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Dealing with child sexual exploitation (CSE)

Child sexual exploitation: a practical guide for professionals

Child sexual exploitation (CSE) is a growing issue affecting thousands of children and young people under 18 in England every year. It is a type of sexual abuse where children are groomed or persuaded to perform sexual acts for food, accommodation, drugs, alcohol, cigarettes, affection, gifts or money.

Sexual exploitation can take many different forms, such as:

  • Inappropriate relationships – often involving a significant age gap. The young person exploited may think they are in a loving relationship.
  • Boyfriend exploitation – the teenager is groomed into a relationship but then forced to have sex with friends or associates.
  • Peer exploitation – this is similar to boyfriend exploitation but here the young person is forced into sexual activities by their peers and associates. This sometimes happens with gangs as an initiation ritual.
  • Trafficking – a young person is taken away from the environment they know to a different location such as another city or different part of town and then forced into sexual activity with multiple men.

Sexual exploitation can also happen online

Online sexual exploitation can take many forms, including:

  • grooming children (building a trusting and emotional relationship with the victim for the purpose of sex). Find more about grooming on the NSPCC website
  • getting them to post explicit images of themselves
  • sexting
  • perform sexual acts via webcams

This may be accompanied by threats from the perpetrator to expose images to family and friends unless further sexual acts are performed by the child.

CSE exists across society. Boys and girls from all ethnic backgrounds, religions and socioeconomic groups are sexually exploited. Similarly, perpetrators come from all walks of life.

It is important that professionals work together and share information whenever possible to recognise children at risk and to prevent further harm from being inflicted. GPs, nurses, A&E staff, health visitors, sexual health and GUM clinics, hospitals and schools all have a crucial role in this process. If you are aware of a child or young person who is being sexually exploited, it is a child protection issue.

Child sexual exploitation still applies even if the young person is over the legal age of consent. Exploitation is always rooted in a power imbalance and those responsible have control over their victims. No matter what their age, the safety and welfare of the young person is the top priority.

Child sexual violence and abuse can cause severe and long lasting harm to victims, including physical injury, sexually transmitted infections and unwanted pregnancy. It can lead to post-traumatic stress disorder, anxiety and panic attacks, depression, social phobia, substance abuse, obesity, eating disorders, self-harm and suicide, domestic violence and in some cases, offending behaviour.

Point young people or parents to the teen section on this site, which offers articles about healthy relationships and CSE: Abuse in teenage relationships or Is your teenager’s relationship healthy? and how to spot child sexual exploitation

Try the CSE e-learning tool on Brook's website. The interactive tool teaches professionals how to prevent, identify and respond to child sexual exploitation.

 

Download the Spot the signs (PDF, 188kb) leaflet, specially created for professionals by Barnardo's.

 

Spotting signs and risk factors

There are a number of signs that indicate a child is at risk of CSE or ongoing exploitation. For more expert advice watch the CSE: spotting signs and risk factors video, part of a video series about CSE.

Indicators that a child is at risk 

Ambulance services and A&E staff may be able to offer additional information. Ambulance personnel are often in the position of responding to CSE victims in the first instance and may be admitted to houses and establishments where entry has been refused to doctors, midwives, health visitors and social services. Often the information they record is not shared. Ambulance services are happy to share this information as there is no problem with confidentiality and CSE is seen as a safeguarding issue. As with A&E services they also have regular callers whose addresses are well known to the service.

Physical signs

Physical signs that a child is at risk of CSE include:  

Taking pictures as part of the assessment is a good way to record any changes in appearance, but may prove tricky for A&E staff and other professionals in high pressure environments.

Young people may lie about their patient details so that a 15-year-old girl can pass through the system as a 19-year-old under a false name, for example. Ask to see proof of age and identity. Explain that it is an administrative procedure of the hospital or department, so the young person knows it's part of the routine. This is also important as the offender may listen in or accompany the young person. If it is an administrative requirement then it's not the young person's fault if they have to give their real age.

Behavioural signs

Behavioural signs that a child is at risk of CSE include:

Try to look beyond a child's initial reactions. Children or young people who are sexually exploited may instinctively mistrust adults and react aggressively at first.  

Being involved in criminal activities or having a record of drug and alcohol problems can also be signs or symptoms of CSE. Find more advice in the CSE: coping with difficult behaviour video.

How to ask questions and collect evidence

Many of the above points can only be confirmed by asking questions. If a child evades questions this is a strong indicator that something is not right.

However, it's unlikely that a young person will volunteer information. They'll only engage if a basic level of trust can be established. Asking questions can prove tricky for both the young person and the professional.

Young people may wrongly assume that a professional is not really interested in them and is only asking questions because they are obliged to. And professionals may struggle because they don't know how to deal with challenging behaviour or they are afraid of compromising evidence in court.

For more expert advice watch the CSE: the law and how to secure evidence video, part of a video series about CSE.

Tips 

Don't ask leading questions. This could be interpreted as interfering with evidence and you could be accused of manipulating the child's version of events. Instead, ask questions so the child will give their own account of what happened.

  • Don't ask: So he took you to … and then he …
  • Ask: And what happened next? (open question)

Explain why you are asking questions. More importantly, explain what you are going to do with the information given. Tell the young person what you have heard them say so they are clear you understand what they are trying to tell you.

Create a safe environment. If you work in a busy environment see if there is a quiet room available.

Children and young people who are being exploited often use nicknames for themselves and their acquaintances. They may do this to protect themselves as they do not want to use their real name. It's important that you use the name the child wants to be known by.

You may not get all the answers in your first consultation. Some sensitive questions may need to be left for the next visit. Either arrange for a follow-up or, if you don't feel confident about handling the situation, arrange for an appropriate referral.

Some perpetrators insist that their victims carry their mobiles switched on and connected so they can listen to what is being said. Point out that hospital policy is for mobile phones to be turned off. The person listening will know it's not the child's decision to turn off their phone. Once the phone is turned off you should be able to speak more openly with the child. Similarly, if the child is in the company of an adult tell them that you’ll have to examine the child alone.

Keep a record of everything you do and that has been said. If it comes to a court case your records can be used as evidence.

If the young person is the victim of sexual abuse then everything from their clothes to the mobile phone could be potential evidence and building up a court case means collecting this evidence. One way to collect these items is to offer one-to-one replacements, including exchanging any money that has been handled by the perpetrator.

'What is child sexual exploitation?'  – Use the definition below to explain the matter to children and young people. 

 
"Sexual exploitation is when someone takes advantage of you sexually. They might use threats, bribes, violence, humiliation or tell you that they love you to gain power over you and to get you to do sexual things for their own, or other people's, benefit or enjoyment. This can include having sex, touching or kissing private parts, or taking sexual photos."

Tips on dealing with kids and teenagers

Communicating with children and teenagers can be tricky. Following some simple rules can make a consultation more effective for both sides.

Keep in mind that many children and young people have several problems at any one time and each of these issues will need to be addressed. This includes dealing with abuse; alcohol and drug problems; mental health and self-esteem issues or behavioural issues. It's useful for children or young people if one professional can help them with all of their problems. However, if you have to refer them explain why you can't deal with the issue yourself.

Building trust is the key objective when working with children. The following can help you build trust with a child:

  • Treat them with respect.
  • Don't be patronising and try not to judge.
  • Don't try to act young or cool. Try to be understanding and listen to the person in front of you.
  • Don't turn up with a clipboard and a standard questionnaire. If you do have a sheet you are working from show it to the young person and explain why you are asking these questions.
  • Be open and provide as much detail as possible about what happens with the information provided. In particular, tell them about information you may have to share with others.
  • Explain confidentiality rules from the start and repeat them if necessary, especially if you are about to share information.
  • Don't lie.
  • Explain options and what the consequences of not engaging with services might be, for example, losing a support worker, being taken into care, being subject to a recovery order or being put into a secure unit.
  • Work to the speed of the young person not your own agenda. This can mean several sessions before you see a result. Don't push them – once they are ready to talk they will.
  • If in doubt, talk to colleagues.
  • Try to involve the families where appropriate to get their support as well.

Download the two leaflets below and hand them out to young people. The leaflets were produced by young people and the Association for Young People's Health for young people and professionals.

 

For more expert advice watch the CSE: talking with children and young people video, part of a video series about CSE.

Issues of confidentiality and consent

Confidentiality and consent are important issues when dealing with sexual exploitation of children and young people. Most young people understand that some information needs to be shared. 

Child protection rules apply for all children up to the age of 18. This means that if a boy or girl is 17 and has given consent the child protection guidelines still apply. 

If you share information with other services explain to the child or young person. Tell them how, when, why and where their information is being shared so they understand that it's in their best interest. Explain also what's likely to happen after the information is shared. Being in control of what is happening is important to these children, so knowing the possible effects of information sharing is essential.

Explain the policy around confidentiality and what it means in practice from the start. If necessary, remind the child or explain it again at a later stage. Include information on what needs to be shared and what will remain confidential. Also:

  • Explain that families may share information with other services if they are engaged in the young person's welfare.
  • Think about whether information can be made anonymous before it is shared.
  • If you have evidence of a crime, inform the police.

Again, it is a good idea to keep a record of what information you have shared and when. Ideally, note down your motivation for sharing information as you may have to report on it at a later stage.

Resources and useful links

Useful materials

Useful links

Other useful organisations

Self-esteem and mental health

Drugs and alcohol support

  • FRANK
    Phone: 0800 77 66 00

Sexual exploitation and abuse

Body image and eating disorders

Sex and healthy relationships

  • Ask Brook
    Phone: 0808 802 1234
  • CPS – Consent is (over 16 year olds) – The Crown Prosecution Service has launched a social media campaign to get people talking about consent to sex within the context of sexual assault and rape.

Page last reviewed: 21/10/2015

Next review due: 21/10/2017

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CSE: what is child sexual exploitation?

Child sexual exploitation is when people use the power they have over young people to sexually abuse them. In this video series experts explain who is most vulnerable, typical behaviour patterns of the abusers and how to spot the signs. You’ll also get advice on what you can do if someone you know is at risk or has been a victim of CSE.

Media last reviewed: 01/03/2016

Next review due: 01/03/2018