Sexual Health

RELATED CHAPTERS

Promoting the Health and Well Being of Looked After Children: Statutory Guidance for Local Authorities Integrated Care Boards and NHS England (March 2015)

Additional guidance can be obtained from Brook Advisory Service.

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 encouraged to learn and practice key life skills including: 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 any information and advice, staff/carers should contact 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. Any specific arrangements must be incorporated into the child's Individual Placement Plan.

2. Puberty and Sexual Identity

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

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

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

As necessary this must be addressed in the Placement Plan.

3. Pornography

The use of online filters can help to ensure that younger children do not accidentally access pornographic or sexual images online. See UK Safer Internet for more information.

Older young people are likely to be curious about sex and relationships and may search for online for pornographic or sexual material. It is important that carers have an open discussion with young people about pornographic images and the impact that viewing these can have on young people and their own developing relationships. The NSPCC have produced comprehensive guidance for parents and carers on how to talk to young people about online porn and healthy relationships.

For more information please see Online porn - Advice on how to talk to your child about the risks of online porn and sexually explicit material (NSPCC).

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 abusive or exploitative behaviour it must be discussed with the social worker and consideration given to making a referral under the West Yorkshire Consortium Safeguarding Procedures

Should staff or carers become aware 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

Young people who are looked after should be given information on contraceptives.

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. 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, who will coordinate specialist advice from a multi agency team.

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.

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 West Yorkshire Consortium 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.

See also Pregnant Looked After Young People Procedure.

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. Child Sexual Exploitation

The following should be read in conjunction with relevant West Yorkshire Consortium Procedures, Child Exploitation: Policy, Procedures and Guidance.

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

Foster carers must be aware of and alert to possible indicators of Child Sexual Exploitation and know what to do if they have any concerns.

Any issues related to Child Sexual Exploitation should be addressed in the child's Placement Plan, along with strategies to keep them safe.

Any concerns that a Child in Care is being sexually exploited must be reported to Ofsted.

9. Sexually Transmitted Infections

If it is known or suspected that a child has a sexually transmitted infection the child should be referred, with the parents' consent if possible, to the local Genito-Urinary Medicine Clinic, who will provide the young person 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 the strategies or measures to be adopted.

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.

9.1 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.