Sexual Health and Relationships

Westbrook supports and promotes the right of all people with additional needs to have a safe, fulfilling and informed sexual identity and sexual experiences. The aim of the policies in place at Westbrook is to provide a framework which offers both support and protection to staff and young people when planning and delivering services related to sexual health. Sexual identity is a core element of everyone’s sense of self and wider personal identity.

The content of this statement is informed by “Learning disabilities, sex and the law”, Fanstone, C., and Andrews, S. (2009), Family Planning Association. This text is held in the manager’s office and is available to all staff. This statement does not encompass all aspects of the book and so staff should refer to the book for further information in conjunction with the other policies in place at Westbrook.

All staff at Westbrook are to be confident in delivering information relating to sexual health and responding to situations of a sexual nature. Where staff are unsure of the information to give they should address this through training or, in the first instance, accessing of information from:

See Brook for Young People website.

Brook provides free, confidential advice about sexual issues to young people under the age of 25, the content of this website is appropriate and accurate. Staff are not to use their lack of knowledge as a way of avoiding delivering sexual information to young people. All information is to be accurate. Where more specialist information or guidance is needed, staff are to communicate this to the senior management team and advice is to be sought from the appropriate professionals, for example CYPMHS or the challenging behaviour team.

Staff at Westbrook are not expected to deliver specialised or explicit information about sexuality; staff are not to provide any materials to young people that are explicit in nature, even if they are intended to assist in understanding sexual health or development. Westbrook’s Statement of Purpose clearly documents that the Unit will respond to issues of sexual health and conduct in an open, honest manner. Where parents/ carers demonstrate concern about this, staff are to be clear about the importance of sex and relationship information and also the boundaries in place. Such concerns must be reported to the senior management team who will decide on further action, which may include informing the social/ Child In Need worker. Westbrook acknowledges the importance of including parents/ carers in this work as a way of delivering a holistic, appropriate and consistent message to young people.

Westbrook delivers services to children and young people aged 10-18 who have complex learning disabilities, as such, Westbrook has a duty to protect the wellbeing of the young people who use its services, and as such, this may mean sharing information which would normally be considered confidential. When in doubt, staff are to refer to the senior management team in the first instance. All staff have a responsibility to report any suspicion of abuse or exploitation immediately (see Child Protection Referral Procedure).

When dealing with any issues in relation to sexual health and identity staff are advised to seek help from the senior management team and where necessary external, relevant professionals.

The law:

It is legal for anyone over the age of 16 to participate in sexual activity; this includes people with a learning disability who have the mental capacity to consent to such activity in a free and informed manner. The Mental Capacity Act (2005) details the questions that need to be asked to ascertain mental capacity, staff at Westbrook would not be expected to conduct such an assessment themselves (see page 8-10 in Learning disabilities, sex and the law for further information).

Consent and confidentiality:

This relates to engaging in sexual activity, sexual health treatment and contraception.

All service users have a right to confidentiality; however, the level of mental capacity demonstrated by the client will impact on the need to share information with other parties as a way of promoting their wellbeing.

“The Fraser Guidelines apply to all young people and are based on maturity, rather than age…A doctor or other professional can proceed to provide treatment or advice without the parent’s knowledge or consent if it is established that:

• The young person understand the advice;
• He/ she can’t be persuaded to inform a parent/ care;
• He/she is likely to have sex anyway whether or not the treatment or advice is given;
• His/ her physical or mental health would suffer without the advice or treatment;
• His/ her best interest require it.

pg 53 - 54, Learning disabilities, sex and the law"

A person over the age of 16 with the capacity to consent can make decisions about their medical care without their parent’s knowledge. This applies for clients 15 or under if they understand the treatment and it is in their best interests. Where treatment is deemed to be in their best interest, a client under the age of 17 cannot refuse it, medical staff should always try to get their consent and a court order maybe necessary.

Where a person under 18 does not have the mental capacity to make informed decisions, those with parental responsibility or a court of law should do so. If a decision has been made which staff do not agree with, they should communicate this to the senior management team who will decide on the action to be taken, decisions made can be challenged in court if they are not agreed with.

A person 18 years or over can refuse any treatment prescribed, but they must understand all the consequences of refusal. Doctors can make decisions about care and treatment where a patient does not have the capacity to do so, although this should be done in a multi-agency manner, with appropriate family members consulted too.

Every attempt should be made to support all clients (including those under 16) to understand their options and the consequences of these options.

People with learning disabilities have the same right to use contraception as the general population but it’s use must be in their best interests, people with the mental capacity to make choices should be supported to do so, where they do not have this capacity, a doctor may decide in their interests. Sterilisations can only be prescribed after a legal declaration is put in place.

The Unit Manager must ensure that children are provided with suitable, good quality, up to date, information and advice on matters relating to sexual health and relationships.

Such information and advice must be provided in a manner appropriate to children's age and understanding and which is provided in a creative, child friendly manner.

During care planning the keyworker will discuss with the parents/ carers and where possible the young person, the young person’s needs around their sexuality and sexual health, information is to be recorded on the young person’s care plan and where necessary risk assessments too. Any areas that need further work should be addressed with the senior management team. Amendments to these documents should be made as needed and at the least every 6 months.

Staff must adopt a non-judgemental attitude toward children, particularly as they mature and develop an awareness of their bodies and sexuality.

Staff must adopt the same approach to children who explore or are confused about their sexual identity or who have decided to embrace a particular lifestyle so long as it is not abusive or illegal.

Children who are confused about their sexual identity or indicate they have a preference must be afforded equal access to accurate information, education and support to enable them to move forward positively.

As necessary this must be addressed in Placement Plans.

All materials published, circulated or available to children must promote and encourage healthy lifestyles and promote images of men and women that are positive and encouraging.

Buying and owning pornography is legal from the age of 18 and though most young people transition from Westbrook at age 18, there may be occasions when individuals remain at the Unit past their 18th birthday. Children must be positively discouraged from obtaining material that is potentially offensive or pornographic. Where a young person uses pornography, an agreement will need to be made regarding obtaining and storing and use of such materials. The agreement will need to be made between the individual, their carers, the Unit and other relevant professionals and will require a specific risk assessment.

If pornography is discovered within the Unit which has not been sanctioned by the management team, this is to be removed to the Manager’s office, this discovery should be handed over to the senior management team as soon as possible and the parents/ carers.

Some pornography is illegal, anything involving children or people who look like children is illegal, as is anything explicit( a sensible way to assess what is legal is that anything available on the mainstream high street (such as newsagents) is legal). If individuals obtain such material that is suspected to be illegal it must be confiscated and in extreme circumstances consideration must be given to reporting the matter to the Police.

See Offending and Anti-Social Behaviour - Guidance on when to Involve the Police Procedure.

At times Westbrook may be called upon to support young people to explore and understand their sexuality using materials which are explicit in nature. Such work will only ever be undertaken if it has been assessed as being in the young person’s best interests in terms of supporting them to develop a healthy and safe sexual identity. Such Work will only ever be undertaken with the advice of external experts and after the completion of required risk assessments.

If children obtain material legally they should be required to keep it private.

Serious or persistent concerns or occurrences must be reported to relevant social workers and an Incident Report must be completed. The Care Plan and risk assessments should also be reviewed to consider strategies to reduce or prevent future occurrences.

Children under the age of 13 are deemed to be incapable of giving consent to sexual activity. Therefore, children of this age who engage in sexual activity must be referred under safeguarding children procedures (as a Child Protection Referral) as potentially suffering from Significant Harm.

The Unit Manager must be alert to such relationships when considering the placement of children under 13. Children of this age who are likely to be at risk from each other (or from older children) should not be placed together. See Child Protection Referrals Procedure.

When considering the placement (or ongoing placement) of children over the age of 13, the Unit Manager must assess the risk of sexual relationships developing and should ensure strategies are in place to reduce or prevent these risks if they are likely to be exploitative or abusive.

Where children aged 13 - 18 are placed together with no identified risk of exploitative or abusive behaviour, The Unit Manager and staff must monitor any developing relationships, sensitively but positively discouraging children from engaging under aged sexual relationships.

Overall, staff should be mindful of their duty to consider the overall welfare of children and this may mean recognising that illegal activity is taking place and working to minimise risks and consequences. If there is any suspicion that a child is engaging in illegal behaviour it must be discussed with the Unit Manager, parents/carer and Child In Need/ social worker and consideration given to consulting the Child Protection Agencies.

Any actions taken in this respect will be subject to consultation and must be addressed in Care Plans and risk assessments.

Should staff suspect children are engaging in sexual relationships, they should:

1. Ensure the basic safety of all the children concerned;
2. Notify the Unit Manager, who should notify/consult relevant parents/ carers, social workers and consideration given to reviewing the Care Plan;
3. Record all events on the Daily Report, and an Incident Report should be completed.

Should staff discover children engaging in sexual relationships, they should:

1. Ensure the basic safety of all children concerned (if necessary staff may consider removal of one or more children);
2. t79 Inform the Unit Manager, who should notify/consult relevant parents/ carers, social workers and consideration given to reviewing the Care Plan and risk assessments. Record all events on the Daily Report and an Incident Report should be completed.

If the incident is serious or persistent the Unit Manager should be notified and consideration given to whether the incident is a Notifiable Event, see Notification of Serious Events Procedure.

Use of Sex Workers

The age of consent is 16 and it is possible that a young person at Westbrook would wish to engage the services of a sex worker. If this were communicated to a staff member they would be required to hand this information of the request over to the senior management team immediately. This information would also need to be passed to the parents/ carers and Social/ Child In Need worker. Planned and professionally informed work around this would then need to be conducted.

Although this could be seen as a breach of confidentiality, the need to safeguard the young person and provide them with the appropriate information and support would deem such a breach necessary.

If a young person is suspected to be pregnant this must be brought to the attention of the Unit Manager immediately. The Unit Manager will ensure that the young person is supported in the way deemed appropriate to the young person’s needs. The Unit Manager will ensure that the parents/ carers and Child in Need/ social worker are informed.

In all cases where there are any concerns or suspicions that the pregnant child or the unborn child is or will be at risk of Significant Harm, the Unit Manager must discuss it with the parents/ carers and Child In Need or social worker with a view to making a child protection referral. In these circumstances it must be explained to the child why his or her request for confidentiality cannot be agreed. See Child Protection Referral Procedure.

In all cases of pregnancy the parents/ carers and social/ Child In Need worker will be notified.

See also: Safeguarding Children and Young People from Sexual Exploitation Procedure.

The following should be read in conjunction with relevant procedures held by Local Safeguarding Children Board Procedures in the area where the home is located.

Children may have previously been involved with sex for rewards, gifts, drugs, accommodation and money.

The Unit Manager and staff must be alert to such behaviours and should do all they can to create an environment which encourages children to be open about their past or present attitudes and behaviours and which demonstrates they will be supported to guide them away from such lifestyles.

Where there is any suspicion that a child is engaged in such behaviour it should be addressed in the child's Care Plan shared with and signed by the social worker together with strategies to be adopted to help the child find alternative lifestyles.

In addressing these behaviours consideration must be given to the extent to which the child is suffering Significant Harm - and whether it is necessary to make a child protection referral, see Child Protection Referral Procedure.

In any case, the social worker must be notified, and the Unit Manager must consider whether the incident is a Notifiable Event, see Notification of Serious Events Procedure.

Also see: Blood Borne Viruses (BBVs) Procedure.

If it is known or suspected that a child has a sexually transmitted infection (other than HIV and AIDS, which is dealt with in HIV and AIDS Guidance), the Unit Manager must be informed and this information included in the Care Plan and risk assessments.

Parents/ carers retain the responsibility to provide health care to young people and Westbrook will support this planned health delivery.

The only other individuals who will be told are the child's GP and Health Visitor.

Before disclosing to any other agency or individual, the following criteria must be satisfied

• The child (where appropriate) and the parents have given their written consent to the disclosure;
• The disclosure would be in the best interests of the child.

Those receiving the information are aware of its confidential nature.

It is accepted that masturbation is part of normal sexual behaviour but children must be positively encouraged to undertake such activities in private and in a manner, which is not harmful to themselves or other people.

If a young person masturbates this should be included in their care plan along with the arrangements to support them to be safeguarded when doing so. Staff are not to manually support any young person to masturbate, any requirement for manual masturbation support would need to go through the appropriate channels and the delivery of such support is outside of the remit of staff at Westbrook. Staff may support young people by removing their clothes or pad and allowing them private time, again in the security of their bedroom or bathroom, staff should vacate the room until the young person has completed their private time, again this is to be documented in the care plan. Where a young person cannot be left alone due to their health needs, special arrangements need to be put in place, for example the young person uses a bedroom where the bed has high panels so that the staff member can remain in the room without being visible to the young person. All these issues must be explored with the parent/carers, where possible the young person and other relevant professionals. All support delivered around masturbation must be recorded on the young person’s daily reports, risk assessments and care plan. Any identified concerns must be handed over to the senior management team and family. All attempts must be made to support the young person be independent in catering to their masturbation needs, including personal and domestic hygiene once they are finished.

The following should be read in conjunction with relevant procedures held by Local Safeguarding Children Board procedures - in the area where homes are located.

The possibility of peer abuse will always be taken seriously but we recognise it is equally important not to label or stigmatise normal sexual exploration and experimentation between children.

Behaviour is not a cause for concern unless it is compulsive, coercive, age-inappropriate or between children of significantly different ages, maturity or mental abilities.

If at any time staff suspect children are engaged in abusive sexual relationships as perpetrators and/or victims, they must immediately inform the home's manager, who must consult the social worker and make a referral under the Safeguarding Children and Young People and Referring Safeguarding Concerns Procedures.

Consideration should be given by the home's manager as to whether a Notifiable Event has occurred, see Delegated Authorities and Notifiable Events Procedure.

Young people may not understand which behaviours are appropriate, both in public and within the Unit.

Behaviour management plans should be devised with relevant professionals to support young people to understand the boundaries between appropriate and inappropriate behaviours.

Where a young person exposes themselves or inappropriately touches a member of staff, other young people or community members, this must be recorded and techniques explored to help minimise this behaviour( this may require that the pattern of stays the young person receives may need to be altered to safeguard them and other young people in the Unit).

Exposure of the genitals where there is intent to cause distress is an offence and prosecution can follow, however issues of mental capacity are mitigating factors in such situations.

However we need to be mindful that the presence of a learning disability does not exempt either the young person or staff team from exploring ways of minimising future inappropriate behaviours.

Staff always have a duty to prevent behaviour which is harmful to either the perpetrator or others.