Child Sexual Abuse in the Family Environment

Working Together to Safeguard Children defines sexual abuse as behaviour which:

'Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening.

The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse.

Sexual abuse can take place online, and technology can be used to facilitate offline abuse.

Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.'

Sexual abuse often occurs in conjunction with the other categories of child abuse especially emotional abuse in order to maintain control and secrecy.

There is no single agreed definition of Child Sexual Abuse (CSA) within the family environment (also known as Intra-familial Child Sexual Abuse), but in addition to abuse by a relative (such as a parent, sibling or uncle), it may also include abuse by someone close to the child in other ways (such as a step-parent, a close family friend or a babysitter).

Children from the age of birth onwards may be subjected to sexual abuse. Sexual abuse can have a long-term impact on emotional, social and educational development and is linked to the development of mental health issues in later life.

 See also the procedures for: Child Sexual Exploitation, Online Safety, Harmful Sexual Behaviour and Underage Sexual Activity.

Sexual abuse which takes place within family environments often remains hidden and is the most secretive and difficult type of abuse for children and young people to disclose. It may be particularly difficult to disclose abuse by a sibling.

Many children and young people do not recognise themselves as victims of sexual abuse - a child may not understand what is happening and may not even understand that it is wrong especially as the perpetrator will seek to reduce the risk of disclosure by threatening them, telling them they will not be believed or holding them responsible for their own abuse.

Where sexual abuse is being perpetrated on one or more family members, it may be possible to identify by patterns of referrals or presentations to different agencies in their local community over time. There may be a range of signs but any one sign doesn't necessarily mean that a child is being sexually abused; however, the presence of number of signs should indicate that you need to consider the potential for abuse and consult with others who know the child to see whether they also have concerns.

Signs include:

• Changes in behaviour, including becoming more fearful, aggressive, withdrawn, clingy;
• Problems in school, difficulty concentrating, appearing distracted and distant or dissociated, drop off in academic performance;
• Sleep problems, nightmares or regressed behaviours i.e. bed wetting;
• Frightened of or seeking to avoid spending time with a particular person;
• Knowledge of sexual behaviour/language that seems inappropriate for their age;
• Physical symptoms including pregnancy in adolescents where the identity of the father is vague or secret, STIs, discharge or unexplained bleeding;
• Poor hygiene, which often leads to social isolation in school;
• Injuries and bruises on parts of the body where other explanations are not available especially bruises, bite marks or other injuries to breasts, buttocks, lower abdomen or thighs;
• Injuries to the mouth, which may be noted by dental practitioners.

Other Factors

• Frequent house moves;
• Isolation of children (and other members) within the family from practitioners, and the wider community;
• Failure to register with a GP;
• Frequent absences from school;
• Failure to cooperate with agencies or to let police, children's social care or other agencies into the home, or letting children be seen alone by professionals;
• Attempts to disguise injuries or attribute them to other causes;
• A child or young person who self-harms, misuses drugs, alcohol or solvents, and/or develops mental health problems;
• Domestic abuse within the family heightens the risk;
• Repeated pregnancies with no evidence of a father;
• Genetic abnormalities in pregnancy or in children who are born.

Finkelhor and Browne, (1986) describe four likely impacts of CSA:

1. Traumatic sexualization (where sexuality, sexual feelings and attitudes may develop inappropriately);
2. A sense of betrayal (because of harm caused by someone the child vitally depended upon);
3. A sense of powerlessness (because the child's will is constantly contravened);
4. Stigmatisation (where shame or guilt may be reinforced and become part of the child's self-image).

The Centre of Expertise on Child Sexual Abuse highlights the impact that secrecy (including the fear and isolation this creates) and confusion (because the child is involved in behaviour that feels wrong but has been instigated by trusted adults) has on the child. While these impacts are not unique to Child Sexual Abuse in the Family Environment, their combination and intensity in the context that they take place makes the experience particularly damaging.

See: Key Messages From Research on Identifying and Responding to Disclosures of Child Sexual Abuse (Centre of Expertise on Child Sexual Abuse).

Whenever a child reports that they are suffering or have suffered significant harm through sexual abuse the initial response from all practitioners should be to listen carefully to what the child says and to observe the child's behaviour and circumstances. Practitioners must:

• Clarify the concerns;
• Offer reassurance about how the child will be kept safe;
• Explain what action will be taken and within what timeframe.

The child must not be pressed for information, led or cross-examined or given false assurances of absolute confidentiality, as this could prejudice police investigations, especially in cases of sexual abuse.

See Referrals Procedure and Child Protection Enquiries - Section 47 Children Act 1989 Procedure.

If you are concerned/unsure that a child is at risk of/experiencing CSE, this should be discussed with your manager in the first instance with a view to deciding whether a referral is required. In addition, you may wish to seek input from your agency’s safeguarding lead to help your decision-making.

As a professional, you must balance the need for swift action with the need to make informed decisions. If a child is at immediate risk, you must call Surrey Police on 999 (Report rape, sexual assault and other sexual offences | Surrey Police).

When considering making a referral to Surrey Children’s Social Care, you will also need to balance the need for confidentiality with your responsibility to share information to protect the child. Where possible, you should always ascertain the views of the child, and keep them, and their parents/carers informed about your actions.

You should consult your agency’s information sharing agreements to help guide your decision.

Any decision not to share information or not to refer a child should be recorded using your agency’s formal case recording systems together with the reasons for non-referral.

See also Information Sharing Procedure.

You should send your referral (Request for Support Form: Report a concern about a child or young person - Surrey County Council (surreycc.gov.uk) to the Surrey Children's Single Point of Access (C-SPA)

Surrey Children's Single Point of Access (C-SPA)

Phone: 0300 470 9100

Email: cspa@surreycc.gov.uk  – emails are dealt with during normal office hours

Out of hours phone: 01483 517898 to speak to our Emergency Duty Team.

Assessment

Once the C-SPA or the child’s lead professional has received a CSE Screening Tool and confirms the identified risk(s), a full CSE Assessment will be undertaken by a suitably qualified practitioner in Children’s Services or Family Services.

The completed CSE Risk Assessment form will be forwarded to the weekly CSE Risk Management Meetings (RMM). The RMM is responsible for confirming risk ratings and for reviewing identified risk if a child’s circumstances change

CSE Risk Management Meetings

Multi-agency CSE Risk Management Meetings (RMM) take place weekly in each of the Children’s Social Care areas. Jointly chaired by Children’s Services and Family Services, the RMM provide a multi-agency forum with responsibility for assessing and reducing the risk of CSE for children assessed as at risk of/experiencing CSE. These meetings will also include representatives from Surrey Police, Education and Health and any other agencies appropriate to the children being discussed.

Each week, the RMM will consider new referrals with a view to agreeing a risk rating and a CSE Safety Plan for children assessed as medium or high risk.   Children discussed at the RMM and given a risk rating will be added to the county-wide CSE list which is updated and circulated weekly.

The RMM will allocate a lead agency with responsibilities for the implementation of an agreed CSE Safety Plan. The RMM will review and assess the effectiveness of each CSE Safety Plan and adapt interventions in accordance with changing risk/circumstances.

The RMM is responsible for confirming the risk rating.

The weekly RMM will convene a strategy discussion if at any stage:

• There is reasonable evidence that the child is suffering or likely to suffer Significant Harm; or
• The child is in Police Protection (under Section 46, Children Act 1989); or
• The child is subject to an Emergency Protection Order.

Intervention Planning and Review

The weekly RMM will develop a bespoke CSE Safety Plan for each child assessed as high or medium risk of CSE and will maintain ongoing oversight of a child’s Safety Plan. The RMM will furthermore agree and allocate a lead agency for those who do not have an allocated lead professional. Lead professionals will be required to provide regular updates to the RMM.

Children assessed as low risk will be held at an Early Help level by Surrey Family Services, unless they already have a social worker in Children’s or Family Services. The responsibility for closing the CSE safety plan remains the responsibility of the RMM.

For children already open to Children’s Services of Family Services, the CSE Safety Plan should complement a child’s existing plans and will be developed with and overseen by the child’s lead professional.

Ensuring a child is safe from CSE will require input from a range of people. As part of the safety planning processes, a child’s views should always be taken into consideration. In addition, the views and role of a child’s parents/carers as well as wider professional network to build resilience and to keep a child safe should be considered.

Actions agreed as part of the CSE Safety Plan should be proportionate to the level of assessed risk, focus on enhancing protective factors and reflect a child’s communication requirements and developmental needs.

Please refer to the multi-agency service response diagram to help with decision-making.

Where a Strategy Discussion / Meeting takes place all Surrey core agencies involved with the child should participate. A clear plan should be agreed and circulated to each agency participant. Wherever possible these should be face to face meetings rather than telephone discussions to allow better analysis of the available information.

Closing a CSE Safety Plan

• The weekly RMM are responsible for confirming that the risk of CSE has reduced to such an extent that the safety plan can be closed. Once a child’s risk of CSE has been reduced and the child is no longer felt to be at risk, the weekly RMM will consider closing the CSE Safety Plan and removing the child from the CSE List;
• The RMM will maintain a record of the decision to close the CSE Safety Plan together with the reasons for this decision and areas of good practice. If there are any ongoing support requirements, the RMM will refer to the appropriate agency.

Any child protection medical assessment must be planned carefully in order to secure any forensic evidence, if it is judged to be appropriate. A referral to the Surrey Sexual Abuse Referral Centre (SARC) must be completed (Home - The Solace Centre (surreysolace.org).

Any child protection medical assessment must be planned carefully in order to secure any forensic evidence, if it is judged to be appropriate.

Visually recorded interviews must be planned and conducted jointly by trained police officers and social workers in accordance with the Achieving Best Evidence in Criminal Proceedings: Guidance on interviewing victims and witnesses, and guidance on using special measures (Ministry of Justice). All events up to the time of the video interview must be fully recorded. Consideration of the use of video recorded evidence should take into account situations where the child has been subject to abuse using recording equipment.

Visually recorded interviews serve two primary purposes:

• Evidence gathering for criminal proceedings;
• Examination in chief of a child witness.

Relevant information from this process can also be used to inform Section 47 Enquiries, subsequent civil childcare proceedings or disciplinary proceedings against adults, where allegations have been made.

The single and most important consideration is the safety and well-being of the child or children. 

In reconciling the difference between the standard of evidence required for child protection purposes and the standard required for criminal proceedings, emphasis must be given to the protection of the children as the prime consideration.

The investigation and enquiries must also address the religious, cultural, language, sexual orientation and gender needs of the child, together with any special needs of the child arising from illness or disability.

A victim support strategy and service should be established at the outset. Support will be required in pre-trial, trial and post-trial periods if the case/s proceed to court. Minimum periods for contact should be established. It is clear from experience in research about sexual abuse investigations that many victims and families feel strongly that it is important that they remain in contact with the same practitioners throughout the investigative process.

Where an Initial Child Protection Conference takes place great care should be taken beforehand if the child / young person wishes to participate. The child should not be put in the position of meeting the alleged perpetrator or of attending the meeting at the same time.

Barriers to Disclosure

Children may disclose sexual abuse directly and verbally while others may attempt to disclose by non-verbal means including changes in their behaviours, requiring those around them not just to focus on the behaviour but why the behaviour may be happening. Rates of verbal disclosure are low at the time that abuse occurs in childhood. However, children say they are trying to disclose their abuse when they show signs or act in ways that they hope adults will notice and react to. This is particularly important for disabled children.

Children and young people often disclose abuse while it is still ongoing, there may be a significant delay between the onset of the abuse and any disclosure. The younger the age of the child when the sexual abuse starts, the longer it usually takes to disclose.

Many children are experiencing multiple forms of abuse and may live in households that are not safe and in which emotional support is not available to them.

Disclosures are more likely to come in adolescence as they learn about healthy relationships and how to recognise abusive behaviour. Adolescents often first ‘reach out’ to friends and peers after an experience of sexual abuse and these relationships can have significant influence on young people's emotional wellbeing after experiencing sexual abuse. Schools also have a very important role to play in aiding the disclosure process in providing developmentally appropriate education and a safe space within which to disclose. Professionals and children both highlight the importance of a trusted relationship between a child and a reliable professional as an important to aid disclosure.

See Helping Education Settings Identify and Respond to Concerns.

Children may disclose for a number of reasons possibly because they are not able to cope with the abuse any longer or because the abuse is getting worse. They may disclose in order to protect others from abuse or because they are seeking justice.

Barriers to disclosure include fear of not being believed, embarrassment and shame and fear of the consequences of telling. Some groups of young people will have additional challenges in disclosing due to communication, religious, language, cultural or sexuality issues.

Disabled children are at increased risk of experiencing sexual abuse especially due to communication and developmental issues.

Whenever they choose to disclose, it is important that they are believed, that they are told what will happen next and kept informed and that they are provided with emotional support.

Research into young people's experience showed that they wanted someone to notice that something was wrong and to be asked direct questions.

Practitioners must be mindful of managing information to minimise the risks to the child when responding to any concerns or disclosures.

There will be situations where due to lack of forensic evidence or corroborating witnesses the threshold for criminal proceedings is not met. It is important in these cases that the lack of police action is not interpreted as disbelieving the child's disclosure.

The Centre of Expertise on Child Sexual Abuse, is a multi-disciplinary team, funded by the Home Office, who have produced a range of resources to support professionals. These resources aim to give professionals the knowledge to identify concerns of child sexual abuse and the confidence to respond to it, not just with the child, but with the whole family.

These include:

• Signs and Indicators: A template for identifying and responding to concerns of child sexual abuse. It helps professionals to gather the wider signs and indicators of sexual abuse and build a picture of their concerns;
• Communicating with children: A guide for those working with children who have or may have been sexually abused. This guide aims to help you communicate with children in relation to child sexual abuse, including when you have concerns that such abuse is happening;
• Supporting parents and carers: A guide for those working with families affected by child sexual abuse. This guide helps professionals provide a confident, supportive response when concerns about the sexual abuse of a parent or carers child have been raised or identified;
• Safety Planning in Education: A guide to support education professionals' knowledge, skills and confidence to understand and respond to incidents of harmful sexual behaviour and ensure the safety of all children and young people is addressed;
• Helpful 12 part short film series: The CSA Centre have produced an accompanying 12-part short film series which distils key information from these resources quickly and accessibly for professionals. These films are designed for anyone whose role brings them into contact with children and young people under 18 years old or their parents or carers; including social workers, teachers, police officers, health professionals, voluntary-sector workers or faith leaders/workers – whether they are new to the role, still in training or highly experienced.

Useful Websites

Key messages from research on intra-familial child sexual abuse (Centre of Expertise on Child Sexual Abuse).

Centre for Expertise on Child Sexual Abuse - Measuring the Scale and Changing Nature of Child Sexual Abuse and Child Sexual Exploitation - Scoping Report June 2021, Professor Liz Kelly and Kairika Karsna (Centre of Expertise on Child Sexual Abuse)

Key Messages from Research on Child Sexual Abuse Perpetrated by Adults (Centre of Expertise on Child Sexual Abuse).

Protecting Children from Sexual Abuse (NSPCC)

Getting Support with Ssxual Abuse (Childline) help for children in talking about sexual abuse

Protecting Children from Harm - A critical assessment of child sexual abuse in the family network in England and priorities for action.

Research in Practice - Child Neglect and its Relationship to Sexual Harm and Abuse: Responding Effectively to Children's Needs - open access resource considering the potential relationship between neglect and forms of sexual harm and abuse.

University of Bedfordshire 'Making Noise: Children's Voices for Positive Change after Sexual Abuse' - Children's experiences of help-seeking and support after sexual abuse in the family environment

Safeguarding Children as Victims and Witnesses (Crown Prosecution Service)

Pre-Trial Therapy (inc Annex A: Specific considerations for children) (Crown Prosecution Service)

The Solace Centre, Surrey Sexual Abuse Referral Centre (SARC): Home - The Solace Centre (surreysolace.org)

Surrey Children’s Social Care: Report a concern about a child or young person - Surrey County Council (surreycc.gov.uk)