3.6.9 Sexual Health and Relationships Guidance

1. Introduction

This guidance applies to all young people regardless of age, ethnicity, gender, sexuality religious, cultural differences or ability.

The document provides Sexual Health and Relationships guidance to all employees working directly with children and young people. For employees working with vulnerable groups, such as Children in Care, additional guidance has been provided where applicable.

Sexual health and relationships should be considered a natural part of personal development. Children and Young People should feel confident in being able to discuss such matters and it is the responsibility of Children's Services to ensure that communication around sexual health and relationships should be encouraged and non-judgemental.

World Health Organisation (WHO) Definition of Sexual Health

"Physical, mental and social well-being in relation to sexuality. Positive and respectful approach to sexuality and sexual relationships as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination and violence".

Children and young people with learning disabilities/ difficulties and those with mental health problems will require tailored support to ensure their needs are met.

In addition a child and young person's cultural and religious background must be central to planning and carrying out sexual health and relationship work, with employees having an understanding of specific cultural and religious needs when working with children and young people. However, children and young people should not be denied the benefits of information and support on sexual health and personal relationship issues because of religious and cultural values.

2. Definition of Sexuality and Sexual Orientation

An individual's sexuality and sexual orientation is part of an individual's wider development and sense of self. It is an important aspect of identity, security, attachment and relationship with other people, family, peers and wider society. Sexuality and sexual orientation develop continually throughout childhood, pubescence, adolescence, teenage years and younger adulthood.

Sexuality can be defined in terms of gender identity, sexual identity, sexual awareness, physical and emotional attraction, friendships, relationships, and how a child or young person relates to his or herself and to others.

Sexual Health and Relationships Education

Sex and relationships, education and support is part of a lifelong process of learning, forming beliefs, values and attitudes about sex, sexuality, sexual health and emotions. It should support children and young people in coping with adolescence and enable them to prepare for an adult life in which they can:

Be aware of and enjoy their sexuality;
Behave responsibly within sexual and personal relationships;
Communicate effectively;
Have sufficient information and skills to protect themselves from unintended / unwanted conceptions or sexually transmitted infections including HIV;
Access confidential advice and support;
Neither exploit or be exploited;
Develop a personal values and moral framework that will guide their decisions, judgments and behaviour.

In achieving this it is essential that employees recognise and work with the different needs children and young people may have according to their race, gender, disability, age, religion and belief and sexual orientation. Employees who have a moral or cultural objection have a responsibility, as part of their duty of care to young people, to signpost to another professional.

3. Puberty and Sexual Identity

All Professionals and Carers must adopt a non-judgemental attitude towards children and young people, particularly as they mature and develop an awareness of their bodies and sexuality.

Employees should be aware and supportive with children and young people who are undecided about their sexual identity as this will often cause stress.

4. Principles and Guidance

All sexual health and relationship work with children and young people must be child-centred and children and young people should receive information, advice and guidance to make informed choices about relationships and sexual health;
Employees/carers working with children and young people must work in line with the Lincolnshire SCP Policy and Procedures Manual;
Employees/carers should work in partnership with parents providing it does not conflict with the overriding principle that the welfare of the child/young person is paramount;
Employees/carers must maintain professional boundaries with children and young people at all times;
Employees/carers must explain to children and young people about the principles of confidentiality under which they work. The detail of how information is recorded, shared, stored and used, and for what period of time must be made clear, preferably both verbally and in writing, to all people involved and must be in line with the Lincolnshire Safeguarding Children Partnership Procedures, Children's Policy, Values and Principles, including Principles of Recording, Equality, Confidentiality and Consultation. Please see Section 5, Legal Issues, Confidentiality and Fraser Guidelines for additional information;
Employees/carers should not allow their own sexual attitudes to affect their professional work;
It is important not to make assumptions about a young person's sexuality and there is a need to support all children and young people to develop a positive sense of their sexuality;
Employees/carers need to be aware of the influences of alcohol, drug and substance use and their effect on sexual activity.

5. Legal Issues, Confidentiality and Fraser Guidelines

Legal Issues

The Sexual Offences Act 2003 is the main act of law which proscribes sexual activity in the UK.

The age of consent for sexual activity in England, Wales Northern Ireland and Scotland is set at 16yrs. The age of consent applies regardless of the type of sexual activity, not simply penetrative sexual activity. The age of consent also applies regardless of the gender or sexual orientation of those involved.

The law states that a child or young person under the age of 13yrs can never, under any circumstance, give consent to sexual activity of any kind.

Where one, both or all the parties involved in sexual activity are under 16, the situation should be assessed using the Fraser Guidelines. If the age of one, both or all the parties is/ are under 13, the situation must be dealt with through safeguarding procedures.

Situations causing concern involving electronic, cyber or internet activity should be assessed under the Sexually Active Young Persons policy and Safeguarding procedures.

The Equality Act (Sexual Orientation) Regulations 2007 makes it unlawful to discriminate in the provision of goods, facilities and services on the grounds of sexual orientation. This means that all aspects of the work of Children's Services must be free from discrimination on the grounds of sexual orientation.

Any issues involving bullying or discrimination should be referred to the Anti-Bullying Officer in Lincolnshire County Council.

Confidentiality

Children and young people have a right to confidentiality when discussing sex and relationship issues, including contraception. A disclosure of underage sex is not in itself a reason to breach confidentiality However, it is paramount that children and young people are encouraged to discuss matters with their parents or legal guardian as part of healthy family relationships and be made aware of any legal issues.

Professionals should advise young people prior to any interaction "the worker will keep what they tell them private and confidential. The only time they will need to share what you have told them is if it is about harm to yourself, or another person, or if a crime has been committed. In this case, they may need to talk to the police or children's services. They will normally tell you when they plan to do this".

Fraser Guidelines

The Fraser Competent guidelines provide legal guidelines for professionals working with children and young people aged 13 to 15yrs. Advice and contraception treatment may be given to a person between the ages of 13 to 15yrs without parental consent providing the young person can demonstrate they meet the below criteria:

The young person understands the advice that is being given;
The young person cannot be persuaded to inform or seek support from their parents and will not allow the Professional to inform their parents that contraceptive advice is being given. Professionals are obliged to respect the young person's right to confidentiality;
The young person is likely to begin or continue to have sexual intercourse with or without contraception;
The young person's physical and mental health are likely to suffer unless they receive contraception advice or treatment;
It is therefore in the young person's best interests to receive contraceptive advice or treatment without parental consent.

6. Under-age Sexual Relationships

Children under the age of 13yrs are deemed by the law to be incapable of giving consent to sexual activity. Therefore, children of this age who engage in sexual activity must be referred and supported under Safeguarding Children Procedures (as a Child Protection Referral) as potentially suffering from Significant Harm.

The law is not intended to prosecute mutually agreed teenage sexual activity between two young people of a similar age unless there is evidence of abuse, coercion or exploitation. Where one, both or all the parties involved in sexual activity are aged between 13 and 15yrs the situation should be assessed using the Fraser guidelines.

7. Contraception

Employees/Carers should identify local sources of professional help and information for young people, and can accompany them to health clinics if requested to do so.

There are a variety of forms of contraception available for young people, for example, the pill, implant or injections. These should be used with condoms to protect against Sexually Transmitted Infections.

For information and advice about contraception professionals, young people and carers can access information from Brook website and FPA website.

Long Acting Reversible Contraception (LARC)

There are a variety of forms of contraception available for young people, for example, the pill, implant or injections. These should be used with condoms to protect against Sexually Transmitted Infections. Condoms are the most easily available, non-prescribed form of contraception, they also protect against many sexually transmitted infections for more information see C Card Condom Scheme.

Condoms and Under 16's

Staff who are trained in the C-Card Scheme and who have authorised internet access to the C-Card scheme should refer to the Lincolnshire C-Card Scheme Quality Standards. Further information is available in the C-Card handbook.

Any professional issuing condoms to a young person must be part of an organisation which has agreed to uphold the C Card Scheme Quality Standards and must attend the C Card training prior to giving condoms to a young person.

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 condoms correctly in order to reduce the risk of condoms being used ineffectively.

The Lincolnshire C-Card Condom Scheme is a confidential service which provides sexual health information, free condoms, lube and oral dams to young people aged 13 - 19 years old. The Scheme is provided county-wide from lots of different venues which are accessible to young people.

The C-Card Scheme can be offered to young people 20 - 25 years at the discretion of the C-Card Worker for young people with learning difficulties and disabilities.

Through the C-Card Condom Scheme employees/Carers can advise and provide condoms where it is clear that a young person aged under 16yrs intends to engage in sexual activity and the provision of condoms would protect the sexual health of the young person. Provision of these would be seen as an act of protection and not an act of facilitation of sexual activity.

Emergency Contraception

Children and young people need to know about the use and availability of emergency contraception and emergency health advice.

In the event of contraception failure or it not being used, free emergency contraception for young people under the age of 20yrs is available from G.Ps, contraceptive clinics and participating pharmacists.

The emergency pill can be taken up to 72 hours after unprotected sex and the coil (IUD) fitted up to 5 days after.

8. Pregnancy and Termination

Pregnancy tests can be offered free under the C Card Pregnancy Test Scheme or a young person can go to a GP for a free test. Pregnancy test kits can also be bought from pharmacies and supermarkets.

If the result of the pregnancy test is negative information on contraception including C Card should be given and the young person signposted to a sexual health clinic for information on Long Acting Reversible Contraception (LARC).

If the result of the pregnancy test is positive and the young person is finding it difficult to make a decision on whether to progress with the pregnancy, have an abortion or place the baby for adoption, support must be given to the young person in making their decision.

If the young person is happy to continue with the pregnancy they should be referred to a GP or Midwifery Service in the locality in which they live.

If the young person does not wish to continue with the pregnancy they should be referred to either their own GP to discuss termination of pregnancy or Sexual Health Services by contacting the central booking number 01522 308800.

9. Sexually Transmitted Infections

It is the absolute right of children and young people to have information and advice on safer sex, HIV, Hepatitis (HBV and HCV) and other sexually transmitted infections (STI's).

In providing such advice and guidance to children and young people, it is important that they are made aware that there are many safer and pleasurable alternatives to penetrative sex. Guidance should also be provided to the child or young person that they are still at risk to a STI through the alternative practice of oral sexual relations.

Further information regarding STI's can be found on the:

Young People should be encouraged and supported to take responsibility for their own sexual well being. The opportunity to discuss this with a trusted professional should be available.

With regard to sexually transmitted infections including HIV, young people should be advised of the central booking number 01522 308 800 to access a clinic and book an appointment. Where anonymity and appropriate pre and post testing counselling are available. They should be made aware that, if they are tested by their G.P. then the results of this will be recorded in their medical notes.

There is, however, complete confidentiality at all Genito-Urinary Medicine (G.U.M.) clinics a pre and post-test counselling is available.

10. Pornography

All materials published by Children's Services, circulated or available to children and young people must promote and encourage healthy lifestyles.

It is important to recognise that some young people will access pornography through a variety of means including the internet and magazines, this viewed as part of a child's sexual development. If they obtain 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.

For further information and guidance please refer to the Lincolnshire Safeguarding Children Partnership Procedures Manual, Child Abuse and Information Communication Technology.

10.1 Sexting

Sexting Nude pictures can have long term consequences for young people. If a young person has shared something they regret or they are being bullied because of it, they can get support. For further information and support contact www.ceop.police.uk/safety-centre or Childline 08001111

11. Sexual Exploitation

Caption: sex_health

Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology. See DfE Child sexual exploitation: definition and guide for practitioners (2017).

This section should be read in conjunction with

Note: The Safe Hub is a multiagency arrangement that includes officers and staff from Lincolnshire Police, Children's Service, Lincolnshire Community Health Service and the Youth Offending / Future 4 Me Service.

It takes the lead in the identification, prevention, investigation and prosecution of case of Child Sexual Exploitation in Lincolnshire.

Children may have previously exchanged sex for rewards, gifts, drugs, accommodation and money. Some maintain this lifestyle whilst continuing to be accommodated by the authority. Such situations must be reported to by the carers/residential staff to their managers and the child's social worker to decide on the actions that should be taken.

Carer/residential staffs must be alert to such behaviours and should do all they can to create an environment which encourages children to be open about their past or present attitudes and behaviours and which demonstrates they will be supported to guide them away from such lifestyles.

Where there is any suspicion that a child is engaged in such behaviour it should be addressed in the child's Placement Plan together with strategies to be adopted to help the child find alternative lifestyles need to be identified.

In addressing these behaviours consideration must be given to the extent to which the child is suffering Significant Harm and whether it is necessary to refer the child under Safeguarding Children Procedures in the area where the child is living.

If there is any suspicion that a child is involved in prostitution, Ofsted must be notified.

Caption: serious crime act 2015

Serious Crime Act 2015 As part of the Serious Crime Act 2015 an offence of sexual communication with a child was introduced. This applies to an adult who communicates with a child and the communication is sexual or if it is intended to elicit from the child a communication which is sexual and the adult reasonably believes the child to be under 16 years of age. The Act also amended the Sex Offences Act 2003 so it is now an offence for an adult to arrange to meet with someone under 16 having communicated with them on just one occasion (previously it was on at least two occasions).

Sexual Exploitation in Children in Care

(See above also.)

Where there is any suspicion that a Child in Care is being sexually exploited then this should be addressed as a key safeguarding issue in the child's Placement Plans together with Strategies to be adopted to safeguard the child. The Regulatory Authority, Lincolnshire County Council (or other Local Authority) and Police, where the child is placed, must be informed with a view to considering whether a Section 47 Enquiry should be undertaken.

12. Training and Useful Contact Details

Training

Anyone delivering services either on behalf of Lincolnshire County Council or in partnership with them can access the following training courses: C- Card, Chlamydia and Pregnancy Test training.

Useful Contact Details

For children and adolescents under 18, the Child ISVA (Independent Sexual Violence Adviser) service is provided by the (Castle Project at Victim Support in Lincoln).

The Castle Project is for children and young people affected by child sexual exploitation and is a Victim Support initiative, that provides direct support services to children and young people who have been victims of child sexual exploitation, sexual violence, sexual offences, rape and sexual abuse.

Further information on this service can be found on the Victim Support website

There is also the East Midlands Children and Young Person’s Sexual Assault service, although they are based in Nottingham, they do cover Lincolnshire.

East Midlands Children and Young People Sexual Assault Service
Queens Medical Centre, Derby Road, Nottingham, NG7 2UH

Tel: 0800 183 0023 (24 hour Single Point of Access)
Email: NUHNT.Emcypsas@nhs.net

Domestic Abuse encompasses a range of abusive behaviours which are used by an abuse partner (or ex-partner) to maintain power and control over the victim. For further information and services available please visit the Domestic Abuse website.

13. Children in Care and Children with Additional Needs

The following sections of this document are relevant to Looked and After Children and Children with Additional Needs.

It is important to recognise that Children in Care may be more likely to be at a different stage of emotional development than their chronological age. It is also important to ensure that Children in Care have access to resources and information that are age appropriate and gender specific on a full range of sexual health and relationship issues.

Some disabled children and young people may require these to be in specific formats e.g. Braille, large print, tapes etc. Children and young people with learning disabilities/ difficulties and those with mental health problems will require tailored support to ensure their needs are met. Consideration must be given to the impact on young people of the emotional aspects of a sexual or physical relationship.

In addition a child and young person's cultural and religious background must be central to planning and carrying out sexual health and relationship work, with employees having an understanding of specific cultural and religious needs when working with children and young people. However, children and young people should not be denied the benefits of information and support on sexual health and personal relationship issues because of religious and cultural values. Disabled children and young people must be regarded like any other child and should have access to resources and information about sexual health, relationships and sexuality, though this should be in a format to suit their disability needs.

Looked After Children should be supported to make their own informed choices about their sexuality according to their age and maturity, and they should also be provided with an environment where stigma and harassment are not tolerated.

14. Provision of Information and Advice to Children in Care

Those responsible for the care and planning of Children in Care must make sure that they are provided with appropriate, accurate and up to date information and advice on matters relating to sexual health and relationships.

The information provided must be discussed with a Line Manager and if appropriate, a specialist in the field of sexual health and must be provided in a manner appropriate to children's age and understanding and should be provided in a creative, child friendly manner.

Before providing such information and advice, relevant Social Workers must be consulted and, if possible and where appropriate, Parents/ Carers to ensure it is provided in the context of children's backgrounds and needs; and any specific arrangements must be incorporated into the Placement Plan.

For Looked After Children information regarding sexual identity must be addressed in Placement Plans as necessary. This information is solely recorded so that it may be taken into account when considering the suitability of a placement for a Child in Care.

15. Placement of Children in Care

When considering the placement of children under 13yrs, the child's vulnerability to engage in under-age sexual relationships should be carefully considered and children of this age who are likely to be at risk from each other (or from older children) should not be placed together.

When considering the placement (or on-going placement) of young people over the age of 13, Managers must assess the impact of sexual relationships developing and should ensure strategies are in place to reduce or prevent these risks if they are likely to be exploitative or abusive.

Where young people aged 13 - 18 are placed together with no identified risk of exploitative or abusive behaviour, Carers, Managers and Employees must be mindful of any developing relationships and sensitively but positively support young people to delay early sexual activity, this should be monitored on a regular basis.

Overall, employees should be mindful of their duty to consider the welfare of children and young people and this may mean recognising that illegal activity is taking place, if there is any suspicion that a child is engaging in illegal behaviour it must be discussed with the Child's Social Worker and consideration given to consulting the Child Protection and Support Agencies. Any actions taken in this respect will be subject to consultation and must be addressed in Placement Plan.

Should employees suspect that children and young people are engaging in sexual relationships, they should:

Ensure the basic safety of all the children and young people concerned;
Notify the Manager, who should notify/consult relevant Social Workers and if applicable, Line Manager for the Home;
Record all events, distinguishing between fact and opinion.

If employees become aware that children and young people are engaging in sexual relationships, they should:

Ensure the basic safety of all children and young people concerned (if necessary employees may consider removal of one or more child);
Inform the Manager, who should notify/consult relevant Social Workers and if applicable, the Line Manager for the Home;
Record all events, distinguishing between fact and opinion.

16. Sexual Activity in Homes

This section must be read in conjunction with Section 6, Under-age Sexual Relationships.

Children under the age of 13yrs are deemed by the law to be incapable of giving consent to sexual activity, but it is understood that older children may develop relationships with each other and that they will wish to express themselves sexually and explore their feelings.

This may be acceptable so long as their behaviour is respectful of the wishes and feelings of everyone they live with including other children. However Employees may not condone or permit unhealthy, exploitative, abusive or illegal behaviour and must take all reasonable steps to reduce or prevent it.

If employees are seriously concerned about a child's behaviour they must draw this to the attention of the Manager who may invoke strategies to reduce or prevent the behaviours from escalating. Such strategies must be developed in consultation with relevant Professionals and consideration given to consulting the Child Protection and Support Agencies.

17. Sexually Transmitted Infections in Children in Care

If it is known or suspected that a Child in Care has a sexually transmitted infection (other than HIV) the Manager and Social Worker must be informed and decide what measures to take to ensure both the child's, and other children's welfare and well being.

In principle, the child should be referred, to the local Genito-Urinary Medicine Clinic, who will provide the child and Carer with advice, counselling, testing and other support. Only the immediate Carers of the child will be informed of any suspicion or the outcome of any tests and strategies or measures to be adopted. Other children in the Home should only be informed if there is a direct risk to them; for example if the infected child deliberately attempts to infect them.

The only other individuals who will be told are the child's GP and Health Visitor.

Before disclosing to any other agency or individual, the following criteria must be satisfied:

The child (where appropriate) and the Parents have given their written consent to the disclosure;
The disclosure would be in the best interests of the child;
Those receiving the information are aware of its confidential nature.

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. However, only where it is practical and appropriate parental involvement should be sought. The child should not be put under any pressure to give consent to involve parents. The rights of the child or young person and confidentiality should be considered in line with Fraser Guidelines.

If Parents are 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.

18. Pregnancy in Children in Care

If a young woman is suspected or known to be pregnant the Manager should talk openly to the young woman about who should be informed and what support may be required in order to promote the young woman's welfare and that of the unborn baby.

Under normal circumstances, the young woman's Social Worker and Parent(s) should be informed and they should collaborate with the young woman in drawing up a plan which promotes the young woman's and the unborn child's welfare. It is important that employees are mindful of additional considerations when dealing with this situation as a young woman's or families understanding and reaction to such circumstances could be impacted upon by their race, gender, disability, age, religion or belief and sexual orientation.

However, a young woman who has reached the age of sixteen may request that her Parent(s) and/or the Social Worker is not informed. Where a young woman is under the age of sixteen, they may also request confidentiality if they are of an age and level of understanding to make such an informed decision.

Where a young woman under sixteen makes such a request, the Manager should seek legal advice before agreeing.

In all circumstances, should there be suspicions that the pregnant young woman or the unborn child are at risk of Significant Harm, the Manager must discuss it with the young woman's Social Worker/ Professional with a view to making a child protection referral.

Termination of Pregnancy in Children in Care

Any decision to terminate a pregnancy should be reached by the pregnant young woman. Advice, counselling and support in making the decision must only be given by suitably qualified independent counsellors.

If the pregnant young woman decides to terminate the pregnancy, the Manager 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 taking into consideration if the young woman has learning or mental health disabilities.

Consideration should be given to the father of the unborn child and support and advice offered where necessary.