1. Sexual Coercion, Exploitation, and Violence
and the New Sexual Health System:
The role of Sexual Health
Services
Tuesday 18th
March 2014
#2ndcitysex
2. Welcome and Overview
Jak Lynch
Senior Commissioning Manager – Sexual Health
Birmingham City Council
3. Programme
12.00pm Registration, Lunch, Networking and Stalls
1.05pm Welcome and overview
1.15pm Violence Against Women and Children
1.25pm Violence Against Women and Children – Focus on the Outcome
1.35pm A Public Health Priority – Challenge of Co-Production
1.40pm Sexual Violence and Sexual Health Services
1.50pm Exercise 1: Improving The Outcomes Framework
2.20pm Break
2.35pm What You Need to Know…
3.15pm Child Sexual Exploitation
3.30pm Exercise 2: Improving The Service Specification
4.00pm Plenary and Questions
4.30pm Close
#2ndcitysex
4. Aims and Objectives
• Bring prospective providers together
• Orientate providers on the Violence Against
Women and Children (VAWC) topic
• Improve the Sexual Health Performance
Framework in relation to VAWC
• Improve the Service Specification in relation to
VAWC
#2ndcitysex
5. M in d T h e G a pM in d T h e G a pSexual Health
Cllr Jess Phillips
Chair
Violence Against Women and Children Steering Group
Violence Against Women and Children
6. M in d T h e G a pM in d T h e G a pSexual Health
Birmingham strategic approach
• Health & Wellbeing Strategy
• Birmingham VAWC Strategy
• Birmingham VAWC Steering Group
What does VAWC cover?
• Sexual exploitation
• Domestic violence
• Rape and sexual violence
• Female Genital Mutilation
• Forced marriage
• Sexual harassment
• Stalking
• Trafficking
• Prostitution
7. M in d T h e G a pM in d T h e G a pSexual Health
Sexual Exploitation, Violence and Coercion
• Nationally 55,000 reported incidents of sexual violence per year
- compared to 60,000 strokes in women.
• Estimated 193,000 adults living in the West Midlands victims of
sexual violence – 50% live in Birmingham.
• Children in residential care were identified at greatest risk, with
42% being identified as at risk of sexual exploitation.
• Young people, especially females, are at greater risk of sexual
violence as are people with long standing illness or disability
and the unemployed.
• One quarter of LGBT respondents to the Out and About survey
indicated that they has been victims of domestic abuse.
8. M in d T h e G a pM in d T h e G a pSexual Health
Opportunities for the new sexual health
‘System’
Opportunity to ask the right questions
• Systematic identification of victims and those at
risk of sexual exploitation, coercion and violence
in our mandated services
Opportunity to contribute to our city wide
response
• Through developing local policies
• Contributing to safeguarding children and adults
• Support capacity building in associated 3rd
sector
and primary care
9. M in d T h e G a pM in d T h e G a pSexual Health
• Core business
• Policies, pathways and procedures
• Building capacity and capability
What I want the market to deliver through this procurement…
10. M in d T h e G a pM in d T h e G a pSexual Health
Thank you
11. M in d T h e G a pM in d T h e G a pSexual Health
Cllr Steve Bedser
Cabinet Member for Health and Wellbeing
Violence Against Women and Children
– Focus on the Outcome
12. M in d T h e G a pM in d T h e G a pSexual Health
1. Reducing under 18 conceptions
2. Increasing chlamydia diagnosis in the 15-24 age groups
3. Reducing the late diagnosis of HIV
4. Improved support for people vulnerable to, and victims of, sexual
coercion, sexual violence and exploitation
5. Providing better access to services for high risk communities
6. Ensuring prompt access for earlier diagnosis and treatment
7. Increasing the use of effective good quality contraception
8. Reducing the number of people repeatedly treated for STIs
9. Reducing the number of initial and repeat abortions
10.Reducing the transmission of HIV, STIs and blood borne viruses.
Sexual Health & Wellbeing Outcomes
13. M in d T h e G a pM in d T h e G a pSexual Health
Improved support for people vulnerable to,
and victims of, sexual coercion, sexual
violence and exploitation
• Our consultation found overwhelming support that Sexual
Health Services should address this outcome
• The challenge for providers is to co-produce with users,
commissioners and other services what should be done to
address the outcome
14. M in d T h e G a pM in d T h e G a pSexual Health
Consultation December 2013
15. M in d T h e G a pM in d T h e G a pSexual Health
• Outcomes
• Diversity and inclusion
• Respecting and responding
• Integration
What I want the market to deliver through this procurement…
16. M in d T h e G a pM in d T h e G a pSexual Health
Thank you
17. A Public Health Priority –
Challenge of Co-Production
Dr Adrian Phillips
Director of Public Health
Birmingham City Council
#2ndcitysex
18. Status Quo or Game Changing?
• Game Changing!
• Sexual violence and exploitation
• Primary Care
• Think family, think people
#2ndcitysex
19. What I want the market to deliver through
this procurement...
• Integration
• Modernisation
• Transformation
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21. Sexual Violence
and Sexual Health Services
Jak Lynch
Senior Commissioning Manager – Sexual Health
#2ndcitysex
22. Laying the Track
• Strategic Outcome
• Policy and Practice
• Procurement
• Service users experience and views
• ISVA’s
• SARC
• CYP SARC
• Care Pathway
#2ndcitysex
23. Tested in Procurement
• Subject of a detailed method statement in the
competitive dialogue
• Question relates to mandated services- core
specification- a proper service response
• Question relates to non mandated services-
targeted non clinical outreach and capacity
building
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24. Interpolation of Lifetime Prevalence of Non Volitional Sex
(NSAT-3)
* ONS 2012 Mid year estimate
#2ndcitysex
25. Interpolation of Prevalence of Intimate Partner Violence
(BCS 2013)
* ONS 2012 Mid year estimate
#2ndcitysex
27. Recorded Crime Statistics
Police recorded sexual offences in Birmingham -
number and rate of offences
•1 per 1,000
•1,242 cases in 2012/13
•No real variation in rate year on year
•Expect approx. 115 cases of current recorded crime to
be associated with Sexual Health Services
#2ndcitysex
28. Service Users Views
• Use of qualitative Research
• Local action learning
• Focus on users experience
#2ndcitysex
32. Improving the Outcomes Framework
1. Do these outcomes adequately capture measures of
the outcome?
2. Are there any additional measures that should be
considered?
3. Are there further national and local metrics that
could be used, in particular based on existing data
returns?
4. Other comments?
#2ndcitysex
33. Break
Do you have any thoughts or questions so far?
Please tweet using:
#2nd
citysex
#callitout
#2ndcitysex
35. Barnardo’s & Child Sexual
Exploitation (CSE)
CSE is possibly the biggest child protection issue facing
our young people.
Barnardo’s is the largest provider of child sexual
exploitation support services in the UK. Last year we
worked with 1,940 victims through 29 specialist services.
In Birmingham:
Space provides services for children/young people
abused through sexual exploitation, and also works with
children/young people who are vulnerable (and their
families) to prevent sexual exploitation.
Amazon provides counselling and keep safe work for
children/young people who have been sexually abused/
exploited.
#2ndcitysex
36. Child Sexual Exploitation
• children and young people under 18
• exploitative situations, contexts and relationships
where young people receive ‘something’ (eg food,
accommodation, drugs, alcohol, affection, gifts, money,
on-line gaming access) as a result of them performing,
and/or another or others performing on them, sexual
activities
• can occur through use of technology without the child’s
immediate recognition (e.g being persuaded to post
sexual images on the Internet, mobile phones)
• the abuse is based on an imbalance of power which
severely limits victims options
May not understand that they are being abused and
exploited.
Or
The pain of their ordeal and fear that they will not be
believed means they are too often scared to come
forward.
#2ndcitysex
37. Risk Indicators
Regularly missing school or not taking part in
education
Going missing or regularly returning home late
Rapid change in appearance
Sexualised behaviour
Disruptive/Challenging behaviours
Criminal/antisocial behaviours
Repeated STI testing
Pelvic inflammatory disease
Repeat Pregnancy
Misuse of drugs and alcohol
Mental Health Problems
Suicide Ideation
Unexplained injuries#2ndcitysex
38. What this means fordeveloping the
service response in Sexual Health
Children who are sexually exploited need to workwith
professionals who:
• They can trust
• Are consistently available – the young person can see the
same professional as needed
• Can be contacted by telephone, text or email
• Able to go to where the young person is – not necessarily
expect the young person to keep appointments
• Joint visit with other workers who the young person trusts
• Are non-judgemental
• Have a child-centred approach
• Understand the child’s situation, their lack of choice &
control
• Will plan with the young person, not for them
• Know how to recognise CSE and escalate concerns – not
expect the young person to be responsible for stopping the
abuse
#2ndcitysex
39. Birmingham Space and Amazon
Contact Information
Debbie Southwood
(Manager)
40 Rupert Street
Nechells
Birmingham B7 4PS
T: 0121 359 5333
e: amazon@barnardos.org.uk
e: birminghamspace@barnardos.org.uk
#2ndcitysex
40. Learning from Lucy-a survivor of child
sexual abuse
Lisa Thompson, Chief Executive of RSVP
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41.
42. Experience of using local sexual health
services
• Sexual health history was traumatic to disclose
• Asked to re-disclose information repeatedly
• No choice offered re the gender of sexual health
staff
• Staff comments about her sexuality being the
result of the abuse
#2ndcitysex
43. Experience of using local sexual health
services
• Lack of support provided when experiencing STD
testing and smears
• Lack of psychosexual support
• Repeatedly offered 'contraception' and 'family
planning'
• Poor understanding about high proportion of missed
appointments
• Lack of coordinated plan to increase Lucy's
engagement #2ndcitysex
44. What this means for developing the sexual
health service response?
• Safe environment to disclose with no need to repeat
• Choice of gender of worker
• Specialist sexual violence and abuse training
• Consistent support from a key worker
• LGBT appropriate services
• Plan of how to engage with survivors who regularly miss
appointments
#2ndcitysex
46. Aims of a SARC
•To offer informed choices
•To collect sound forensic evidence
•To offer therapeutic Medical and Emotional
Care
•To facilitate the onward referral to appropriate
services
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50. Vulnerable Groups
• Mental Health
• Learning Difficulties
• Physical Disability
• Communication Difficulty
• Intoxication/Dependency
• Sex-Workers
• Children
• Teenagers
• Elderly
• Gang association
• Looked-After Children
• Previous Sexual Abuse
• Financial Difficulties
• Domestic Abuse
• Cultural background where to report will bring shame and dishonour
• Human Trafficking
• Socially Isolated
#2ndcitysex
55. Referrals to Sexual Health Service
• 79% of clients attending the SARC were
referred for Sexual Health Follow-up
• Of these, 57% attend
#2ndcitysex
56. What this means for developing the
service response in Sexual Health
• Why might a victim of sexual assault not
attend follow-up appointments?
• How can these issues be overcome?
• How easy is it to get an urgent appointment?
• How convenient are the appointments?
• Would a tailored service for victims of sexual
assault improve attendance?
57. Presented by Yvette Waide
( Assistant Director, South Area) and
Nazima Kiyani ( Team Manager)
Directorate for People
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58. Birmingham has a population of 1818 Children in Care
Up to age 18 years old
Children can be placed in Foster homes, Children’s homes, family or
Supported accommodation
Spilt between Children subject to Care Orders/ Interim Care Orders or
Section 20 Accommodation
Birmingham supports approx. 900 Care Leavers
From the ages of 18 to 24 years old
Reside in own tenancy, supported accommodation or with family
The City Council, members and staff are Corporate Parents. As Corporate
Parents, we want Children in Care and Care Leavers to achieve their
potential and grow to become positive citizens!
59. Children in Care and Care Leavers are recognised as a vulnerable group
nationally.
Likely to have had poor parenting experiences, suffered abuse and instability
within their care arrangements resulting in poor physical, emotional and
psychological development / skills. Children in Care as a group are more likely
than the general population to experience:
◦ Emotional and behavioural concerns
◦ Poor educational attainment
◦ Poor self esteem and confidence
◦ Social isolation
◦ Criminalisation
◦ Dependency on substances
◦ Increased vulnerability to bullying, abuse and exploitation
Care leavers are more likely to experience homelessness, criminalisation,
social isolation, NEET, poor Mental Health, exploitation and become
younger parents.
60. Early childhood experiences of neglect, emotional, physical
and sexual abuse, and exposure to adult sexual activity or
violence
Disrupted/ fragmented family life and poor
family/community support networks
Compromised parenting – more likely to have experienced
loss
Conflictual relationships between parents and professionals
Had a number of care and educational placement changes
Turnover of changes in staff/ carers/social workers
61. Differing rules and boundaries/ unsupervised time away.
Feelings/ thoughts of “No one to trust or No one cares for
me”.
No significant person in their life and unmet emotional needs.
Poor social boundaries and skills to keep themselves safe
Easily influenced and wanting to fit in.
Going Missing regularly.
Unable to recognise harm and therefore not disclose.
May be motivated economically or by possessions.
Overwhelming need to be accepted and belong.
More difficult to engage.
62. Careful consideration of the location and accessibility to the
service
Proactive and creative promotion of service
Straightforward referrals processes with efficient timescales for
intervention
Outreach support -not focus solely on area
Viewing Child / Young person as an individual - holistic needs,
strengths and areas of development
Understanding the barriers/ risks children and young people
may face
Not to give up on the young person. Try, Try and try again!
63. Proactivity
Diverse and creative approaches to intervention and therapy. One size does not fit
all!
Paced response
Relationship based practice, intuition and resilience - not to give up!
Education on healthy relationships
Increasing self belief and aspirations
Feedback to Social Care Practitioners
Safeguarding Vs Confidentiality
Provision of proactive educational work in group settings i.e. schools, Children’s
homes, Youth Clubs
Links to Universal and other Specialist Services
Being open to keeping in touch
Strategically
Joined up system and information sharing
Use resources effectively to maximise efficiency
65. Sexual Health & Sexual Violence
Stephen Rimmer
West Midlands Strategic Lead – Preventing Violence against
Vulnerable People
Stephen.rimmer@birmingham.gov.uk
BCC Event
18 March 2014
#2ndcitysex
66. PVVP Strategic Leader – what does that mean?
Co-funded by and accountable to the seven LA Chief
Executives and Chief Constable
Assessed effectiveness and impact of existing work to
tackle CSE risks and other key domestic and sexual
violence threats - report endorsed by Chief Executives and
Council Leaders and is now a “Delivery Plan”
Provides co-ordinated leadership and authoritative public
engagement in tackling these threats across the West
Midlands
Ensures senior oversight, support & challenge through a
PVVP Board in West Midlands – focus on outcomes
#2ndcitysex
67. What is the mission?
“We have collective responsibility to protect those who are most
vulnerable in our society - children, young people and vulnerable adults -
and we discharge this through:
Prevention –engaging communities through awareness raising,
prevention and culture change
Protection - safeguarding those at risk and supporting those affected
Justice - dealing with offenders and preventing reoffending
Our approach will be integration, not partnership, and we will transform
our delivery of core public services as a result”
#2ndcitysex
68. Some key facts
1027 reports of child sexual abuse over the last financial year, 400 were
non-familial.
245 children at risk of CSE in West Midlands in 2013
Increasing perpetration by offenders under 18
WMP had 33,105 DV incidents logged in 2013 / Region has ~30 DHRs
in process / 31% of all women experienced some form of DV since age
16 (CSEW)
CSEW reveals 24,000 WM adults have been victims of sexual assault,
only 13% of victims of serious sexual assault report to the police
Clear need for further work to get beyond “tip of iceberg”
#2ndcitysex
69. CSE: What is it?
Child sexual exploitation (CSE) is a form of sexual abuse that involves
the manipulation and/or coercion of young people under the age of 18
into sexual activity in exchange for things such as money, gifts,
accommodation, affection or status. The manipulation or ‘grooming’
process involves befriending children, gaining their trust, and often
feeding them drugs and alcohol, sometimes over a long period of time,
before the abuse begins. The abusive relationship between victim and
perpetrator involves an imbalance of power which limits the victim’s
options.
(Barnardo’s, 2012)
"Online pornography is teaching a grim and misleading lesson – that
girls are for the sexual gratification for boys. And as we see from this
court case it can result in tragic consequences.”
NSPCC, tackling sexual abuse 2014
#2ndcitysex
70. Victims of CSE are most commonly
female,
white skinned
British born teenager; average age of 15
who come from a single parent home, consume alcohol and drugs
live in a deprived area with high levels of ASB, crime, demand for police
resources, unemployment and a volume of troubled families
Suspects in CSE
85% Asian Males (Pakistan Origin)
Multi ethnicity street gangs
Previous criminal history
However, national study by Muslim Women’s Network argues……..offender and
victim usually same ethnic group.
WMP Problem Profile suggests….
#2ndcitysex
71. SARCs
SARCs are specialist medical and forensic services for anyone
who has been raped or sexually assaulted.
Majority police referrals (2/3)
Service users: 287 women, 19 men, 1 transgender (1 female
offender)
257 adults, 51 children
63 assaults linked to night time trade, 22 to internet, 37
substance assisted
Most common location was a home (offender’s 77, victim’s
54, or friend’s 14)
Rape most common offence
#2ndcitysex
72. Some key issues
Clarity of outcomes – victim reports up / high risk victims down / cases through
CJS up / community confidence up
Assurance of priority in resource planning across key agencies
Development of significant capability – especially West Midlands Public
Services Intelligence Hub
Accelerate a more integrated approach amongst key agencies – including effective
build of Multi Agency Safeguarding Hubs
Generate a more consistent approach to prevention – particularly in schools
Mobilise communities – especially young people and parents – to challenge
“normalising” of violence factors, e.g. online porn
Ramp up disruption and prosecution of perpetrators
Deliver agreed minimum standards in tackling Child Sexual Exploitation
consistently across West Midlands
Establish a Sexual Assault Referral Centre for under 18s
Generate a stronger commitment to consistent operational practice in tackling
Domestic Violence across West Midlands
Child Trafficking pilot
#2ndcitysex
73. Some key challenges
Capacity to deliver more proactive and front foot services
Complexities of the health landscape / mental health
Massive under-reporting of victims
Insufficient challenge of offending behaviour
Confronting community and cultural attitudes.
#2ndcitysex
76. Improving the Service Specification
1. Are these service responses located in the correct
tier of service
2. Are there any additional measures that should be
considered?
3. Other comments?
#2ndcitysex
Space : in the past 9 months – direct work with 132 young people, family programme with 15 families, over 50 referrals every quarter, 34 training event to over 1000 people.
Amazon: in the past 9 months – work with 142 children and 14 parents
