1.4.8 Child Sexual Abuse in the Family Environment

1. Definitions

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 other forms of child abuse, such as emotional abuse and physical abuse in order to maintain control and secrecy.

Children from birth onwards can be sexually abused. Sexual abuse can have a devastating long-term impact on a young person's behavioural, emotional, social and educational development.

Research by the Children's Commissioner (2015) defined 'child sexual abuse in the family environment' as:

"Child sexual abuse perpetrated or facilitated in or out of the home, against a child under the age of 18, by a family member, or someone otherwise linked to the family context or environment, whether or not they are a family member"

This definition is deliberately broad. It captures a range of relationships between victim and perpetrator, some of which are more clearly 'familial' than others. Biological family relationships are included, as are foster family members, partners of parents/carers, and adults otherwise involved in the home life and upbringing of the victim on a more informal basis, including family friends and babysitters. Adults have been included in the scope of child sexual abuse in the family environment where the familial context of the relationship between victim and perpetrator exacerbates the impact of abuse on the victim and undermines their ability to access help and support.

See also the procedures for:

• Child Exploitation: Policy, Procedures and Guidance;
• Child Abuse and Information Technology;
• Harmful Sexual Behaviour; and
• Allegations of Harm Arising from Sexual Activity (including Under Age Sexual Activity).

2. Indicators

Intra-familial Sexual abuse often remains hidden and can be the most difficult type of abuse for children and young people to disclose. It can be particularly difficult to disclose abuse by a sibling.

Many children and young people do not initially recognise themselves as victims of sexual abuse - a child may not understand what is happening and may not even understand that it is wrong. In addition the perpetrator may seek to reduce the risk of disclosure by threatening them, telling them they will not be believed or blaming them in some way for their own abuse. They may also seek to normalise the abuse.

Children who are sexually abused may exhibit a range of signs but any one sign doesn't necessarily mean that a child is being sexually abused; however if you identify the presence of number of signs you will need to consider the possibility of sexual abuse and follow your individual agency safeguarding children procedures. Where there are concerns that care givers may be involved in the suspected abuse, information should not be shared with them.

Signs include:

• Changes in behaviour, including becoming more anxious, 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;
• Being frightened of or seeking to avoid spending time with a particular person;
• Knowledge of / or interest in sexual behaviour/language that is not appropriate for their age;
• Children who behave sexually or play sexual games;
• Physical symptoms including pregnancy (particularly where the identity of the father is vague or secret), STIs, discharge or unexplained bleeding;
• Poor hygiene;
• 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;
• Soreness in genital / anal areas;
• Continence issues;
• Injuries to the mouth, which may be noted by dental practitioners.

Other Contributing Factors to be mindful of

• 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 Services 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;
• Repeated pregnancies with no information on the father;
• Genetic abnormalities in pregnancy or in children who are born.

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

1. Traumatic sexualisation (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)

In the longer term people who have been sexually abused are more likely to suffer with depression, anxiety, eating disorders and post-traumatic stress disorder (PTSD). They are also more likely to self-harm, become involved in criminal behaviour, misuse drugs and alcohol, and have an increased risk of suicide.

3. Protection and Action to be Taken

Disclosure from a child or young person

Whenever a child discloses that they have been sexually abused, 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 re-assurance about how the child will be kept safe (if this is known);
• Reassure the child that they have done the right thing by disclosing (however avoid physical reassurance of the child where possible);
• Record the child's disclosure using their own words;
• Explain what action need to 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. The practitioner should then share details of the disclosure with their designated safeguarding lead without delay, and a prompt referral should then be made to Children's Social Care Services. Any concerns that a child is an imminent risk of harm should be passed to Children's Social Care Services immediately.

In cases of intra-familial sexual abuse, parents / carers should not usually be informed about the referral as they may put pressure on the child to retract any disclosure and seek to destroy any evidence that could be used by the Police in the pursuance of criminal investigations.

It is not unusual for children and young people to retract disclosures, particularly when their alleged abuser is part of the family network; this makes it especially important that they are supported and reassured that they have done the right thing in disclosing.

Professional Concerns / Observations

If a professional has concerns about sexual abuse (for example due to a child's presentation or behaviour) it may (depending on their role / relationship with the young person) be possible for them to speak to the young person directly - without asking direct or leading questions. Where this would not be appropriate, concerns should be shared with the safeguarding lead / a manager and a decision made regarding referral to Children's Social Care Services.

Details of all observations / concerns and any discussions with the child / young person or any other professional should be recorded.

Where you have concerns that a child is at immediate risk of harm, the Police should be contacted immediately.

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

Where a Strategy Meeting takes place following receipt of the referral the, the core agencies involved with the child and their family 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.

Any child protection medical assessment must be planned carefully in order to secure any forensic evidence, and a discussion with paediatrician should be undertaken to establish appropriate medical investigations required. See: West Yorkshire Sexual Assault Referral Centre (SARC) - Child Sexual Assault Assessment Services (CSAAS) Pathway.

Section 47 Enquiries

The Police and Children's Social Care Services must co-ordinate their activities to ensure the parallel processes of a Section 47 Enquiry and any criminal investigation are undertaken in the best interests of the child.

The primary responsibility of the Police is to undertake criminal investigations of suspected or actual crime and they must inform Children's Social Care Services when they are undertaking such investigations.

At the Strategy Meeting, the Police should share current and historical information with other services where this is necessary to ensure the protection of a child. Working Together to Safeguard Children states that: The police should assist other agencies to carry out their responsibilities where there are concerns about the child's welfare, whether or not a crime has been committed.

Where another agency become aware that a crime has been committed they must report this to the Police.

See also Joint Protocol between West Yorkshire Police and Children's Social Care regarding Joint Police/Children's Social Care Enquiries.

At the conclusion of the Section 47 investigation, if the case does not proceed to a an Initial Child Protection Conference a second de-briefing Strategy Meeting should be held to ensure that any on-going risks are understood and protective action can be undertaken. All decisions and the rationale for these should be clearly recorded on the child's case file.

All child protection medicals due to concerns over sexual abuse are carried out in the regional Sexual Assault Referral Centre and are arranged by Children's Social Care Services and the Police.

Digitally recorded interviews with the child 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 in the case notes.

Consideration of the use of digitally recorded evidence should take into account situations where the child has been subject to abuse using recording equipment.

Digitally recorded interviews serve two primary purposes:

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

4. Issues

The single and most important consideration when there are concerns in relation to child sexual abuse 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 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 proceeds to court. An agreement should be reached about who will assume responsibility for keeping the child and their non abusing family members informed about the progress of the investigation, including frequency of contact. Where an Initial Child Protection conference takes place great care should be taken beforehand if the child / young person wishes to participate – the local Children's Rights Team should be contacted for advice and support.

Barriers to Disclosure

Sexual abuse by a family member is largely hidden, and some children and young people wait years before telling anyone about the abuse they have experienced. Abuse by a family member can be particularly difficult to disclose as children who have been abused in such a way may find it difficult to know which adults they can trust, and are likely to have been threatened that they must keep the abuse a secret and / or told that they will not be believed.

Professionals should, therefore, seek to understand the reasons behind any child's behaviour and presentation; children who have been sexually abused have said in research they wanted someone to ask them what was wrong.

Children and young people may disclose abuse to a trusted adult while the abuse is still on-going, but there maybe 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. Disclosures are more likely to come in adolescence as children learn about healthy relationships and how to recognise abusive behaviour. Schools have a very important role to play in aiding the disclosure process by providing developmentally appropriate education and a safe space within which to disclose. Schools should be mindful of the potential for increased disclosure when a year group starts a programme of sex education.

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 (such a younger siblings) 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.

Children with disabilities (physical/sensory) are at increased risk of experiencing sexual abuse due to communication and development issues, a lack of appropriate sex education and accompanying vocabulary for sexual issues and a tendency of adults to dismiss the sexual identifies of children with disabilities.

Whenever a young person makes a disclosure, it is important that they are believed and reassured that they have done the right thing by disclosing, that they understand what will happen next (i.e. that their disclosure will have to be shared with Children's Social Care Services / the Police), that they as far a possible will be kept informed and provided with specialist emotional support.

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.

5. Best Practice

Points for best practice:

• 'Hearing the voice of the child' requires safe and trusting environments for children to be seen individually, speak freely, and be listened to;
• Practitioners must consider how to enable children to express their views while taking account of the child's age, development, and language. This will be compounded if the child is in any way threatened or coerced by an abusive family member, or if the child has other underlying developmental or communication needs;
• Previous research emphasises how children have extreme difficulty in expressing their concerns and that practitioners should not expect children to disclose abuse;
• The onus falls to the practitioners to seek to understand how children express themselves through their behaviour and what they say rather than seeing them as 'difficult' or 'demanding';
• An active effort must be made to actually see and assess children in their families;
• Considerations must be made for children who do not communicate in English or who cannot communicate verbally with the wider world.

6. The Centre of Expertise on Child Sexual Abuse

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.

7. Further Information

Protecting Children from Harm - (Children's Commissioner) - A critical assessment of child sexual abuse in the family network in England and priorities for action (Children's Commissioner, 2015).

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.

'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

Preventing Child Sexual Abuse - The Role of Schools - examines the important role schools can play in enabling children to recognise abuse.

Measuring the Scale and Changing Nature of Child Sexual Abuse and Child Sexual Exploitation Scoping Report July 2017, Professor Liz Kelly and Kairika Karsna (Centre of expertise on child sexual abuse)

Investigating Child Sexual Abuse - examines timescales for sexual abuse prosecutions and makes recommendations.

Therapeutic Services for Sexually Abused Children and Young People Scoping the Evidence Base, Prepared by Debra Allnock and Patricia Hynes Summary Report December 2011.

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

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

Therapy: Provision of Therapy for Child Witnesses Prior to a Criminal Trial (CPS).