• ADOLESCENT
• CHILDREN
• SEXUAL ABUSE
• SEXUAL ASSAULT
• COMMUNICATION SKILLS

It has been widely reported in research and inquiries that child sexual exploitation (CSE) is both under-reported and unrecognised by statutory and voluntary sector organisations.1–3 A report by the Office of the Children's Commissioner found that at least 16 500 children were identified as being at risk of CSE each year by gangs and groups.1 Between 5% and 17% of children under 16 (between 650 000 and 2 million children) experience sexual abuse, and more than one in three do not tell anyone during childhood.2

CSE has been defined by the National Working Group for Sexually Exploited Children and Young People3 as the involvement of those aged <18 in exploitative situations, contexts and relationships where the young people (or a third person) receive something (eg, affection, gifts) as a result of them and/or others engaging in sexual activities. It is an abuse of power by those exploiting by virtue of their age, gender, intellect, and physical strength and/or economic or other resources. Children and young people who are victims face huge risks to their physical, emotional and psychological health and well-being. Recent high-profile cases of CSE reported in the media may suggest that victims and perpetrators originate from distinct ethnic groups and that victims are primarily women, but evidence suggests that CSE can affect children of either gender and from any social or ethnic background.4 CSE rarely occurs in a vacuum: drugs, alcohol, going missing, problems at home, self-harm and not attending school are frequently associated vulnerability factors as well as indicators of risk. Importantly young people may not recognise they are being exploited, making them unlikely to disclose.1

In response to the increasing understanding about the prevalence and nature of CSE, in 2013 the British Association for Sexual Health and HIV Adolescent Special Interest Group, in collaboration with Brook (a major provider of young people's services), was awarded a grant by the Department of Health and the Home Office to develop a tool to aid detection of CSE among young people attending services for sexual health. Consultations within sexual health services routinely include detailed exploration of sexual, relationship and risk-taking behaviours and assessment of vulnerability factors placing sexual health services as key settings to identify individuals at risk of CSE. The formation of a multiagency advisory group, in partnership with young people, some of whom were victims of CSE, has resulted in the development of a document Spotting the Signs. This document is freely available5 and aims to prompt health professionals working with young people to ask key questions to identify and explore risk factors associated with CSE.

During the consultation period, young people were clear that the questioning style of the health professional is important and a conversational tone desirable, an approach that is reflected in Spotting the Signs.

Prior to being launched in April 2014, Spotting the Signs was piloted in sexual health clinics, outreach settings and general practice and was evaluated by the staff and young people who used it. Feedback from young people has been positive; the vast majority of respondents feeling able and comfortable answering the questions. It was acknowledged by health professionals that in order to elicit a comprehensive history using of the proforma consultation time may be increased; however, nearly all health practitioners reported that the proforma picked up on the key issues. Since its launch, Spotting the Signs has been rolled out in many sexual health and young person's services across the country.

Review of the use of the proforma is to be undertaken in 2015, with plans to extend its use into other healthcare settings such as emergency departments. In order to help further train healthcare professionals to use the proforma effectively, a toolkit resource will be released in December 2014 and Brook will be producing an e-learning resource.

As professionals providing sexual health services for young people, we must recognise our vital role in safeguarding against CSE and rise to the challenges such as increased time costs inherent in providing these services. For this reason, rigorous safeguarding procedures such as the use of the proforma need to become embedded in commissioning sexual health contracts that reflect additional costs for longer appointment times, including in non-National Health Service provider settings.

This area is now receiving increasing recognition by the wider medical community as shown by a recent BMJ article.6 The Academy of Medical Royal Colleges has also produced a report on the role of healthcare professionals in the identification of CSE,7 which highlights how to improve the recognition and response in all healthcare settings. All these initiatives together will help to protect young people now and in the future.