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Child sexual exploitation - the role of public health in prevention and intervention

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For young people who are affected by child sexual exploitation (CSE), the consequences can be profound and long-lasting.

It’s important that when we talk about CSE we are clear about what it actually means. CSE is a form of child abuse.

It is when an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child under 18 into sexual activity.

This happens either in exchange for something the victim needs or wants and/or for the financial advantage or increased status of the perpetrator.

Sexual exploitation can happen even in cases where the sexual activity appears consensual. You can find a full definition from the Department of Education in their CSE guidance.

The scale of the problem

There are a few key things that we need to keep in mind when planning how best to prevent CSE and intervene early when we know it is happening.

Firstly, there is no such thing as a ‘typical’ case of CSE. The average age when concerns about CSE are first identified are between the ages of 12-15.

And although most identified cases relate to young females, young males are also abused.

CSE exists across every ethnic group and can be perpetrated by family members and those in positions of trust, as well as strangers or people the child does not know.

Secondly, it’s important to remember that being proactive is key.

Young people rarely report experiences of abuse and professionals may not always identify or register concerns around CSE.

Due to challenges around recognition and reporting as well as a lack of definitional and data clarity, we can’t at the moment offer a definitive count of how common CSE is.

Local areas should always be proactively looking to identify and respond to CSE.

The role of public health

Public health has a critical role to play in reducing children and young people’s risk to CSE, and intervening when it does happen.

As part of a collaboration with the Association of Directors of Public Health and the Children’s Commissioner for England, we have developed a resource to help Directors of Public Health structure their approach to CSE.

Produced with the help of services, organisations who work with young people, and academics, our new document sets out the evidence and a framework through which three key local actions can be taken.

For each of these suggested actions, we have given examples from across the country of how public health teams and their councils are being proactive:

LEAD: Directors of Public Health (DPHs) have a unique role as the local authority’s statutory public health officer to lead prevention and early intervention work.

Through strategic planning, such as Public Health Annual Plans, Joint Strategic Needs Assessments (JSNAs), and Children’s Plans, the role of public health can be clearly articulated and seen as part of interventions, including policing.

The commissioning of public health services used by young people also gives DPHs a way to embed CSE awareness so that children get the support and protection they need.

UNDERSTAND: Through a range of local data sources, DPHs can build up a picture of potential areas of vulnerability in local areas.

PHE’s Fingertips tool provides a breadth of data at local authority level that will assist in this, including young people’s health profiles.

When triangulated with other service activity data, such as drug and alcohol services, CAMHS, and sexual health, a picture of potential vulnerability can be built up, and often a very localised one.

A critical element of building our understanding is of course to listen to what children, young people and their carers have to say about CSE.

In doing this we strengthen our approach and avoid the mistakes that previously allowed children to remain in unsafe situations.

ACT: The evidence, and the experience of children and carers, shows that taking action demands an approach that is sensitive to the age and needs of individual children.

So how are schools being supported to take an approach that raises awareness and builds resilience amongst anyone affected by CSE? Many public health teams are currently actively supporting schools.

The PHE CSE Pathway gives advice on the critical role of the school nursing service and how this can help prevent and identify CSE. Some authorities are also using their Licensing Act powers to address CSE both proactively and reactively when considering licences.

By making best use of the evidence, the data and listening to children and young people, public health can make a vital contribution to keeping all our children safe from harm. We trust that this resource will help increase and enhance local action.

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