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6.4 Sexual Health and Relationships

REGULATIONS AND STANDARDS

The Health and Well-being Standard
Regulation 10

RELATED GUIDANCE AND INFORMATION

Promoting the health and well-being of looked-after children: Statutory guidance for local authorities, clinical commissioning groups and NHS England

NHS Choices – Sexual Health

Family Lives – Teenagers and Sex

AMENDMENT

In July 2017, Section 3, Pornography, was updated to include advice for staff on how to deal with issues relating to young people’s access to pornography online.


Contents

  1. Provision of Information and Advice
  2. Puberty and Sexual Identity
  3. Pornography
  4. Sexual Activity in Homes
  5. Contraception
  6. Pregnancy and Termination
  7. Child Sexual Exploitation
  8. Sexually Transmitted Infections
  9. Masturbation
  10. Peer Group Abuse


1. Provision of Information and Advice

Home Managers must ensure that children are provided with suitable, good quality, up to date, information and advice on matters relating to sexual health and relationships.

Such information and advice must be provided in a manner appropriate to children's age and understanding and which is provided in a creative, child friendly manner.

Before providing such information and advice, Home Managers must consult social workers and, if possible, parents or those with Parental Responsibility to ensure it is provided in the context of children's backgrounds and needs; and any specific arrangements must be incorporated into the child's Placement Plan.


2. Puberty and Sexual Identity

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

Staff must adopt the same approach to 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.

Children 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 Placement Plans.


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.

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 staff 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).

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.


4. Sexual Activity in Homes

Children under the age of 13 are deemed to be incapable of giving consent to sexual activity. Therefore, children of this age who engage in sexual activity must be referred under safeguarding children procedures (as a Child Protection Referral) as potentially suffering from Significant Harm.

Home Managers must be alert to such relationships when considering the placement of children under 13. Children of this age who are likely to be at risk from each other (or from older children) should not be placed together. See Referring Safeguarding Concerns Procedure.

When considering the placement (or ongoing placement) of children over the age of 13, Home Managers must assess the risk of sexual relationships developing and should ensure strategies are in place to reduce or prevent these risks if they are likely to be exploitative or abusive.

Where children aged 13 - 18 are placed together with no identified risk of exploitative or abusive behaviour, Home Managers and staff must monitor any developing relationships, sensitively but positively discouraging children from engaging under aged sexual relationships.

Overall, staff 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. 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 consulting the Child Protection Agencies.

Any actions taken in this respect will be subject to consultation and must be addressed in Placement Plans.

Should staff suspect children are engaging in sexual relationships, they should:

  1. Ensure the basic safety of all the children concerned;
  2. Notify the Home Manager, who should notify/consult relevant social workers and consideration given to reviewing the Child's Placement Plan;
  3. Record all events in the Daily Log, relevant Child's Daily Record and an Incident Report should be completed.

Should staff discover children engaging in sexual relationships, they should:

  1. Ensure the basic safety of all children concerned (if necessary staff may consider removal of one or more child);
  2. Inform the Home Manager, who should notify/consult relevant social workers and and consideration given to reviewing the Child's Placement Plan. Record all events in the Daily Log, relevant Child's Daily Record and an Incident Report should be completed.

If the incident is serious or persistent, the Designated Manager (Sexual Health) should be notified and consideration given to whether the incident is a Notifiable Event, see Notification of Serious Events Procedure.


5. Contraception

Access to contraceptives will not be conditional on children giving information about their lifestyles and contraception will never be withdrawn as a punitive measure.

Whilst not encouraging it, it is understood that children may engage in sexual activity; some before they reach the age of consent.

In such circumstances staff must take reasonable steps to minimise risk of pregnancy or infection, including facilitating contact with relevant agencies providing contraceptive advice; such as the Brook Advisory Service.

Matters of concern must be discussed with the social worker and addressed in Placement Plans.


6. Pregnancy and Termination

If a child is suspected or known to be pregnant the Home Manager should normally talk openly to the child about who should be informed and what support the child may require to promote their own and the unborn baby's welfare.

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

However, a child may request that parent(s) and/or that the social worker is not informed.

In all cases where there are any concerns or suspicions that the pregnant child or the unborn child is or will be at risk of significant harm, the Home Manager must discuss it with the child's social worker with a view to making a child protection referral. In these circumstances it must be explained to the child why his or her request for confidentiality cannot be agreed. See Referring Safeguarding Concerns Procedure.

In any case, the Designated Manager (Sexual Health) should be notified.

In cases where there are no child protection concerns, the child should be encouraged to inform his or her social worker and parents. Where the child is sixteen, however, a request to keep the pregnancy confidential from his or her parents may be respected. Where a child under the age of sixteen requests confidentiality, it may be possible to agree this if the child is of an age and level of understanding to make such an informed decision.

However, where a child under sixteen makes such a request, the Home Manager should notify/consult the Designated Manager (Sexual Health) before agreeing.

See Consents Guidance.

Where a child wishes to terminate a pregnancy, the social worker must be notified/consulted with a view to providing advice, counselling and support by suitably qualified independent counsellors.

If the termination goes ahead, the manager must ensure that the child's privacy is protected and any physical or emotional needs are addressed sensitively.


7. Child Sexual Exploitation

Also see Safeguarding Children and Young People from Sexual Exploitation Procedure.

The following should be read in conjunction with relevant procedures held by Local Safeguarding Children Board Procedures in the area where the home is located.

Children may have previously exchanged sex for rewards, gifts, drugs, accommodation and money. Some maintain this lifestyle whilst continuing to be accommodated by the authority.

The Home Manager and staff must be alert to such behaviours and should do all they can to create an environment which encourages children to be open about their past or present attitudes and behaviours and which demonstrates they will be supported to guide them away from such lifestyles.

Where there is any suspicion that a child is engaged in such behaviour it should be addressed in the child's Placement Plan together with Strategies to be adopted to help the child find alternative lifestyles.

In addressing these behaviours consideration must be given to the extent to which the child is suffering significant harm - and whether it is necessary to make a child protection referral, see Referring Safeguarding Concerns Procedure.

In any case, the social worker must be notified, and the Designated Manager (Sexual Health), who must consider whether the incident is a Notifiable Event, see Notification of Serious Events Procedure.


8. Sexually Transmitted Infections

Also see HIV and AIDS Guidance

If it is known or suspected that a child has a sexually transmitted disease (other than HIV and AIDS, which is dealt with in HIV and AIDS Guidance), the Home Manager and social worker must be informed and decide what measures to take. The Designated Manager (Sexual Health) should also be notified and consulted.

On 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 staff 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 home 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.

8.1 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.


9. 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, which is not harmful to themselves or other people.


10. Peer Group Abuse

The following should be read in conjunction with relevant procedures held by Local Safeguarding Children Board procedures - in the area where homes are located.

The possibility of peer abuse will always be taken seriously but we recognise it is equally important not to label or stigmatise normal sexual exploration and experimentation between children.

Behaviour is not a cause for concern unless it is compulsive, coercive, age-inappropriate or between children of significantly different ages, maturity or mental abilities.

If at any time staff suspect children are engaged in abusive sexual relationships as perpetrators and/or victims, they must immediately inform the Home Manager, who must consult the social worker and make a referral under the Referring Safeguarding Concerns Procedure.

The Designated Manager (Sexual Health) must be notified and consulted, consideration should be given to whether the a Notifiable Event has occurred, see Notification of Serious Events Procedure.

End