Sexual health sexual violence event - March 18


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Slides from Birmingham Public Health looking at why sexual violence and exploitation is the focus of a major review of sexual health services.

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  • Space : in the past 9 months – direct work with 132 young people, family programme with 15 families, over 50 referrals every quarter, 34 training event to over 1000 people.
    Amazon: in the past 9 months – work with 142 children and 14 parents
  • 63% NCD, 24% MH, 7% LD
  • 43% 26% 26%
  • Sexual health sexual violence event - March 18

    1. 1. Sexual Coercion, Exploitation, and Violence and the New Sexual Health System: The role of Sexual Health Services Tuesday 18th March 2014 #2ndcitysex
    2. 2. Welcome and Overview Jak Lynch Senior Commissioning Manager – Sexual Health Birmingham City Council
    3. 3. Programme 12.00pm Registration, Lunch, Networking and Stalls 1.05pm Welcome and overview 1.15pm Violence Against Women and Children 1.25pm Violence Against Women and Children – Focus on the Outcome 1.35pm A Public Health Priority – Challenge of Co-Production 1.40pm Sexual Violence and Sexual Health Services 1.50pm Exercise 1: Improving The Outcomes Framework 2.20pm Break 2.35pm What You Need to Know… 3.15pm Child Sexual Exploitation 3.30pm Exercise 2: Improving The Service Specification 4.00pm Plenary and Questions 4.30pm Close #2ndcitysex
    4. 4. Aims and Objectives • Bring prospective providers together • Orientate providers on the Violence Against Women and Children (VAWC) topic • Improve the Sexual Health Performance Framework in relation to VAWC • Improve the Service Specification in relation to VAWC #2ndcitysex
    5. 5. M in d T h e G a pM in d T h e G a pSexual Health Cllr Jess Phillips Chair Violence Against Women and Children Steering Group Violence Against Women and Children
    6. 6. M in d T h e G a pM in d T h e G a pSexual Health Birmingham strategic approach • Health & Wellbeing Strategy • Birmingham VAWC Strategy • Birmingham VAWC Steering Group What does VAWC cover? • Sexual exploitation • Domestic violence • Rape and sexual violence • Female Genital Mutilation • Forced marriage • Sexual harassment • Stalking • Trafficking • Prostitution
    7. 7. M in d T h e G a pM in d T h e G a pSexual Health Sexual Exploitation, Violence and Coercion • Nationally 55,000 reported incidents of sexual violence per year - compared to 60,000 strokes in women. • Estimated 193,000 adults living in the West Midlands victims of sexual violence – 50% live in Birmingham. • Children in residential care were identified at greatest risk, with 42% being identified as at risk of sexual exploitation. • Young people, especially females, are at greater risk of sexual violence as are people with long standing illness or disability and the unemployed. • One quarter of LGBT respondents to the Out and About survey indicated that they has been victims of domestic abuse.
    8. 8. M in d T h e G a pM in d T h e G a pSexual Health Opportunities for the new sexual health ‘System’ Opportunity to ask the right questions • Systematic identification of victims and those at risk of sexual exploitation, coercion and violence in our mandated services Opportunity to contribute to our city wide response • Through developing local policies • Contributing to safeguarding children and adults • Support capacity building in associated 3rd sector and primary care
    9. 9. M in d T h e G a pM in d T h e G a pSexual Health • Core business • Policies, pathways and procedures • Building capacity and capability What I want the market to deliver through this procurement…
    10. 10. M in d T h e G a pM in d T h e G a pSexual Health Thank you
    11. 11. M in d T h e G a pM in d T h e G a pSexual Health Cllr Steve Bedser Cabinet Member for Health and Wellbeing Violence Against Women and Children – Focus on the Outcome
    12. 12. M in d T h e G a pM in d T h e G a pSexual Health 1. Reducing under 18 conceptions 2. Increasing chlamydia diagnosis in the 15-24 age groups 3. Reducing the late diagnosis of HIV 4. Improved support for people vulnerable to, and victims of, sexual coercion, sexual violence and exploitation 5. Providing better access to services for high risk communities 6. Ensuring prompt access for earlier diagnosis and treatment 7. Increasing the use of effective good quality contraception 8. Reducing the number of people repeatedly treated for STIs 9. Reducing the number of initial and repeat abortions 10.Reducing the transmission of HIV, STIs and blood borne viruses. Sexual Health & Wellbeing Outcomes
    13. 13. M in d T h e G a pM in d T h e G a pSexual Health Improved support for people vulnerable to, and victims of, sexual coercion, sexual violence and exploitation • Our consultation found overwhelming support that Sexual Health Services should address this outcome • The challenge for providers is to co-produce with users, commissioners and other services what should be done to address the outcome
    14. 14. M in d T h e G a pM in d T h e G a pSexual Health Consultation December 2013
    15. 15. M in d T h e G a pM in d T h e G a pSexual Health • Outcomes • Diversity and inclusion • Respecting and responding • Integration What I want the market to deliver through this procurement…
    16. 16. M in d T h e G a pM in d T h e G a pSexual Health Thank you
    17. 17. A Public Health Priority – Challenge of Co-Production Dr Adrian Phillips Director of Public Health Birmingham City Council #2ndcitysex
    18. 18. Status Quo or Game Changing? • Game Changing! • Sexual violence and exploitation • Primary Care • Think family, think people #2ndcitysex
    19. 19. What I want the market to deliver through this procurement... • Integration • Modernisation • Transformation #2ndcitysex
    20. 20. Thank you #2ndcitysex
    21. 21. Sexual Violence and Sexual Health Services Jak Lynch Senior Commissioning Manager – Sexual Health #2ndcitysex
    22. 22. Laying the Track • Strategic Outcome • Policy and Practice • Procurement • Service users experience and views • ISVA’s • SARC • CYP SARC • Care Pathway #2ndcitysex
    23. 23. Tested in Procurement • Subject of a detailed method statement in the competitive dialogue • Question relates to mandated services- core specification- a proper service response • Question relates to non mandated services- targeted non clinical outreach and capacity building #2ndcitysex
    24. 24. Interpolation of Lifetime Prevalence of Non Volitional Sex (NSAT-3) * ONS 2012 Mid year estimate #2ndcitysex
    25. 25. Interpolation of Prevalence of Intimate Partner Violence (BCS 2013) * ONS 2012 Mid year estimate #2ndcitysex
    26. 26. Rape and Sexual Assault Activity Model #2ndcitysex
    27. 27. Recorded Crime Statistics Police recorded sexual offences in Birmingham - number and rate of offences •1 per 1,000 •1,242 cases in 2012/13 •No real variation in rate year on year •Expect approx. 115 cases of current recorded crime to be associated with Sexual Health Services #2ndcitysex
    28. 28. Service Users Views • Use of qualitative Research • Local action learning • Focus on users experience #2ndcitysex
    29. 29. Sexual Health Outcomes Framework #2ndcitysex
    30. 30. Thank you #2ndcitysex
    31. 31. Exercise 1 Improving the Outcomes Framework #2ndcitysex
    32. 32. Improving the Outcomes Framework 1. Do these outcomes adequately capture measures of the outcome? 2. Are there any additional measures that should be considered? 3. Are there further national and local metrics that could be used, in particular based on existing data returns? 4. Other comments? #2ndcitysex
    33. 33. Break Do you have any thoughts or questions so far? Please tweet using: #2nd citysex #callitout #2ndcitysex
    34. 34. Child Sexual Exploitation Barnardo’s: Birmingham Space Amazon Debbie Southwood Children's Services Manager #2ndcitysex
    35. 35. Barnardo’s & Child Sexual Exploitation (CSE) CSE is possibly the biggest child protection issue facing our young people. Barnardo’s is the largest provider of child sexual exploitation support services in the UK. Last year we worked with 1,940 victims through 29 specialist services. In Birmingham: Space provides services for children/young people abused through sexual exploitation, and also works with children/young people who are vulnerable (and their families) to prevent sexual exploitation. Amazon provides counselling and keep safe work for children/young people who have been sexually abused/ exploited. #2ndcitysex
    36. 36. Child Sexual Exploitation • children and young people under 18 • exploitative situations, contexts and relationships where young people receive ‘something’ (eg food, accommodation, drugs, alcohol, affection, gifts, money, on-line gaming access) as a result of them performing, and/or another or others performing on them, sexual activities • can occur through use of technology without the child’s immediate recognition (e.g being persuaded to post sexual images on the Internet, mobile phones) • the abuse is based on an imbalance of power which severely limits victims options May not understand that they are being abused and exploited. Or The pain of their ordeal and fear that they will not be believed means they are too often scared to come forward. #2ndcitysex
    37. 37. Risk Indicators Regularly missing school or not taking part in education Going missing or regularly returning home late Rapid change in appearance Sexualised behaviour Disruptive/Challenging behaviours Criminal/antisocial behaviours Repeated STI testing Pelvic inflammatory disease Repeat Pregnancy Misuse of drugs and alcohol Mental Health Problems Suicide Ideation Unexplained injuries#2ndcitysex
    38. 38. What this means fordeveloping the service response in Sexual Health Children who are sexually exploited need to workwith professionals who: • They can trust • Are consistently available – the young person can see the same professional as needed • Can be contacted by telephone, text or email • Able to go to where the young person is – not necessarily expect the young person to keep appointments • Joint visit with other workers who the young person trusts • Are non-judgemental • Have a child-centred approach • Understand the child’s situation, their lack of choice & control • Will plan with the young person, not for them • Know how to recognise CSE and escalate concerns – not expect the young person to be responsible for stopping the abuse #2ndcitysex
    39. 39. Birmingham Space and Amazon Contact Information Debbie Southwood (Manager) 40 Rupert Street Nechells Birmingham B7 4PS T: 0121 359 5333 e: e: #2ndcitysex
    40. 40. Learning from Lucy-a survivor of child sexual abuse Lisa Thompson, Chief Executive of RSVP #2ndcitysex
    41. 41. Experience of using local sexual health services • Sexual health history was traumatic to disclose • Asked to re-disclose information repeatedly • No choice offered re the gender of sexual health staff • Staff comments about her sexuality being the result of the abuse #2ndcitysex
    42. 42. Experience of using local sexual health services • Lack of support provided when experiencing STD testing and smears • Lack of psychosexual support • Repeatedly offered 'contraception' and 'family planning' • Poor understanding about high proportion of missed appointments • Lack of coordinated plan to increase Lucy's engagement #2ndcitysex
    43. 43. What this means for developing the sexual health service response? • Safe environment to disclose with no need to repeat • Choice of gender of worker • Specialist sexual violence and abuse training • Consistent support from a key worker • LGBT appropriate services • Plan of how to engage with survivors who regularly miss appointments #2ndcitysex
    44. 44. Jo Hollinghurst SARC Manager #2ndcitysex
    45. 45. Aims of a SARC •To offer informed choices •To collect sound forensic evidence •To offer therapeutic Medical and Emotional Care •To facilitate the onward referral to appropriate services #2ndcitysex
    46. 46. #2ndcitysex
    47. 47. Access to SARC Service #2ndcitysex
    48. 48. Who? #2ndcitysex
    49. 49. Vulnerable Groups • Mental Health • Learning Difficulties • Physical Disability • Communication Difficulty • Intoxication/Dependency • Sex-Workers • Children • Teenagers • Elderly • Gang association • Looked-After Children • Previous Sexual Abuse • Financial Difficulties • Domestic Abuse • Cultural background where to report will bring shame and dishonour • Human Trafficking • Socially Isolated #2ndcitysex
    50. 50. #2ndcitysex
    51. 51. Age of SARC Clients #2ndcitysex
    52. 52. Gender of SARC Clients #2ndcitysex
    53. 53. Aftercare #2ndcitysex
    54. 54. Referrals to Sexual Health Service • 79% of clients attending the SARC were referred for Sexual Health Follow-up • Of these, 57% attend #2ndcitysex
    55. 55. What this means for developing the service response in Sexual Health • Why might a victim of sexual assault not attend follow-up appointments? • How can these issues be overcome? • How easy is it to get an urgent appointment? • How convenient are the appointments? • Would a tailored service for victims of sexual assault improve attendance?
    56. 56. Presented by Yvette Waide ( Assistant Director, South Area) and Nazima Kiyani ( Team Manager) Directorate for People #2ndcitysex
    57. 57.  Birmingham has a population of 1818 Children in Care  Up to age 18 years old  Children can be placed in Foster homes, Children’s homes, family or Supported accommodation  Spilt between Children subject to Care Orders/ Interim Care Orders or Section 20 Accommodation  Birmingham supports approx. 900 Care Leavers  From the ages of 18 to 24 years old  Reside in own tenancy, supported accommodation or with family  The City Council, members and staff are Corporate Parents. As Corporate Parents, we want Children in Care and Care Leavers to achieve their potential and grow to become positive citizens!
    58. 58.  Children in Care and Care Leavers are recognised as a vulnerable group nationally.  Likely to have had poor parenting experiences, suffered abuse and instability within their care arrangements resulting in poor physical, emotional and psychological development / skills. Children in Care as a group are more likely than the general population to experience: ◦ Emotional and behavioural concerns ◦ Poor educational attainment ◦ Poor self esteem and confidence ◦ Social isolation ◦ Criminalisation ◦ Dependency on substances ◦ Increased vulnerability to bullying, abuse and exploitation Care leavers are more likely to experience homelessness, criminalisation, social isolation, NEET, poor Mental Health, exploitation and become younger parents.
    59. 59.  Early childhood experiences of neglect, emotional, physical and sexual abuse, and exposure to adult sexual activity or violence  Disrupted/ fragmented family life and poor family/community support networks  Compromised parenting – more likely to have experienced loss  Conflictual relationships between parents and professionals  Had a number of care and educational placement changes  Turnover of changes in staff/ carers/social workers
    60. 60.  Differing rules and boundaries/ unsupervised time away.  Feelings/ thoughts of “No one to trust or No one cares for me”.  No significant person in their life and unmet emotional needs.  Poor social boundaries and skills to keep themselves safe  Easily influenced and wanting to fit in.  Going Missing regularly.  Unable to recognise harm and therefore not disclose.  May be motivated economically or by possessions.  Overwhelming need to be accepted and belong.  More difficult to engage.
    61. 61.  Careful consideration of the location and accessibility to the service  Proactive and creative promotion of service  Straightforward referrals processes with efficient timescales for intervention  Outreach support -not focus solely on area  Viewing Child / Young person as an individual - holistic needs, strengths and areas of development  Understanding the barriers/ risks children and young people may face  Not to give up on the young person. Try, Try and try again!
    62. 62.  Proactivity  Diverse and creative approaches to intervention and therapy. One size does not fit all!  Paced response  Relationship based practice, intuition and resilience - not to give up!  Education on healthy relationships  Increasing self belief and aspirations  Feedback to Social Care Practitioners  Safeguarding Vs Confidentiality  Provision of proactive educational work in group settings i.e. schools, Children’s homes, Youth Clubs  Links to Universal and other Specialist Services  Being open to keeping in touch Strategically  Joined up system and information sharing  Use resources effectively to maximise efficiency
    63. 63. #2ndcitysex
    64. 64. Sexual Health & Sexual Violence Stephen Rimmer West Midlands Strategic Lead – Preventing Violence against Vulnerable People BCC Event 18 March 2014 #2ndcitysex
    65. 65. PVVP Strategic Leader – what does that mean? Co-funded by and accountable to the seven LA Chief Executives and Chief Constable Assessed effectiveness and impact of existing work to tackle CSE risks and other key domestic and sexual violence threats - report endorsed by Chief Executives and Council Leaders and is now a “Delivery Plan” Provides co-ordinated leadership and authoritative public engagement in tackling these threats across the West Midlands Ensures senior oversight, support & challenge through a PVVP Board in West Midlands – focus on outcomes #2ndcitysex
    66. 66. What is the mission? “We have collective responsibility to protect those who are most vulnerable in our society - children, young people and vulnerable adults - and we discharge this through: Prevention –engaging communities through awareness raising, prevention and culture change Protection - safeguarding those at risk and supporting those affected Justice - dealing with offenders and preventing reoffending Our approach will be integration, not partnership, and we will transform our delivery of core public services as a result” #2ndcitysex
    67. 67. Some key facts 1027 reports of child sexual abuse over the last financial year, 400 were non-familial. 245 children at risk of CSE in West Midlands in 2013 Increasing perpetration by offenders under 18 WMP had 33,105 DV incidents logged in 2013 / Region has ~30 DHRs in process / 31% of all women experienced some form of DV since age 16 (CSEW) CSEW reveals 24,000 WM adults have been victims of sexual assault, only 13% of victims of serious sexual assault report to the police Clear need for further work to get beyond “tip of iceberg” #2ndcitysex
    68. 68. CSE: What is it? Child sexual exploitation (CSE) is a form of sexual abuse that involves the manipulation and/or coercion of young people under the age of 18 into sexual activity in exchange for things such as money, gifts, accommodation, affection or status. The manipulation or ‘grooming’ process involves befriending children, gaining their trust, and often feeding them drugs and alcohol, sometimes over a long period of time, before the abuse begins. The abusive relationship between victim and perpetrator involves an imbalance of power which limits the victim’s options. (Barnardo’s, 2012) "Online pornography is teaching a grim and misleading lesson – that girls are for the sexual gratification for boys. And as we see from this court case it can result in tragic consequences.”  NSPCC, tackling sexual abuse 2014 #2ndcitysex
    69. 69. Victims of CSE are most commonly female, white skinned British born teenager; average age of 15 who come from a single parent home, consume alcohol and drugs live in a deprived area with high levels of ASB, crime, demand for police resources, unemployment and a volume of troubled families Suspects in CSE 85% Asian Males (Pakistan Origin) Multi ethnicity street gangs Previous criminal history However, national study by Muslim Women’s Network argues……..offender and victim usually same ethnic group. WMP Problem Profile suggests…. #2ndcitysex
    70. 70. SARCs SARCs are specialist medical and forensic services for anyone who has been raped or sexually assaulted. Majority police referrals (2/3) Service users: 287 women, 19 men, 1 transgender (1 female offender) 257 adults, 51 children 63 assaults linked to night time trade, 22 to internet, 37 substance assisted Most common location was a home (offender’s 77, victim’s 54, or friend’s 14) Rape most common offence #2ndcitysex
    71. 71. Some key issues  Clarity of outcomes – victim reports up / high risk victims down / cases through CJS up / community confidence up  Assurance of priority in resource planning across key agencies  Development of significant capability – especially West Midlands Public Services Intelligence Hub  Accelerate a more integrated approach amongst key agencies – including effective build of Multi Agency Safeguarding Hubs  Generate a more consistent approach to prevention – particularly in schools  Mobilise communities – especially young people and parents – to challenge “normalising” of violence factors, e.g. online porn  Ramp up disruption and prosecution of perpetrators  Deliver agreed minimum standards in tackling Child Sexual Exploitation consistently across West Midlands  Establish a Sexual Assault Referral Centre for under 18s  Generate a stronger commitment to consistent operational practice in tackling Domestic Violence across West Midlands  Child Trafficking pilot #2ndcitysex
    72. 72. Some key challenges Capacity to deliver more proactive and front foot services Complexities of the health landscape / mental health Massive under-reporting of victims Insufficient challenge of offending behaviour Confronting community and cultural attitudes. #2ndcitysex
    73. 73. Thank you #2ndcitysex
    74. 74. Exercise 2 Improving the Service Specification #2ndcitysex
    75. 75. Improving the Service Specification 1. Are these service responses located in the correct tier of service 2. Are there any additional measures that should be considered? 3. Other comments? #2ndcitysex
    76. 76. Plenary and Questions Cllr Jess Phillips #2ndcitysex
    77. 77. Thank you #2ndcitysex