3.11.1 Working with Sexually Active Young People
A summary of this chapter is available – see the Factsheets section in Local Resources.
Sheffield Sexual Health Services
'Best practice guidance for doctors and other health practitioners on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health'
AMENDMENTThis chapter was updated in October 2019. Appendix 2: CSE Spotting the Signs guidance was added.
Cases of underage sexual activity are likely to raise difficult issues for practitioners, and need to be handled with particular sensitivity. The Sexual Offences Act 2003 sets out the law in relation to all children and young people under 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, we recognise that most young people aged over the age of 16 will have a healthy interest in sex and sexual relationships.
Therefore this protocol 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 primarily it is associated with a power imbalance. This may be due to a child, young woman or young man's mental ill health, psychological problems, emotional immaturity, physical disability, learning disability or other communication difficulty, substance misuse, low self-esteem or other vulnerability. It may also reflect differences in age, size, or development between the partners. The partner may have psychological problems, or a personality disorder, or they may be in a position of trust in relation to the child or young person. It may be a combination of these factors.
2. The Sexual Offences Act 2003
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.
2.1 Children under the Age of 13
Sexual activity with a child under the age of 13 is illegal, as under the law s/he is not considered able to consent to such behaviour. Any type of sexual activity therefore, is considered as risk of Significant Harm to the child.
In all cases where a practitioner becomes aware that a young person under the age of 13 is sexually active they must discuss it with the safeguarding lead in their agency or their line manager. The practitioner, their manager or safeguarding lead must contact the Public Protection Unit, South Yorkshire Police (0114 220 2020) and Children's Social Care to make a referral (see Local Contacts).
2.2 Children and Young People aged 13-15
Sexual activity with a child under 16 is also an offence. Where the young person is in agreement it may be legally less serious than if the child was under 13, but nevertheless it may have serious consequences for the welfare of the young person. Consideration should be given in every case of sexual activity involving a child or young person aged 13 - 15, as to whether there should be a discussion with other agencies, and whether a contact is required with the Public Protection Unit, or a referral should be made to Children's Social Care. The practitioner involved should make this assessment, in consultation with their line manager, using the Assessment (see Section 4, Assessment).
Within this age range, the younger the child the stronger the presumption must be that sexual activity should be a matter of concern. Cases of concern should be discussed with the safeguarding lead within the agency, and subsequently with other agencies if required. Where confidentiality has been provisionally offered, a discussion can still take place without identifying the child (directly or indirectly). Where there is reasonable cause to suspect that Significant Harm to a child has occurred or might occur, there would be a presumption that the case is reported to Children's Social Care. A Strategy Discussion should be held to discuss appropriate next steps. South Yorkshire Police should also become involved at this stage, through this process. Again, all cases should be fully documented and include detailed reasons where a decision is taken not to share information. For more information about Information sharing, see Section 3, Confidentiality below and see Underlying Principles and Values Procedure, Information Sharing and Confidentiality.
In some cases a decision may be made by South Yorkshire Police and the Crown Prosecution Service, to prosecute in conjunction with the other agencies involved. If so, South Yorkshire Police should liaise with all the agencies involved and keep them informed, as much as they are able, about relevant information about the investigation.
2.3 Young People over 16 and under 18 Years Old
Although sexual activity in itself is not an offence over the age of 16, young people under the age of 18 are still offered protection under the Children Act 2004. Consideration needs to be given to issues of sexual exploitation and abuse of power in circumstances outlined above. If such an incident occurs, the circumstances should be explored with them and reported to South Yorkshire Police, as appropriate. If a practitioner is concerned a young woman or young man is being sexually exploited, advice can be obtained from the Sexual Exploitation Service (see Local Contacts). See Child Sexual Exploitation Procedure for more information.
Young women and men over the age of 16 and under the age of 18 are not deemed able 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.
In 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 (for guidance on information sharing and confidentiality, please refer to see Underlying Principles and Values Procedure, Information Sharing and Confidentiality.
This discussion with the young person may 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 further information is given 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 there will need to be a process of information sharing and discussion in order to formulate an appropriate plan. There should be time for reasoned consideration to define the best way forward.
The following factors should be considered when assessing whether a child or 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;
- 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 or young person in sexual activity are consistent with the grooming process; and
- Whether the sexual partner/s is known by one of the agencies.
All discussions should be recorded, giving reasons for action taken and who was spoken to, as support for the practitioner decisions made. It is important that all decision-making is undertaken with full practitioner consultation, never by one person alone.
In cases of concern, when sufficient information is known about the sexual partner/s, the practitioner should check with other agencies, particularly the police to see what information is known about them. The police should be able to share this information if the agency requests this, without launching a full investigation.
5. Sharing Information with Parents / Carers
Decisions to share information with parents / carers will be taken using practitioner judgement, following discussion with the child or young person and in consultation with other involved agencies. Decisions will be based on their age, maturity and ability to appreciate what is involved in terms of the implications and risks to themselves. Their relationship with their parents / carers, and the nature of the sexual relationship should also be considered when making a decision, as well as the parents' / carers' ability and commitment to protect their child.
Given the responsibility that parents have for the conduct and welfare of their children, practitioners should encourage the child or young person, at all points, to share information with their parents wherever it is safe to do so.
6. Advice, Information and Support
If a young person has admitted sexual activity to a practitioner but there are no causes for concern, the following discussions should take place with them:
- Risk of pregnancy and contraceptive advice;
- Sexually transmitted infections;
- Safer sex;
- Emotional response to being involved in a sexual relationship.
Information leaflets should also be provided to the young person and referral to local specialist agencies for further support may also be necessary, for example:
Further guidance is provided by the Department of Health, 'Best practice guidance for doctors and other health practitioners on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health'.