Working with Sexually Active Young People

ACKNOWLEDGEMENT

This chapter has been adapted with the permission of Lincolnshire Safeguarding Children Partnership.

AMENDMENT

This chapter was updated in May 2024..

1. Introduction

There are two parts to this document: Part One is a Protocol and should be followed and embedded within Agency processes and the Part Two is broader Guidance/information that Practitioners may find useful when supporting young people who are sexually active.  Both Part One and Part Two are relevant to all Practitioners working with children and young people.

In relation to Part One (Protocol):

Cases of underage sexual activity must be handled sensitively by Practitioners. The Sexual Offences Act 2003 sets out the Law in relation to all children and young people under the age of 16 who legally cannot consent to sex, but makes a separate distinction for children under 13 for whom any sexual activity should be considered to put a child at risk of serious harm. However, it is recognised that most young people aged over the age of 16 will have a healthy interest in sex and sexual relationships.

Therefore Part One is designed to assist staff to identify where sexual relationships may be abusive and whether a child or young person may need the provision of protection or additional services in relation to sexual activity. Sexual relationships can be abusive for a number of reasons, but the primary association is the presence of a power imbalance.

2. Part One - Protocol for Working with Sexually Active Young People

2.1 Legislation

The following information, based on the Sexual Offences Act 2003, provides an outline of the Law in relation to children and young people under the age of 18 years old. 

The legal age that a young person can consent to sexual activity is 16; but it is not clear cut in all circumstances.

Children under the Age of 13

Sexual activity with a child under the age of 13 is illegal, as according to Law, s/he is not considered able to consent to such behaviour; therefore any type of sexual activity, is considered as risk of significant harm to the child. (See Section 5, Sexual Offences Act 2003).

In all cases where a Practitioner becomes aware that a child under the age of 13 is sexually active they must discuss it with the Safeguarding Lead in their Agency, or their Line Manager and make a referral to Children's Social Care and/or the Police.

Brook's online Traffic Light Tool distinguishes between healthy and harmful sexual behaviours by the age of the child or young person. You can use this as a guide if you are concerned about any sexual behaviours of someone you are supporting. You should consider the maturity and developmental age of the child/young person when using the tool.

Children and Young People aged 13-15 years

Sexual activity with a young person under 16 is also an offence. However, the Law does not intend to prosecute mutually agreed teenage sexual activity, between two young people of a similar age unless there is evidence of abuse or exploitation. This can only be ascertained through the use of professional curiosity and the sharing of information to inform an assessment of the risk. (See Safeguarding Children from Sexual Exploitation Procedure).

Consideration should be given in every case of sexual activity involving a young person aged 13 - 15, as to whether there should be a discussion with other Agencies, and whether a referral should be made to Children's Social Care and/or the Police.

Young People over 16 and under 18 Years Old

Sexual activity with a young person over the age of 16 is not an offence; however young people under the age of 18 are still offered protection under the Children Act 2004 and can still suffer Significant Harm as a result of sexual exploitation and abuse. The support and protection they are entitled to should not be downgraded as a result of their age.

Young women and men over the age of 16 but under the age of 18 are deemed unable to give consent if the sexual activity is with an adult in a position of trust or a family member; as defined by the Sexual Offences Act 2003. It is also illegal for someone to have sex with a person who has a mental disorder that impedes choice (see Mental Capacity Act 2005).

If a Practitioner is concerned that a child or young person may be experiencing, or is at risk of, child sexual exploitation then they should complete the Pan Bedfordshire Child Exploitation Risk Identification Tool.

Child Sexual Exploitation

The Government has recently revised the definition of Child Sexual Exploitation: 

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.

(Child sexual exploitation: definition and guide for practitioners, DfE, 2017)

Like all forms of child sexual abuse, child sexual exploitation:

  • Can affect any child/young person (male or female) under the age of 18 years, including 16 and 17 year olds who can legally consent to have sex;
  • Can still be abuse even if the sexual activity appears consensual;
  • Can include both contact (penetrative and non-penetrative acts) and non-contact sexual activity;
  • Can take place in person or via technology, or a combination of both;
  • Can involve force and/or enticement-based methods of compliance and may, or may not, be accompanied by violence or threats of violence;
  • May occur without the child/young person's immediate knowledge (through others copying videos or images they have created and posting on social media, for example);
  • Can be perpetrated by individuals or groups, males or females, and children or adults. The abuse can be a one-off occurrence or a series of incidents over time, and range from opportunistic to complex organised abuse; and
  • Is typified by some form of power imbalance in favour of those perpetrating the abuse. Whilst age may be the most obvious, this power imbalance can also be due to a range of other factors including gender, sexual identity, cognitive ability, physical strength, status, and access to economic or other resources.

(See Bedfordshire Against Violence and Exploitation (BAVEX), Violence Exploitation Reduction Unit (VERU) for further information)

Non consensual sex is rape, whatever the age, sexuality, gender (including transgender) of the victim.

Guidance issued by the College of Policing states that 'if a victim is incapacitated through drink or drugs, or the victim, or his or her family, has been subjected to violence or the threat of it, they cannot be considered to have given true consent and, therefore offences may have been committed'. [1]

In these circumstances the following may be helpful for practitioners to be aware of:

[1] College of Policing (www.app.college.police.uk/app-content/major-investigation-and-public-protection/child-sexual-exploitation)

2.2 Confidentiality

When working with children and young people, it must always be made clear to them at the earliest appropriate point that absolute confidentiality cannot be guaranteed. This is because there may be some circumstances where their needs can only be safeguarded by sharing information with others. This could include parents/carers, other practitioners and the child/young person should be informed.

This discussion with the child/young person may also prove useful as a means of emphasising the gravity of some situations.

On each occasion that a child or young person is seen, consideration should be given to whether their circumstances have changed or whether further information is disclosed which may lead to the need for referral or re-referral.

In some cases urgent action may need to be taken to safeguard the welfare of a young person. However, in most circumstances Practitioners will need to complete and Early Help Assessment with the child/young person and/or family to explore the circumstances further. If on completion a need is identified that requires other practitioner's involvement then a Team Around the Child (TAC) can be initiated (See Early Help and Team Around the Child).

2.3 Factors to consider in Assessment

The following factors should be considered when assessing whether a child/young person is at risk of harm because of involvement in sexual activity:

  • The age of the child - sexual activity at a young age is a very strong indicator that there are risks to the welfare of the child (whether boy or girl) and, possibly, others;
  • The level of maturity and understanding of the child;
  • What is known about the child's living circumstances or background;
  • Age imbalance - in particular where there is a significant age difference;
  • Overt aggression or power imbalance;
  • Coercion or bribery;
  • Familial child sex offences;
  • Behaviour of the child i.e. Withdrawn, anxious;
  • The misuse of substances as a dis-inhibitor, or a coping mechanism;
  • Whether the child's own behaviour, e.g. Because of the misuse of substances or other reason, places him or her at risk of harm so that he or she is unable to make an informed choice about any activity;
  • Whether any attempts to secure secrecy have been made by the sexual partner, beyond what would be considered usual in a teenage relationship;
  • Whether the child denies, minimises or accepts concerns;
  • Whether the methods used to involve a child/young person in sexual activity are consistent with the grooming process; and
  • Whether the sexual partner/s is known by one of the agencies;
  • Child/young person with SEND subject to their learning ability and capacity.

2.4 Assessment and Referral

The Early Help Assessment (EHA) process has been designed to help Practitioners assess needs at an early stage and then work with the child young person, their family and other practitioners and agencies to meet these needs. As such, it is designed for use when:

  • You are worried about how well a child/young person is progressing;
  • You might be worried about their health, development, welfare, behaviour, progress in learning or any other aspect of their wellbeing;
  • A child/young person or their parent/carer raises a concern with you;
  • The child/young person's needs are unclear, or broader than your service can address alone;
  • The child/young person would benefit from an assessment to help a practitioner understand their needs better.

If you have any of these concerns complete an Early Help Assessment with the child and family. If on completion a need is identified that you are unable to address as a single Agency, you will need to initiate a Team Around the Child (TAC) (please see Early Help Assessment (EHA) Procedure).

If you are unsure what action to take you could have a consultation with the Early Help Service via the relevant Children's Services Social Care.

If you believe a child or young adult under the age of 18 years might be suffering or is likely to suffer significant harm (including any mistreatment or abuse), please contact the relevant Children's Social Care. If it is outside normal office hours you can contact the Emergency Duty Team on 0300 300 8123. If your referral is assessed as a safeguarding concern, then you will be required to complete the Safeguarding Referral Form as written confirmation of your referral. Send this via secure email (or post) to the locality area team as directed by the call advisor at the time of referral. If your concern is in relation to an unborn child then you should follow the Pan Bedfordshire Procedure and Guidance in relation to Pre-Birth Planning and Assessments Procedure.

For all Safeguarding Children Policies and Procedures go to the Pan Bedfordshire procedures or consult your own Agency's Policies and Procedures.

3. Part Two - Further Guidance for Practitioners Working with Sexually Active Young People

3.1 Healthy Relationships

When relationships are healthy, they help people to thrive.

If a young person has been abused is can be difficult for them to talk about it. Often people feel worried about what will happen if they speak out. Sometimes people who have been abused are fearful that they won't be believed. Some young people may not recognise that they are a victim of abuse.

Always make sure the young person is aware of the confidentiality statement prior to entering into any discussion so it understood that the information may need to be shared with someone else if a crime has been committed or the young is at risk of harm.

Most people have more than one sexual relationship during their life. Going out with different people helps determine what people want from a relationship. Good relationships are based on respect, trust, and good communication regardless of who the relationship is with.

Being in a relationship with someone should be a positive experience. It probably won't be perfect all the time, but a relationship should never make anyone feel bad. No-one should EVER feel like they are not able to be 'who they are' in a relationship.

Good communication allows individuals to have a deep understanding of each other and helps to prevent misunderstandings. It is important that partners express to each other anything they are not comfortable with; whether related to sex, family and friends, personal space, money, or time.

In a healthy relationship with boundaries, both partners respect each other and allow each other to spend time with friends and family. The use of technology to check on a partner is a form of abuse and coercive control.

There are many organisations that can offer support, and who are there to help:

Recent research commissioned by the Office of the Children's Commissioner has examined young people's understanding of sexual consent. The researchers found that for many young people, both consent and coercion were 'slippery concepts'. Many of the young people were unclear that consent was something which still had to be sought and given even when in a sexual relationship.  When discussing sexual assault, young people drew on stereotypes of rape as an act committed by strangers. Many young people reported that they were unsure if being coerced into sex when drunk constitutes rape. The researchers also identified that 13 to 14 year olds are the age group that is least likely to recognise non-consensual sex than older age groups. [2]

Resources for Practitioners to explain consent to young people

  1. How to discuss sexuality, sexual abuse, and violence with young people.

What young people say about how practitioners can build a relationship with them?

  • Don't force me to talk;
  • Don't act as if you have more power;
  • Don't assume;
  • Don't put the blame on me.

What young people say about helping them to talk about sex?

  • I need to trust the person;
  • It's important to be available; to build a connection;
  • Be human!
  • Share some of your own experiences. This makes me realise I'm not crazy;
  • The setting/environment needs to feel safe and be young person friendly (not an office);
  • I'd prefer not to have to look the other person straight in the eye;
  • Let me do something creative, for example draw;
  • Meet me in my space, or a space I have chosen.

What young people say about practitioners asking specific questions?

Don't:

  • Ask me 'Why did you do this? Why didn't you just kick him out?'
  • Ask me to give details.

Do ask:

  • Do you know what you like and what you don't? How do you deal with that?
  • Did you ever go too far? How did you feel?
  • Do you dare say no? How do you do that?
  • Did something happen in the past (which you haven't had the courage to talk about yet)?
  • Can you tell me what happened?
  • Do you ever feel like it's your own fault, that you're to blame?

For practitioners to help young people understand that sexual consent is where a person has the freedom and the mental capacity to agree to sexual activity they can show them this video which will help them understand what consent means by instead of initiating sex they are making a cup of tea (see Tea and Consent).

[2] Coy, M et al. (2013) "Sex without consent, I suppose that is rape": How young people in England understand sexual consent. A report commissioned for the Office of the Children's Commissioner's Inquiry into Child Sexual Exploitation in Gangs and Groups. (London Metropolitan University: Child and Woman Abuse Studies Unit) p68

3.3 Contraception

Contraception refers to the methods that are used to prevent pregnancy. Some methods of contraception (condoms) can also be used to prevent some sexually transmitted infections (STIs).

Emergency Hormonal Contraception (EHC) can be used after unprotected sex, to protect from pregnancy. This is often referred to as 'the morning after pill'. Some EHC can be taken up to 5 days after unprotected sex or an emergency coil can be fitted up to 7 days after unprotected sex. There is always a risk of sexually transmitted infections (STIs) after unprotected sex however some pharmacies offer Emergency Hormonal Contraception free of charge, call iCaSH on 0300 300 3030 to find out which pharmacies offer this service.

Contraception is free on the NHS and is available from a range of places including Young People's Services, GP Surgeries, Genitourinary Medical Clinics (GUM) or Sexual Health Clinics and Family Planning Services. The 'C Card' scheme offers free advice and condoms to young people between the ages 13-19 (25 LDD) for information on contraception including 'C Card' visit. See iCASH C-Card Scheme or Luton Sexual Health C-Card.

3.4 Sexually Transmitted Infections

An STI, or sexually transmitted infection, is any kind of bacterial or viral infection that can be passed on through unprotected sexual contact. Anyone can get an STI as it doesn't matter how many partners you have had, or how many times a person has had sex.

STIs don't always have noticeable symptoms so after having unprotected sex testing is always recommended to prevent further spread of infection or long-term harm.

To protect from STIs it is advised that a barrier method should be used every time a person has any type of sexual contact. Condoms and femidoms are the methods of contraception that protect against pregnancy and STIs. Even if you're using another method of contraception, like the pill, to protect against pregnancy, you should still use a barrier method as well.

Chlamydia is one of the most common sexually transmitted infections in the UK. In England, it is recommended that those under 25 years who are sexually active get tested for chlamydia every year, or when a person has a new sexual partner.

A young person can feel nervous about being tested but most infections are easily treated if identified at an early stage. The young person should be supported to attend a Sexual Health Clinic and be reassured that staff at Sexual Health Clinics are non-judgemental, professional and supportive. Advice will also be given on protecting the young person in the future. Online testing is also available for anyone over the age of 16.

For further information on sexual health issues visit iCaSH Bedfordshire and www.lutonsexualhealth.org.uk.

3.5 HIV (Human Immunodeficiency Virus)

HIV is a virus that damages the body's immune system so it cannot fight off infections. It is most commonly transmitted through vaginal or anal sex without using a condom.

Over half of those living with HIV are heterosexual. It is a myth that HIV only affects men who have sex with men.

AIDS (Acquired Immune Deficiency Syndrome, sometimes referred to as 'late stage HIV') is the final stages of HIV infection when the body can no longer fight off life threatening infections. With early diagnosis and regular effective medication most people with HIV will not go on to develop AIDS.

Often a person with HIV won't have symptoms for many years but in that time, HIV will multiply and cause progressive damage to the immune system. Testing often and as early as possible is recommended.

The causes of HIV and how it's passed on

HIV is passed on by blood and some bodily fluids, so to get HIV, one of these fluids from someone with HIV, must get into the blood.

HIV is most commonly transmitted by sex without a condom. Around 95% of all people living with HIV in the UK most likely acquired their infection through sex without a condom.

  • Anal or vaginal sex without a condom is the main route of transmission.

YOU CAN GET HIV FROM:

  • Vaginal or anal sex without a condom if your partner has an unknown HIV status, a detectable viral load and you aren't taking PrEP—high risk;
  • Sharing injecting drug equipment—high risk;
  • Oral sex—low risk;
  • A woman can pass HIV onto her baby in the womb, during childbirth and from breastfeeding, though effective HIV medication makes this extremely unlikely – low risk – testing now takes place in ante-natal and is an opt-out.

YOU CAN'T GET HIV FROM:

  • Sex with a partner who has HIV but is on treatment and has an undetectable viral load (learn more about undetectable equals untransmittable (U=U));
  • Touching, hugging, shaking hands or sharing utensils;
  • Kissing, spitting or sharing saliva;
  • Urine or faeces;
  • Biting or scratching;
  • Insect bites;
  • Contact with a discarded needle.

Who is most at risk?

  • In 2017, 2,330 of men who have sex with men were newly diagnosed. This is a 31% decrease since 2015 and reflects the success of increased HIV testing and increased uptake of HIV treatment.
  • Black African people make up 29.1% of all people accessing HIV care in 2017.

Testing for HIV

Everyone should be tested. Delaying testing and treatment will allow the virus to damage the immune system. It also means the virus could easily be passed to someone else.

HIV can be tested for four weeks after exposure to the virus. The test does not detect the virus itself but the antibodies that your body has developed to fight it. The most common way of testing for HIV involves taking a small sample of blood for analysis. In some cases, this is sent away to a laboratory and results come back in a few days. Same-day tests are also available and can give an instant result.

It is also possible to test a saliva sample or to test blood taken from pricking the finger with a needle.

If no sign of infection is found, the test results are 'negative'. If the infection is detected, the test results are 'positive'. All positive results should be tested again to confirm as a 'false positive' may occur. This can happen, for example, when antibodies fighting another infection are detected but wrongly identified as being antibodies fighting the HIV infection.

False negatives are also possible and are most likely to happen in the window period between infection and the antibodies reaching a high enough level to be detected (around four weeks).

HIV testing is free on the NHS and can be provided at GUM or sexual health clinics, clinics run by charities and some GP surgeries.

Emergency treatment for HIV

If someone has/possibly been exposed to HIV within the last 72 hours (three days), it is possible to take anti-HIV medication called PEP (post-exposure prophylaxis) which may stop the person becoming infected.

This is sometimes described as being like the morning after pill (emergency hormonal contraception) for HIV. But this is misleading as PEP is a 28-day treatment of powerful drugs. It is only recommended after high-risk of exposure (for example if a partner is known to be HIV positive).

Information for schools and other professionals

The Children's HIV Association (CHIVA) have released a good practice guide to supporting children living with and affected by HIV, which includes how a school can be HIV friendly, how to manage disclosure, confidentiality, and a links to other school policies, including first aid procedures. CHIVA Resources.

3.6 Pregnancy

Everyone reacts differently to finding out they're pregnant. The young person may feel very happy or may feel shocked or worried. Most people need time to think about their situation and will require information about what to do next.

If a young person thinks they might be pregnant but is not sure, it is important they take a pregnancy test as soon as possible. For young people under 25 years free pregnancy testing is part of the 'iCaSH Scheme; to find the nearest venue see iCaSH Bedfordshire and Luton Sexual Health.

If the young person is less than 24 weeks pregnant (a doctor will confirm) there are two options available, and the young person has the right to choose any one of them:

  • Continuing the pregnancy;
  • Ending the pregnancy.

The legal limit for termination in England, Scotland and Wales is, in most cases, is under 24 weeks' gestation.

For some people, making a decision about what to do can be difficult. However easy or hard the decision, it is the young person's decision to make. The more the young person feels they have made their own choice, the better they will feel about it. It is important that the practitioner has assessed that the young person has the capacity and competence to make this decision. Please refer to NSPCC, Gillick competency and Fraser guidelines or for young people 16 years and over to the Mental Capacity Act.

Information available to the young person should include the following:

  • How to take a pregnancy test;
  • All about emergency contraception;
  • Information about having a baby;
  • Advice on having a termination of pregnancy;
  • Having a termination of pregnancy if you're under 16;
  • How terminations of pregnancy are carried out.

For more information:

3.7 Young People with Special Educational Needs (SEND)

All children and young people are potentially at risk of harm, though some groups – for example, children and young people who have a disability – may be at increased risk of sexual exploitation.

Every young person with special educational needs and/or physical disabilities has a unique set of needs. Open communication and good quality sex and relationships education can protect young people from harm; enable them to make informed decisions and help them look after their sexual health when they eventually start having sex.

Both the 2015 report 'Overprotected, Unprotected' commissioned by Barnardo's and the NSPCC recommended that 'all educational establishments should provide high quality, age appropriate sex and relationships education; including same sex relationships, with information adapted and made accessible.' If not delivered as part of the curriculum, young people with SEND are less likely to have access to sexual health information or develop an understanding of sexual relationships.

The Disability Discrimination Act states:

  • Give people with any kind of impairment, including learning disability, the right to equal treatment, in terms of accessing goods and services, which includes services such as family planning clinics and advice centres;
  • This law is saying that schools and sexual health services have a legal obligation to give young people with learning disabilities an equal service.

Mental Capacity Act states:

The Mental Capacity Act applies to young people aged 16 years and over.

  • A person is assumed to have capacity unless it is established that he or she lacks capacity. (Presumption of capacity);
  • A person is not to be treated as unable to make a decision unless all practicable steps to help him or her to do so have been taken without success. (Provision of support to assist to decision making);
  • A person is not to be treated as unable to make a decision merely because he or she makes and unwise decision. (Right to make unwise decisions);
  • An act done or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his or her best interests. (Act in person's best interests);
  • Before the act is done or the decision is made, regard must be given to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. (Consider less restrictive option).

What is healthy sexual development?

There are a range of sexual behaviours that reflect safe and healthy sexual development. They are:

  • Displayed between children or young people of similar age or developmental ability;
  • Reflective of natural curiosity, experimentation, consensual activities and positive choices;
  • Expressing sexuality through sexual behaviour is natural, healthy and a part of growing up. These behaviours provide an opportunity to positively reinforce appropriate behaviour, and to provide further information and support.

If you are concerned that behaviour is outside safe and healthy development you can get help from a specialist organisation who will advise you. These include:

Sexual Health Services

Sexual Health Services are free and confidential, and available to everyone; regardless of sex, age, ethnicity, disability and sexual orientation.

If a Professional is referring a young person with a disability or special educational requirement or needs an interpreter, it is useful to let the Sexual Health Service know so they can make arrangements in advance of their attendance.

It is important for the Professional within the Sexual Health Service to establish if the young person:

  • Understands about sexual health, consent and the Law;
  • Understands the difference between friendships and relationships;
  • Understands sexuality and same sex relationships and consent;
  • Understands the difference between appropriate and inappropriate behaviour;
  • Has an understanding of sexual reproduction and contraception;
  • Knows how to stay safe online and can identify sexual exploitation.

Everyone has the right to get all the information they need so that they can make informed choices about what's right for them. They also need to know when the Law will make those choices. iCaSH services are free and confidential and open to anyone from 13 years and older.

Sexual Health Services can support young people to make informed choices about their sexual health and well-being as well as providing access to contraception, screening for sexually transmitted infections and signposting to other support services when necessary.

Caring for a young person with special educational needs and/ or disabilities can present a range of different support requirements and concerns for parents or carers. These can include concerns about the individual's capacity to consent to make sexual decisions, addressing inappropriate behaviours, or not being able to form or sustain relationships.

Other services may need to be contacted if Healthcare Practitioners believe that the young person or another person is at risk of harm, such as physical or sexual abuse. However, if this is the case, it should be discussed with the young person during their visit.

If the young person needs to have an examination, this should be undertaken by an appropriately trained practitioner and the young person should be offered a chaperone; in accordance with Agency protocols.

There are support services across the Country offering advice and information to children and young people. You can contact:

  • GPs;
  • Social Care;
  • Specialist Children's Learning Disability services;
  • 5 -19 Service Children and Young People's Nurse or School Nurse;
  • Hospital and Women's and Children Staff.

For detailed information on supporting young people: Contact Website.