The role of social workers in safeguarding and child protection has received much critical attention in recent years, in an evolving political and social context, where policy and practice has shifted following both public outcry of serious case reviews (Munro, 2011) and subsequent policy and practice changes concerning the profession and how it services the needs of the most vulnerable in society (Corby, 2006; Department for Education [DfE], 2017a). This article seeks to critically examine the current methodology for identifying suspected child sexual abuse (CSA) signs and indicators, the evolving spectrum of abuse, and to evaluate current perspectives on child sexual exploitation (CSE) (DfE, 2017a). Research in this area has shown that a history of abuse increases the risk for individuals of being further exploitated or becoming an exploiter themselves; alongside child trafficking, this is an area of current concern (Davies, 2012; Melrose and Pearce, 2013; Hallett, 2015; 2017). The article will also provide a critical evaluation of the current policy and practice for professionals engaged in child protection social work, eliciting current perspectives from this field (Broadhurst et al, 2009; Melrose and Pearce, 2013), with evidence drawn from serious case reviews and subsequent changes to policy on the back of these.
Background
In order to understand the context of safeguarding children suffering abuse and in turn, possible exploitation, and how evidence-based practice is informing current direction of policy and practice, we first need to take a brief look at how this area was defined in the past and how it has evolved. Wilson and James (2007) described the developments in child neglect and abuse from the post-war period and legislative changes as moving away from the hated Poor Laws of the 19th century to a model of social welfare, supporting families with a focus on preventative work to help them remain together. Leading up to the 1960s–70s, neglect was viewed as a consequence of poverty and a growing social concern as it led to increased delinquency and criminal activity among the young (Alcock et al, 2003). Only cases leading to significant harm or the death of a child were gaining prominent government attention when reviewing policy and legislation, such as the introduction of the Children Act 1948 (Wilson and James, 2007).
Still, at this point in time, notions of abuse where not conceptualised in a specific form. Only serious cases of harm where treated through the legal system on the back of a criminal act to a child. Substantial health problems in children being labelled as neglect, with conditions such as rickets sighted against living in poverty and deprivation (Davies, 2012). In the wider social professions, from the 1970s there was a growing momentum for the medical professions to lead on evidence identification and diagnosis of abuse, on the back of emerging concepts such as ‘battered baby syndrome’ and later ‘non-accidental injuries’ (Broadhurst et al, 2009). This concept was broadly supported by a growing wealth of research in the area of child protection, as public concern was increasing on the back of moral panic with attendant demand for something substantive to be done (Lawrence, 2004).
Defining abuse
‘Child abuse is any action by another person—adult or child—that causes significant harm to a child. It can be physical, sexual or emotional, but can just as often be about a lack of love, care and attention.’
This broader definition of abuse, with a key change in vocabulary, has only really come fully into scope in the last 10–20 years. Prior to this and in terms of both state interventions and wider societal perspectives, as Munro (2007) discussed, society's response to child abuse was changing throughout the industrialised communities of the last century, to one of acceptance that not only does abuse occur but it is morally wrong. It changed from a reactive perspective dealing with child deaths and incidents of serious harm caused by individuals, through to a proactive one of preventative work with children and families. Likewise, Broadhurst et al (2009) provided a contemporary view of the changing perspectives on abuse and emerging development in the principles of safeguarding, through its re-emergence in the 1960s, with paediatricians becoming key players in the decision-making process, and providing fresh focus on detection and psychological factors. Moreover, the introduction of the Children Act (1989) saw a new emphasis on ‘significant harm’ and ‘risk of harm’, setting key thresholds and clearer definitions from which professionals should base their decisions on (Goodyear-Brown, 2012).
Current perspectives on abuse are widening, reflecting the changing landscape of society and how it affects individuals, bringing new terms of reference such as child sexual and child criminal exploitation, female genital mutilation, extremism, child trafficking and county lines (Alexander, 2017; DfE, 2017a; 2018a).
Melrose and Pearce (2013) highlighted the need for closer cooperation between local agencies and minority ethnic groups to better understand and service the needs of unaccompanied and migrant children who have been trafficked into the UK. Conversely the understanding and interpretation of child trafficking is now widening with the emergence of county lines, where gangs are trafficking vulnerable young people within the country for criminal activities (Melrose and Pearce, 2013; Children's Society, 2018).
Defining child trafficking
‘The recruitment, transportation, transfer, harbouring or receipt of a child for the purpose of exploitation shall be considered “trafficking in persons” even if this does not involve any of the means set forth in subparagraph (a) of this article;’
‘“Child” shall mean any person under eighteen years of age.’
(United Nations Palermo Protocol, 2000)
Under the Palermo Protocol, two important aspects need attention, the first being defining a child; as with other UK and EU child-related legal acts, a child is any person under the age of 18 and entitled to the same services, recognition and support as child up to the age of adulthood (Kirton, 2009; DfE, 2018a). The second element being the movement of the child against their wishes. Trafficking by its definition can take place in the same building, if the person is being utilised for criminal activities against their will. A child (or person) does not have to be transported across boarders or other countries (Melrose and Pearce, 2013; Every Child Protected Against Trafficking, 2018).
Further considerations from a practitioner's perspective evolve from the growing use of children to move drugs and facilitate other exploitation activities, particularly in respects of both sexual exploitation and illicit drug movement (‘county lines’) (Melrose and Pearce, 2013; Kwhali et al, 2016). As part of the response to this growing avenue of abuse, prosecutions throughout the UK, are now being sought under section 2 of the Modern Slavery Act (2015) (Crown Prosecution Service, 2018).
Key points
- Any person up until their 18th birthday, under UK and EU Law is defined as a ‘child’ with the corresponding rights and entitlement to support services
- A child or young person ‘cannot legally consent to being exploited’, even if they directly seek to engage in such activities
- A person does not have to be moved from one country or location to another to be trafficked.
The role of social workers
Dixon et al (2017) outline the role of social workers in regards to safeguarding children and child protection practice as primarily one of statutory assessment, investigation and co-ordination of family support services for a ‘child in need’ or ‘child at risk of significant harm’, enacting the requirements of the Children Act (1989; 2004) and ‘Working Together to Safeguard Children’ (DfE, 2018a).
Defining a ‘child in need’
‘A child in need is defined under the Children Act 1989 as a child who is unlikely to achieve or maintain a reasonable level of health development, or whose health and development is likely to be significantly or further impaired, without the provision of services; or a child who is disabled’.
Following initial referral or contact, social workers as part of a multi-agency response, will complete an early help assessment of need, they may draw upon universal services to meet general support requirements. If the needs are more complex, then the social worker will lead a multi-agency assessment under section 17 of the Children Act (1989) aligned with current specific DfE (2018a) guidelines. If there is a concern that the child might be ‘at risk of significant harm’, further enquiries will be made followed by a strategy meeting under section 47 of the Act, a decision made quickly to manage such risk. This may include the removal of the child from the immediate carer, to another family member or into other external accommodation (Goodyear-Brown, 2012; Milner et al, 2015; DfE, 2017a; DfE, 2018a). In all instances, the social worker is pivotal in bridging the child and family with wider support services and social care casework (Broadhurst et al, 2009; Davies, 2012).
The above view seems relatively simplistic and procedural in its form, legislation is defining the context from which professionals identify appropriate pathways to meet a given situation (Dixon et al, 2017; DfE, 2018a). However, the role is much deeper, broader and requires the professional to work in a complex, highly contested environment with conflicting and shifting forces acting upon it, particularly in the context of exercising the child's views, and often facing structural reform and further legislative changes (Bell, 2011; Wilson et al, 2011). Legislation, policy and strategy have continued to evolve systematically, such as the change from local safeguarding children boards to local safeguarding partnerships, consisting of police, clinical commissioning groups and local authorities (DfE, 2017b; DfE, 2018a).
Approaches to professional practice in safeguarding and child protection have also seen substantial changes in discourse over recent years, predominantly on the back of serious case reviews (Laird et al, 2018). Moreover, how society and government define children and childhood creates additional tensions and difficulties for social work practice. Broadhurst et al (2009) illuminated this field of thought, where under New Labour's Third-Way children are in one sense, in need of protection from people, practices or structures that may affect their wellbeing and development, and in turn, are a key asset of a more flexible economy to come. Yet their voices, agency and rights to self-determination are becoming more common in social policy rhetoric, as critical factors that need focus and opportunity (Bell, 2011).
Equally, ‘Every Child Matters’ (HM Treasury, 2003) the then government's response to the findings of the Victoria Climbié inquiry, highlights the duty of care of social workers and other relevant professionals, who are required to effect protection and facilitate the opportunity for wellbeing and development with the following underlying message:
‘children are precious…, entitled not just to the sentiment of adults but a strategy that safeguards them as children and realises their potential to the very best of our ability.’
Indeed, current safeguarding policy (DfE, 2018a) strongly emphasises for the welfare, health and wider developmental needs of the child. Where the capacity for the immediate carers around them to provide this is deemed lacking, then the state will intervene, alongside strong expressions of involvement of the child and their views in the decision-making process of how the intervention will proceed (Dixon et al, 2017). However, as Evans (2009) elaborates, these expressions of the child's voice, although prominent in Every Child Matters and various policies since, lack plausibility in practice. The lack of rights-based language aligning to that of Article 12 of the United Nations Convention on the Rights of the Child, in turn, lowers the priority for the child's participation in everyday practice for social workers, often based on the fear of the impact this would have on the child.
Likewise, Munro (2011) suggests that all too often social workers continue to work in a polarised context between meeting the needs of the child and how these should be met by adults, and with ambivalence fail to effectively illicit the voices and views of the child, leading to flawed assessments in child protection reviews.
Correspondingly, in Haringey Local Safeguarding Children Board's (2009) review of Peter Connelly's case, social workers were heavily criticised for not making meaningful engagement with him, focusing too much on the voices and needs of his adult carers and subsequently allowing the tragedy to unfold. McCafferty (2017) argues a strong case for urgency in social workers effectively engaging with Article 12 of the Concluding Observations of the United Nations Convention on the Rights of the Child (2008). Involving children of all ages in the decision-making processes at all stages, using this as a developmental tool for the child as much as ensuring decisions are more inclusive and responsive to their individual needs (Bell, 2011; Salter, 2018).
As indicated previously, the role social workers play in ensuring a child in need is adequately safeguarded requires a balanced approach, alongside ensuring suitably detailed and informative assessments of needs of both child and carers (Goodyear-Brown, 2011; DfE, 2018a), while making sure that traditional Piagetian notions (where a child cannot competently interact with its environment until later in development) are avoided. Children should be involved in all aspects of child protection decisions affecting them, and more imaginative ways of communicating and listening to their needs and wishes need to be developed (Arnold and Fisch, 2011; Lundy and McEvoy, 2012; McCafferty, 2017).
In broad terms, policy and practice around children and families, particularly regarding child protection social work, have substantially evolved and become more focused. Similarly the individual roles and expectations of both organisations and practitioners have become more concise and refined, and political context has helped shape and move forward this agenda (Doyle, 2012; Morris et al, 2018).
Key points
- Children's views regardless of age, should be elicited and taken seriously, remaining at the heart of any decision-making affecting the child's welfare and caregiving
- Practitioners need to utilise creative and intuitive forms of gathering these from children without fear of harm inhibiting the process.
Identification
Current research (Melkman et al, 2017; Erkkila et al, 2018) suggests that the most common source of referral for suspected CSA is from disclosure, accounting for around 50–70% of documented criminal cases. Evidence suggests that most disclosures were from children of school age. In younger children, referral was most common following presentation of abnormal behaviour or physical symptoms, although in isolation these will often not provide a coherent diagnosis for sexual abuse (Erkkila et al, 2018). Melkman et al (2017) goes on to suggest that credibility of witnesses increases with age. Conversely, Giroux et al's (2018) examination of changes in CSA over the last 26 years proposed that children reaching adolescents show a decreased rate of disclosure across this age group, with notification only increasing again in later adulthood.
In addition, there are further complexities for older children in the legal system as they may be perceived as ‘quasi-adults’ and better able to understand sexual encounters and able to consent, in turn often receiving a greater allocation of joint blame.
It would be useful at this stage to consider more broadly the possible indicators of CSA. Faugno et al (2016) called our attention to some of the most common early indicators, including:
- The child starts to use broad, general statements which they may use to gauge the response of a trusted listener
- They present sexualised behaviours or language that is not age appropriate for them.
Other common possible indicators of concern are; playing games, using dolls referring to genitals, sexualised activities, drawings and pictures may show reference to sexual activity (Goodyear-Brown, 2012).
Children with learning disabilities tend to present play behaviours much younger than they had previously or may display increased aggressive behaviours (Goodyear-Brown, 2012). Some children will seek to avoid close proximity to the perpetrator, this is particularly noticeable with family members whom they previously felt comfortable with (Linden and Webb, 2016). Further indications that professionals, health and social care teams engaging with children may be presented with include; physical, behavioural or psychiatric concerns.
Presentation may include:
- Physical indicators—STIs, pregnancy, constipation aligned with anal discomfort or vaginal discharge, for example (Dixon et al, 2017)
- Behavioural indicators—e.g. obsessive disorders such as a need for continuous cleanliness, or neglect of such, self-harm, early experience in sexual relationships, anger and aggression (Boyle, 2012)
- Psychological indicators—e.g. depression, regression bias, not wanting to accept what has happened, locking away the experience they wish to forget, withdrawal, poor sustainability of attachments or development of inappropriate attachments, trust disorders, suicidal tendencies and nightmares (Alexandra, 2017).
No one person or professional will have a full picture of a child's needs or risk, but early cause for concern and following the local safeguarding partnership's published guidance, sharing such concerns and working collaboratively may help identify early and appropriate interventions before a situation becomes a significant risk of harm for a child (DfE, 2018a). Every organisation or individual who engages or provides services and interventions to children and young people should be fully conversant with local safeguarding arrangements. When a professionals sees or is informed by another concerned party of a possible change in a child or young persons presentation as describe above, this should warrant a discussion with other professionals engaged with the child and if appropriate, the child's parents or guardians, being informed of such concerns and actions taken to refer following local safeguarding arrangements.
One of the key challenges for professionals responding to suspect CSA is that of delay. Physical sexual abuse is very difficult to identify, and often presents as normal even within a relatively short time frame of hours and days. In such circumstances, greater prevalence is placed on the accounts from the child, the child's history, credibility and assessment of cognitive ability aligned with age, and careful forensic evidence collection following ‘Achieving Best Evidence’ guidelines (Criminal Justice Joint Inspection, 2014; Erkkila et al, 2018).
Another important aspect suggested by recent research evidence is that of the nature of the relationship between the child and the perpetrator. Sharman (2017) and Salter (2018) found that cases involving male victims in particular, victims of trusted community officials and religious leaders, will significantly delay in disclosing for fear of disbelief. Often, years will have passed. Similarly, culture, religion and ethnicity are critical factors in delaying disclosure, often for fear of being ostracised from their community or family groups (Salter, 2018). Some cultures have strong beliefs in relation to the stigma attached to sexual abuse or toward the person disclosing that this took place within their community or setting (Connolly et al, 2006). Children who have suffered intra-familial abuse by a family member, are more likely to delay disclosure or seek to deny physical indicators were caused by abuse for fear of the impact on the family environment, for fear of the consequences and perceptions of the child by other family members, compared to those who experienced extra-familial abuse (Tener, 2018).
‘Contention with other key agencies; practitioners being focused to meet their own internal; and external, local and government policy driven targets and priorities have been cited repeatedly in past inquiries, reviews and reports into failures of serious maltreatment and abuse of children.’
Key points
- Any change in normal ‘presentation of behaviour, communication or health’ of a child should be seen as a cause for concern and warrant further investigation
- If cause for concern is identified, it must be taken further following local safeguarding arrangements, if following investigation no further action is required no harm will be done
- All practitioners need to develop awareness of ‘Achieving Best Evidence’ guidance and practices. At the very least this will aid in quickening a possible referral.
Long-term implications
Having discussed the challenges faced in recognition and identification of sexual abuse, it is now worth considering the long-term implications for the child, and how these may impact on their development and subsequent life course. A key differentiator in relation to long-term effects from CSA is that, for those who experienced intra-familial abuse, evidence strongly indicates long-term difficulties in sustaining trusting relationships, safe attachments and dependency (Wilson and James, 2007; Boyle, 2012). There is substantial evidence to suggest that children who suffered maltreatment, sexual abuse in particular, show increased prevalence to post-traumatic stress disorder, depression, anxiety, suicidal tendencies, psychotic episodes and a range of health-related issues in later adult life (Clayton et al, 2018; Morais et al, 2018).
Teicher and Sampson (2016) presented findings from recent advancements in neurological assessments which show that early exposure, or exposure at specific age points in relation to specific types of abuse, leads to distinct neurobiological brain development dysfunctionality, and presents in specific psychopathology. Critical implications of this is through the psychopathological assessments and subsequent treatment pathways (Gunter and Bruns, 2013). Concurring with this, Morais et al (2018) present evidence which strongly suggests that individuals with a history of CSA, in direct comparison to those without, have a significantly higher prevalence of internalising behavioural difficulties, increased levels of problematic and risk-taking behaviours; yet lower levels sexual offending behaviours, with key differences in psychological functioning. As indicated previously, the epidemiology of CSA with deeper understanding of the long-term neurobiological changes affecting children's recognition and interpretation of dangers, aligned with the increasing concerns of an emerging and evolving spectrum of exploitation, trafficking and radicalisation affecting the most vulnerable in society infers that those who have experienced CSA are at greater risk of being drawn into these fields of current societal concern, due to their inherent vulnerabilities (Melrose and Pearce, 2013; Hallett, 2017). This places additional longer-term developmental and health concerns that need consideration for such children (Smith, 2008; Reis et al, 2014).
Key points
- Intrafamilial abuse is a strong precursor to longer-term attachment, psychological and health detriments
- A child or young person who has suffered abuse, is significantly more vulnerable to further exploitative scenarios.
Partnership working
Organisations, teams and individuals working independently in the child protection environment, often in silos, leads to ineffective partnership working. Contention with other key agencies; practitioners being focused to meet their own internal; and external, local and government policy driven targets and priorities have been cited repeatedly in past inquiries, reviews and reports into failures of serious maltreatment and abuse of children (Corby, 2006; Wilson and James, 2007; Munro, 2007; 2011; The Lord Laming, 2009). Despite repeated, revised and new government policy (DfE, 2011; DH, 2013; DfE, 2013; 2015), there is a growing body of evidence that suggests current government policy and strategy is continuing to adversely affect child and family social work (Hood et al, 2016; Bilson and Martin, 2017; Bywaters et al, 2018; Morris et al, 2018).
Hood et al (2016) strongly argued the case that interprofessional expertise is integral to developing effective collaboration, particularly in the concepts of the team around the child. This highlights the fact that, rather than an integrated response, the tendency is to form a collective of specialist interventions providing separate solutions to separate problems (Milner et al, 2015). In this collaborative working environment, further barriers and difficulties continue to present challenges. Smith et al (2014) discussed the complexities and confusion often attributed to differing terminology and categorisation.
This area of confusion not only presents often its own variations across government departments in the language used, but also across the four nations of the UK through political devolvement. Another important finding that is showing consistency in critical perspectives on current practice, is one of professionals' perceptions of both children and young people's choices being central to causing or aiding facilitation of the abuse and maltreatment experienced (Firmin, 2018). Correspondingly, Melrose and Pearce (2013) and Hallett (2017) explores the evidence base of children and young people adapting to abusive concepts as a survival strategy; in some cases, making informed choices to consent, providing themselves agency in the social context they are living in, or for monetary or commodity gain, recognising the value of their bodies.
The research to date on improving partnership working has focused heavily on past failures; developing practice that is overtly controlled by managerialism and bureaucratisation to meet the needs of defensive practice, protecting the organisation, and heavy burden of preoccupation with risk (Rowgowski, 2014). Prominent voices in the academic research fields have been suggesting that a shift in political policy is urgently needed to address increasing volumes of children and young people requiring child protection plans or further state involvement to afford them the protections and opportunities the government aspired to (Lindon and Webb, 2016). Policy and practice need to move away from a ‘victim blame culture’ and focus on integrating both the therapeutic and legal prerogatives; providing a responsive, yet flexible system to meet the needs of children and their families in a coordinated interagency approach, with fresh narratives for professional cultures to be developed around the child (Salter, 2018).
Information sharing and communication are central to improving partnership working to affect positive experiences and deliver change. The Criminal Justice Joint Inspection (2013) in its report on the effectiveness of multi-agency work with children and young people in England and Wales, highlights the disparate approaches across the regions in relation to appropriate, essential and timely information sharing impacting the quality and consistency in risk management, and ensuring appropriate safeguarding measures were implemented (Munro, 2011; The Lord Laming, 2011). Often simple fear or naivety on what information can and cannot be shared, how and with whom, acts to dilute or remove completely what is or should be shared to provide an informed approach and assist with the identification of appropriate needs and resourcing (Information Commissioner's Office [ICO], 2018). Conversely, inappropriate sharing of personal information can have a profound impact on individuals' lives. Both have been regularly cited as areas of concern in serious case reviews (Lamming, 2009; Munro, 2011). A 2018a DfE publication provides some much-needed clarity, with key emphasis on the importance of balancing the needs and rights of the individual against the need to safeguard the welfare of the child who may be at risk of maltreatment or abuse with a quintessential myth busting guide.
Key points
- Social workers need to provide clear and cohesive leadership supporting and directing the team around the child—ensuring that all actions and decision are coherent, collective and mutual in servicing the needs of the child
- Information sharing should be proactive and fluid without fear, following current ICO guidelines.
Conclusions
Child protection social work has seen significant evolutionary change, challenges, and often though provoking exploration of the issues this sector and practitioners face, both at a macro and micro level. Safeguarding and child sexual abuse has progressed from a responsive situational context often on the back of criminal proceedings to one of prevention—providing interventions that are immediately responsive in the child's best interest, while retaining the need to understand the wider context of the situation, the family and the voice of the child. A child, regardless of their age, has a right to be engaged as an individual, and is not just an object or point of reference in a wider societal concern.
Current society and sociological developments are presenting new challenges and opportunities for children and young people to express their agency and become entranced in new, evolving situations of exploitation for the sexual gratification or criminal needs of others. The role of social workers engaging in this field has also substantially evolved. Widening professional knowledge and personal attributes are required to work in a highly contested and often emotional sector. Social workers are challenged to work innovatively in competing political and sociological spheres, where the needs of the individual are often balanced against the expectations of regulation and legislation, further compounded by a fear of ‘dammed if you do or dammed if you don't’.
In a similar light, the broad spectrum of research has helped enhance our understanding of not only recognising and responding to safeguarding concerns and disclosures, but the wider political, environmental and societal influences that are shaping them. The developing knowledge set enables more informed, longer-term planning to meet the developing and emerging needs of individuals who may have experienced abuse often at a very young age and who may not present until much later in adolescence or adulthood.
Recommendations for practice:
Regardless of a child or young person's age and seemingly inferred consent, if they are under 18 years they cannot legally consent to engage in sexual acts in return for goods, money or social gain. In the eyes of the law they are still children being exploited and local safeguarding arrangements must be implemented.
Similarly, if a child or young person is being coerced for criminal acts where they are the carriers of illicit goods or providing or being involved with the production of sexual material or acts, even within the same building, they are being trafficked and again local safeguarding arrangements need to be implemented immediately.
Children of any age are entitled to having their views listened to and for them to be directly engaged in the decision-making process affecting their lives.
Children should not be passive actors in their environments and should be supported proactively to develop their own agency.
Even with very young children, their views and thoughts should still be elicited using imaginative and creative ways that are age and developmental stage appropriate, and these should be used centrally in all discussion and decision-making.
All practitioners engaging regularly with children, including teachers, youth leaders, registered childminders, religious leaders, sports instructors, etc. alongside health and social care professionals, such as school nurses, who notice changes in children's presentation, emotionally, psychologically or physically should have cause for concern and speak to fellow colleagues about this. Often one person will notice one small change and another something else, all of which forms the jigsaw of concern that should invoke following local safeguarding arrangements.
If concern of maltreatment or possible harm to a child is raised, then awareness of ‘best evidence collection’ alongside local safeguarding arrangements can make a significant difference in not only the early identification and removal from potential or actual harm, but also greatly aid in the preparation of evidencing for any future potential criminal investigation and possible progression to a conviction.
The effects of maltreatment, particularly intrafamilial abuse, will most likely have long-term implications for the child or young person, with further difficulties and health concerns not presenting for some time. In addition, such children are substantially more vulnerable to further exploitation and maltreatment, requiring greater sensitivity to their immediate and longer-term developmental needs.