Welcome to the NSPCC Learning podcast, where we share learning and expertise in child protection from inside and outside of the organisation. We aim to create debate, encourage reflection and share good practice on how we can all work together to keep babies, children and young people safe.
Hi, and welcome to the latest NSPCC Learning podcast. The episode you're about to listen to was recorded in May 2022 and focuses on a UK-wide study by the University of Bedfordshire, Safer Young Lives Research Centre in partnership with the Association for Young People's Health.
The study explored the mental health and emotional wellbeing impacts of experiencing childhood sexual abuse in adolescence. This has resulted in the development of learning resources and a report which you'll find links to on this podcast's webpage. Chloe Gill, the NSPCC's Senior Research and Evaluation Officer, met with two of the report authors, Dr. Helen Beckett and Dr. Deborah Allnock, Director and Senior Research Fellow respectively, at the Safer Young Lives Research Centre.
In this episode, they discuss the gaps they aimed to fill around the impacts of experiencing sexual abuse during adolescence; the importance of learning from young people themselves, taking a trauma-informed approach so that the work was safe, ethical and supportive for the young people participating; what young people said about how sexual abuse had impacted their mental health, emotional wellbeing, and how they navigated daily life; the resources that have been developed; and the six pillars of an effective adolescence response. Chloe began by asking Helen and Deborah about why they embarked on researching the wellbeing needs of adolescents who have experienced sexual abuse.
To get going then, can we first of all tell me a bit about how this work came about in the first place? So, the research, the report and the resources: where did that come from?
Well, I'll kick off with that. I suppose the first thing to say is it was in response to a call that NSPCC and ESRC put out calling for applications for funding for research about how children and young people could be better supported after their experiences of abuse.
And I guess in terms of what the piece of work focused on: it focused particularly on young people's experiences of experiencing sexual abuse in adolescence specifically, and that was really – we knew from other work that we've done at the Centre – at the Centre we have expertise in research on sexual abuse and also participatory approaches, and we knew from that work that actually there were a number of gaps in our knowledge base around this. And that's really what drove us to put the application in in the first place.
We really wanted to try to start to fill some of these gaps in the research evidence base. And we put the application in with our partner, the Association of Young People's Health, who also brought participatory experience to the project. But alongside that brought a real depth of expertise around young people's health, which we felt was very complementary for this particular call, looking at mental health and wellbeing.
The focus of the work was informed by gaps in the literature. And I suppose there were three key things really that was informing how we approached this work. The first was: Debbie and colleagues did a literature review at the start and just reinforced that message that actually there's very little in the existing body of research literature that is specific to adolescence and experiencing sexual abuse in adolescence. What's already there either looks at younger children or just looks at children and young people as one category and doesn't differentiate their experience. But actually we know really clearly from research that adolescence is really quite a specific and unique life phase. And so we felt it was really important to understand what experiencing abuse in this distinct life phase meant for children and young people, how it impacted them and what they need.
And because adolescence is so different to being a younger child or being an adult, we hypothesised that young people's experiences and needs would probably be different than those of younger children, and that actually we needed to be able to understand that to inform a better response that is better fitted for young people who experience sexual abuse in adolescence. And the other – it's not an entire gap in the literature, there are some studies – but certainly there's a very clear need in the existing body of knowledge to learn more from children and young people themselves.
Very often conversations around mental health and wellbeing following abuse are dominated by professional narratives, and it's really important to us at the Centre that all of the work we do tries to centre learning from children and young people. And so we really wanted to make sure this study – that was the main focus of it. What can children and young people teach us about their experiences, what their needs are, how they want us to respond? Hence the name of the research: 'Learning from the Experts'. Young people are the experts in their lives.
Debbie, do you want to talk a wee bit then about what that meant for why we did the research?
Yep. So, to address those gaps that Helen just talked through, we focused on adolescence. In terms of the age range of young people, it was a broad age range of 11 to 18 initially, but we did include a few young people up to the age of 21. Sexual abuse, in terms of our definitions, was defined as per at the time of working together [in] 2015, which takes a broad definition of sexual abuse, including online, as well as abuse by peers or adults, males and females, etcetera.
Those young people who we wanted to engage with with this research could have a range of these different experiences. But we also did recognise that young people may experience other forms of abuse and neglect which will also shape these impacts. We also, as Helen noted, focused on sexual abuse that occurs in adolescence – again recognising that many young people may have experienced ongoing abuse from younger ages that extend into their adolescence – or separate experiences of abuse at younger ages, in addition to other abuse that they experience in adolescence.
The aim was to prioritise and amplify young people's views and their self-defined impacts and needs related to this. So rather than researchers or practitioners identifying what those impacts are, we really wanted to hear from young people about what they said impacted them. And so our work with young people was really at the heart of this research.
Integral to all of this, we also built into the project a number of youth advisor posts. We had four youth advisors involved in helping us think about the project design, testing out our tools and methods. They were involved in presentations to our funders and at conferences and within our stakeholder consultations. And this really helped keep us grounded in young people's needs and what were the right questions to ask.
Helen, you might want to speak about the trauma-informed approach?
Yeah. And I suppose it's helpful to briefly reflect on the context of this to start. You know, we know from our work, and I know you'll say it as well, that very often there can be a real reticence or anxiety around involving young people who've experienced sexual abuse in research, and quite rightly: thinking about the impact it might have and might it have any negative impacts on them. But actually what we've seen is sometimes that anxiety can override thinking about the positive experience that taking part in research can actually be for young people. And so for us as a Centre, and in this project, it was absolutely critical that we found ways to engage children and young people, but that we did so in a way that was safe, ethical, meaningful, and that we really paid attention to that.
I know probably most people listening have heard the phrase of being 'trauma-informed'. There's a lot of talk about it over the last number of years, and we tried to be trauma-informed in how we actually approached this research as well. We felt it was really important to engage in these difficult conversations about how do you talk about things that may be upsetting? How do you provide wraparound support? You know, how do you engage with these tensions between the benefits of taking part and the potential negative impacts of taking part? But for us it felt really important to do that because far too often young people who've experienced sexual abuse are silenced and they're stigmatised. And in fact, we know that's an issue in society around sexual abuse: the silencing and stigmatisation of people. And actually finding safe and meaningful ways for young people to express their views, their needs, their wants is really important in countering that stigma and that silencing and also in letting young people realise their right to have a say about matters that affect them.
And in addition to that, we have consistently found over the last 15 years of research at the Centre, that we learn so much from children and young people that we would not have found out if we only engaged professionals in our research.
It's been really challenging in a positive way to us to hear from children and young people, to actually realise that their priorities are not necessarily what our priorities might be and to hear directly from them. We drew on approaches that we've developed over the last 15 years thinking about how do we safely hold young people to take part in the research?
And I guess it's important to say you can't ever eliminate risk. Nobody can in any research. And it certainly wasn't about eliminating risk, but it was about identifying what potential risks might be and what support structures could we put in place to help hold some of that stuff.
We talk about this in the report. We have a section on the trauma-informed approach that we took. But it included things like doing 'risk and needs assessments' for young people to identify what the risks might be. That wasn't to say they couldn't take part if there were risks, but it was to say, "Well, what can we put in place to counter some of these risks?" And actually, what can we do for this particular young person to mean their engagement is the best possible experience for them? So we looked at that.
We worked in partnership with the agencies, and that's really important so that every young person who took part had a support worker lined up to provide wraparound support. They spoke to them before they took part, they were available while they were taking part and they proactively followed up.
But choice and control was absolutely central to how we do this. We know that an experience of abuse is all about the other's wants and needs and the other's control. And we really wanted to make sure that we didn't do anything that would replicate those dynamics and, in fact, proactively tried to offset those dynamics and gave young people as much choice and control as to how they took part in our research. And indeed, if they took part, and if it wasn't the right thing for them, you know, we didn't push that at all.
Great, thank you, you've really clearly explained the importance of this research and the importance of involving young people in different roles in the research. And it'll be interesting to read the report and hear those practical tips and hear about how you went about doing the research.
Now I want to ask you a little bit about the findings and if you could tell us what young people told you about how experiencing sexual abuse in adolescence impacted on them and what they wanted or needed in response to that.
That's the big question isn't it. We could probably speak all day about that. What we thought we might do is just share a few overarching themes that struck us. I mean, this will come as no surprise: an experience of sexual abuse in adolescence affected young people's lives in a myriad of ways. Their mental health and their emotional wellbeing. And actually, as part of the research, there were a range of diagnosable mental health conditions identified by young people that had come as a result of their experience of sexual abuse. But I guess, and in some ways I was maybe slightly surprised by this, the degree to which actually what they really talked about was the impacts on their more general wellbeing.
So, yes, there's the point at which it reached a threshold and will be diagnosed and dealt with as mental health difficulty. But actually most of what young people shared was just the day-to-day impacts on their emotional wellbeing, on navigating life and on their emotions – how they felt – on their behaviours and their interactions with people and their relationships and how they engaged in school and other settings. So there were lots of things that young people identified of the... how an experience of abuse affected the day and daily for them in lots of different what may potentially seem on their own, you know, maybe insignificant ways. But actually, when you added them up altogether, meant that actually there really was a very significant impact on navigating life and on young people's emotional wellbeing.
Now I think what we discovered and what young people shared is unfortunately a lot of that was missed. And I know that one of the particular focuses of this call for research bids when it came out was about learning about what can we do better earlier on before things reach a diagnosable mental health stage. And certainly what young people told us is there were lots of things manifesting in their lives that actually could be picked up and could be seen and could be intervened with at a very early stage. But, unfortunately, most of them reported that that didn't happen. That actually there were quite a few missed opportunities to intervene early on. And I think one of the messages related to that that came out is very often the impacts on young people's emotional health and wellbeing wasn't actually really being picked up until people actually found out about the abuse. So unless the abuse was discovered or the young person disclosed the abuse, even though it may have happened some time before and the young person had been manifesting the impacts in many ways.
It's not just about thinking about emotional health and wellbeing needs once there is a disclosure of abuse, but it is about flipping that and becoming much more proactive about: "is something going on in this young person's life? Are we seeing something changing or something that doesn't quite add up?" And starting to engage in the emotional health and wellbeing impacts in the absence of disclosure or in the absence of a diagnosis, because that early intervention feels like a really important phase. I think one of the other, probably, really overarching findings that struck us as a team when we went through what young people had shared was young people, yes, of course, they talked about the impact of the abuse itself on their mental health and wellbeing.
But actually, much more frequently what they talked about was the impact of other people's reactions to their abuse on their mental health and wellbeing. And that struck me really significantly as we were going through the data and looking at what they were telling us, because it was, "yes, of course, the abuse has had an impact, but actually how my teachers responded, how my family responded, how my friends responded, how going through a criminal justice process impacted me; that massively impacted on my emotional health and wellbeing." And again, I suppose like the missed opportunity message, there's also a positive side to that because actually we can have more control over how we respond and how we support people to respond to young people after sexual abuse. And so that does feel slightly in our gift to be able to make changes and minimise the impact that those engagements with other people and reactions of other people have after abuse.
We thought it might be helpful just to give a couple of concrete examples of that and maybe think across a few spheres of young people's lives. Because the other thing that consistently came out and how young people talked about emotional health and wellbeing impacts, they didn't talk about it as a vague concept – somewhere up there – they talked about how it impacted their daily life. They talked about how it manifested in the family, how it manifested in school. We thought we might just take a bit of a reflection on that.
Debbie, do you want to kick off just a wee bit on what they talked about, how they experience those impacts in the family environment?
Yeah, sure Helen, thanks. It's interesting because I think in the wider literature on adolescence and development, there's a sense that in adolescence the importance of family decreases while the importance of peers and friends increase. Now certainly we did see the importance of peers, and Helen is going to talk about that in a minute. But young people talked extensively about their families. And so in that regard, family does appear to still remain quite important to young people in terms of their support. We saw some really great examples of positive family support. Young people talked around being reassured by their family members that it wasn't their fault and advocating for their needs.
Particular sources of distress were identified, though, by young people. These included things like fears and actual experiences of being blamed by the parents, or anger and also awareness of, and a sense of responsibility for, how others might be negatively affected by learning about the abuse. These concerns appear to be exacerbated by that increase in cognitive capacity of their own age being adolescents, being– becoming adults and developing sexuality of adolescents as well. So really, although we found some of these negative experiences, there are those opportunities, I think, ways that parents can be supported. Be supported to support their children through these kinds of experiences.
We know that peers take on increasing significance in adolescence and young people spend more time with their peers and outside of the family environment. And again, it was it was a bit of a mixed message in terms of young people's experiences of their peers and how that impacted upon their emotional wellbeing and their mental health.
So, again, as Debbie has talked about in the family, there were some lovely examples of young people sharing the really important and significant role that their friends had in helping them navigate life after abuse. You know, both in terms of just being a listening ear, providing support and reassurance, there were also examples of friends actually helping young people access professional support when something was shared, they were like, "well, I think we might need a bit of help about that." And they helped them access that.
And also one of the messages I think came across was that you do still need to do life, but you do also need to process the impact of the abuse. And so it's this what's this balance that you have in life where actually you do need to engage with and process what's happened to you, and that's really important to young people. But they didn't feel they could keep doing that all the time because that would just be far too overwhelming.
So there was a really clear message as well about the important – I don't know if source of distraction is the right word – but, you know, that friends could give a sense of so-called normality and distraction from having to be thinking about what had happened to you all the time and processing that. So there were lovely examples of how friends supported and that really feels like actually an important message for us to take on board in terms of where we can invest a little more and support peers to better support their friends when something like this happens to them.
Unfortunately, however, there were also quite a few examples of the reactions of friends and peers actually compounding the distress that young people were experiencing rather than alleviating it. And these were really quite varied. Some were really unintentional, and the young people knew they were unintentional. So it wasn't that their friend was trying to hurt them, but their friend just didn't understand what they'd been through and they didn't know what to say or how to act. I think that that message came out really clearly that we do need to think about how do we support young people? What support can we put in place for them? So if a friend shares something like this that you know, that they know how to deal with it without, of course, because we don't want them feeling it's their responsibility to fix things. It's not. But how do they respond to it?
But there were also, unfortunately, some examples of peers... And probably the best way to say it is like turning on young people, particularly in the examples of peer-on-peer harm, of people taking sides and blaming the young person for what had happened and aligning with the person that the young person said had abused them and undermining their story and all of that type of stuff. There were really very understandably distressing examples of actually feeling you've been alienated by your peers because of your experience of abuse or you've been blamed that it was somehow your fault. A bit like Debbie talked about with parents, that fear as well.
And [there were] also examples of young people breaking confidence. So they thought they had told a friend in confidence, but the friend then told someone else. And again, back to what we talked about earlier in the podcast, the importance of control for young people following the experience of abuse that could feel like a real betrayal and a real taking away of any control they had when people shared their confidence.
The other thing, finally, that came up, which feels really unique to the adolescence life phase rather than abuse experienced at a younger age, is navigating intimate and sexual relationships; romantic relationships. And actually this really was quite clearly identified by young people as a real need. That they actually needed support, direction, a space to work out how do I be a teenager and do romantic relationships and sexual relationships following an experience of abuse?
So there was a really clear ask from young people that actually, when they are being worked with, that in adolescence, that is part of what they need is "how do I then work out what's a healthy relationship, what's not a healthy relationship? Who do I trust? Who do I not? What am I comfortable doing?" You know, a sexual encounter might trigger something for them. So that was again, you know, if we're thinking about what was particular in adolescence, that felt like a really strong theme coming out in the research as well.
And I think, Debbie, the other area we thought it might be helpful just to reflect on a bit here was schools, because again it came across as a really strong theme in the research, didn't it?
Yeah, it did, and maybe that's unsurprising in adolescence. Young people spend quite a lot of their time within schools. So, we did hear a lot about those experiences, and school was identified as a particularly challenging context for young people to navigate after sexual abuse in adolescence. And we found three key challenges around this.
The first was around this idea of managing educational expectations whilst dealing with the impacts of abuse. And young people told us, for example, that in schools, they often felt like the priority was on their educational attainment and achievement and attendance and those sorts of things, at the expense of recognising the impacts of the abuse that they were experiencing. That was a real challenge for young people who were really trying to balance those two things. And oftentimes the emotional impacts that they were experiencing did conflict with their ability to engage within the educational those educational expectations.
Secondly, they were really navigating a fear of actual reactions from peers. Of course, within the school environment, it's not just teachers and educational staff, but their peers, their social networks are widening and becoming increasingly important to them. There were some examples where young people were, you know, questioned by police, by social care, by educational staff there within the school. And this could really generate a lot of fear and anxiety for young people.
And then thirdly, staff responses to the abuse and associated changes in young people's behaviour. That idea that they're just being teenagers, this is just teenage behaviour, was something that young people talked about within the school environment quite often. So, you know, there's something there about needing to develop and help staff to recognise what sits underneath of those behaviours and those changes that they might see because staff are really well placed if they're seeing young people quite often within the school environments throughout the day. Young people identified a number of ways in which schools could help – could better help – them to navigate these difficulties. And that's things like timeouts, school-based counselling, due regard for privacy, those sorts of things. However, they also recognise that schools couldn't provide the holistic support on their own. And so they also emphasised that importance of onward referrals to external services.
Lovely, thank you. I mean, your research is clearly... there's clearly so much learning from this research. I'm interested in the resources that you're producing as a result of doing this research. Can you describe those to us a little bit and what they look like and what the purpose of those different resources are?
Yeah, Chloe, I'll kick off with this. We've tried in terms of the outputs of the research to take a bit of a varied approach and hope that different outputs that we've put out will speak to different people and feel accessible to different people.
So we had previously released a 'key messages' from the research just based on our emerging findings and highlighting some of the overarching findings from the research.We have written up what we would call the full research report, which is a longer report, which goes into detail. And then we're also working with our Young Researcher Advisory panel on an output for young people, and also creating a short output for parents. And then alongside that, actually, the young people who've been involved in the project have been working on a training resource for professionals, which is really exciting. I think it's a wonderful piece of work that they've pulled together.
They all sound really great. And I think it's really helpful that you've pulled out those different messages together for different people who might need to support young people who have experienced sexual abuse in different ways.
So just to finish up then, my last question is, from your research findings and from what young people have told you, what are the key recommendations that you would give to anyone who is providing support to young people who have experienced sexual abuse in adolescence?
I think what we have found in the research, what young people have shared, is a really clear need for an adolescent-specific response. And that's not to say it's not situated in a wider framework of how we respond to everybody, but a response that attends to the uniqueness of the adolescence life phase and what young people are going through at that stage in time.
Adolescence itself is often described as a stage of 'storm and strife'. And yes, there are lots of changes and difficult things that young people are experiencing during that time. However, during that time, young people also have increasing agency, increasing cognitive ability to understand what's going on. And so a holistic and meaningful response to adolescents experiencing sexual abuse has to attend to those challenges of adolescence, but also the opportunities that adolescence offers and a way to work in a more meaningful partnership way with young people, as Debbie talked about before, working with them and not doing to them.
Another really important message, and I know we've said this as we've chatted, is about [how] it's so important that we don't just focus on diagnosable mental health, that we actually get better at identifying that actually a young person is struggling here and things are changing. So, paying attention to their wellbeing, their sense as a person. It is about looking for those earlier opportunities to notice what's going on and to provide some support alongside a young person. And I think, you know, I guess just to reiterate the message, we've hopefully shared a bit during this chat, is, yes, there were negative messages about missed opportunities and things that could be done better.
But, actually, we also feel that the research shows lots of opportunities for getting better and actually offers a bit of a blueprint for going forward, of, well, if we thought about attending to these things, then we could actually provide a better, more meaningful, better fitting response to young people who experience abuse in adolescence.
And so in the report we've identified, I think, what we call six pillars of an effective response to responding to a young person who's experienced sexual abuse.
The first pillar is that need for professionals and those supporting young people to understand the adolescent life stages, as well as understanding the abuse and the experiences and the impact of these, and then also understanding vulnerabilities and challenges that young people face during this period.
The flip side of what Debbie's talked about, about recognising the difficulties of adolescence and the vulnerability that can be there at the same time, is also about those opportunities that I mentioned. So about working with adolescents, of adopting a strengths-based approach that really puts young people at the centre and that actually moves the way... I think as a society and as how we respond to adolescents, we very much frame their agency as a problem. "Oh my goodness, they're off doing this, this, that and the other." Actually, that agency is a resource that can really be harnessed to support young people following the experience of abuse.
It is about moving from that very deficit-based approach to understanding adolescents full stop.
And then a third pillar is this notion of a rights-based framework. We talked a lot through this podcast about that, that notion of choice, control, and that's really important to prioritise those things where all possible for young people. To challenge disempowerment and promote self-efficacy amongst young people. We found a real need, I think, for young people to be given more information about their rights to safety, their rights to access to support, and how they do that, including mental health and emotional wellbeing interventions.
Yeah. And I guess the fourth... You know, we have these six things, but they're obviously all very interconnected. The fourth one is about the importance of relationship and recognising the importance of relationship during adolescence and attending to that when we're looking to support young people.
We know that relationships are important full stop in adolescence, and young people spoke about them as so critical to their experience of mental health and wellbeing following abuse. And so to try to actually just work with a young person about their experience of abuse without thinking about "these are all of the relationships and experiences in other spheres of my life that I'm concurrently trying to navigate" actually is just not going to cut it because we have to think about the reality of their lives and all of the relationships and things that are going on.
So the importance of helping young people think about how they can navigate, and supporting them to navigate, this complex web of relationships that they seem to have to navigate. And Debbie I suppose that leads on, the theme of being holistic, to the next one, doesn't it?
Quite nicely leads on to the next one, which is this holistic focus on emotional wellbeing. There seems to be a real need to really look at emotional wellbeing beyond and before diagnosable mental health issues arise. So young people talked about the fact that they recognised in themselves these emotional wellbeing needs before they disclosed abuse or before abuse had been discovered, but that these tended to be missed. So again, really focusing on early signs, early indicators of some emotional wellbeing needs would be really, I think, really important in this a framework.
And recognising the need for support from multiple sources because those emotional wellbeing needs are quite varied and wide and different. And so recognising that multiple professional sources of support, expertise, would be helpful, and informal support as well, could come in and help to address and meet some of those needs.
And last, but certainly not least, is that the response needs to be centred around the young person. We've talked before about the importance of working with not for, of identifying with them, how they understand their circumstances, what they see their needs as, what they see helpful support as being rather than us as professionals assessing what we think they need or what we think they'd like and what would be helpful for them. And I guess, as researchers, we really hope that the report and the centrality of young people's quotes and young people's voices throughout the report starts to offer some insights into that; to how young people view and understand what has happened to them, view and understand their needs and how they would like those to be addressed by other people.
It's really important that that's the road we keep going, which isn't what do we as professionals think needs done about this but what does the young person sitting in front of me or who's in my life or who's in my school, for example, what do they need from their perspective? What's going on and how can I meet their need? It's really important at the start of any engagement with young people, you know, and we know this about sexual abuse generally and also about mental health and wellbeing, that you co-create a language, you co-create a framework that works for them and that we don't just engage with them within our predetermined terminology and categories. But actually that really the language we use, the ways in which we engage, is really driven by what the young person sees, the language they're comfortable with, the ways in which they want to explore what has happened to them.
And so I think it's really important we find another language, another framework for talking about emotional health and mental wellbeing after abuse.
Thank you. That's been so helpful. And you know, NSPCC and ESRC are really pleased that we funded this research and there's some really clear messages coming out there for people to hear that will ultimately help us improve how we respond to young people's wants and needs after abuse. So, thanks again.
Thanks for listening to this NSPCC Learning podcast. At the time of recording, this episode’s content was up to date but the world of safeguarding and child protection is ever changing – so, if you're looking for the most current safeguarding and child protection training, information or resources, please visit our website for professionals at nspcc.org.uk/learning.