14.10 Child Sexual Abuse & Pan Merseyside Child Sexual Abuse Pathway

If you have a concern that a child may have been subjected to sexual abuse review the following:

Child Sexual Abuse

1 in 10 child assessments undertaken by English local authorities recorded concerns about some form of sexual abuse.

Under-18s make up one-fifth of the population in England and Wales, but two-fifths of victims of recorded sexual offences (www.csacentre.org.uk) < link

1. Definition

Working Together to Safeguard Children (2023) defines sexual abuse as follows:

‘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 (including via the internet).

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.’

Sexual abuse often occurs in conjunction with the other categories of child abuse, especially emotional abuse in order to maintain control and secrecy.

Children from the age of birth onwards may be subjected to sexual abuse. Sexual abuse can have a long-term impact on emotional, social and educational development and is linked to the development of mental health issues in later life. 

Children and young people may not always understand that they are being sexually abused (IICSA, 2022) < link

The Centre of Expertise on child sexual abuse in collaboration with the Centre for Abuse and Trauma Studies, Middlesex University, has developed a typology of child sexual abuse offending focusing on the context of offending rather than the characteristics of the victim or perpetrator. Different types of child sexual abuse can occur:

• Within the family environment
• Through trusted relationships outside the family environment
• Through an intermediary
• Through online interactions
• Through viewing, sharing or possessing images
• Through groups and networks
• Arranged and perpetrated for payment, gifts, time, attention
• Through a personal connection
• Through attack by an unknown person

Case examples for each type are available within A new typology of child sexual abuse offending (2020) < link

Child Sexual Abuse can include:

• Intra-familial Sexual Abuse

What is intra-familial child sexual abuse?

There is no single agreed definition of intra-familial child sexual abuse. However, it is generally recognised that, in addition to abuse by a relative (such as a parent, sibling or uncle), it may include abuse by someone close to the child in other ways (such as a step-parent, a close family friend or a babysitter). This understanding is in accordance with Crown Prosecution Service guidelines on the Sexual Offences Act 2003, which state:

‘These offences reflect the modern family unit and take account of situations where someone is living within the same household as a child and assuming a position of trust or authority over that child, as well as relationships defined by blood ties, adoption, fostering, marriage or living together as partners.’

In thinking about whether abuse is intra-familial, perhaps the most important question for professionals to consider is: ‘Did this perpetrator feel like family to the child?’

• Female Genital Mutilation (FGM) < link

Female Genital Mutilation (FGM) involves the partial or total removal of external female genitalia for non-medical reasons and is a form of child sexual abuse 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 beliefs, but often it is thought 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.

Extra familiar abuse including:

• Child Exploitation (CE)

Child sexual exploitation is a form of child sexual abuse. It occurs when 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.

 Pan Merseyside Child Exploitation Protocol (2020) < link

• Online Abuse

Individuals often associate online safeguarding with online grooming, cyberbullying or inappropriate images or videos. 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.

Online Safety < link to Sefton SCP’s Online Strategy

Sexting: advice for professionals - Advice about sexting and what to do to help a young person who has received or sent an explicit image, video or message

• Harmful Sexual Behaviour (HSB)

Harmful Sexual Behaviour (HSB) is developmentally inappropriate sexual behaviour which is displayed by children and young people which may be harmful or abusive. It can be displayed towards younger children, peers, older children or adults. It is harmful to the children and young people who display it, as well as those it is directed towards.

Harmful Sexual Behaviour < link to Sefton SCP’s Harmful Sexual Behaviours guidance and protocol

2. Risks and Indicators

When dealing with any form of child sexual abuse, practitioners must consider whether speaking to a child’s parents or carers would place a child at further risk or provide opportunities for evidence to be destroyed/altered. If you are unsure, please speak to your Safeguarding Lead or contact CHAT on 0151 934 4013 for further guidance and advice.

Sexual abuse which takes place within family environments often remains hidden and is the most secretive and difficult type of abuse for children and young people to disclose. It may be particularly difficult to disclose abuse by a sibling.

Many children and young people do not recognise themselves as victims of sexual abuse - a child may not understand what is happening and may not even understand that it is wrong especially as the perpetrator will seek to reduce the risk of disclosure by threatening them, telling them they will not be believed or holding them responsible for their own abuse.

Where sexual abuse is being perpetrated on one or more family members, it may be possible to identify by patterns of referrals or presentations to different agencies in their local community over time. There may be a range of signs but any one sign doesn't necessarily mean that a child is being sexually abused, however the presence of number of signs should indicate that you need to consider the potential for abuse and consult with others who know the child to see whether they also have concerns.

Signs include:

• Changes in behaviour, including becoming more fearful, aggressive, withdrawn, clingy;
• Problems in school, difficulty concentrating, appearing distracted and distant or dissociated, drop off in academic performance;
• Sleep problems, nightmares or regressed behaviours i.e. bed wetting;
• Frightened of or seeking to avoid spending time with a particular person;
• Knowledge of sexual behaviour/language that seems inappropriate for their age;
• Physical symptoms including pregnancy in adolescents where the identity of the father is vague or secret, STIs, discharge or unexplained bleeding;
• Poor hygiene, which often leads to social isolation in school;
• Injuries and bruises on parts of the body where other explanations are not available especially bruises, bite marks or other injuries to breasts, buttocks, lower abdomen or thighs;
• Injuries to the mouth, which may be noted by dental practitioners.

Other Factors

• Frequent house moves;
• Isolation of children (and other members) within the family from practitioners, and the wider community;
• Failure to register with a GP;
• Frequent absences from school;
• Failure to cooperate with agencies or to let police, children’s social care or other agencies into the home, or letting children be seen alone by professionals;
• Attempts to disguise injuries or attribute them to other causes;
• A child or young person who self-harms, misuses drugs, alcohol or solvents, and / or develops mental health problems;
• Domestic abuse within the family heightens the risk;
• Repeated pregnancies with no evidence of a father;
• Genetic abnormalities in pregnancy or in children who are born.

Finkelhor and Browne, (1986) describe four likely impacts of child sexual abuse:

1. Traumatic sexualisation (where sexuality, sexual feelings and attitudes may develop inappropriately);
2. A sense of betrayal (because of harm caused by someone the child vitally depended upon);
3. A sense of powerlessness (because the child’s will is constantly contravened);
4. Stigmatisation (where shame or guilt may be reinforced and become part of the child’s self-image).

The Centre of Expertise on Child Sexual Abuse highlights the impact that secrecy (including the fear and isolation this creates) and confusion (because the child is involved in behaviour that feels wrong but has been instigated by trusted adults) has on the child. While these impacts are not unique to Child Sexual Abuse in the Family Environment, their combination and intensity in the context that they take place makes the experience particularly damaging.

See Key Messages From Research on Identifying and Responding to Disclosures of Child Sexual Abuse (Centre of Expertise on Child Sexual Abuse) < link

In the long-term people who have been sexually abused are more likely to suffer with depression, anxiety, eating disorders and post-traumatic stress disorder (PTSD). They are also more likely to self-harm, become involved in criminal behaviour, misuse drugs and alcohol, and die by suicide as young adults.

3. Protection and Action to be Taken

Whenever a child reports that they are suffering or have suffered significant harm through sexual abuse the initial response from all practitioners should be to listen carefully to what the child says and to observe the child’s behaviour and circumstances. Practitioners must:

• Clarify the concerns;
• Offer reassurance about how the child will be kept safe;
• Explain what action will be taken and within what timeframe.

The child must not be pressed for information, led or cross-examined or given false assurances of absolute confidentiality, as this could prejudice police investigations, especially in cases of sexual abuse.

A referral should always be made to Children Social Care and reference made to Sefton Safeguarding Children Partnership Level of Need Guidance < link

Where a strategy discussion / meeting takes place, the core agencies involved with the child should participate.

This should always include a representation from the Rainbow Sexual Assault and Referral Centre (SARC).

Reference should always be made to the Care Pathway Flow Chart within Strategy Meeting documentation.

A clear plan should be agreed and circulated to each agency participant. Wherever possible, these should be face to face meetings rather than telephone discussions to allow better analysis of the available information.

At the conclusion of the investigation, if the case does not proceed to an Initial Child Protection Conference, a second de-briefing strategy meeting should be held to ensure that any ongoing risks are understood and protective action can be undertaken.

Where reports of rape or sexual assault cannot be followed up through the criminal process, the police (and partners) should give consideration to what other support services might be helpful (Sefton CSPR: Child Charlotte).

Any child protection medical assessment must be planned carefully in order to secure any forensic evidence, if it is judged to be appropriate.

Visually recorded interviews must be planned and conducted jointly by trained police officers and social workers in accordance with the Achieving Best Evidence in Criminal Proceedings: Guidance on interviewing victims and witnesses, and guidance on using special measures (Ministry of Justice) < link. All events up to the time of the video interview must be fully recorded. Consideration of the use of video recorded evidence should take into account situations where the child has been subject to abuse using recording equipment.

Visually recorded interviews serve two primary purposes:

• Evidence gathering for criminal proceedings;
• Examination in chief of a child witness.

Relevant information from this process can also be used to inform Section 47 Enquiries, subsequent civil childcare proceedings or disciplinary proceedings against adults, where allegations have been made.

4. Issues

The single and most important consideration is the safety and well-being of the child or children. 

In reconciling the difference between the standard of evidence required for child protection purposes and the standard required for criminal proceedings, emphasis must be given to the protection of the children as the prime consideration.

The investigation and enquiries must also address the religious, cultural, language, sexual orientation and gender needs of the child, together with any special needs of the child arising from illness or disability.

A victim support strategy and service should be established at the outset. Support will be required in pre-trial, trial and post-trial periods if the case/s proceed to court. Minimum periods for contact should be established. It is clear from experience in research about sexual abuse investigations that many victims and families feel strongly that it is important that they remain in contact with the same practitioners throughout the investigative process.

Where an Initial Child Protection Conference takes place great care should be taken beforehand if the child / young person wishes to participate. The child should not be put in the position of meeting the alleged perpetrator or of attending the meeting at the same time.

4.1 Barriers to Disclosure

Children may disclose sexual abuse directly and verbally while others may attempt to disclose by non-verbal means including changes in their behaviours, requiring those around them not just to focus on the behaviour but why the behaviour may be happening. Rates of verbal disclosure are low at the time that abuse occurs in childhood. However, children say they are trying to disclose their abuse when they show signs or act in ways that they hope adults will notice and react to. This is particularly important for disabled children.

Children and young people often disclose abuse while it is still ongoing, there may be a significant delay between the onset of the abuse and any disclosure. The younger the age of the child when the sexual abuse starts, the longer it usually takes to disclose.

Many children are experiencing multiple forms of abuse and may live in households that are not safe and in which emotional support is not available to them.

Disclosures are more likely to come in adolescence as they learn about healthy relationships and how to recognise abusive behaviour. Adolescents often first ‘reach out’ to friends and peers after an experience of sexual abuse and these relationships can have significant influence on young people's emotional wellbeing after experiencing sexual abuse. Schools also have a very important role to play in aiding the disclosure process in providing developmentally appropriate education and a safe space within which to disclose. Professionals and children both highlight the importance of a trusted relationship between a child and a reliable professional as an important to aid disclosure.

See Helping Education Settings Identify and Respond to Concerns < link.

Children may disclose for a number of reasons, possibly because they are not able to cope with the abuse any longer or because the abuse is getting worse. They may disclose in order to protect others from abuse or because they are seeking justice.

Barriers to disclosure include fear of not being believed, embarrassment and shame and fear of the consequences of telling. Some groups of young people will have additional challenges in disclosing due to communication, religious, language, cultural or sexuality issues.

Disabled children are at increased risk of experiencing sexual abuse especially due to communication and developmental issues.

Whenever they choose to disclose, it is important that they are believed, that they are told what will happen next and kept informed and that they are provided with emotional support.

Research into young people’s experience showed that they wanted someone to notice that something was wrong and to be asked direct questions.

Practitioners must be mindful of managing information to minimise the risks to the child when responding to any concerns or disclosures.

There will be situations where, due to lack of forensic evidence or corroborating witnesses, the threshold for criminal proceedings is not met. It is important in these cases that the lack of police action is not interpreted as disbelieving the child’s disclosure.

Impact of sexual abuse on children

Click on the link below to watch an NSPCC video of children talking about their experiences of abuse and speaking out.
https://youtu.be/2-MStSRnQmo

5. The Centre of Expertise on Child Sexual Abuse

The Centre of Expertise on Child Sexual Abuse < link, is a multi-disciplinary team, funded by the Home Office, who have produced a range of resources to support professionals. These resources aim to give professionals the knowledge to identify concerns of child sexual abuse and the confidence to respond to it, not just with the child, but with the whole family.

These include:

• Signs and Indicators < link: A template for identifying and responding to concerns of child sexual abuse. It helps professionals to gather the wider signs and indicators of sexual abuse and build a picture of their concerns;
• Communicating with children < link: A guide for those working with children who have or may have been sexually abused. This guide aims to help you communicate with children in relation to child sexual abuse, including when you have concerns that such abuse is happening;
• Supporting parents and carers < link: A guide for those working with families affected by child sexual abuse. This guide helps professionals provide a confident, supportive response when concerns about the sexual abuse of a parent or carers child have been raised or identified;
• Safety Planning in Education < link: A guide to support education professionals' knowledge, skills and confidence to understand and respond to incidents of harmful sexual behaviour and ensure the safety of all children and young people is addressed;
• Helpful 12 part short film series < link: The Centre have produced an accompanying 12-part short film series which distils key information from these resources quickly and accessibly for professionals. These films are designed for anyone whose role brings them into contact with children and young people under 18 years old or their parents or carers; including social workers, teachers, police officers, health professionals, voluntary-sector workers or faith leaders/workers – whether they are new to the role, still in training or highly experienced.

6. Further Information

Useful websites linked below:

Key messages from research on intra-familial child sexual abuse (Centre of Expertise on Child Sexual Abuse).

Centre for Expertise on Child Sexual Abuse - Measuring the Scale and Changing Nature of Child Sexual Abuse and Child Sexual Exploitation - Scoping Report June 2021, Professor Liz Kelly and Kairika Karsna (Centre of Expertise on Child Sexual Abuse)

Key Messages from Research on Child Sexual Abuse Perpetrated by Adults (Centre of Expertise on Child Sexual Abuse).

Protecting Children from Sexual Abuse (NSPCC)

Getting Support with Sexual Abuse (Childline) - help for children in talking about sexual abuse

Protecting Children from Harm - A critical assessment of child sexual abuse in the family network in England and priorities for action.

Research in Practice - Child Neglect and its Relationship to Sexual Harm and Abuse: Responding Effectively to Children's Needs - open access resource considering the potential relationship between neglect and forms of sexual harm and abuse.

University of Bedfordshire 'Making Noise: Children's Voices for Positive Change after Sexual Abuse' - Children's experiences of help-seeking and support after sexual abuse in the family environment.

Safeguarding Children as Victims and Witnesses (Crown Prosecution Service)

Pre-Trial Therapy (inc Annex A: Specific considerations for children) (Crown Prosecution Service)

Contacting Sefton Children's Help & Advice Team (CHAT) 

Professionals in all agencies should use their knowledge and agency resources to contact children's social care or the police about their concerns directly and to make a referral through the Children's Help and Advice Team (CHAT), by calling 0151 934 4013. 

In such circumstances a formal referral to Sefton Children's Social Care, the police or accident and emergency services (for any urgent medical treatment) must not be delayed by the need for consultation with management or the nominated safeguarding children adviser, or the completion of an assessment.

All professionals in agencies with contact with children and members of their families must make a referral to Sefton Children's Social Care if there are signs that a child or an unborn baby:

• Is suffering significant harm through abuse or neglect;
• Is likely to suffer significant harm in the future.

The timing of such referrals should reflect the level of perceived risk of harm, not longer than within one working day of identification or disclosure of harm or risk of harm.

In urgent situations / out of office hours, the referral should be made to the Sefton’s Children's Social Care emergency duty team / out of hour's team (0151 934 3555).

Please find below the current multi-agency pathway. 

Pan Merseyside Child Sexual Abuse (CSA) Pathway

CARE PATHWAY: BOOKING an APPOINTMENT at PAEDIATRIC SARC (RAINBOW) ALDER HEY (When a professional has a concern that a child may have been subjected to sexual abuse, concerns must be raised with Police and Children's Social Care before a child can attend the paediatric SARC at Rainbow).

CSA GLOSSARY AND References for Child Sexual Abuse PATHWAY.

For further resources and information on child sexual abuse, including signs, symptoms and direct work tools on how to communicate with children- please see Home | CSA Centre.