Welcome to NSPCC Learning, a series of podcasts that cover a range of child protection issues to inform, create debate, and tell you all about the work we do to keep children safe. At the heart of every podcast is the child's voice, and how what they tell us, informs the work we do.
Hi, welcome to the latest NSPCC Learning podcast. This week, we’re looking at our child sexual exploitation service, Protect and Respect. Before we get into the podcast, there are a couple of acronyms used - child sexual exploitation is CSE and there’s a reference to CBT - Cognitive Behavioural Therapy. And, a quick apology, there is some background noise around the 24-minute mark, we hope it's not too distracting.
Protect and Respect (P&R) is the NSPCC’s Child Sexual Exploitation (CSE) service for children and young people aged 11 to 19 who either need support to learn about healthy relationships or who may be experiencing exploitation.
Protect and Respect offers two types of support: awareness raising group work for children and young people who need a safe and reflective space to learn about healthy relationships and consent. Support and protection service - if there are concerns that a child or young person is experiencing exploitation we provide tailored support for the child and their parent or carer.
We talk to four members of the Protect and Respect team. Holly, the Impact and Development Manager for the service, Laura and Amy, Child Service Practitioners for P&R, and Mike, Senior Evaluation Officer, who conducted the service’s evaluation. We discuss the service, how open the children and young people who access it are to Protect and Respect, and how a combination of evaluation, research and the voices of practitioners, children and young people are helping evolve Protect and Respect. I began by asking Amy and Laura to give me an overview about the children and young people they work with.
I think it's important to note that generally when working with child sexual exploitation, young people won't identify themselves as victims of that, or that is something that is happening to them, because of the very nature of the grooming that happens. So that I would say is probably 90, 95 percent of the young people that we work with.
And then there are young people that we work with where there are indicators but there has been disclosures. So that might be a disclosure of something in the journey, but they still don't realise yet, that they are being exploited or, they may be at a place where they're realising, actually this is what's happening to me, they've disclosed that. So, I guess that would be the two main groups.
When children and young people are referred, how open are they to service?
I've been surprised about how open young people have been to the service. I think I was thinking if I was a teenager why would I want you know an adult to come and meet with me? But even if they may kind of present as being reluctant and not bothered I've most of them I feel like they do appreciate having the space to talk.
I think sometimes their circumstances can mean that it even if there is a willingness to engage it's that's not always there, they're happy to kind of give it a go but may still be unsure of the kind of longer term-ness of that of that work. I think sometimes I guess what I mean is why they can't engage is if they are being exploited they're being pulled in different directions, so there's other kind of things at play, I guess there, and so it can mean that sometimes even though were aiming to see young people weekly it can be once a month, once every six weeks, because if there's missing episodes that are happening regularly that can interfere with regular engagement so then they can't be expected to turn up to a weekly to a week session.
There can be blocks in them engaging but yeah, they may actually just want the service even if they're not able to commit.
So yeah. So, I guess there's something about them appreciating the relational aspect of the work but sometimes it can take six months or more to get them into a regular flow of the work because of their circumstances or because of things that have already happened to them that make it quite difficult for them to relate to adults.
I think it can take a long time for children to trust as well, it can take many months, can't it? Yeah, yeah.
And so, in what ways do you work to build that trust?
I think consistency is the most important. I just think turning up and being there for them and showing them that you're not going anywhere. Spending time to take an interest in what they're about and what they like. That's important. Just connecting with them as, like, individuals.
It's something about understanding them as a whole person rather than just the concerns.
Yeah. They're not just their abuse.
And because often they can be having lots of professionals involved with them and having social work reports written about them, sometimes health reports, you know, lots of meetings at school and they can be very specific around different things and so I guess there is something in, kind of, hearing what their voice is in that and what their experience is.
Yeah. Having a sense of humour as well. You know, these are like heavy things going on in the child's life, and they've been through a lot, and sometimes, you know, having, making a sense of humour can open up discussion, so it's easy to talk about heavier stuff.
The big thing that can work in CSE work is the relational work with that young person, and what you bring to them, and the consistency as Laura's talked about, trust, modelling, you know, giving and not expecting something in return, working to disrupt some of what we'd call 'push and pull' factors for that young person. So that could be helping them get back into education, if there's housing issues with the family, supporting the network in stabilising that. They would be all the things that we would be calling push and pull factors into CSE, so it's not just about presenting resources to young people about learning about CSE, I guess, it's about making their world a bit more safer and secure so there isn't so much vulnerability of being pushed and pulled into CSE.
I think that's been picked up in literature as well hasn't it, that sometimes it's not the actual approach or, you know, the method it's the development of trust that makes all the difference in others to whether you get a successful outcome.
I think it's worth contextualising all this within the sort of discussion of the evolution of CSE policy and service provision. So about 2009 the concept of child sex exploitation first appeared with its own guidance. And that really was a push by the government to give Local Safeguarding Boards across England the sort of responsibility and the motivation to start developing responses to CSE.
And you can kind of understand how naturally that resulted in a number of services which attempted to explicitly address the issues, what I call a 'head on' approach, with young people. And one of the things I suppose that we found through practice, through the evaluation, is that actually quite often diving in there at the beginning and saying, 'there's is an issue and we're concerned about CSE' is not necessarily the best approach to engaging that young person in trying to, sort of, address a range of issues which are inextricably linked to those concerns, so it's about taking a step back.
And so even raises a question about whether a CSE service ought to be called a CSE service or something else. So, I think all these experiences have allowed practitioners, researchers, to sort of reflect on this journey and I think this is something that policymakers at quite high level are now aware of.
That's interesting about CSE, because sometimes I don't feel right by going in and saying this is child sexual exploitation and that comes in like second or third episode, session even, so then I'll say it's about healthy relationships and thinking about what you want to talk about and what's going to help you.
And what was really interesting is that some of the young people that I heard about through the evaluation had other concerns in their life, and even though they may recognise, at some level, the concerns, even maybe that they're involved in relationships where there may be some exploitation, or the potential for it, they're saying to the practitioner, but this isn't the big issue for me, it's education, or it's my family, or it's this, that and the other, which I think when you're a practitioner, and your focus is on providing that CSE service, at least in the early days, I think put some practitioners in a bit of a dilemma, because they thought 'well I need talk to you about CSE but you want to do this'....
And that can be the hook, that like what they want to talk, can be the hook to then build that relationship and then talk about that. Or, by talking about that, it can disrupt the push and pull factors.
I think there's something about the perspective of CSE work being around talking to young people about child sexual exploitation, when actually, you know, I've had social workers say to me, 'so tell me the kind of topics you've covered in sessions with the young person', and say 'how much have you talked about CSE? Do they get it now? Do they understand it?' And I'm saying well we haven't actually talked about what child sex exploitation is, but what we have done is worked on building trust, kind of their stability in education, you know, we've supported them in accessing sexual health services, and that's still CSE work, and I think there is this perspective that CSE work is sitting and educating young people around what it is, where actually I think that's such a small part of what' CSE work is, and it's such a kind of bigger picture than that.
My impression from some of the case studies that we looked at, as part of the evaluation, was that young people for whom there maybe the being concerns about CSE, had a large range of different issues and that, in some ways, was a function of, you know, familial breakdown, a sort of quite narrow focus in terms of the child protection sector, looking at some things but not other issues that might be affecting that young person, maybe a lack of services in the area. So, what you found was that practitioners would need to address a whole range of different issues, and some practitioners and managers talked about Protect and Respect being ‘social work’, I think what they meant by that was that you actually had to attend to a whole range of different issues if you were going to address the CSE issue as well.
Shall we talk about some of the approaches that you adopt? I'm guessing there's some creativity involved in your approaches.
So, talk us through from the approaches that you use during this service.
We draw on lots of different approaches. So, using bits of motivational interviewing, CBT, solution-focused approaches, kind of therapeutic styles, so maybe thinking about different activities to regulate their emotions, or maybe mindfulness, lots of, it's so broad.
It's very broad, isn’t it? I think it can often come under promoting wellbeing for a child, or promoting their resilience. I think it depends at what point the child's at in their journey. You know, some children really enjoy the socio-educative work, learning about different issues in their lives that are important to them, and then other children I think are more ready to talk about the impact of exploitation or impact of trauma on their lives and can work with our practitioners to develop coping strategies that help improve some of the traumatic symptoms that they're experiencing. But I think it really depends on where the child's at in their journey. And I think also practitioners really can often engage in arts-based work as well. We're very creative and I think art can be a really important medium for communication with a child and building that relationship and allowing them to express their feelings in a different way.
And I think sometimes I guess our flexibility and creativity and engagement and approaches with young people can be simple things like, okay so this week we're going to go to a coffee shop for an hour, or even though you're 20 minutes, 30 minutes late for coming to meet me I'm still going to turn up at the same time every week for you or the time that we've arranged, and even if we only get 10 minutes, five or 10 minutes of seeing each other, that's brilliant.
To begin with, it is just about them being comfortable with sitting in a room with a professional. And so, then I'd be spending weeks kind of building that up. So, some weeks, that's too much, there's too much else going on for them, they've come out of lessons and, you know, are quiet, kind of, frustrated or upset or angry about what's going on and just can't sit in a room, and that's fine. And for me, great that you've even come to say that, that's fine. And then the next week or two weeks later they're able to sit for five or 10 minutes, and almost a little bit of a test of like, 'well I'm only going to be with you for five or 10 minutes' and for me, great, you know, I really appreciate that you've kind of done that, I'm just really glad that I've seen you got to say hi to you, and then, you know, young people eventually can come to a place where they can sit for 45/50 minutes with you, which then, when asked the question, 'so what CSE work are you do with this young person?', well, what we are doing is helping that young person feel safe with the same adult and helping stabilise, put some stability in their week. So, I think creativity can be just in how we meet with them.
Yeah, those simple things can be really important. I think if a child can't make a meeting just you know sending that text letting them know that you're thinking about them and you'll be there you know next week. I think those things are really important to show that you care, then they're not another name on the list of your allocated cases you know they really mean something.
And what we were saying before like a lot of the time they may come with their own issue of what they want to talk about that day and it might be nothing to do with CSE. So then just letting them...being child-led and going for what they want to work on.
I think there's a really interesting point about how ‘engagement’, as it's termed, is often thought to be a physical achievement of getting someone in a room. But some of the cases that were fed through to the evaluation about how young people who weren't turning up to appointments later on reflected on how they felt touched by the fact that the practitioner had turned up, and they knew that they'd turned up because they'd text them or called them, and already there was an engagement, but it was in the mind.
What's interesting about this is that all organisations have this sort of tension around the issue of, if young people don't turn up to appointments, does this mean they're not engaged? And if they're not turning up, should we closed the case because there are other young people who also need the service who may who may attend the appointment? And I suppose what it brings to our awareness is the need to understand engagement at a wider level, not just whether they're there, but how they're feeling and I know that in some cases practitioners and managers felt that they should keep the case open a little bit longer and that did actually lead to, eventually, that kind of physical engagement. But it does pose a challenge for all organisations, because, how long do you keep the case open for whilst not attending in the hope that eventually you'll be able to encourage them to come in?
Can we discuss the evaluation, Mike? We've obviously, during this conversation, alluded to it. Can you talk us through it?
Where the NSPCC had decided that it wanted to test, innovative models of service delivery and use the impact study methodology to demonstrate whether they were working or not, with the hope that if they were working we could then encourage other organisations around the country to use these methods to be more effective for children. And then that in that context we created five different services in Protect and Respect, and each one had its own service delivery model. They were quite similar, it has to be said, but each one had had their own model. And the idea was to collect outcomes measure data for young people accessing each of those five services so that we could conduct an impact study over time.
The impact study ambition also depended on the model of delivery being delivered consistently across the different cases. However, a year into the evaluation we reflected on the data that we had and we found that there was a huge range of delivery in terms of the five-different service. Some of the expectations, some of the assumptions, that had been made at the beginning of the program weren't being met.
One of them was that we could reach certainty at the assessment stage on whether young people were vulnerable to exploitation, or at risk of exploitation, or were being exploited, and that was actually quite hard to achieve. The other assumption related to young people being ready to engage with an assessment process and then with a sort of reasonably standardised intervention approach.
And what we found was a lot of young people that got referred on to the service and allocated for all the reasons that were discussed earlier on, were not in a position where they wanted to talk about exploitation necessarily, didn't want to talk about the most personal issues to them, didn't like paperwork, didn't want to go through 17, because the assessment involves 17 looking at 17 different areas in their life. So, the reality was that assessment could take anywhere between a couple of days to a year, the intervention could take anything between maybe a month to a couple of years, depending on the needs of the young person, and all of this together meant that we didn't...we weren't really in a position to deliver an intervention model and therefore to do an impact study.
So, we had to take stock. And what we appreciated was that, despite our best efforts, we nevertheless had a huge amount of experience that we were building up over what amounted to 15 service centres across England and Wales. And that through doing interviews, and doing analysis of case studies, we could build up some fine-grained knowledge of the challenges and some of the things that we could do in terms of what worked to help overcome those challenges to help young people. So, we did a range of interviews, and a range of case studies, and we continue to collect data on the demographics of our service users, because what we wanted to understand more was about which service users tended to complete, and which service users tended to sort of stop at a certain point.
And we want to see if there's a difference between them. Was our service being picked up more by boys than girls, for example? Was it being picked up more by people from certain ethnic groups or religious groups? So on and so forth. So, we ended up collecting a huge amount of data on that and I think we're probably the only study that has done that, so we're in quite a sort of unique position in terms of being able to, at some point in the future not right now, report back on that.
We also collected a lot of information on evaluation attrition as well. So, this is where young people either fill in measures or they don't fill in measures. Because a lot of the data that we've got across the field, not just in the NSPCC, but across the field, is based on those young people that said yes to participation in the evaluation. So, everything that we know is based on what, on just that select group of young people. Well they may be the tip of the iceberg in terms of service-user experience and if they're quite different to the young people that say no, it's very important to know that, because it means we've only really covered a tiny piece of the jigsaw in trying to understand service-user experience and an outcome.
And another thing is that, for example in the case that that we did, I think we had one boy and nine girls. So, we've probably got a service, and an evaluation, which is focused more on the experiences of girls than boys. And it may be that when we do more fine detailed analysis, and we haven't got to that point we where we've been able to do that, but that we find the same thing applies for maybe disabilities, or risk level, or religion, or ethnicity or a whole range of different issues.
How did protect respect evolve, change in light of the evaluation?
So, we've been through quite a lengthy period of reflection really, probably about 12 months. We've had a lot to reflect on. The evaluation captured several different things that we needed to really think through and those things were quite complicated. And I think we've also had a model that was introduced in 2014 but CSE knowledge and discourse has drastically transformed since that time. So, I think what happened was the practice and practitioners, I think, stayed up to date with contemporary thinking and practice in the area of CSE, but there was a model which was out of date and I think practice just left it behind really.
Also, I think it was really important that service centers responded to their localised need as well. So, I think really after a period of reflection, we're now at the point of coming into the final stages of developing our delivery guide, that's currently being reviewed externally. And I think that the guide that we are about to launch is really reflecting current practice. So it's all been a really interesting learning journey. I think also what we have to take from this is we're a learning service. So, we have to be, we have to have a solid standing, grounding, and we have to have a solid framework around us in our service but we also have to be really open to continually change and adapt to new knowledge and new circumstances.
So, in terms of what the new service looks like, we've got two interventions that are sit under Protect and Respect. So, we've got our one to one work, which we've termed 'support and protection', that's for children who there are concerns about exploitation, or exploitation is believed to be happening, or known, or as has happened in the past. So, we've really worked on our criteria in relation to that.
And we're also working on our referral pathways as well, which again, has to reflect local need because there's a variety of different service provision happening around the country, but I think it's in our best interest to have a wide referral pathway, which also includes parents and children being able to refer themselves in, because that they're the ones that will notice the concerns arising in the first instance. I think it's disempowering if families can't refer themselves into services.
I think the areas that we've changed, we've really looked at our assessment. So, as Mike was saying, we have previously had a really thorough in-depth assessment which had many strengths and explored numerous domains. But what that assessment did have, with the older previous assessment, it involved scoring. We also knew from other assessment models that scoring can be very inconsistent and there can be children who have who have no identifiable vulnerabilities, however they are experiencing exploitation.
Because it can be really misleading.
Yeah, children with multiple vulnerabilities and they will never experience exploitation. So, what we've developed, and this was very much practitioner-led, we moved to a much more strengths-based assessment, which is very much about us working in partnership with the child and talking about what they want to talk about, what they want to work on, looking at their support needs from their perspective and also including their reflections on other people's concerns. But it's very much centered around them and at their pace.
And the other thing that that we've changed in service delivery is we're going to make our parents' support offer a much more robust offer. So that's being practiced differently across the country really. I think some service centers have really embraced parent support work. It's new to some service centers and I think all the evidence is really suggesting, as well as our own evaluation findings, is telling us that we get better outcomes the more parents are engaged.
The other really important aspect that we've been thinking a lot about is how we practice in a trauma-informed way. So, one element of that is we've been engaged in a review of all resources that we've been using. Practitioners started raising concerns about some of the resources, saying they're very outdated, some of the language being used in those resources is victim-blaming. So, we've reviewed our resources and we've actually adopted the Barnardo's Basic Checklist that they've recently developed, to support us thinking through particularly around footage, you know, what footage is suitable to engage children with in group work or one to one
And what could be retraumatising for them
Exactly. Yeah. Yeah. So, the 'No More CSE Films' campaign is really highlighting, through the voices of children, that the medium of film, particularly around Internet safety and child sexual exploitation, can be a trauma-trigger to children who are survivors of sexual abuse. So, I think we're now getting to the point in Protecting and Respect, where we have a good grip on what is being shown to children across our service centers and what resources are being used. And I think we're feeling a lot more confident than we were a year ago.
I guess thinking about our learning around what language you use and what resources we use and I think for me one of the big changes that we've made, which I think is reflective of that, is even how we label the areas of work we do. So where, in the past, we may have called some forms of work 'preventative' work, and we now call that 'awareness raising' work because we want to move away from language which could imply that, by having this socio-educative work, short piece of work with us, you being educated is then preventing you from being exploited, where actually what we're doing is raising awareness so that, if something happens, they've got a framework to understand that, rather than, there's an emphasis on you now because you've had this preventative work. Not then that's what we ever thought, but sometimes unintentionally our use of language... So I think there's been lots of learning in the organisation about how we frame
The narrative of what CSE is and I guess changing the resources like the grooming line, moving away from that narrative that it just happens in a linear way, and the boyfriend and girlfriend kind of model.
Yeah, definitely. I was just thinking I guess that it's about recognition that if we're using victim-blaming language, or prevention, you know the language of prevention of CSE, we're really looking at solely focusing on the child's vulnerabilities and we're not considering the presence of a perpetrator and the protective structures around the child. So, we are just solely focusing on the child in that way. So, it's very much about trying to move away from that approach of victim-blaming. So yeah, we've definitely been on a learning journey in that respect. I feel confident our new services is an evidence-informed service and I think we've learnt a lot connected with evaluation, and the type of research questions and methods we want to ask, and also, I think how I see an evidence-informed approach, is we're very much using knowledge that stems from research, but we're also giving equal value to the voices of children and families and practitioners experience as well. And I think those combined into an evidence-informed approach.
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