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["Baseline assessment: Harmful sexual behaviour among children and young people"]
["NG55"]
[]
[]
["Published: September 2016"]

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["Baseline assessment tool for harmful sexual behaviour among children and young people (NICE public health guideline NG55)"]
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["This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in harmful sexual behaviour among children and young people.  It can also help to plan activity to meet the recommendations."]
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["The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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["It should be used in conjunction with harmful sexual behaviour among children and young people (NICE public health guideline NG55)."]
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["In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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["Is the guideline relevant?"]
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["The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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["The table can be adapted to include any other local information that is thought to be useful."]
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["If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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["Tools and resources to help put the guidance into practice are available on the NICE website. "]
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["National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2019. All rights reserved. Subject to Notice of rights.\n"]

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["Baseline assessment tool for harmful sexual behaviour among children and young people (public health guideline NG55)"]
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[]
["NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
["1.1 Multi-agency approach"]
["Multi-agency, multidisciplinary team"]
["Ensure multi-agency, multidisciplinary teams promote continuity of care and, wherever possible, ensure the child or young person has contact with the same staff over time, so they can develop trust in their care team.","1.1.1"]
["Ensure young people who are nearly 18 are prepared for the transition to 1.1.2adult services by developing links between child and adult services. See NICE’s guideline on transition from child to adult services.","1.1.2"]
["Ensure multi-agency, multidisciplinary teams: \n• have links to clinical and non-clinical services and can make prompt referrals\n• collaborate with specialists when children and young people have difficult or complex needs (for example, those with neurodevelopmental or learning disabilities or conduct disorders)\nNICE guideline: harmful sexual behaviour among children and young people 2 of 55\n• establish relationships with statutory, community and voluntary organisations that work with at-risk children and young people, to provide a broad range of support services\n• meet regularly to plan, implement and evaluate care pathways for the children and young people whose care they are overseeing\n• understand that the care plan is the responsibility of the whole multi-agency team and not individual practitioners.","1.1.3"]
["Multi-agency, multidisciplinary working"]
["Use established mechanisms, such as local multi-agency safeguarding arrangements, to develop local safeguarding policies and procedures and agree a harmful sexual behaviour operational framework between agencies. (See: Common Assessment Framework in the Department of Health’s Working together to safeguard children, Ofsted’s Early help: whose responsibility?; Children Act 1989 and Children Act 2004.)","1.1.4"]
["Local multi-agency safeguarding arrangements should ensure:\n•\tLead agencies are identified to commission specialist harmful sexual behaviour services.\n•\tThresholds are established for when to refer a child or young person for an early help assessment or to specialist harmful sexual behaviour services.\n•\tNamed safeguarding leads and practitioners working in relevant services are told what the referral thresholds are. This includes those working in education, children's social services, health and youth criminal justice (such as young offender teams and youth justice boards) and voluntary sector organisations. \n•\tNamed safeguarding leads working in universal services use locally agreed resources as part of their policy and procedures to determine whether a child or young person should be referred for an early help assessment. (See recommendation 1.3.4 for examples of resources.) \n•\tChildren's social services have access to policies and procedures for training staff to deal with concerns about a child or young person's sexualised behaviour.","1.1.5"]
["The multi-agency team should agree which service is responsible when children and young people are referred for assessment. Consider one of the following for the lead role:\n• child health services such as child and adolescent mental health services (CAMHS)\n• children's social services\n• voluntary sector organisations such as Barnardos or the NSPCC.","1.1.6"]
["Consider a range of care pathways based on the 5 core domains identified in the NSPCC harmful sexual behaviour framework.","1.1.7"]
["The designated lead practitioner responsible for coordinating the care plan (see recommendation 1.3.2) should request a review of the care plan via the multi-agency, multi-disciplinary team meeting if:\n• the child or young person’s needs are not being met, or\n• the referral and assessment procedure is unnecessarily delayed.","1.1.8"]
["Information sharing"]
["Agree a protocol for information sharing between all agencies. Base this on local safeguarding and child protection procedures and address legal and confidentiality issues.","1.1.9"]
["Ensure the designated lead practitioner responsible for coordinating the care plan can access information on the child or young person's family situation and factors that may affect parenting capacity and attachment (see recommendation 1.4.2). Do this as part of the assessment process (See NICE’s guideline on children’s attachment and recommendations on sexualised behaviour in NICE’s guideline on when to suspect child maltreatment.)","1.1.10"]
["Ensure information is collected and shared in a sensitive and professional manner, as set out in the Caldicott guardian information standards.","1.1.11"]
["If there is a need to share information with other agencies and carers to inform risk management, do this in consultation with the multidisciplinary team.","1.1.12"]
["1.2 Named safeguarding leads in universal services"]
["Immediately inform your organisation's safeguarding lead when a child or young person displays sexualised behaviour that is not appropriate for their age or developmental stage (for tools see recommendation 1.3.4). Possible signs of problems include:\n• using sexualised language such as adult slang to talk about sex\n• sexualised behaviour such as sexting or sharing and sending sexual images using mobile or online technology\n• viewing pornography that is inappropriate for age and developmental status.","1.2.1"]
["Immediately inform your organisation's safeguarding lead when a child or young person displays sexualised behaviour that is always inappropriate, regardless of age, such as public masturbation.","1.2.2"]
["Named safeguarding leads should use locally agreed resources to assess concerns about the sexual behaviour of a child or young person. See recommendation 1.3.4. ","1.2.3"]
["Named safeguarding leads concerned about a child or young person's sexual behaviour should contact their local children's social services to discuss their concerns and determine whether a referral is appropriate. ","1.2.4"]
["1.3 Early help assessment"]
["Children's social services should refer children and young people who display inappropriate sexualised behaviour for an early help assessment, in line with local thresholds and referral procedures (see recommendation 1.1.5). Focus on the child or young person as an individual and not on the presenting behaviour.","1.3.1"]
["At point of referral, early help professionals should identify a designated lead practitioner in the multi-agency, multidisciplinary team (see recommendation 1.1.6) who will:\n• act as a single point of contact for the child or family\nNICE guideline: harmful sexual behaviour among children and young people 5 of 55\n• coordinate early help and subsequent assessments and develop the care plan to avoid unnecessary or repetitious assessments that may be stigmatising\n• coordinate delivery of the agreed actions\n• involve children, young people and their families and carers in the design and delivery of early help services, as appropriate\n• reduce overlap and inconsistency in services provided.","1.3.2"]
["Early help professionals should be familiar with the child or young person’s health and social care record and have access to neonatal and early health information, if necessary. This includes information on developmental delays or a diagnosis of autism spectrum condition, for example.","1.3.3"]
["Use a locally agreed tool as part of the early help assessment that accounts for the severity of the behaviour, to avoid unnecessary and potentially stigmatising referrals. Examples of tools include:\n• The Brook Sexual Behaviours Traffic Light Tool. This helps identify a range of sexual behaviours between infancy and adulthood and distinguishes between 3 levels, using a traffic light system to indicate the level of seriousness.\n• Models that place a child or young person's sexual behaviour on a continuum indicating various levels of seriousness, such as Hackett's model.","1.3.4"]
["Take account of the child or young person's age, developmental status and gender and, if relevant, any neurodevelopmental or learning disabilities.","1.3.5"]
["Recognise that inappropriate sexualised behaviour is often an expression of a range of problems or underlying vulnerabilities.","1.3.6"]
["Use the early help assessment to identify whether the child or young person has unmet needs that can be met by universal services. See Ofsted’s Early help: whose responsibility? and the Department of Health’s Working Together to Safeguard Children. Also:\n• For pre-school children see recommendations 1 to 5 in NICE’s guideline on social and emotional wellbeing: early years.\n• For children in primary education see recommendation 3 in NICE’s guideline on social and emotional wellbeing in primary education.\n• For children and young people in secondary education see recommendations 4, 5 and 6 in NICE’s guideline on social and emotional wellbeing in secondary education.","1.3.7"]
["Ensure services support children and young people of all ages. See the principles of care recommendations from NICE’s guideline on children’s attachment and the principles and values in NICE’s guideline on looked-after children and young people.\n• For children and young people who may have a conduct disorder, see NICE’s guideline on antisocial behaviour and conduct disorders in children and young people.\n• For children and young people who may have experienced trauma, see the sections on specific recognition issues for children (section 1.3.4) and children (section 1.9.5) in NICE’s guideline on post-traumatic stress disorder.","1.3.8"]
["If harmful sexual behaviour is displayed, refer to harmful sexual behaviour services, child protection services and the criminal justice system, if necessary.","1.3.9"]
["1.4 Risk assessment for children and young people referred to harmful sexual behaviour services"]
["Children's social care services and NHS England should identify services employing staff with the skills to undertake a specialist assessment of risk for children and young people displaying harmful sexual behaviour. This may include:\n•\tchild health services such as CAMHS\n•\tchildren's social services\n•\tvoluntary sector organisations such as the NSPCC or Barnardos\n•\torganisations within the criminal justice system such as youth offender teams and youth justice boards.","1.4.1"]
["Professionals responsible for specialist harmful sexual behaviour assessments should access any additional information they need. This includes incident reports of any behaviour that is causing concern. Get this information from the child or young person's:\n• social care history\n• educational records\n• health records\n• youth offending and youth justice records\n• police records.","1.4.2"]
["Consider the child or young person's developmental age, neurodevelopmental disabilities, learning disabilities and gender as part of the assessment. Do this in collaboration with other specialist services, if relevant.","1.4.3"]
["Professionals responsible for assessing risk should use risk assessment tools suitable for the child or young person's developmental age and gender. For example, when assessing:\n• Pre-adolescent children or those aged under 12, consider psychometric measures and questionnaires such as the Child Behaviour Checklist and the Child Sexual Behaviour Inventory.\n• Children under 12 who have not been charged with a sexual offence, consider the relevant elements of AIM plus clinical judgement.\n• Children aged 10 to 12 who have been charged with an offence, consider the relevant elements of AIM plus clinical judgement.\n• Adolescent boys, consider tools such as J-SOAP-II, ERASOR or AIM2, plus clinical judgement","1.4.4"]
["1.5 Engaging with families and carers before an intervention begins"]
["Consider family or social factors that may contribute to the child or young person's harmful sexual behaviour, particularly if there is evidence of abuse within the family. See NICE's guideline on child maltreatment.","1.5.1"]
["Think about the impact a child or young person's harmful sexual behaviour may have on all family members.","1.5.2"]
["If the person at the receiving end of the harmful sexual behaviour is another child within the family, provide support for the family or a referral as needed.","1.5.3"]
["Consider the following before providing an intervention:\n• Meeting families and carers to discuss any concerns they may have, including any potential barriers to attendance.\n• Providing families and carers with information about the intervention and including them, when appropriate.\n• Adopting a flexible approach to accommodate the child or young person’s social activities.","1.5.4"]
["1.6 Developing and managing a care plan for children and young people displaying harmful sexual behaviour"]
["General principles"]
["Recognise that children and young people with learning and neurodevelopmental disabilities have specific needs. Consider providing short and more frequent sessions for them. Work with specialists in these areas to provide the intervention.","1.6.1"]
["Help children and young people develop a strong sense of personal identity that does not include harmful sexual behaviour. This includes helping them to maintain their cultural and religious beliefs.","1.6.2"]
["Developing and managing a care plan"]
["Develop a care plan using an established risk assessment model, such as J-SOAP-II, ERASOR, AIM assessment for under 12s, or AIM2, and a recognised treatment model such as the Good Lives Model, AIM or AIM2. The plan should:\n• recognise the needs and strengths of the child or young person and the risks they may pose\n• support them, their families and carers\n• include clearly defined therapeutic goals\n• include a safety plan that is agreed with the child or young person, their parents or carers and support network.","1.6.3"]
["Ensure the care plan: \n• Encourages and supports children and young people to participate in a range of peer, school and community activities to help build a sense of belonging.\n• Includes supervised social activities that promote self-esteem, develop resilience and encourage socially appropriate behaviour.","1.6.4"]
["Ensure the care plan is reviewed by the multidisciplinary team, and with the child or young person and their parent or carers at 3–6 monthly intervals, or if there is a significant change in circumstances.","1.6.5"]
["1.7 Developing interventions for children and young people displaying harmful sexual behaviour"]
["Structure interventions, but make them flexible enough to meet changing needs and the developmental status and age of the child or young person. Include regular progress reviews by practitioners delivering the intervention.","1.7.1"]
["Base interventions on: \n• A comprehensive assessment of the child or young person's family and social context. This includes: their placement (for example, home, foster care, residential care, secure children's home or other custodial settings).\n• Developmental stage, gender, learning ability, culture and religion.\n• Factors that may have contributed to the harmful sexual behaviour, such as their background, past care or any trauma they may have experienced.\n• The harmful sexual behaviour itself.","1.7.2"]
["Consider including the following elements:\n• safety planning to reduce the risk they pose to others and themselves\n• engagement and working that takes account of their denial of the behaviour\n• sex and relationships education including consent, boundaries and social and moral considerations\n• empathy development\n• how to make good choices to keep themselves and others safe sexually\n• emotional and self-regulation\n• life story work\n• understanding of their harmful sexual behaviour\n• victimisation\n• peer and social relationships\n• community reintegration for those who have spent time in residential or secure units\n• support to make future plans.","1.7.3"]
["Use recognised treatment resources or guided interventions such as:\n• AIM assessment and intervention model for boys and girls. This includes components for:\n- children aged under 12 who have not committed a criminal offence, and\n- children aged 10 to 12 who have committed an offence (10 is the age of criminal responsibility in England).\n• AIM2 assessment and intervention model for boys aged 12 to 18 within or outside the criminal justice system. This also has a component aimed at girls in the same age group and for those with learning disabilities. But note: the 'level of supervision' scale for young females (12 to18 years) is likely to misrepresent the level of risk. A degree of caution is also advised when using it to predict sexual reoffending in young people with learning disabilities.\n• Barnardo's Cymru Taith project for girls - assessment and treatment workbook.\n• The California Evidence-Based Clearinghouse for Child Welfare Children with problematic sexual behaviour cognitive-behavioural treatment program: preschool program and school-age program.\n• Good Lives Model, a strengths-based programme.\n• NSPCC manualised treatment programme Change for Good aimed at boys aged 12 to 18 in residential care.\n• NSPCC harmful sexual behaviour programme Turn the Page, a guided intervention that follows certain key principles for boys and girls aged 5 to 18 and those with learning disabilities. This is suitable as a community-based approach.","1.7.4"]
["Use therapeutic approaches such as: \n• cognitive behavioural therapy\n• multisystemic therapy for problematic sexual behaviour\n• psychotherapeutic approaches\n• strengths-based approaches\n• systemic therapy (a type of family therapy).","1.7.5"]
["Consider 1 or more of the following modes of delivery:\n• individual therapy\n• group therapy\n family therapy.","1.7.6"]
["Deliver interventions in community and family settings, if it has been assessed as safe to do so.","1.7.7"]
["Work alongside care staff when delivering interventions in residential, secure or custodial settings. Ensure the care plan includes safety planning to reduce the risk the child or young person may pose to others in the same environment.","1.7.8"]
["Consider including family members when delivering interventions in residential, secure or custodial settings. Do this only if it is safe and has been agreed as part of the care plan (see recommendation 1.6.4).","1.7.9"]
["Children and young people not living with their birth parents"]
["Ensure links with their family of origin or community are maintained if it is in the best interests of the child or young person. Maintain links with birth parents if safe and appropriate.","1.7.10"]
["Children and young people who have been abused by a family member"]
["If it is in the best interests of the child or young person, consider family reconciliation, re-integration and restorative approaches, if it is safe and appropriate.","1.7.11"]
["Looked after children and young people"]
["Ensure the intervention supports carers. This includes giving them advice on how to respond to the risks presented by children and young people in their care.","1.7.12"]
["Working with parents and carers"]
["Encourage caring relationships between the child or young person and their family and carer, if it is safe to do so. Recognise that looked after children and young people may have problems arising from insecure attachment, making the relationship with their carer very challenging (See NICE’s guideline on children’s attachment).","1.7.13"]
["Help carers create a sense of belonging and trust to ensure the child or young person feels safe, valued and protected.","1.7.14"]
["Consider including the following elements in the programme: \n• how to work with parents and carers in denial about their child's harmful sexual behaviour\n• support to come to terms with harmful sexual behaviour and its impact\n• how to understand harmful sexual behaviour risk indicators\n• maintaining safety plans, including ongoing supervision\n• addressing the parent-child relationship, if needed\n• communications and problem solving\n• behaviour management.\nSee NICE’s guidelines on:\n• challenging behaviour and learning disabilities, sections 1.5 to 1.11\n• autism in under 19s: support and management, recommendations 1.4.1 to 1.4.13 and section 1.5\n• violence and aggression: short-term management in mental health, health and community settings.","1.7.15"]
["1.8 Supporting a return to the community for 'accommodated' children and young people"]
["Provide ongoing support when children and young people in residential homes, secure children homes or young offenders' institutions move back into the community or return to the family home. This includes continuity of care for those who need this type of support.","1.8.1"]