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3.7.8 Sexual Health

RELATED GUIDANCE

This chapter should be read in conjunction with the following guidance:

Enabling Sexual Wellbeing: A Relationships Policy for Looked After Children and Young People

Brook (provider of free, confidential sexual health and well being services)

AMENDMENT

This chapter was reviewed in June 2016 and updated as required. Section 2, Confidentiality is new.


Contents

  1. Provision of Information and Advice
  2. Confidentiality
  3. Puberty and Sexual Identity
  4. Pornography
  5. Under age Sexual Relationships
  6. Contraception
  7. Pregnancy and Termination
  8. Working with Young Fathers
  9. Child Sexual Exploitation
  10. Sexually Transmitted Infections
  11. Masturbation


1. Provision of Information and Advice

Children Looked After should be provided up to date, age appropriate information and advice on matters relating to sexual health and relationships. Training on sexual health and relationships is available and it is the responsibility of Social Care staff to ensure that their skills meet the needs of the young people they are supporting.

The relationships policy for Children Looked After and young people Enabling Sexual Wellbeing: Relationships Policy for Looked After Children and Young People should be referred to before providing such information and advice.

When a child becomes Looked After, their parents / carers should be made aware that they will receive sexual health information and advice according to his/her needs, and that the child/young person has a right to this information.

Children and young people who are Looked After will be able to access confidential support around contraception and sexual health without the need to secure the consent of or notifying their parents.

Parents should be given the opportunity to discuss any concerns or specific needs of the child/young person so that support can give due consideration to the child's cultural and religious background. Any specific arrangements must be incorporated into the child's Placement Plan. The recording of information relating to sexual health issues is subject to the informed consent of the child or young person including details of what information will be shared with whom. Refer to the Enabling Sexual Wellbeing: A Relationships Policy for Looked After Children and Young People for further information.


2. Confidentiality

Doctors and health professionals have a duty of care and a duty of confidentiality to all patients, including those under 16s years. Children and young people are entitled to confidential advice on sexual health matters such as contraception, pregnancy and abortion.  However, when a professional is working with children or young people, it must always be made clear to them that absolute confidentiality cannot be guaranteed, and that there may be some circumstances where the needs of the young person can only be safeguarded by sharing information with others.

Any child protection concerns will over-ride the requirement for agency confidentiality and allow information to be shared across agencies. For example where a health professional believes that there is a risk to the health, safety or welfare of the young person or others which is so serious as to outweigh the young person's right to privacy, they should follow locally agreed safeguarding and child protection procedures, in accordance with Working Together to Safeguard Children. When considering any disclosure of confidential information to other agencies, including the police, professionals should balance the young person's right to privacy against the likelihood of current of future harm.

Any disclosure should be justifiable according to the particular facts of the case and legal advice should be sought in cases of doubt. Except in the most exceptional of circumstances, disclosure should only take place after consulting the young person and offering to support a voluntary disclosure.

Decisions to share information with parents and carers will be taken using professional judgement, and consideration of Fraser guidelines. Such decisions will be based on the child’s age, maturity and ability to appreciate what is involved in terms of the implications and risks to themselves. This should be coupled with the parents’ and carers’ ability and commitment to protect the young person. Given the responsibility that parents have for the conduct and welfare of their children, professionals should encourage the young person, at all points, to share information with their parents and carers wherever safe to do so.

For more information please see the following West Yorkshire Consortium Safeguarding Procedures:

Information Sharing and Confidentiality Procedure

Allegations of Harm Arising from Sexual Activity (including Under Age Sexual Activity) Procedure


3. Puberty and Sexual Identity

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

The same approach must be adopted towards children who confused about, or wish to explore, 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.

As necessary this must be addressed in Placement Plan, again subject to the informed consent of the young person.


4. Pornography

Children must be positively discouraged from obtaining or viewing material that is potentially offensive or pornographic (including online).

If they obtain (or are found to have viewed) material that is suspected to be illegal it must be confiscated and, in extreme circumstances, consideration must be given to reporting the matter to the Police.

Such an incident is an ideal opportunity to provide sex and relationships education.


5. Under age Sexual Relationships

The legal age of consent to sex is 16 for all young people irrespective of their sexual orientation.

Staff/carers 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. Staff/carers may not condone or permit exploitative or abusive behaviour and must take all reasonable steps to reduce or prevent it.

Staff/carers should endeavour to establish whether any relationship is mutually consensual and between two young people of a similar age/maturity, and if so provide appropriate support around contraception and sexual health.

It is important that staff/carers recognise that under age sexual activity should not automatically trigger child protection procedures.

Please refer to the Enabling Sexual Wellbeing: A Relationships Policy for Looked After Children and Young People.


6. Contraception

Staff/carers should identify local sources of professional help and information for children/young people and can accompany them to clinics if requested to do so.

Condoms are the most easily available, non-prescribed form of contraception. They also protect against many sexually transmitted infections. Young men and women should learn how to use them correctly - this will require practice! It is important that girls are equally confident in using them. Condoms and condom demonstrations are available for this purpose.

Training is available for staff and carers regarding the distribution of condoms.
  • Forms part of a broader sex and relationship education programme which includes helping children resist any pressure to have early sex;
  • Complements local service arrangements for the distribution of free condoms e.g. C-card scheme;
  • Is always accompanied by verbal and written advice about using condoms correctly, information about sexually transmitted infections and services and where to access emergency contraception if the condom breaks or is not used;

Please refer to the Enabling Sexual Wellbeing: A Relationships Policy for Looked After Children and Young People.


7. Pregnancy and Termination

If a young woman is suspected or known to be pregnant the social worker, staff and carers should talk openly to the young woman about who should be informed and what support the young woman may require to promote her own and the unborn baby's welfare.

If the young person consents then it is good practice for their parent(s) to be informed and be part of drawing up a suitable plan for the promotion of the welfare of the pregnant young woman and the unborn child.

It is important to note that a young woman may be pregnant and not disclose this information to her Social Worker.

Please refer to the Relationships Policy for further information.

In all cases, consideration should be given to the welfare of the pregnant young woman and/or the unborn child, including the likelihood of either suffering Significant Harm.

Any decision to terminate a pregnancy should be reached by the young woman. If she has a partner and wants him to be involved this should be supported.

Advice, counselling and support in making the decision must only be given by suitably qualified independent counsellors.

If the young woman decides to terminate the pregnancy, her social worker and staff/carers must ensure that adequate support is given throughout and afterwards to ensure the young woman's privacy is protected and any physical or emotional needs are addressed sensitively.


8. Working with Young Fathers

This can be a difficult area of work because the choice and responsibility in decisions relating to the baby lies with the mother. Regardless of how the mother views the situation, young fathers still need to be supported. The following points should be addressed:

  • What does the young man want his role to be?
  • Does this conflict with what the young woman wants? If so, how will this be managed?
  • How will you support him to deal with his thoughts, feelings, hopes and fears?
  • How can he play an active role in the child's life?
  • Is the young man clear about his legal rights, choices and responsibilities in relation to his child?

Please refer to the Enabling Sexual Wellbeing: A Relationships Policy for Looked After Children and Young People.


9. Child Sexual Exploitation

Children of any sexual orientation and ability may be abused through sexual exploitation.

Staff/carers need to be alert to any behaviour that might indicate that the child is involved in Child Sexual Exploitation or at risk of becoming involved.

For further information, please see Child Sexual Exploitation Procedure and West Yorkshire Consortium Procedures Manual, Safeguarding Children and Young People from Child Sexual Exploitation: Policy Procedures and Guidance.


10. Sexually Transmitted Infections

If it is known or suspected that a child has a sexually transmitted infection the child should be referred, with the parents’ consent if possible, to the local Genito-Urinary Medicine Clinic. The clinic, who will provide the child and their carer with advice, counselling, testing and other support.

Only those immediate carers of the child/young person who need to know will be informed of any suspicion or the outcome of any tests and strategies or measures to be adopted.

Please see the Relationships Policy for further information and HIV Procedure.

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.


11. Masturbation

It is accepted that masturbation is part of normal sexual behaviour; however children must be positively encouraged to undertake such activities in private and in a manner that is not harmful to themselves or other people.

Please refer to the Enabling Sexual Wellbeing: A Relationships Policy for Looked After Children and Young People.

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