A new national screening tool to help nurses screen for child sexual exploitation, which is based on prompting conversation rather than ticking boxes, is due to be unveiled later this year, Nursing Times can reveal.
Young people have taken the lead in the NHS England project designed to help nurses and other healthcare professionals more easily identify those at risk of child sexual exploitation.
“A lot of the professionals were telling us that these are difficult conversations”
The new resources are the result of research commissioned by the government arm’s length body into current screening tools that are available to support frontline practitioners.
Salford University and Pennine Acute NHS Trust were tasked with assessing the tools, including gathering the views of frontline staff.
“The feedback from frontline health staff was very varied because there are lots of different tools out there,” said Lisa Cooper, NHS England’s lead for child sexual exploitation.
“Some screening tools were very long, some didn’t appear to be to be relevant and some of them weren’t always the easiest to use when you are sat in front of a young person aged 13, 14, 15 asking questions – it can feel very much like a tick-box exercise,” she said.
The research covered about 30 child sexual exploitation screening tools developed by various agencies including the police, health and local authorities and ranging from “a raft of pages to one side of A4”.
However, the team believe there may be as many as 50 different screening tools currently in existence.
“It is designed to prompt conversation with young people and ensure they genuinely feel supported”
More than 100 frontline practitioners from a wide variety of backgrounds were consulted during the course of what became the Not Just A Thought project – named by young people.
These included NHS nurses working in primary and secondary care, registered nurses working outside the NHS, doctors, social workers, police officers, teachers, charity staff, and child sexual exploitation leads.
Project lead Professor Andrew Rowland, a consultant in paediatric emergency medicine at Pennine Acute and honorary professor in paediatrics at Salford University, said feedback from both professionals and young people showed there was room for improvement when it came to child sexual exploitation screening models.
“For every tool we looked at – without exception – the professionals had something good to say but also some features they would want to be improved, so that says there isn’t a perfect model currently,” he said.
While the team did not specifically explore whether young people had been consulted when devising each tool, “there were only a very small number of those tools where it was obvious to us that young people had been involved”, said Professor Rowland.
He said this might mean the tools were less effective than they could be. “The feedback that I have had from young people when they have looked at the tools currently in existence suggests to me that just using tools that haven’t been co-designed with children and young people won’t pick up everything we could otherwise have picked up,” he said.
At least 75 young people of different ages and backgrounds – mainly from the North West but also the Midlands and south west England – were consulted and made suggestions on ways to improve child sexual exploitation screening.
Nurses to get new screening tool for child sexual exploitation
These ideas – together with the input from the professionals – were taken forward by a core group of 22 youngsters who came up with a series of core questions designed to spark meaningful conversations between healthcare staff and young people.
The young people made it clear that engaging with them properly was “not a one-way process” and just as much about them assessing whether they could confide in and trust professionals, said Mr Rowland, who has worked on the project with Donna Peach, lecturer in social work at Salford.
“They didn’t want to feel like it was a questionnaire, quiz or interview,” he said. “It is conversation and a conversation is two ways.
“They make a lot of assessments of the professionals in the same way the professional will be doing an assessment of the young person,” he added.
Young participants wanted to be absolutely clear about how any sensitive information they divulged would be used or shared.
They also said health professionals needed to speak to them using appropriate language they could understand, and nurses and others should expect to get answers “given in language that might be different from words they normally use” or in the form of pictures, video or another format, noted Professor Rowland.
Professionals highlighted the challenges in raising sensitive and difficult topics with young people, who more often than not present at settings like A&E, walk-in centres and sexual health services not specifically geared to treat younger patients.
“Some people – such as someone who works in a sexual assault centre – are specially trained to do this and it is what they do in their job every single day, so they find it a lot easier, but that’s not to say that every one of their interactions is easy,” said Professor Rowland.
“But a lot of the professionals were telling us that these are difficult conversations and any help they can get to build a positive rapport would be a real help,” he said.
The issue of time was also discussed given A&E departments, wards and other health services across the country are under considerable pressure and hit by staffing shortages.
One A&E nurse who took part in the project explained it was possible to have meaningful conversations with children and young people even when time was short.
“This is about a conversation and she explained that conversation starts the moment the child or young person arrives at your facility,” said Professor Rowland.
“You’re observing them on your way out to the waiting room to collect them. On the way to the cubicle you will be having a conversation – you won’t be walking in silence,” he said.
“You will have had a discussion when you get them into the cubicle or wherever this is taking place, and you get them seated and do some introductions,” he added.
“In that space of time which people might not consider to be part of the consultation time, they have already dealt with a third of the material and the rest is picked up during the assessment,” said Professor Rowland.
“What that nurse was saying was: this is entirely possible to do even in a time-limited resource, because it is just about changing the way you recognise your assessments are taking place and the way the conversation happens,” he told Nursing Times.
Professor Rowland said he and clinical colleagues had been testing the approach and he believed he had been able to find out more about young people’s safety and wellbeing as a result.
“I found out things I don’t think I would have found out from young people by having a conversation with them in a different way and using language in a different way,” he said.
This included some frank conversations with teenagers about their sexuality and mental health concerns.
“I have definitely had a conversation with people who, as a result of this discussion, identified a risk of child sexual exploitation as well as with some young people who were prepared to disclose for the first time things that were worrying them about potentially harming other people,” he said.
“I know our nurse practitioner who has also been trialling the approach has experienced similar results,” he added.
The model is due to be formally evaluated by Tony Long, professor of child and family health at Salford and a nurse by background.
Nurses to get new screening tool for child sexual exploitation
Ms Cooper, who is deputy director for quality and safeguarding for NHS England North, said using the new approach may involve a change of mindset for professionals like nurses who were trained to use more traditional screening tools.
“We like a tick-box exercise and if a screening tool says ‘yes’ or ‘no’, then we do that and often ignore that professional curiosity or gut instinct that something is not quite right,” she said.
“It will be a change because people will want to have a score or a red, amber, green rating and it doesn’t give you any of that deliberately, as it is designed to prompt conversation with young people and ensure they genuinely feel supported,” she noted.
Ms Cooper said it had quickly become clear that the Not Just A Thought project had a much wider scope than child sexual exploitation and would hopefully prompt conversations about wider safeguarding issues.
This could include substance misuse, mental health problems, parental substance abuse and mental health, domestic violence and, crucially, neglect “the big issue that health staff often fail to recognise but is the underlying cause of a lot of safeguarding issues for children”, she said.
Not Just A Thought is due to be launched later this year – the general election may delay the original start date of July – with a website and a range of other resources.
Professor Rowland said he would like to see professionals try them and make suggestions for how they could be improved further.
“What I would like to think is that over time we could perhaps harmonise the assessment tools or models we have so we don’t have 30 or 50 but have just a few, or maybe even just one, that has different parts to it,” he said.
NHS England will also launch some new child sexual exploitation training for healthcare professionals responsible for training others, developed with Great Ormond Street Hospital for Children NHS Foundation Trust and specialists in the area CYP First.
Ms Cooper said the plan was to pilot the two-day face-to-face “train the trainer” course with named nurses for safeguarding, A&E staff and walk-in centre staff at eight or nine sites across England.
She said the pilot would help determine “what was best for frontline staff”, such as whether it was feasible to deliver standalone child sexual exploitation training, or whether it should be incorporated into mandatory safeguarding training.