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NICE issues first guidance on harmful sexual behaviour in young people

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School nurses and other members of the profession should “immediately inform” their organisation’s safeguarding lead when a child or young person displays sexualised behaviour that is not appropriate for their age, new guidelines state.

Possible signs of problems include using sexualised language such as adult slang to talk about sex, sexualised behaviour such as “sexting” or sharing and sending sexual images using mobile or online technology, or viewing pornography that is inappropriate for age and developmental status.

“It’s about encouraging practitioners to recognise when there is a problem and seek advice”

Maeve Murphy

Nurses who are named safeguarding leads should then use “locally agreed resources” to assess concerns about the sexual behaviour, said the National Institute for Health and Care Excellence in its new guideline.

Such tools should form part of an “early help assessment” that accounts for the severity of the behaviour involved, to avoid unnecessary and potentially stigmatising referrals.

NICE said practitioners should use risk assessment tools that are suitable for the child or young person’s developmental age and gender when concerns were initially raised.

In particular, the guidance recommended professionals use resources such as the Brook Sexual Behaviours Traffic Light Tool2 to help gauge the severity of the behaviour.

“Harmful sexual behaviour has gone under the radar for too long”

Jon Brown

The Brook tool identifies a range of sexual behaviours between infancy and adulthood and distinguishes between their seriousness using a traffic light system.

For the first time, the NICE has published guidance to enable practitioners to help children and young people who display harmful sexual behaviour.

Overall, NICE called for a joined up approach between universal services, child health services, children’s social services and the voluntary sector when responding to concerns about behaviour.

Other recommendations included that practitioners should consider engaging with families and carers before beginning an intervention, and that care plans and structure interventions should be tailored to meet the needs of the individual child or young person.

The guideline also identified the need for further research into the impact that electronic media has on sexual behaviour, such as so-called “sexting” where people exchange intimate photographs.

NICE noted that while many children would naturally grow out of behaviours such as engaging in inappropriate sexual discussions or acts, it was important they were not ignored.


Gillian Leng

It highlighted that in the small number of cases involving children and young people committing sexual offences evidence suggested early opportunities to address their behaviours were missed.

Professor Gillian Leng, deputy chief executive of NICE, said: “This guidance is about preparing teachers, nurses, social workers and others to recognise harmful sexual behaviour when it occurs and ensure they can work across team boundaries so that problem behaviour is not ignored or missed and children and young people receive the help they need.”

Maeve Murphy, a clinical nurse at Greater Manchester West Mental Health NHS Foundation Trust, was part of the NICE guideline development group.

She said: “There is a disparity in the provision of services throughout the country to tackle these issues, both in terms of quality and quantity.

“This guideline is about encouraging collaboration and support between services so that these gaps can be addressed,” she said.

“It’s also about encouraging practitioners to recognise when there is a problem and seek advice,” she noted.


Guidance on harmful sexual behaviour in children

Jon Brown

Jon Brown, head of development and impact at the charity the NSPCC, was also a member of the guideline development group.

“Harmful sexual behaviour has gone under the radar for too long,” he said, adding that there were “three key messages” in the guidance.

He said these were that children and young people should not be treated as “mini sex offenders”, that the approach should be shaped to the individual, and that steps to change behaviour will only be effective if families and support networks understand there is an issue and are supportive.

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