13.5 Sexual Health

RELEVANT GUIDANCE

Isle of Man Safeguarding Board Procedures, Underage Sexual Activity Procedure

This chapter should be read in conjunction with any relevant policies and procedures of Fostering First or St Christopher’s.

Definition
The Parenting Responsibilities of Children’s Social Care
Equalities
National Curriculum and Schools
Sex and the Law
Values and Boundaries
Confidentiality
Working with Disabled Children
Magazines
Websites and Chat Rooms
Intimacy, Sexual Activity and Changes in Behaviour
Working with Lesbian, Gay, Bisexual, Questioning and Transgendered Children
Contraceptive Advice for under 16s
Pregnancy and Choices
Abortion
Masturbation
Pornography
Puberty
Sexual Exploitation

1. Definition

1.1

Relationship and Sex Education (RSE) is lifelong learning about sex, sexuality, emotions, relationships and sexual health. It involves acquiring information, developing skills and forming positive beliefs, values and attitudes. It should support Looked After children in managing adolescence and help to prepare them for adult life.

2. The Parenting Responsibilities of Children’s Social Care

2.1	RSE forms a key part of parenting and staff/carers have a responsibility to ensure that Looked After children receive quality RSE through providing consistent messages and ensuring that questions are responded to in a positive way as they arise. Staff/carers should also take opportunities to raise with the child any concerns they may have about the child's sexual knowledge, skills or behaviour.
2.2	It is important that RSE starts in the early years of child development. Building self-esteem is essential to building healthy relationships and young children should be encouraged to explore friendships as they are growing up.
2.3	Children have the right to high quality information about sexuality and sexual health and the right to express their sexuality in any way that is consensual and non-oppressive. Children also have the right to negotiate the kind of sex they want and to refuse sex they don't want. To support this, staff/carers should enable children to be able to make informed choices about engaging in sexual activity and to understand that they have a range of choices about sexual activity that include not engaging in sexual activity at all.
2.4	Language is an important aspect of RSE and often, children may not know the correct words to describe parts of the body or sexual acts. Sometimes the words they use are offensive and oppressive. It is part of staff/carers' role to provide information about why certain terms are inappropriate, offensive or oppressive and to introduce alternative terms. Often the use of inappropriate language is a starting point for the work. It is vital that staff/carers do not ridicule or punish children for using inappropriate language, but use it as an opportunity to extend their knowledge.
2.5	In situations where a child has questions or concerns about his or her own sexuality a worker may be in a unique position to support the child by providing an opportunity to discuss their feelings with a helpful and objective adult.

3. Equalities

3.1

The Isle of Man has a diverse and varied population and staff should remain aware that there are different cultural and religious views regarding sexual activity and related issues such as contraception, termination, marriage, etc. Where staff find themselves supporting a child of a different religion or culture they should always provide accurate value free information and wherever possible consult with the child's parents before discussing potentially controversial areas.

3.2

Disabled Children should have the same rights and life chances around sexual health and relationships as their non-disabled peers. Historically, people who are disabled have been viewed as different and their sexuality and sexual health needs denied, as it was assumed they did not have any sexual needs. Disabled Children are children first and their disability is a secondary, albeit significant, issue. Disabled Children will need to address similar issues to other children around relationships, self-esteem, puberty etc. All sections of the RSE policy equally apply to Disabled Children.

4. National Curriculum and Schools

4.1	Schools are the main source of RSE for many children. It is important that workers are aware of what is covered within the National Curriculum so that children receive consistent messages about sex and relationships. This will also enable staff/carers to be aware of some of the questions that children may ask as a result of what is being covered in school.
4.2	It is important to note that parents may withdraw their children from sex education focussing on areas such as relationships and contraception. However, children cannot be withdrawn from biological aspects of sex education, taught as part of the National Curriculum For Science.
4.3	Parents/carers of Disabled Children in particular may need time to discuss any issues or anxieties, as their view about their child's sexuality and sexual health needs may well differ from that of staff. Recognition and sensitivity is required when discussing these issues with them.

5. Sex and the Law

Caption: sex and the law

5.1	In the Isle of Man, the age of consent for heterosexual and homosexual sexual intercourse is 16.
5.2	Children both under and over 16 may need support and advice on sex and relationship issues at any time. Sexual activity between children under 16, although illegal, will not automatically be a matter of child protection concern and staff/carers should use as their benchmark what they would expect as a good parent. Within the confines of confidentiality, any judgements of this sort should be discussed, recorded and revisited in supervision, and monitored closely.
5.3	In the event of a person over the age of 18 having sexual intercourse with a person under 16, this constitutes being guilty of an offence and liable to conviction (Sexual Offences Act 1992 Section 4 (2)). See: Isle of Man, Sexual Offences Act 1992. Under such circumstances, staff must report this to the police so that action can be taken against the perpetrator.
5.4	Rape
	5.4.1	Rape is defined as intercourse, whether vaginal or anal, with a person who at the time does not consent to it. This includes male rape. Forcible penetration of an object or fingers is also an offence that carries a lower maximum penalty.
	5.4.2	A boy aged 14 or over can be convicted of rape or attempted rape if it can be proven that he knew he was doing wrong.
5.5	Talking About Lesbian and Gay Issues
	5.5.1	Sexuality is a key part of sexual health and therefore, the provision of information and discussions of lesbian and gay issues forms a key part of RSE. The Department has a responsibility to ensure that information is available on sexuality and the services to support gay, lesbian and bisexual children.

6. Values and Boundaries

6.1	It is recognised that people will be at different stages of awareness with regard to prejudices about particular groups in society and challenging these stereotypes. However, members of staff have a responsibility to operate sensitively and appropriately in relation to situations where power and diversity are key issues; oppressive behaviour will not be tolerated.
6.2	Where staff/carers feel unable to support a child with a specific issue, they must, with the child's agreement, refer them to an appropriate individual/agency. Ideally there should be provision for another carer/staff member to be able to address these issues with the child, ensuring that the child receives consistent messages.
6.3	Staff/carers should recognise that children may come to this subject with a range of experiences, misconceptions, misinformation and prejudices and that their role is to extend children's knowledge, skills and attitudes within a supportive environment.
6.4	Whilst it can be useful to share examples from personal experience, staff/carers are expected to maintain professional boundaries and must not disclose intimate information about their own experiences of sexual relationships. Intimate disclosure can make both staff/carers and children vulnerable and may alienate some children, so clear agreements and boundaries must be put in place from the outset.
6.5	Disclosure by staff/carers of intimate information to children will be treated as a serious breach and be subject to disciplinary procedures.
6.6	If staff/carers are uncomfortable or in doubt about how to answer a question or provide certain information, they must explain that they need advice before answering.
6.7	Establishing confidentiality and its limits in advance will be important in this process.

7. Confidentiality

7.1	Clarity about confidentiality is important in enabling children to share experiences and ask questions about relationships and sex.
7.2	It is vital to have clear working agreements that relate to confidentiality within groups and between workers and individual children, so that both staff/carers and children know what information may be kept confidential and what information will be passed on, to whom and why. Children should be helped to understand that their health and safety is the most important factor in decisions relating to confidentiality.
7.3	Staff/carers must be vigilant about the settings within which discussions take place, and must ensure that children are protected from disclosing sensitive information in unsafe settings, such as group discussions or locations where there is no confidentiality agreement in place, and they may be overheard.
7.4	Staff/carers are expected to maintain confidentiality in most situations. The only exception is when they receive information that a child is suffering, or is at risk of suffering Significant Harm or when they suspect that a criminal act has been committed (See Section 5, Sex and the Law, above).
7.5	Effective RSE brings an understanding of what is and is not acceptable in a relationship. This may lead to disclosure of a child protection issue. Children have the right to expect the provision of a safe and secure environment for this work, and that fears or worries they raise with staff/carers will be taken seriously.
7.6	Wherever possible, the child will be told that information is going to be passed on to another agency and be made aware of the reasons for this.
7.7	If a child discloses that they are being abused or there is a serious risk to the mental, physical or emotional health of a child, the Strategy Discussion / Meeting Procedure must be followed WITHOUT EXCEPTION.
7.8	The sexual activity of a child under the age of 16 is not, in itself, a reason for breach of confidentiality, unless paragraph 7.4 (above) applies. Workers have a responsibility to provide the relevant information for all children to enable them to make informed decisions and act upon them. If a worker believes that a child is worried about visiting a service and is at risk of pregnancy or a sexually transmitted infection, they may accompany them to a sexual health service or GP. See also Isle of Man Safeguarding Board Procedures, Underage Sexual Activity Procedure.
7.9	Best practice guidelines for confidentiality within RSE: Children, parents and carers should be aware of the confidentiality policy and how it works in practice; Children should be reassured that their best interests will be maintained; Children should be encouraged to talk to their parents, staff/carers and be given support to do so; Children will be made aware of what information may remain confidential and what may not; Children will be made aware that if confidentiality has to be broken, they will be informed first and then supported as appropriate; If there is any possibility of abuse, the Inter-agency Child Protection Procedures will be followed; Children will be made aware of sources of confidential support, for example local sexual health services for Children, and GP services.

8. Working with Disabled Children

Caption: working with disabled children

8.1	Issues of dynamics in the relationship between staff/carers and disabled children should be kept in mind throughout and opportunities should occur across all settings to enable the children to develop skills in making choices and exercising assertiveness. Narrow life choices will impact on their ability to generalise learning from one area to another.
8.2	Addressing sexual health needs with disabled children needs to happen in an environment and ethos that values them for who they are and respects their diversity arising from religion, cultural heritage, gender and sexual orientation.
8.3	Opportunities to learn skills in making relationships is important as often Disabled Children are denied these through the separate provision they attend and the lack of chances to make ensuring friendships. This should be part of a generic life skills programme not seen as an add-on.
8.4	Intimate Care
	8.4.1	Many Disabled Children have a level of intimate/personal care needs, supported by adults, which is not experienced by other children. It is important they have equal access to information about what is and is not appropriate contact and about what to do if they are unhappy about any aspect of their care.
	8.4.2	Learning Disabled Children may find it more difficult to communicate when something is wrong but staff/carers need to be aware of their usual behaviours and any changes to these.
8.5	Enabling/Communication/Planning
	8.5.1	The most appropriate ways of enabling Disabled Children to communicate their feelings around sexual health and sexuality matters must be implemented by exploring the child's preferred means of communication e.g. Makaton symbols and drawings. Sufficient time needs to be allowed for this to happen and to go at the child's pace and in manageable parts, taking into account the child's cognitive abilities. It will be important to recognise that some learning Disabled Children may have little understanding of what feelings mean, how to interpret them and express them. A number of children will have difficulty in understanding the concept of sex, sexuality and appropriate boundaries in relationships because of their level of learning disability. Their lack of opportunity to mix with their non-disabled peer group will also impact on the learning of appropriate social skills and cause them difficulty in generalising behaviours to different environments.
8.6	Specific resources when working with Disabled Children 'The sexuality and sexual rights of people with learning disabilities: considerations for staff and carers' - BILD publications 01755 202301; Sex Education Forum - 'Ensuring entitlement: Sex and Relationships Education for Disabled Children' - NCB 2001.

9. Magazines

9.1	It is important to recognise that the material used in some magazines can be sexually explicit, demeaning towards women and can perpetuate stereotypes that are unacceptable.
9.2	It is important that staff/carers agree with children the material that is and is not acceptable to bring into the home. However, should a child be in possession of material that is unacceptable this can provide an opportunity to discuss why the images/language etc. are not appropriate and to challenge stereotypes, rather than simply confiscating the magazine.

10. Websites and Chat Rooms

10.1	There are a great many websites on sexual health and teenage pregnancy that are a great source of accurate information and support. Often these websites are designed with children and offer an interactive and anonymous way of exploring what can sometimes be sensitive and embarrassing issues. This is why websites are a popular source of information for children, and in particular young men. Some websites also offer the opportunity to ask questions of a trained professional such as a doctor or counsellor who then offers their advice.
10.2	However, the nature of the internet makes it very difficult to 'police' and there are risks for users, in particular older children who may use the computer unsupervised and are more likely to be inquisitive about sex and participate in online discussions or in chat rooms regarding relationships or sexual activity. Unfortunately, this could lead to exposure to inappropriate sexual material, discussions with adults who are intending to hurt a child and a child may provide information or arrange an encounter that could risk his or her safety or the safety of other family members. In the past and currently, paedophiles have used email, bulletin boards, and chat areas to gain a child's confidence and then arrange a face-to-face meeting or sent inappropriate messages.
10.3	However, there are a number of steps that can be taken to reduce the risk: Site computers in an area where it is easy to monitor what a child is doing. If possible have it in a family room like the living room; Establish reasonable guidelines and tips for their use of the internet or chat-line and put them on the wall near the computer; Become familiar with the internet and the services or sites the child uses; Get to know about on-line friends in the same way you would other friends; If the child arranges to meet an on-line friend ensure it is in public place with a responsible adult present; Encourage them to come to you if they see or read anything on the internet which upsets them; If in doubt, contact the police.
10.4	Computers in residential homes are monitored using a 'net nanny' and access to websites with an educational sexual content is agreed by prior arrangement with Children’s Social Care. Foster carers may wish to contact a local computer retailer to find out about protective software packages that you can be installed on home computers.

11. Intimacy, Sexual Activity and Changes in Behaviour

11.1	The nature of intimate relationships is diverse, making it difficult to provide a list of indicators for staff/carers to look out for in respect of an appropriate time to approach discussing sexual activity with children. It may be apparent that a child is in an intimate relationship or staff/carers may observe indications of this, for example noticing that a Child is asking questions about relationships, becoming interested in a particular person or finding a condom in a child's pocket whilst doing the washing. There are potentially a whole range of reasons for this and it may not be that a child is engaging in sexual relationships but that they received information/condoms during RSE at school. What is important is this is an opportunity to engage the child in discussion in a sensitive way, and one that does not assume a particular course of action.
11.2	It is essential that children are supported to decide and negotiate levels of sexual activity that are right for them at different times and in different relationships and know ways of resisting unwanted physical contact.
11.3	Where Children have suffered sexual or other kinds of abuse this can be challenging and requires professional support. Should staff/carers find themselves in a position of talking to child who has been in this situation they should first explore with their supervisor whether the child would benefit from support from elsewhere, or whether sufficient, appropriate support can be provided by the staff/carer concerned.

12. Working with Lesbian, Gay, Bisexual, Questioning and Transgendered Children

12.1

It should be emphasised that lesbian, gay, bisexual, questioning and transgendered children have the same entitlement to Relationships and Sex Education as all other children. There is no legal or procedural reason as to why this should not be the case.

12.2

Some children may also question their gender identity. The relationship between sexual identity and gender identity is a complex area and staff/carers also need to be sensitive to this.

12.3

Like their heterosexual peers, lesbian, gay, bisexual, questioning and transgendered children continue to be at risk from sexually transmitted infections including HIV. Their formal experience of RSE in school contexts may not have addressed the issue of homosexuality in any depth and staff/carers could have an educative and supportive role to play particularly in relation to:

Dealing with invisibility and being marginalised - a particular issue for lesbians and bisexual women;
Issues relating to self-esteem, confidence and assertiveness in sexual situations;
The role of alcohol and other drugs in relation to sexual situations;
Knowledge relating to the transmission of sexually transmitted infections;
Knowledge relating to safer sex practices;
Dealing with homophobic bullying;
Dealing with isolation and establishing friendship networks;
The risks associated with selling sex.

13. Contraceptive Advice for under 16s

13.1

Workers may be approached by children under the age of 16 seeking advice or information about contraception. Staff/carers should be aware of the guidance concerning provision of information about sexual health and contraceptive services to children, which asserts that the provision of contraceptive advice should be viewed within the context of a child's safety and prevention of the possible long-term consequences of teenage pregnancy and sexually transmitted infections (STIs), namely poor health and social exclusion and potential sexual exploitation.

13.2

Doctors and health professionals have been issued with guidelines on the provision of advice and treatment to children less than 16 years of age. They are referred to as the Fraser Guidelines and allow health professionals to provide confidential contraceptive advice to a child under the age of consent providing that certain criteria are followed:

The child understands the advice that is being given;
The child cannot be persuaded to inform or seek support from their parents, and will not allow the doctor to inform the parents that contraceptive advice is being given;
The child is likely to begin or to continue to have sexual intercourse with or without contraception;
The child's physical and mental health is likely to suffer unless they receive contraceptive advice or treatment;
It is in the child's best interests to receive contraceptive advice and treatment without parental consent.

This does not exempt the health professionals from following Child Protection Procedures when they believe a child is at risk.

14. Pregnancy and Choices

14.1

It should not be assumed that a pregnancy is unwanted. It is the role of the worker to ensure that any Looked After child in their care who becomes pregnant, or is the partner of a young woman who is pregnant, has access to non-judgemental information, advice and counselling about what options are available to them and the implications of continuing with the pregnancy, birth and parenthood.

15. Abortion

15.1

The law; Termination of Pregnancy Act (medical Defences) 1995 states that abortions can legally be performed under certain conditions. The first condition is if 'it is necessary to preserve the life of the pregnant woman.'

An abortion can also be carried out if there will be 'grave permanent injury' to the physical or mental health of the woman. Termination can occur if a foetus is 'unlikely to survive birth' or if there is a risk of 'serious handicap'. Abortion in the case of Downs Syndrome is not allowed.

Pregnancies as a result of rape, incest or indecent assault can also be terminated if certain conditions are met.

A hospital surgeon and an independent medical practitioner must agree that the above criteria have been satisfied before an abortion can be carried out. In the case of 'grave permanent injury' to the woman's mental health, the other medical practitioner must be a consultant psychiatrist.

24 weeks is the accepted point at which a foetus is 'viable'.

See the full Act by using the link below:
www.legislation.gov.im

15.2

The main clinic available for family planning advice is the Family Planning Clinic (gov.im).

16. Masturbation

16.1

Masturbation is a part of sexual behaviour and growing up for many children and it is important that children understand this and are not made to feel guilty or dirty if they do or if they don't masturbate. It is also important that children know that it is an individual activity that is done in their own private space.

17. Pornography

17.1

Pornography is often a primary source of information, particularly for young men. This needs to be acknowledged as does the fact that some children may like it. The negative messages that it can give about power, gender, sexuality, exploitation and self-image may need further exploration. It is important that children receive messages that encourage healthy lifestyles and promote positive images about men and women however this needs to be balanced with children's curiosity about sexual material.

17.2

In cases where material contains illegal images including child pornography and bestiality, it must be confiscated and reported to management. It is vital that these actions are clearly and sensitively explained to the Child ensuring that they understand why these images are illegal and the harm that they can cause and therefore are educated rather than punished.

18. Puberty

18.1	Children have the right to know, understand and be prepared for the physical and emotional changes that take place during puberty before they experience it. It needs to start early enough to prepare for early starters but also explain that it is normal for everyone to develop at different rates to reassure those children who develop later. Schools do provide sex and relationship education however children need to receive this information from a number of sources throughout their childhood and teenage years. This ensures that children have the opportunity to digest, understand and explore the information. It is important that wherever children receive messages on RSE that they are consistent.
18.2	It is important that young girls are prepared for and able to manage menstruation. Early negative experiences such as unexpected bleeding, difficulty in obtaining sanitary supplies and teasing from other children can have a damaging effect on girls' self esteem. All girls should know where they can get sanitary supplies, how to use them and where they can dispose of them. Girls should also be provided with information about hygiene during menstruation and how to deal with accidental stains on clothing and bedding.
18.3	Within residential settings access to sanitary supplies should be both easy and discreet providing young women with a choice of sanitary supplies.
18.4	Boys also need to be prepared for puberty providing them with information and support from wet dreams to how to shave and reassurance about what is 'normal' in terms of development and penis size.
18.5	Although some people may worry about providing children with information that isn't yet relevant it is important to recognise that they will be picking up messages from T.V and magazines and by overhearing conversations. Providing them with the correct information early enough will help them make sense of what they have heard and enable children to come through what can be a confusing and difficult time positively.

19. Sexual Exploitation

19.1	Please refer to the Isle of Man Safeguarding Board Procedures, Children Involved in Prostitution Procedure and Children from Abroad, including Victims of Modern Slavery, Trafficking and Exploitation Procedure for information about recognising these risks and what to do about them.

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