised as such by the victim at the time, and this is notably the case where a child is being groomed.|
|13.||In accordance with guidance from the Department of Health and Social Care, the health professional is responsible for deciding when a referral is or is not made. Where there is any uncertainty and a referral is not made, the reasons and rationale must be documented in the child's notes at the time.|
|14.||Wherever possible, any informal discussions should be carried out in such a way as not to breach confidentiality with the MASH team or Designated safeguarding professionals as per Knowsley Local Safeguarding Procedures.|
|15.||It is important to recognise that any information passed to the MASH, even in confidence, can be released by a Court Order by a judge in the Family Court. The same does not apply to the Police, who are entitled to withhold information under Public Interest Immunity. This should be considered when disclosing any information that could later put a patient or informant at risk.|
Appendix 3: Working with Sexually Active under 18's flow chart who may be at risk of abuse and or exploitation
Appendix 4: Children and Young People's Information Systems
Unique Identification records Schools
Unique NHS Records
Social Care Records - SWIFT/ ICS
Child Index (where appropriate)