Gabrielle Tracy McClelland, Senior Research Fellow/Senior Lecturer

1. Meeting the physical & psychological health needs of young people involved in or vulnerable to sexual exploitation Gabrielle Tracy McClelland, Senior Research Fellow/Senior Lecturer Supervisors: Professor Newell & Dr Sture

2. Defining child sexual exploitation Child sexual exploitation involves exploitative situations, contexts & relationships where young people receive ‘something’ as a result of performing &/or others performing on them sexual activities Reference: National Working Group for Sexually Exploited Children & Young People.

3. Language is important As it influences the response towards young people e.g. affair rather than exploitation denies the criminal element

4. There is always a power differential between a vulnerable young person and an adult • Autonomy is eroded in cse, • Self determination and choice are reduced • The young person may be objectified & seen as a commodity • Human rights are infringed

5. Background to the study • Accurate prevalence data do not exist ; (various estimates of scale & unreliable data) • Child sexual exploitation is a contemporary global issue effecting thousands of children. • Recent high profile events have drawn attention to child sexual exploitation (JC & HW). • There has been a recognition that sexually exploited children & young people are abused children requiring safeguarding, not prosecuting.

6. Value of the research • Emphasis is on prevention, protection & prosecution (limited attention to cse prior to 2000, SCIP, updated 2009) • Explores strategies to improve health & reduce risk • Health is an ‘Every Child Matters’ outcome

7. Value of the research • Raises profile of vulnerable young people • Offers young people a chance to express their opinions about matters that effect them (silent consumers of health care) • This is novel & original research in an under researched area (research available tends to relate to familial sexual abuse, over 18’s & sex work)

8. Research aims • To identify the range of physical & psychological health needs of sexually exploited young people. • To explore perspectives of risks to health. • To identify barriers to meeting health needs. • To recommend strategies to improve health.

9. Methodology Study Design Sequential mixed methods Phase 1- Phenomenological approach taken. Face to face interviews were undertaken with 24 young people involved in or vulnerable to sexual exploitation. Phase 2- A questionnaire survey was undertaken in 11 agencies with professionals supporting this group.

10. The young people • Were aged between 13 & 18 years • Two young people were male & 22 were female • One young person described herself as Black British • One young person described herself as Pakistani • Twenty two young people were White British

11. Health issues included • Physical health • Psychological health & intentional self harm • Sexual health • Drug & alcohol misuse

12. Physical health • Under weight: 5 (3 describe self as anorexic) • Over weight: 2 • Poor sleep: 3 • Deep vein thrombosis:1 • Hepatitis C+:1, Hepatitis B +:1 • Physical assaults

13. Psychological health • Stress: 4 • Anxiety: 2 (1 fears going out) • Panic attacks: 2 • Emotional problems: 5 • Low mood: 8. • Paranoid thoughts: 2

14. Intentional self harm • 5 people reported self laceration. • 1 person burn her arm. • 1 person swallowed razor blades • 3 people reported self poisoning • 1 person sniffed gas (with suicidal intent)

15. Sexual healthMost young people reported using genito-urinary medicine clinics • Sexually assaulted:3 • Slept with men for shelter:1 • Unplanned pregnancy:7 • Miscarriage: 2 • Planned termination of pregnancy: 1.

16. Reported drug use Current drug use:18, no drug use 5, not discussed 1 amphetamine (8) ecstasy (9) cocaine(3) crack (3) heroin (4), (2 intravenous drug users & described self as a ‘prostitute’) cannabis: 12, tobacco: 14

17. Reported alcohol use Declared alcohol use:16 Not stated alcohol use but use drugs:5 No drug use & no alcohol use:3 Drinking patterns Safe limits:1 Increased & high risk drinking: 8 Dependent use:7

18. Important factors in accessing health careaccording to young people & professionals in this study Staff Service design Service delivery

19. Staff • Staff who are able to display warmth, empathy & respect • Have a genuine interest in them & other young people • Young people prefer to be supported by people whom they consider to be young. • Prefer choice of gender of staff

20. Service design (what it offers) • Local, accessible, open access • Short time to be seen/receive test results • Young people prefer services that combine interventions • Support for their families & significant others involved in their lives. • Help lines targeting young people to offer health advice & information • Age specific services • Health support & health education in schools

21. Service delivery (How the service is provided) • Age appropriate information • Avoid treating young people as adults or patronizing them. • Consultation with young people regarding service design/delivery. • Respect, confidentiality & autonomy to make choices • Option to be escorted to appointments by a familiar person • Combining a difficult intervention with a positive experience

22. Recommendations • Child & young person oriented services • Flexible services central to the young person’s needs • Open access & outreach services • ‘Front of house’ staff who are skilled & friendly • Clear & accessible confidentiality policies

23. Recommendations • Early identification & intervention • Interagency, multi-professional working • Care & protection delivered together • Harm reduction approach • Holistic care

24. In summary…….. • Significant levels of health problems were reported by both the young people in this study & the professionals supporting them. • A taxonomy of risk taking behaviours was apparent • Frequent examples of health needs being inadequately addressed were cited. • Vulnerability is increased by not addressing health needs effectively

25. Thank you Gabrielle Tracy McClelland