1. Child Sexual Exploitation
Tracy Dickens
Advanced Practitioner CSE Team
Claire Read
Specialist Nurse CSE Team

2. Aims and objectives of CSE Nurse service:
•To increase the number of children who are at risk of CSE being referred by Health.
• To gather health intelligence on individual cases to contribute to the multi-agency strategy discussions.
•To hold a small caseload of cases in a bridging capacity to achieve smooth transition into the best health services to meet each individual case need.
•To provide targeted training to the health economy on risk factors associated with CSE to aid greater recognition of children at risk and to achieve earlier referral.
•To ensure all children at risk of CSE are flagged across all health systems to ensure their vulnerability is shared and thus services can be tailored to meet their needs

3. Definition of CSE
Sexual exploitation of children and young people under 18 involves exploitative situations contexts and relationships where young people (or a third person or persons) receive 'something' (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities. Child sexual exploitation can occur through the use of technology without the child's immediate recognition; for example being persuaded to post sexual images on the Internet/mobile phones without immediate payment or gain. In all cases, those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources. Violence, coercion and intimidation are common, involvement in exploitative relationships being characterised in the main by the child or young person's limited availability of choice resulting from their social/economic and/or emotional vulnerability
(safeguarding children from child sexual exploitation 2009; safeguarding children and young people from CSE practice guidance LLR 2015; LSCB)

4. Definition of CSE (April 2016)
‘Child sexual exploitation is a form of child abuse. It occurs where anyone under the age of 18 is persuaded, coerced or forced into sexual activity in exchange for, amongst other things, money, drugs/alcohol, gifts, affection or status. Consent is irrelevant, even where a child may believe they are voluntarily engaging in sexual activity with the person who is exploiting them. Child sexual exploitation does not always involve physical contact and may occur online.’

5. Factors that Increase the Risk of CSE for a Child:
Learning Disability
Autistic Spectrum children can be obsessed with relationships and experimentation without the capacity to understand grooming
Gang association
Out of school
Social Isolation
Highly vulnerable
Limited communication (Safer Target )
Disorganised Chaotic family
Bereavement
Domestic Violence
Paternal Mental Health
Alcohol and Substance Misuse
Affects of a relationship
disordered attachment increasing
vulnerability
Earlier Child abuse and
Sexualisation
Neglect
Looked After Children
Peers who are being sexually
exploited
Homelessness or absent

6. The CSE Process – NWG 2016 Opportunity Recruitment Control
Exploitation
Escape/rescue

7. Indicators of CSE Change in behaviour Rapid change in appearance
Regularly coming home late or going missing
Unaccounted money/goods such as mobile phones/drugs/alcohol
Having a much older boyfriend
Disclosure of sexual/physical assault – withdrawal of statement
Absconding or missing from school
Revolving door A/E – abdo pain/
Repeat requests STIs/Pt/EHC/TOP
Drug or solvent abuse
Physical injury/gynaecology trauma
Mental health problems
Self harm
Low self esteem
Disassociation
Depression
Sleep disorder
PTSD
Suicidal ideation
Eating disorders

8. Health Professionals Don’t DO Be judgemental
Assume they are consenting (many young people think they are in a relationship when they are actually being exploited)
Assume they will disclose to you
Share information without sharing this with the young person (unless safety is compromised)
Assume CSE happens to certain age groups/gender/ethnic groups DO
Share information to safeguard children
Check who is accompanying the child
Be curious about injuries
Ask about home/safety
Ask about relationships, sexual relationships, contraception/pregnancy, risk taking
Discuss concerns with safeguarding leads
Document your concerns
Listen and make eye contact
Be friendly/show interest
Ask the right questions
Discuss confidentiality and restrictions
Follow safeguarding procedures
Complete the CSE risk assessment tool
Contact the CSE nurses