Child abuse in the family environment

 Background

Working Together to Safeguard Children (2018) defines sexual abuse as, "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. Activities may involve physical contact (assault by penetration, kissing, touching) as well as non-physical contact (production of indecent images, grooming)."

There is no single agreed definition of Child Sexual Abuse (CSA) within the family environment (also known as intra-familial sexual abuse), but in addition to abuse by a direct relative (such as parent or sibling), the Crown Prosecution Service Guidelines (2013) include situations where someone is living in the same household as the child and assumes a position of trust (such as god parent, close family friend or babysitter).

 The local picture

A study reported by the NSPCC (Radford et al, 2011) found that almost a quarter of young adults experience sexual abuse during childhood. If applied to the local population, this suggests around 11,000 children in Bury will have experienced some form of sexual abuse by their 18^th birthday.

The Sexual Assault and Referral Centre (SARC) at St Mary's Hospital in Manchester report that half of all young people attending their service are under 11 years old.

In the majority of cases where younger children (under 11 years), attended SARC, the perpetrator is identified within the family environment and over half of assaults are said to have taken place in the child's own home.

Almost a quarter of younger children accessing SARC have not made a verbal disclosure of sexual abuse. 27% of school aged children accessing SARC meet SEND criteria.

 Risks and indicators

Sexual abuse in the family environment often remains hidden, with children taking on average seven years to make a verbal disclosure.

In the absence of a verbal disclosure, the responsibility is on professionals to notice subtle changes in behaviour and/or emotional presentation and ask direct questions.

Behaviour should be understood as the primary language of younger children and the responsibility is for professionals to interpret what children are trying to say when they are unable to find the words.

Reframe 'what's wrong with you' to 'tell me how you're feeling?' or 'what has happened to make you feel this way?'

 Referrals and pathways

Where there are concerns that a child is at risk of suffering or has suffered significant harm through sexual abuse, a referral should be made to Bury MASH.

A strategy meeting will be convened with representation from children's social care, police and health (as a minimum).

If a child makes a verbal disclosure or there are physical indicators to suggest contact sexual abuse has occurred, a forensic child protection medical will be arranged with St Mary's SARC as part of section 47 enquires by either the police or children's social care.

 Professional challenges

Safeguarding younger children from sexual abuse in the family environment is a particularly challenging area of safeguarding practice.

Younger children are:

• Less likely to make a verbal disclosure
• More likely to have been abused by someone within the family network
• Less likely to have experienced contact sexual abuse through penetration, meaning physical evidence is less likely
• Less likely to meet the standard of evidence required for the police to initiate criminal proceedings

It's important to reconcile the difference between criminal thresholds (beyond reasonable doubt) and a safeguarding threshold (the balance of probability).

 Understanding impact

The Centre of Expertise on Child Sexual Abuse identifies inappropriate sexualised behaviours, betrayal, powerlessness and stigma as the likely impact of child sexual abuse (Finklehor and Brown, 1986).

Disclosures become more likely in adolescence when young people learn more about healthy relationships and abusive behaviours.

In the longer term young people who have experienced childhood sexual abuse are more likely to suffer with poor mental health, misuse drugs and alcohol and engage in criminal activity.

Of the 12 to 17 year age group of young people accessing St Mary's SARC, 40% reported poor mental health, 35% had self -harmed and 12% had attempted suicide.

 Next steps

Please read alongside the Greater Manchester Safeguarding Procedures - Child Sexual Abuse in the family environment and discuss potential learning for your service.