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Contents

1. Provision of Information and Advice
2. Puberty and Sexual Identity
3. Pornography
4. Under Age Sexual Relationships
5. Contraception
6. Pregnancy and Termination
7. Working with Young Fathers
8. Prostitution and Sexual Exploitation
9. Sexually Transmitted Diseases
10. Masturbation

1. Provision of Information and Advice

Those responsible for the care of looked after children must make sure that they are provided with appropriate, accurate and up to date information and advice on matters relating to sexual health and relationships.

Key elements of sex and relationship work;

Information - children and young people are entitled to clear, relevant, age appropriate information which is accurate and non-judgmental.

Skills - children and young people are entitled to learn and practice key life skills that should include: emotional, social, communication, negotiating, practical and decision-making skills.

Attitudes, values and beliefs - by exploring and challenging attitudes, values and beliefs, children and young people can be helped to develop a positive attitude to sexual health and well-being.

Before providing such information and advice, staff/carers should consult the child's social worker - who will consult the child's parents as appropriate - to ensure any such information and advice are provided in the context of the child's backgrounds and needs; and any specific arrangements must be incorporated into the child's Individual's Placement Plan.

2. Puberty and Sexual Identity

All staff and carers must adopt a non-judgemental attitude toward children, particularly as they mature and develop an awareness of their bodies and sexuality.

The same approach must be adopted towards children who explore or are confused about their sexual identity or who have decided to embrace a particular lifestyle so long as it is not abusive or illegal.

Young People who are confused about their sexual identity or indicate they have a preference must be afforded equal access to accurate information, education and support to enable them to move forward positively.

As necessary this must be addressed in the Placement Plan/Placement Information Record.

3. Pornography

All materials published, circulated or available to children must promote and encourage healthy lifestyles and images of men and women that are positive and encouraging.

Children must be positively discouraged from obtaining material that is potentially offensive or pornographic.

If they obtain such material that is suspected to be illegal it must be confiscated and in extreme circumstances consideration must be given to reporting the matter to the Police.

4. Under Age Sexual Relationships

Staff/carers should be mindful of their duty to consider the overall welfare of children and this may mean recognising that illegal activity is taking place and working to minimise risks and consequences.  Staff/carers may not condone or permit unhealthy, exploitative, abusive or illegal behaviour and must take all reasonable steps to reduce or prevent it.

If there is any suspicion that a child is engaging in illegal behaviour it must be discussed with the social worker and consideration given to making a referral under the Local Safeguarding Children Procedures.

Should staff or carers suspect that children are engaging in under age sexual relationships, they should:

1. Ensure the basic safety of all the children concerned;
2. Notify the manager/supervising social worker, who should notify/consult the relevant social worker;
3. Record all events, distinguishing between fact and opinion.

5. Contraception

Staff/carers should identify local sources of professional help and information for children and can accompany them to clinics if requested to do so.

Condoms are the most easily available, non-prescribed form of contraception.  They also protect against many sexually transmitted infections.  Young men and women should learn how to use them correctly - this will require practice!  It is important that girls are equally confident in using them.  Condoms and condom demonstrations are available for this purpose.

Before a decision is taken to make condoms available, social workers/residential staff/carers should ensure that the supply of condoms:

• Forms part of a broader sex and relationship education programme which includes helping children resist any pressure to have early sex;
• Is supported by clear protocols which have been agreed with management and are understood by the child concerned;
• Complements local service arrangements for the distribution of free condoms;
• Is always accompanied by verbal and written advice about using condoms correctly, information about sexually transmitted infections and services and where to access emergency contraception if the condom breaks or is not used.

6. Pregnancy and Termination

Young people in care or care leavers who become pregnant should be offered non-judgemental information - and where necessary more in-depth counselling - on their options of keeping the baby, abortion or adoption. Whatever choice the young person makes, they should be supported to access a health professional for onward referral to NHS funded abortion or antenatal care.

It is essential that young people in care or care leavers who are continuing the pregnancy or who are expectant fathers are provided with dedicated support through a Lead Professional, coordinating specialist advice from a multi agency team linked to Targeted Youth Support and Children's Centres. Support arrangements are for local decision, but should be in line with Teenage Parents Next Steps: guidance for LAs and PCTs (2007).

Dedicated support should start as early as possible in the antenatal period, continue post-natally and include, for example, support around relationships and emotional health, re-engaging with education, and the on-going use of effective contraception to prevent repeat pregnancies. Actions to improve outcomes for teenage mothers and young fathers - including those in and leaving care - should be integrated into the Children and Young People's Plan

Under normal circumstances, the child's parent(s) should be informed and be part of drawing up a suitable plan for the promotion of the welfare of the pregnant child and the unborn child.

However, a child who has reached the age of sixteen may request that his or her parent(s) are not informed.  In these circumstances, the child should be encouraged to share the information with his or her parents and this must be discussed with the child's social worker in order that a decision can be made as to the way forward.

Where a child under sixteen makes such a request, the child's social worker should seek legal advice before agreeing that the parents should not be informed. 

In all cases, should there be suspicions that the pregnant child and/or the unborn child are at risk of Significant Harm, the child's social worker must take action under the Local Safeguarding Children Board Inter Agency Procedures.

Any decision to terminate a pregnancy should be reached by the pregnant child.  Advice, counselling and support in making the decision must only be given by suitably qualified independent counsellors.

If the pregnant child decides to terminate the pregnancy, the child's social worker and staff/carers must ensure that adequate support is given throughout and afterwards to ensure the child's privacy is protected and any physical or emotional needs are addressed sensitively.

7. Working with Young Fathers

This can be a difficult area of work because the choice and responsibility in decisions relating to the baby lies with the mother. Regardless of how the mother views the situation, young fathers still need to be supported. The following points should be addressed:

• What does the young man want his role to be?
• Does this conflict with what the young woman wants? If so, how will this be managed?
• How will you support him to deal with his thoughts, feelings, hopes and fears?
• How can he play an active role in the child's life?
• Is the young man clear about his legal rights, choices and responsibilities in relation to his child?

8. Prostitution and Sexual Exploitation

It is critically important that Looked after children and care leavers are helped to gain the self esteem and skills needed to develop loving, respectful and safe relationships. This will include the confidence to delay early sex until they are ready to make safe and positive choices and, if and when they do become sexually active, to use effective contraception and condoms to prevent pregnancy and sexually transmitted infections.

Children of any sexual orientation and ability may be abused through prostitution or sexual exploitation.  This can involve more than payment of money in exchange for sexual services; it includes remuneration of any kind, given to the child, for example mobile phones, alcohol, new clothes and other 'treats'.

Young men involved in sexual exploitation are often much less visible than young women. They may be enticed as above but in some cases there may be a strong link to gaming websites. Young men are approached online and offered gaming credit in exchange for sexual favours which may take place in person or via a webcam.

It is important to acknowledge and accept that the sexual exploitation of young men is not a homosexual issue - for either the victims or abusers - who may be heterosexual, bi-sexual or homosexual. Many young men who are sexually exploited identify as heterosexual.

In many cases, the sexual exploitation of young people goes hand in hand with the use of drugs or alcohol and exploiters may use drugs and/or alcohol to draw young people into their adult world. Alcohol and cannabis are very common in the early stages of grooming and adults often allow young people to try things they may not be allowed to try at home. They may introduce substances as a way of disinhibiting them.

Children abused through prostitution should benefit from multi-agency planning and services that ensure the child's immediate protection, and through a longer term strategy, that encourage and support his/her exit from prostitution.

Staff/carers need to be alert to any behaviour that might indicate that the child is involved in prostitution or at risk of becoming involved.  This should be discussed in supervision and a response strategy agreed.  Concerns should be shared with the child.

• Look out for warning signs - changes in appearance, getting lifts home from strangers, coming home having eaten yet not having had to pay for food, having credit on mobile phones that can't be accounted for or updated mobile phones, mood changes, different language, new style of dress, new possessions, truanting from school, losing touch with old friends, telling lies, using drugs, a new name, staying out at night;
• Go slowly - don't rush in. Befriend and form the beginnings of a trusting relationship before mentioning your concerns (unless you think the child is at immediate risk);
• Remember that some children are controlled by pimps and involvement of professionals needs to be handled sensitively in order that the child's safety is not put at further risk;
• Children may need you to act as their advocate regarding liaison with other agencies;
• Children often have immediate practical support needs upon which you can build a relationship;
• Be supportive and non-judgmental.

Where there is any suspicion that a child is engaged in such behaviour it should be addressed in the child's Placement Information Record through strategies to help the child find alternative lifestyles.  If a child is engaged or suspected to be engaged in prostitution, the Regulatory Authority, local authority and Police for the area where the child is placed, must be informed.

9. Sexually Transmitted Diseases

Click here for BAAF Practice Note No 53 - Guidelines for the Testing of Looked After Children who are at risk of a Blood-Borne Infection.

It is the absolute right of children to have information and advice on safer sex, HIV, AIDS, hepatitis and other sexually transmitted infections. In providing such advice and guidance to children, it is important that they are made aware that there are many safer and pleasurable alternatives to penetrative sex, for example, stroking, exploration of erogenous zones, sucking, kissing, licking, or mutual masturbation.

Children should be encouraged and supported to take responsibility for their own sexual well being, acknowledging cultural diversity.  The opportunity to discuss this with staff/carers and a variety of health professionals should be available.

With regard to sexually transmitted infections including HIV, children should be advised of clinics where anonymity and appropriate pre and post testing counselling are available.  They should be made aware that, if they are tested by their G.P., then the results of this will be recorded in their medical notes and these may be available to prospective employers etc. in the future.  There is, however, complete confidentiality at Genito-urinary Medicine (G.U.M.) clinics.

If it is known or suspected that a child has a sexually transmitted disease, the child's social worker must be informed and decide what measures to take. In principle, the child should be referred, with the parents' consent if possible, to the local Genito-urinary Medicine Clinic, who will provide the child and carer with advice, counselling, testing and other support.

Only those immediate carers of the child who need to know will be informed of any suspicion or the outcome of any tests and strategies or measures to be adopted. Other children in the placement should only be informed if there is a direct risk to them; for example if the infected child deliberately attempts to infect them. The only other individuals who will be told are the child's GP and Health Visitor.

Before disclosing to any other agency or individual, the following criteria must be satisfied:

• The child (where appropriate) and the parents have given their written consent to the disclosure;
• The disclosure would be in the best interests of the child;
• Those receiving the information are aware of its confidential nature.

Consent to testing

The permission of the child aged 16 or over must be given before testing.

If a child under 16 has sufficient age and understanding, his or her permission must be given before testing.

Wherever possible, the consent of the parents should be obtained.  In order for parents to be able to participate in decision-making, they must be provided with adequate information and given appropriate support including access to counselling both before the test and in the event of a positive diagnosis.

Where parental consent is not forthcoming but there is a clear medical recommendation that testing is in the child's best interests, legal advice should be obtained as to whether the test can proceed.

10. Masturbation

It is accepted that masturbation is part of normal sexual behaviour but children must be positively encouraged to undertake such activities in private and in a manner that is not harmful to themselves or other people.

End