Sexual Abuse

Sexual Abuse

1. Introduction

1.1 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 birth onwards may be subjected to child sexual abuse which can have a long-term impact on physical, emotional, social and educational development. The psychological harm of child sexual abuse can be at least as severe as the physical effects (IICSA 2018).

1.2 The independent investigation into child sexual abuse (IICSA 2018) reported that victims and survivors of child sexual abuse can be more likely to have poorer physical health than those who have not been abused.

1.3 “Well, when I was young, I overused alcohol and I had eating disorders, which I still have difficulty with, not to the same extent, but what they have created in me are many intolerances and difficulties around food. I can’t drink alcohol at all now because I can’t metabolise it. And other things: my whole physical health has been highly compromised by various ways … and my understanding of the way my body has seized up is very much related to the fact that I was holding something down that I didn’t ‒ couldn’t put a name to…”(ICCSA p. 6)

“The sexual assault I experienced aged nine has affected all my relationships with others: family, work, romantic, social and my relationship with myself. Its effect has been and still is catastrophic”.

Victim and survivor, the Truth Project (IICSA ‘Have your say’ 2018)

1.4 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.

1.5 Perpetrators may deliberately target children they know to be vulnerable such as children with special educational needs or disabilities, those who have endured emotional trauma and those whose circumstances make them vulnerable (for example, children in residential settings) (IICSA 2018). Children and their families may be groomed and manipulated by perpetrators to gain their trust and compliance. Some victims and survivors are manipulated into mistaking the sexual abuse they suffered for love and some believe the sexual abuse was their fault. Perpetrators can use their reputation, authority and position of trust as opportunities to abuse and also to deflect and discredit accusations where concerns arise (IICSA 2018).

“All I ever wanted as a child was to be loved, to do normal stuff like dress up, bake cakes, be innocent. Never should a child be so frightened to be alive.”

Victim and survivor, the Truth Project (IICSA ‘Have your say’ 2018)

2. Definition of Sexual Abuse

2.1 Working Together to Safeguard Children (2018) 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. 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” (HM Gov 2018, p.103).

2.2 Some of the following signs may be indicators of sexual abuse

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, sexually transmitted infections (STIs), anogenital warts, soreness in the genital and anal areas, discharge or unexplained bleeding in the genital areas

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;

Children displaying sexually harmful behaviours

Child perpetrators of sexual violence and abuse

Injuries to the mouth, which may be noted by dental practitioners.

Children who use sexual language or have sexual knowledge that you wouldn’t expect them to have;

Children who ask others to behave sexually or play sexual games;

Frightened of or seeking to avoid spending time with a particular person;

3. Other factors to consider

Changes in behaviour, including becoming more aggressive, withdrawn, clingy;

Problems in school, difficulty concentrating, drop off in academic performance;

Sleep problems or regressed behaviours i.e. bed wetting;

Poor hygiene, which often leads to social isolation in school;

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;

Anti-social behaviour/criminal activity/exploitation/CSE

Domestic abuse within the family heightens the risk;

Genetic abnormalities in pregnancy or in children who are born.

4. Barriers to Disclosure

4.1 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.

4.2 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.

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

4.4 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 as the sibling may also be a child themselves.

“From as early as she can remember and until she was sixteen years old, Suzanne’s mother and her mother’s family abused her ‘in every way they could think of’. From three or four years old she remembers being beaten ‘so hard [she] couldn’t feel it anymore’ and at six, her maternal grandfather began sexually abusing her. ‘My life was worth absolutely zero’ she recalled”.

An anonymised summary from a victim and survivor, the Truth Project (IICSA 2018)

4.5 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.

4.6 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 to commit suicide as young adults.

5. Responding to Disclosures

5.1 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.

5.2 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.

5.3 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.

5.4 Disclosures are more likely to come in adolescence as they learn about healthy relationships and how to recognise abusive behaviour. Schools 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.

5.5 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.

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

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

5.8 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.

5.9 Some children may never disclose sexual abuse or may disclose it at a much later stage. However where children begin to demonstrate changes in behaviours as listed above, potential child abuse should be considered. Children should be given the time and space to talk and be listened to and practitioners should ask general questions to provide opportunities for children to potentially open up and disclose abuse.

5.10 ‘Not just a thought’ is a communication model which was co-produced by 75 children and young people and many professionals from different agencies including the NHS, Police, social care, education and the voluntary sector. Two key messages the children and young people wanted professionals to do were to:

1. Ask direct questions

If, as a practitioner, you have concerns about a child or young person you are seeing, ask about training. (If you are unsure about communicating with young people and asking direct questions please consult your multi-agency training programme for your area).

2. Think about your presentation

Young people want you to smile at them, to be friendly, to let them know you are ready to hear the thoughts they might want to share.

5.11 They also created some core questions (for health and well-being, where you spend your time, who you spend your time with and next steps) which may help when engaging with children and young people, a sample of the health and well-being questions is listed below.

5.12 For more information go to Not-Just-a-Thought-Report.pdf

How are you feeling today?

How is your general health?

Are you eating ok, all of the time?

Do you smoke anything?

Do you drink any alcohol?

Have you ever taken any drugs?

Do you always feel safe?

Do you have any worries?

Is there anything you are keeping from anyone else or do you have any secrets?

6. Protection and action to be taken

6.1 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 time-frame.

6.2 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.

6.3 See Referrals Procedure and Child Protection Enquiries - Section 47 Children Act 1989 Procedure

6.4 Where a Strategy Discussion / Meeting takes place the core agencies involved with the child should participate. 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.

6.5 If the case does not proceed to an Initial Child Protection Conference a follow up meeting should be held to ensure that any ongoing risks are understood and protective action can be undertaken.

6.6 Any child protection medical assessment must be planned carefully in order to secure any forensic evidence, if it is judged to be appropriate. A medical assessment should also be offered in the cases of historical sexual offences to look at both the welfare of the child and the possibility of gathering evidence of possible trauma. See section Child Protection Medical Assessment

6.7 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 (Home Office 2011). All events up to the time of the video interview must be fully recorded. Consideration of the use of video recorded evidence should take in to account situations where the child has been subject to abuse using recording equipment.

6.8 Visually recorded interviews serve two primary purposes:

Evidence gathering for criminal proceedings;

Examination in chief of a child witness.

6.9 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. (need to check this with Police)

7. Issues to consider

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

7.2 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.

7.3 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.

7.4 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.

7.5 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.

8. Learning from Serious Case Reviews

8.1 'Pathways to Harm, Pathways to Protection: A Triennial Analysis of Serious Case Reviews 2011 to 2014' (DfE 2016) made the following findings about child sexual abuse in the family environment:

‘’There were 23 serious case reviews undertaken which related to sexual abuse or sexual exploitation, of which just one review related to a young man, who was in his mid-teens at the time. While the median age was 14 when the incident(s) occurred, or came to light, there were four victims aged five or younger.

The 13 children who were subjected to intra-familial abuse had a median age of 10 years, and four were aged five or under. All were female. The perpetrator, where known from the final report, was the mother’s partner (38% of cases), the father (25%), a male relative (one instance), the mother (one instance) or both parents (one instance). Two of the children were on a child protection plan at the time, and five had been previously. In the eight instances where the detailed child’s social care history was available, all had been known to children’s social care; three were open cases at the time of the incident, four were closed cases at the time, and one had not reached the level for assessment at the time of referral.’’

Victims of sexual abuse, all but one of whom were girls, ranged in age from under one year to 17 years. Those abused by a family member were generally younger than those abused by someone, or a group of people, outside the family (DfE 2016).

8.2 There are lessons for local safeguarding practitioners to consider in how the work with children and young people is carried out when assessing concerns about sexual abuse and sexual abuse in the family.

9. Points for good practice:

Hearing the voice of the child’ requires safe and trusting environments for children, to be seen away from their parent/carer/potential abuser, to speak freely, and be listened to;

Practitioners must consider how to enable children to express their views while taking account of the child’s age, development, and language barriers. This will be compounded if the child is in any way threatened or coerced by an abusive parent, or if the child has other underlying developmental or communication needs;

Previous research emphasises how children have extreme difficulty in expressing their concerns and that practitioners should not expect children to disclose abuse;

The onus falls to the practitioners and requires an interest in how children express themselves through their behaviour and what they say rather than seeing them as ‘difficult’ or ‘demanding’;

An active effort must be made to actually see and assess children in their families. This is a lesson ‘so important that it must be re-emphasised and potentially re-learnt as people, organisations and cultures change’;

Considerations must be made for children who do not communicate in English and for those children with disabilities who have non-verbal communication.

10. For more Information click on the following links:

Abuse by Children and Young People

Sexual Abuse and FGM Pathways

Sexual Abuse and Violence Care Pathway

11. Additional resources:

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.

Independent Inquiry in Child Sexual Abuse (2018) Interim Report: A Summary

Investigating Child Sexual Abuse - examines timescales for sexual abuse prosecutions and makes recommendations.

‘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.

Measuring the Scale and Changing Nature of Child Sexual Abuse and Child Sexual Exploitation - Scoping Report July 2017 , Professor Liz Kelly and Kairika Karsna (Centre of Expertise on Child Sexual Abuse)

NHS England - Strategic Direction for Sexual Assault and Abuse Services (2018-2023)

‘Not just a thought’ A Communication Model. Learning with children, young people and young adults about how we keep them safe. Not-Just-a-Thought-Report

Preventing Child Sexual Abuse: The Role of Schools - examines the important role schools can play in enabling children to recognise abuse.

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

Therapeutic Services for Sexually Abused Children and Young People Scoping the Evidence Base, Prepared by Debra Allnock and Patricia Hynes Summary Report December 2011