Child abuse, neglect, and exploitation of young people

Dear Editor

The British Association of Sexual Health and HIV (BASHH) Adolescent Special Interest Group would like to respond to your package of articles on abuse, neglect, and exploitation of children and young people.

The articles highlight ways of assisting frontline healthcare providers identify such maltreatment. The tools discussed, such as the HEADSSS framework (1), are particularly useful in the acute setting, such as the Emergency Department.

I would like to bring to your attention two further tools that are used across the UK and internationally.

The Spotting the Signs toolkit (2) was originally developed by Brook and BASHH, aiding the identification of young people at risk of child sexual exploitation (CSE). This tool has been used in Sexual Health services since 2014 as part of routine under 18s assessment. It has recently been updated to widen its scope to include child criminal exploitation (CCE) and to be used by broader range of frontline professional seeing young people, including schools, youth services and social services to improve standardisation of practice. It uses trauma informed and conversational approaches and includes essential safety questions relating to CCE, CSE and assessment of online risks.

The updated 3rd edition of the Physical signs of child sexual abuse ('Purple book') (3) is eagerly awaited and due to be published in December 2024 (access will need to be applied for via RCPCH). This evidenced based systematic review was produced by a collaboration of the Royal Colleges of Paediatricians and Physicians, BASHH, the American Academy of Pediatrics and the Royal Australian College of Physicians. It outlines good practice for professionals assessing concerns about child sexual abuse. It also provides an evidence-based review of the interpretation of physical signs and sexually transmitted infections (STIs) in relation to child sexual abuse and is a standard resources used in paediatrics, sexual assault and sexual health services, social care and legal proceedings.

Both UK resources offer guidance and standardisation of best practice for frontline professionals when trying to recognise and manage young people and children at risk of maltreatment.

Your articles highlight the importance of following local safeguarding pathways and accessing experts, both of which will vary depending on area of practice. As well as the named doctor or nurse for safeguarding many localities with have a named Sexual Health doctor who can offer advice and signposting for appropriate follow up of suspected CSE.

1.Contemporary Paediatrics. HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fueled by media. 2014. https://www.contemporarypediatrics.com/view/heeadsss30-psychosocial-inte....
2. https://www.brook.org.uk/spotting-the-signs-tool/
3. https://www.rcpch.ac.uk/shop-publications/physical-signs-child-sexual-ab...