For further guidance on supplying condoms to the under 16s please also refer to the following flowchart.
Stage 1 - Check the Age of the Service User
Staff providing condoms should check the age of the young person accessing Free Condoms. There are 3 possible outcomes;
Stage 2 - Check whether currently sexually active
Staff should be prepared to ask young people aged 13-15 some extra questions to assess their current situation. Ideally, a private space should be utilised for this. Some distributors might prefer to enlist support from a colleague.
Stage 3 - Further assessment - deciding if there are child protection concerns.
We want to ensure that sexually active young people aged 13, 14 and 15 can access condoms and sexual health services. By doing so we must ensure that everyone involved clearly understands what can be described as a consenting relationship and what factors would determine abuse or coercion. In addition, confidentiality must be balanced between the needs of the young person and the need to pass on concerns to relevant agencies.
Most sexual activity is likely to be consensual. If sexual activity in not consensual and the young person is subjected to exploitative, coercive or abusive sexual situations it is important that they are, as far as possible, protected from harm.
Any work we do with young people regarding their health and wellbeing can be checked against the GIRFEC principles (Getting It Right For Every Child). GIRFEC states that it is every worker's responsibility to ask themselves 5 key questions:-
Distributors must ensure that the appropriate response is afforded to each young person based on the guidance questions and prompts. Distributors are advised to have a conversation with the young person rather than performing a formal assessment. As every young person's situation will be different the conversation and questioning will vary. The following questions can be used as guidance:-
Stage 3 responses
1) No concerns
Where there are no child protection concerns or issues the young person can be offered the opportunity to briefly discuss their sexual health using delay messages (see section Delay Messages). A condom pack should also be offered.
2) Child protection concerns
If the responses to the above prompts and questions determine clear cases of abuse, exploitation or coercion then a child protection referral to social services should be made by following your agency's local protocols.
Examples of circumstances which are clearly abusive include:
3) Other concerns but not child protection
There may be variety of "softer" signs that all is not well. None of these "prove" abuse, exploitation or coercion but they might give cause for concern. In some cases, further conversation might heighten concern and suggest child protection concerns. In all cases offer the opportunity to discuss safer sexual health using delay messages (see section Delay Messages) supply an under 16s condom pack and refer the young person to Sandyford services but be aware that further action may be required.
Much will depend on the individual young person and on the circumstances that have brought them to you. The following is a list of potential scenarios which would raise concerns:-
Lack of understanding/consent: if the young person didn't really understand the sexual behaviour they were involved in and hadn't fully agreed to it at the time there is the possibility that this could be an abusive situation. The young person should be given the opportunity to discuss this further with a sexual health professional.
Power imbalance: abuse of power can involve differences in age, size, material wealth and/or psychological, social and physical development. Gender, race and levels of sexual knowledge can all be used malevolently to exert power. It's really a question of degree. You need to listen carefully to the young person's story and use your professional judgement to determine whether the age gap/power imbalance is a cause of concern.
Young person denies or minimises concerns: older young people may not see why you would be worried. However, people at the lower end of the age group should at least understand why you might be concerned. You need to make a professional judgement as to whether, if the young person dismisses your concerns, this is valid, is an attempt to conceal sexual abuse, or indicates they're being abused but aren't themselves conscious of it.
Child on Child Protection Register/Statutory Measures: if you are directly involved with the young person you are likely to know if he or she is subject to registration or statutory measures. If you think it might be an issue, ask the young person. If you still have concerns you should consult with your organisation's Designated Person for Child Protection.
Misuse of substances: young people do sometimes experiment with drink and drugs and they may have sex after drinking or taking drugs. This may be incidental or could be part of a pattern of abuse, particularly where the sexual partner has provided substances with a view to overcoming resistance to sex or where the sexual partner has taken advantage of a young person under the influence of substances. This is a crime if the intention of providing gifts of alcohol/drugs was in exchange for sex.
Coercion/bribery/grooming: This might include bribery, threats, aggression and/or coercion, for example isolating the young person from his or her peer group. Grooming could include attempts to gain the trust and friendship of the young person by indulging or coercing him or her with gifts, treats or money, by befriending his or her family, or by developing a relationship with him or her via the internet. However, many of these can also be part of normal romantic relationships. You need to listen to the young person and use your professional judgement to determine whether the situation they are describing departs from the normal spectrum of behaviour within relationships.
Particular vulnerabilities: a young person may be at higher risk of coercion/bribery/grooming and sexual exploitation if he/she is at disadvantage within society. Young people who have disabilities, young women, young gay men and women, those affected by poverty, those experiencing homelessness, looked-after children and young people, those living away from home and survivors of sexual abuse can all be particularly vulnerable to sexual abuse or exploitation.
However, the fact that a young person falls into one or more of these categories does not necessarily mean they are being exploited. Paradoxically, taking an automatic view that young people within any of these categories are more likely to have been coerced may have the effect of making it more difficult for these young people to access appropriate services, thus disadvantaging them further.
If a young person in one of these categories is involved in underage sex, you should seriously consider the possibility they might be victims of sexual exploitation as, indeed, you should in relation to all young people. You must also be clear in your discussions and practice that vulnerable young people will not face additional barriers in accessing the services they need to keep them safe.
Attempted secrecy: young people may, in any case, want the details of their relationship to be kept confidential. But secrecy is often demanded by an abuser. Professional judgement and good communication with the young person is needed to determine which is which.
Regular visits to risky places: young people often congregate in social groups in town centres and other spaces where they may or may not arrange sexual encounters with each other. This is quite normal. However, you should be concerned if a young person, male or female, is regularly visiting places that are used for public sex or anonymous sex and where the young person may be at additional risk such as risk of physical assault. You should also be concerned if a young person, male or female, regularly visits places that are used for prostitution.
With thanks to Lorraine Mann, Senior Health Promotion Specialist (Sexual Health and Young People), NHS Highland, who kindly allowed us to re-produce some of the information from the 'Highland Underage Sex Protocols' website.