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4.7.5 Sexual Health


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. Child Sexual Exploitation
  9. Sexually Transmitted Infections
  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.

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 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 gender or sexual identity or who have decided to embrace a particular lifestyle so long as it is not abusive or illegal.

Children who are confused about their sexual identity or gender 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 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 in an abusive or exploitative relationship it must be discussed with the social worker and consideration given to making a referral under the Hull Safeguarding Children Board Guidelines and 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.

Fraser Competent

The Fraser Competent guidelines were issued by Lord Fraser in 1985, following the House of Lords ruling in the case of Gillick v West Norfolk and Wisbech are Health Authority. The 'Fraser Guidelines' apply to Doctors and health professionals in England and Wales.


6. Pregnancy and Termination

If a young person is suspected or known to be pregnant the social worker, staff and carers should talk to the young person about who should be informed and what support they may require to promote their own and the unborn baby's welfare.

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

Where a young person under sixteen makes such a request, their social worker should seek legal advice before agreeing that the parents should not be informed.

In all cases, should there be suspicions that the young person who is pregnant and/or the unborn child are at risk of Significant Harm, the child's social worker must take action under the Hull Safeguarding Children Board Guidelines and Procedures.

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

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

See also Hull Safeguarding Children Board Guidelines and Procedures Manual, Unborn Procedures and Guidance (Pre Birth Pathway).


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

See also Hull Safeguarding Children Board Guidelines and Procedures, Children Sexual Exploitation Procedure.

If the child is going missing, see Missing Children and Young People Procedure and Guidance

Children of any sexual orientation and ability may be abused through sexual exploitation.

Staff/carers need to be alert to any behaviour that might indicate that the child is involved in sexual exploitation 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 some children are emotionally and physically controlled by people who organise child sexual exploitation; 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 at the Placement Planning Meeting and in the child’s Placement Plan through strategies to help the child find alternative lifestyles. Consideration should be given to referring to the HSCB Child Sexual Exploitation Meeting. If a child is engaged or suspected to be engaged in sexual exploitation, the Regulatory Authority, local authority and Police for the area where the child is placed, must be informed.

Children abused through sexual exploitation 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 ability to exit child sexual exploitation.


9. Sexually Transmitted Infections

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 infection, 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

See also BAAF Practice Note No 53 – Guidelines for the Testing of Looked after Children who are at risk of Blood-Borne Infections

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.

See also Practice Guidance: Supporting Young People with HIV Testing and Prevention.


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.

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