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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1

Authors:
Research in Practice | NSPCC | Action for Children
Exploring the relationship
between neglect and
child sexual exploitation:
Evidence Scope 1
Elly Hanson
Edited by Steve Flood and Dez Holmes
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 2
Section 1: Introduction
Although any young person could become a victim of
sexual exploitation, some young people may be more
vulnerable to the risk of CSE in part as a result of their
current or earlier adverse life experiences (Berelowitz et al,
2012; Pittenger, Huit and Hansen, 2016).
This scope focuses on the ways in which experience of
neglect may heighten vulnerability to CSE. Why explore the
role of neglect in particular? Firstly, it is found to be the
most prevalent form of child maltreatment (Radford et al,
2011), so there is a particular urgency in understanding its
repercussions and potential impact on later victimisation
– understanding and tackling any vulnerability neglect
may create has the potential to exert a large impact across
society.
Secondly, attention has traditionally been focused on
the link between child sexual abuse and later sexual
exploitation (see for example, Pittenger, Huit and Hansen,
2016), meaning that the relationships between other forms
of child maltreatment and CSE have been less widely
understood. Despite it being the most prevalent form of
child maltreatment, the study of neglect has itself been
neglected (eg, Stoltenborgh, Bakermans-Kranenburg and
van IJzendoorn, 2013).
There are a variety of plausible ways in which neglect might
interact with and contribute to vulnerability to CSE and, so
far, these have not received adequate attention, despite
their potentially signicant implications for preventing the
occurrence and impact of child maltreatment. This scope
is therefore intended to stimulate research and reective
practice, and so help shi this state of play.
This scope has sought to avoid presenting a picture that
contributes to mother or family-blaming for CSE, which is
a danger when focusing on neglect in childhood and its
potential relationship with subsequent CSE. Other risks
of focusing on this area include deecting attention away
from much-needed action around perpetrator behaviour,
and the inappropriate generalisation of interventions (for
example, where treatments aim to tackle vulnerabilities
which are only relevant to some young people).
Focusing on neglect and how it might aect vulnerability
to CSE is not to downplay the other signicant factors at
play, such as the behaviour of perpetrators (with whom the
responsibility clearly lies), and wide systemic factors such
as cultural values and poverty. Rather, this scope focuses on
this potential relationship as it is here that practitioners and
services in the children’s sector can exert most inuence.
Of course, eorts at preventing and tackling sexual
exploitation must clearly involve a focus on perpetrators; it
is perpetrators who take advantage of the vulnerabilities in
order to abuse. However, a better understanding of what
might exacerbate vulnerability in young people is crucial for
informing prevention and early intervention eorts. Such an
understanding might highlight particular groups of children
in need of support who might not otherwise qualify for
help. There may also be factors that not only increase the
risk, and vulnerability to CSE, but also the risk of a young
person becoming entrenched within it or experiencing
worse impact – such an understanding will inform both
eorts at prevention and interventions that seek to address
the impact of CSE.
The scope’s areas of focus and structure
This scope is one of three linked evidence scopes
commissioned by Action for Children and the National
Society for the Prevention of Cruelty to Children (NSPCC)
with Research in Practice. Scope 2 considers the potential
relationship between neglect and intra-familial child
sexual abuse (IFCSA) (Allnock, 2016); Scope 3 considers the
potential relationship between neglect and children and
young people developing harmful sexual behaviours (HSB)
(Hackett, 2016).
This scope explores the following questions:
> Does neglect (in infancy, adolescence, or
throughout childhood) contribute to a vulnerability
to subsequent CSE?
> Does neglect in adolescence create or contribute
to a vulnerability to concurrent CSE? And does
experience of CSE itself contribute to vulnerability
to neglect?
> If neglect does contribute to a vulnerability to CSE,
which factors (psychological, social, behavioural,
material, systemic) might explain this relationship?
In other words, what might be the underlying
reasons for any relationship between neglect and
CSE (including, potentially, the actions of statutory
systems).
> Are there factors that increase or reduce the
strength of any relationship between neglect
and CSE? (this brings into discussion issues of
resilience).
> What are the implications for practice, policy and
further research?
This scope does not explore how childhood neglect could
contribute to becoming a perpetrator of CSE, although
some of the ndings discussed may be of relevance to
considering such a relationship. Scope 3 also oers some
relevant messages in this respect.
In answering these questions, the scope explores both
areas of relative consensus and ideas that are more
speculative – there are some questions that can be
relatively conclusively answered on the basis of current
research, and many others which cannot be, but for which
the research provides clues and invites hypotheses to guide
future research and practice.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 3
Constraints of the current evidence base
There are a number of limitations to the evidence base and
these are described in some detail in Appendix A. Firstly,
there are very few prospective longitudinal studies1 on child
maltreatment, either in the UK or abroad, and it is these
that would provide best evidence for a link between neglect
and CSE. Secondly, as mentioned above, the study of child
neglect has itself been neglected, despite it being the most
commonly reported form of child maltreatment.
Thirdly, few studies directly explore potential ‘mediators’
(or ‘middle factors’) in a relationship between neglect and
CSE. While there are a number of studies (see Section 4)
that indicate a relationship between neglect and mediators
that might increase vulnerability to CSE (for example,
running away, or post-traumatic stress), there is an
absence of studies looking at neglect, CSE and mediators
directly.
Finally, studies use varying denitions and measurements
of neglect, which makes it dicult to draw comparisons,
and research commonly does not dierentiate between
forms of CSE. This makes it hard to identify factors that
may increase vulnerability to dierent forms of CSE, such
as online grooming, organised abuse within a gang, or
coercion into ‘trading sex’ for money.
Nevertheless, there is a range of multiple and diverse
studies that, when considered together, allow a process
of ‘triangulation, whereby clarity is reached from studies
coming to the same conclusion using dierent methods,
which each have strengths in ruling out competing
hypotheses.
The evidence base oers a focus on factors that might
mediate or underpin a relationship between neglect and
CSE, and understanding these will be key to prevention
and intervention eorts. Overall, this scope concludes that,
while there are limits to the strength of the conclusions
that can be drawn, there is enough knowledge on which to
act to improve the lives of children aected by or at risk of
neglect, and to mitigate the risk they will experience and
become entrenched within CSE.
Denitions and terminology
Throughout this scope, ‘child maltreatment’ is used as an
umbrella term to refer to:
All forms of physical and/or emotional ill-treatment, sexual
abuse, neglect or negligent treatment or commercial or other
exploitation, resulting in actual or potential harm to the child’s
health, survival, development or dignity in the context of a
relationship of responsibility, trust or power.
(Butchart et al, WHO, 2006: p9)
The working denitions of ‘neglect’ and ‘child sexual
exploitation’ used in this scope are those set out in statutory
guidance in England. These, and associated denitional
issues, are highlighted here.
Neglect
Neglect is generally considered to be the omission of specic
behaviours by caregivers (oen without the intention to
harm) rather than acts of commission, as is characteristic of
other forms of maltreatment such as sexual and physical
abuse (Connell-Carrick, 2003). Neglect can include acts
of commission, however, such as forcing a young person
to leave home before they are ready. Neglect is dened in
Working Together as:
‘The persistent failure to meet a child’s basic physical and/or
psychological needs, likely to result in the serious impairment
of the child’s health or development.
(HM Government, 2015: p93)
The Welsh Government (through the Social Services and Well-
being (Wales) Act 2014) has recently removed the reference
to ‘persistence, as has the government of Northern Ireland
in its revised guidance issued in March 2016; the English
and Scottish denitions still contain this reference, however
(see Appendix B for the full denitions that apply in all four
countries). All denitions reference physical, emotional,
nutritional, supervisory and medical neglect, although
the wider literature also recognises educational neglect
(Horwath, 2007; Moran, 2010). Appendix C sets out the types
of neglect and their associated features.
Dening neglect is contentious; the approach adopted in
England and other parts of the UK denes neglect in terms
of its likelihood of signicant harm or impairment to the
child’s development, as opposed to whether there has been
actual harm (Brandon et al, 2014).
Whilst the scope draws on research literature that uses
a diversity of denitions, these overlap suciently to be
considered together. There are various forms of neglect (see
Appendix C), although unfortunately the research literature
rarely dierentiates between them. Of the studies that do,
most simply divide neglect into two forms: ‘physical neglect’,
which includes nutritional, supervisory, educational and
medical neglect; and ‘emotional neglect’, which constitutes
a lack of responsiveness to a child’s emotional needs,
including a lack of aection, love and validation. Thus these
two terms are employed in this way in this scope.
1 A longitudinal study is one in which the study of participants is
repeated over time, usually over many years. The prospective study
is important for research on the etiology of outcomes (oen diseases
and disorders, but prospective studies of maltreatment also exist).
The distinguishing feature of a prospective cohort study is that
when investigators enrol participants and begin collecting baseline
information, none of the subjects has experienced any of the outcomes
of interest (in maltreatment research, these studies are oen interested
in long-term outcomes such as mental and physical health eects).
Aer baseline information is collected, participants are followed
‘longitudinally’ – ie, over a period of time, usually for years – to
determine if and when they exhibit the outcomes of interest and whether
their exposure status (to maltreatment) changes outcomes. In this way,
investigators can eventually use the data to answer many questions
about the associations between ‘risk factors’ and long-term outcomes.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 4
Child sexual exploitation (CSE)
The statutory denition, at the time of writing, of CSE for
England is:
Sexual exploitation of children and young people under 18
involves exploitative situations, contexts and relationships
where young people (or a third person or persons) receive
‘something’ (e.g. food, accommodation, drugs, alcohol,
cigarettes, aections, gis, money) as a result of them
performing, and/or another or others performing on them,
sexual activities. Child sexual exploitation can occur through the
use of technology without the child’s immediate recognition;
for example being persuaded to post sexual images on the
Internet/mobile phones without immediate payment or gain. In
all cases, those exploiting the child/young person have power
over them by virtue of their age, gender, intellect, physical
strength and/or economic or other resources. Violence, coercion,
and intimidation are common, involvement in exploitative
relationships being characterised in the main by the child or
young person’s limited availability of choice resulting from their
social/economic and/or emotional vulnerability.
(HM Government, 2009)
England, Scotland, Northern Ireland and Wales each employ
dierent denitions of CSE, and some are in the process of
revision; this reects the complexities and debates around
the denition and nature of CSE. However, there are points of
convergence, which help to outline what this scope includes
within its remit:
> CSE is a form of child sexual abuse.
> There is a focus on the ‘exchange dynamics’ and
power imbalances involved.
> CSE includes exploitation by individuals and within
and by gangs and groups; tracking; and what was
previously termed (by some) ‘child prostitution’
2
.
> CSE can include child sexual abuse within the family
environment (for example, where family members
have traded their children for nancial gain) although
most intra-familial child sexual abuse is not thought of
as CSE.
> CSE does not always involve physical contact; the use
of technology and online elements are common to CSE
(Palmer, 2015; Gohir, 2013).
Part of the rationale for revising the statutory denition of
CSE is to enable greater clarity. There has been confusion in
the UK and internationally (Cameron et al, 2015) with dierent
organisations using the term CSE to mean dierent things.
The term is usually, though not always, used to describe
adolescents engaging in, complying with, or being subjected
to sexual activity within the context of a power imbalance,
and oen involves coercion, emotional manipulation and
control - though equally overt violence is not uncommon.
In many such situations, young people do not perceive the
sexual activity to be a form of abuse. For example, they may
feel that exchanging sex is a way of meeting needs for which
there appear no other means to do so (Dodsworth, 2014).
However in all cases, young people’s ‘choices’ and actions
are highly constrained (Pearce, 2013), and can be better
understood as survival strategies and/or adaption to previous
adverse experiences.
Given these complexities, this scope explores both research
on CSE that is (albeit loosely) dened in accordance with
current UK denitions, as well as research on:
> general adolescent sexual victimisation (much of
which may conform to CSE dynamics)
> children and young people ‘selling sex’ (considered
a subtype of CSE)
> children and young people experiencing commercial
sexual exploitation (an overlapping subtype of CSE
see below).
It does not focus on sexual violence within the context of
an authentic teenage romantic relationship, as this is more
commonly considered a form of domestic abuse or intimate
partner violence (IPV), which has its own distinctive risks and
dynamics (Barter, 2009). However, some of the discussion
and ndings in this scope might usefully be examined in
relation to young people’s IPV too.
Commercial sexual exploitation
‘Commercial sexual exploitation’ overlaps with child
sexual exploitation. It refers to people – whether adults or
children – being sexually exploited for nancial gain, and
has been developed to replace the term ‘prostitution’. (Note
that throughout this scope the abbreviation ‘CSE’ is always
used to denote child sexual exploitation; commercial sexual
exploitation is always named in its full form.)
Although the terms ‘prostitution’ and ‘selling sex’ are
problematic and contentious and the terms ‘sex work’ and
‘sex worker’ are contested by some. They are sometimes used
in this scope to keep as close as possible to the ndings of
studies that use those terms; it is not intended to imply their
uncritical acceptance.
Children, young people and adolescents
Throughout this scope, ‘children’ encompasses people
between 0 and 18 years of age. The terms ‘young people’ and
‘adolescents’ refer to those between roughly ages 11 and 18,
while ‘young adults’ broadly refers to those aged 18 and 25.
While recognising that CSE can aect pre-adolescent children,
discussion in the scope preferentially uses the term ‘young
people’ to describe those experiencing CSE. This is because
CSE disproportionately aects those in this age group (see,
for example, Scott and Skidmore, 2006). In participation
discourse, ‘young people’ is also the term people of this age
most closely identify with. (In this scope the term ‘childhood
neglect’ refers to both neglect of adolescents and younger
children; one or the other is specied when necessary.)
2 Historically, CSE was developed as an alternative term to ‘child
prostitution’ in an eort to ensure the intrinsically exploitative nature of
CSE is never missed and young people who are being exploited are not
blamed (Melrose, 2013).
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 5
Section 2: A brief overview of neglect and
CSE in the UK
Knowledge about the scale of child maltreatment in the
UK comes from three specic sources: recorded oences;
child protection systems; and self-report studies. All have
limitations; for example, recorded oences and child
protection data reect only those cases that come to the
attention of the police or children’s social care. Self-report
studies, such as large-scale prevalence studies, provide a
somewhat broader picture. Taken together with the ocial
data, they reveal the large proportion of maltreatment that
never comes to the attention of systems and services (Gilbert
et al, 2008).
However, experts agree that even self-report prevalence
studies underestimate abuse and maltreatment because
children, young people and even adults abused in childhood
may not report their experiences (Radford et al, 2011). Some
may fear the consequences of disclosure or fear not being
believed (Allnock and Miller, 2013); others may not recognise
their experiences as abuse, as is the case with many young
people involved in CSE.
Neglect
How do children perceive neglect?
A study by the University of Stirling, commissioned by
Action for Children (Burgess et al, 2014)
Researchers surveyed 1,582 children and provided them
with a list of known indicators of neglect. They asked
children to tell them if they’d ever known children who
had experienced any of the indicators. Three-quarters
said they recognised at least one of the indicators
presented, including other children who frequently miss
school, who have few friends (at school or home), whose
parents don’t seem to know where their child is or what
they’re doing, whose clothes may not t or may be old
or smell bad, children who look unwashed or are oen
dirty, or who might say they don’t get meals at home.
The researchers also talked directly to some children
and found they could describe, oen in powerful ways,
what it feels like to be neglected. Children spoke of the
emotional toll neglect can take, including never being
hugged, ‘not getting loved’ and being ‘le at home
alone’. They said neglected children can nd themselves
getting into trouble with the police. And some described
feelings of social isolation and exclusion, and feeling
unable to tell anyone about what is going on.
Children recognise they are neglected when: they are le
on their own, they have to go looking for food, parents
don’t care for them, parents can’t aord things. Children
also recognise that neglect can be physical and/or
emotional, and say that emotional neglect is worse than
physical neglect.
In all four countries of the UK, neglect is consistently cited
as the most common reason for children to be subject to a
child protection plan or on a child protection register (Jütte
et al, 2015). In England in 2014-15, 43% of all child protection
plans were made for neglect (DfE, 2015). There were 7,726
recorded oences for cruelty to children in 2013-14 – a
rate of 7.6 per 10,000 children aged under 16, the highest
it has been in a decade (Jütte et al, 2015). However, many
more cases of neglect fall below the threshold for criminal
intervention (Dickens, 2007).
In a recent child maltreatment prevalence study within the
UK, 16% of young adults reported experiencing some form
of neglect by a parent or guardian during their childhood
(Radford et al, 2011).3 This is similar to North American
prevalence rates (approximately 19%) but substantially
higher than those reported across Europe (approximately
7%) (Stoltenborgh, Bakermans-Kranenburg and van
IJzendoorn, 2013).4 Boys and girls appear to be equally at risk
(Radford et al, 2011; Stoltenborgh, Bakermans-Kranenburg
and van IJzendoorn, 2013).
A child’s risk of neglect is increased by parental substance
misuse; parental mental health problems, such as
depression; domestic abuse;5 and poverty (Antle et al, 2007;
Brown et al, 1998; Dubowitz et al, 2011; Chan, Kelleher
and Hollenberg, 1996; Nikulina, Widom and Czaja, 2011),
and these factors oen intertwine – for example poverty
increases the risk of alcohol misuse, domestic violence and
mental health problems (Benson et al, 2003; Bruce, Takeuchi
and Leaf, 1991; Cerdá et al, 2010; Mulia et al, 2008).
A recent meta-analysis found that children are over four
times more likely to experience neglect if they have physical
or learning disabilities (Jones et al, 2012) – this is likely to
be because poverty increases the risk of both neglect and
disability6 (Bywaters et al, 2016; Hughes and Avoke, 2010),
and also because adequate parenting of children with
disabilities may at times require more resources (mental,
social, nancial), which may not always be available.
Most research presents neglect as almost always an ongoing
or chronic form of maltreatment – a pattern of behaviour,
rather than a single or few incidents. It is oen linked to
parents’ needs: one study suggests neglect is more likely
to persist if a child’s mother experienced severe child
maltreatment herself (Ethier, Couture and Lacharité, 2004);
others suggest substance misuse and domestic abuse might
contribute to neglect being more severe and less responsive
to intervention (Antle et al, 2007; Long et al, 2014).
The impact of neglect, particularly as it relates to risk of CSE,
is explored throughout Section 4 (see also Scope 2: Allnock,
2016), but it is worth noting here that neglect appears
to be most harmful to children when it persists across
developmental stages (in other words, there is cumulative
harm across development) (Graham et al, 2010). Table 1
provides an overview of some of the impacts reported across
the life course.
3 And 9% of 18 to 24-year-olds reported having experienced ‘severe
neglect’ during their childhood.
4 However, dierences in methodology across studies mean that we
cannot draw rm conclusions about this dierence in rates.
5 When domestic abuse is dierentiated from neglect.
6 And, indeed, disability can increase the risk of poverty.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 6
Table 1: Impacts of neglect across the life course
The two categories in the le-hand column are indicative rather than denitive; they are intended to illustrate how neglect can
impact across the life course. It is not possible to predict when (or which) impacts may occur in any individual’s life.
LIFE STAGE REPORTED IMPACTS
Early impacts7 – ie, impacts
most commonly associated
with an early onset
> Alterations in the body’s stress response (the hypothalamic-pituitary adrenal system)
> Insecure attachments
> Delayed/declining cognitive development
> Decreased language function
> Low self-esteem
> Low condence
> Negative self-representations
> Withdrawal, diculty in making friends
> Acting out / aggression / impulsivity
> Poor coping abilities
> Poor problem-solving skills
> Disorganised attachments
> Low achievement in school
Medium and longer-term
impacts8 – ie, impacts that are
more likely to manifest over
the medium to longer term
(including, in some cases,
emerging in later adolescence
or adulthood)
> Depression, anxiety
> Dissociation
> Poor aect/emotion regulation
> ADHD symptoms
> Running away
> Anti-social behaviour
> Violence and delinquency
> More likely (than peers) to be arrested for violent oences
> Substance misuse and addiction
> Social withdrawal, social isolation
> Conict and hostility in relationships
> Poor educational achievement
> Longer-term mental health problems, including PTSD and personality disorders
(such as ‘borderline personality disorder’*)
> Suicide attempts
> Physical health problems, such as increased risk of hypertension and chronic pain
* The use of this term reects its occurrence in the literature and does not imply uncritical acceptance;
we recognise the term BPD can unhelpfully suggest a person has a decient ‘personality’ rather than a
set of adaptive responses to childhood maltreatment.
What constitutes neglect and its most common manifestations can vary according to children’s developmental stage (Rees
et al, 2011). Some parenting omissions may have more immediate impact on younger compared to older children (for
example, not providing an evening meal to a toddler compared to a 14-year-old child) whilst, at the same time, some
neglectful acts may be more commonly directed towards adolescents (for example, inadequate supervision, and placing
inappropriate expectations on a child to look aer younger siblings).9
7 Barnett et al (1999); English et al (2005); Erickson, Egeland and Pianta (1989); Hildyard and Wolfe (2002); Howe (2005); NSCDC (2007); Manly et al
(2001); McCrory (2010); Naughton et al (2013); Strathearn et al (2001); Sylvestre, Bussières and Bouchard (2016); Toth et al (1997). See also Tanner and
Turney (2003), Brandon et al (2014), Davies and Ward (2012) and Corby et al (2012) for more detailed overviews of these impacts.
8 Anda et al (2006); Bolger (1998); Broidy et al (2003); Erickson and Egeland (1996); Gil et al (2009); Hong et al (2011); Hulette et al (2008); Johnson et
al (2000); Kaufman and Widom (1999); Mace, Cicchetti and Toth (2001); Norman et al (2012); Petrenko et al (2012); Widom (1989a and 1999); Widom,
DuMont and Czaja, (2007); Wilson and Widom (2010); Wright, Crawford and Del Castillo (2009).
9 For overviews of the complexities involved with dening and identifying adolescent neglect see Hanson and Holmes (2014) and Rees et al (2011).
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 7
Childhood neglect overlaps substantially with other
forms of child maltreatment. For example, in a sample
of nearly 1,000 neglected children, 68% had experienced
one or more additional forms of maltreatment (Vachon et
al, 2015). This overlap is explained by dierent forms of
maltreatment sharing common risk factors (for example,
parental substance misuse can contribute to neglect
and emotional and physical abuse), and in some cases
by neglect providing opportunities for abusers to harm
children (see Scope 2).
Despite it being the most common form of maltreatment,
Brandon and colleagues (2014) point to a number reasons
why practitioners may nd neglect both hard to identify
and dicult to respond to:
> Professionals may become accustomed to the
chronic nature of neglect
> Neglect relatively rarely manifests in a crisis that
demands immediate action
> Professionals need to look beyond individual
parenting episodes to understand neglect in
context
> Professionals may also be reluctant to make
judgements about parenting, particularly where
there are cultural underpinnings and where
poverty may be a contributory factor
> Neglect may be experienced alongside other forms
of abuse that make it dicult to identify.
Child sexual exploitation
Because of its recent emergence as a specic category of
sexual abuse (despite its existence over the long-term)
and the denitional issues discussed in Section 1, CSE is
not routinely and consistently measured, and there is no
robust prevalence data. However, the studies that do exist
indicate a sizeable problem. An inquiry by the Oce of the
Children’s Commissioner in England into CSE in gangs and
groups identied 2,409 victims in England over a 14-month
period, with additional data indicating many more at risk
(Berelowitz et al, 2012).
CSE can happen in any area. Jay (2014) found evidence
of at least 1,400 victims over a 16-year period within the
single district of Rotherham, and Bedford (2015) estimated
that 370 girls had been sexually exploited by groups within
Oxfordshire over the previous 15 years. Although the sexual
exploitation of boys is a sizeable and overlooked problem
(Lillywhite and Skidmore, 2006; McNaughton Nicholls
et al, 2014),10 for a variety of reasons, including societal
messages that encourage the sexual objectication of girls
(for example, Bohner et al, 2009; Coy et al, 2013), CSE
disproportionately aects girls.
CSE is not a new phenomenon, but public and professional
awareness of CSE has increased signicantly in recent
years. This is partly due to several high prole inquiries
and prosecutions, and the subsequent increased policy
scrutiny on local practice (see for example Casey, 2015;
Coey, 2014; Jay, 2014). The ndings from such inquiries,
alongside other research, has shown CSE to be dynamic
and diverse in how it manifests. In some situations, young
people may be tricked into complying with sexual requests
by individuals posing as boyfriends or romantic partners. In
others, young people may live within gang-related norms
that teach them to comply with sexual activity for the unmet
needs of status and protection. There is no ‘typical CSE’
case or denitive list of models of CSE.
At times young people’s unmet needs, for example for a
home, love or food, are identied by individuals who oer
‘solutions’ on the proviso of sexual activity. Young people
are also exploited when people pay money to engage
sexually with them; their decision-making constrained
by situational and social factors, such as living with adult
sex workers, and by their unmet needs (these and many
other risk factors are explored in Section 4). When CSE is
perpetrated by organised groups it may be particularly
dicult to disentangle from these networks (Jay, 2014).
As noted above, in all its manifestations, young people’s
decision-making around sexual activity is constrained and
should never be interpreted as ‘lifestyle choices’.
A wide body of research has demonstrated that child sexual
abuse is linked to numerous short- and long-term harmful
eects from childhood into adulthood (see Section 3 of
Scope 2). Although very little research has explored the
impact of CSE specically, one recent study found more
severe PTSD symptoms, dissociation, sexual diculties and
substance misuse in young people who had experienced
commercial CSE compared to a matched group who had
experienced other forms of sexual abuse (Cole et al,
2016). The authors suggest that CSE can be particularly
harmful due to the frequency of abuse and the multiple
perpetrators oen involved.
Whilst it has been beyond the remit of this scope to address
in depth the particular issues for neglected or sexually
exploited young people who are male, female, lesbian,
gay, bisexual and transgender (LGBT), black and minority
ethnic (BME), gang-involved, or have disabilities, research
indicates that these groups may have distinct vulnerabilities
and that there may be particular barriers to them receiving
eective help (for example, Beckett et al, 2013; Fox, 2016;
Gohir, 2013; McNaughton Nicholls et al, 2014; Jones et al,
2012; Reid, 2012; Reid and Piquero, 2014).
10
Interestingly, some research in the US found that relatively equal numbers of
boys and girls experienced commercial sexual exploitation (for example, Curtis
et al, 2008); such prevalence data is not currently collected within the UK.
Research in Practice | NSPCC | Action for Children
8Exploring the relationship between neglect and child sexual exploitation: An evidence scope
Summary of key points
> Across the UK, neglect is consistently cited
as the most common reason for children to
be the subject of a child protection plan or
on a child protection register. Neglect occurs
across childhood and adolescence, though
manifestations can vary according to a child’s
developmental stage. Boys and girls appear to
be equally aected.
> The harm resulting from neglect can be wide-
ranging, apparent in multiple domains and
can manifest across the life course. The longer
a child is exposed to neglect, the greater the
harm is likely to be. Neglect is also thought to
be the most likely form of maltreatment to recur
multiple times.
> Despite it being the most common form of
maltreatment, practitioners can nd neglect both
hard to identify and respond to.
> CSE is not routinely or consistently measured
and currently there is no robust prevalence data.
However, studies suggest CSE is a signicant
problem. Although little attention has been paid
to the impact of CSE specically, a wide body
of research has demonstrated that child sexual
abuse is linked to numerous short- and long-
term eects from childhood into adulthood.
> CSE is dynamic and diverse in how it manifests.
CSE and neglect oen interact closely with
other adversities, such as social disadvantage,
domestic abuse and substance misuse,
contributing to long-term harm into adulthood.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 9
Section 3: Evidence indicating a
relationship between neglect and CSE
Evidence of a specic relationship between neglect
and CSE
Prospective controlled studies would provide the strongest
evidence of a relationship between neglect and CSE but,
as far as is known, there are currently no such studies.
However, the studies reviewed in this section do converge,
especially in the light of other research, to indicate such
a relationship. (Studies exploring potential mediators
between neglect and CSE – see Section 4 – provide an
additional body of research that suggests this relationship.)
In the US, Cathy Spatz Widom and her colleagues have
followed over time a large group of individuals who
experienced maltreatment before the age of 11 and a
comparison group of similar age, race/ethnicity, sex
and socioeconomic status.11 Using this data-set, Widom
and Kuhns (1996) found that, when other factors were
controlled, sexual abuse and neglect each increased the
risk of ‘selling sex’ by the age of 29 (the study did not
dierentiate between child sexual exploitation and selling
sex as an adult).
Eleven per cent of individuals who had been neglected
reported having sold sex compared to 6 per cent of
the control group (some in the neglect group had also
experienced other forms of maltreatment, although how
many is not specied). Given that other studies suggest that
for up to half of those who ‘sell sex’ as adults this began
as CSE in adolescence (for example, Cobbina and Oselin,
2011; Dodsworth, 2012), it is reasonable to suggest that a
large proportion of the ‘prostitution’ examined in Widom
and Kuhns’ study was, or started as, commercial sexual
exploitation of children.
Later studies using the same data-set (Wilson and Widom,
2008; Wilson and Widom, 2010) found that early sexual
contact partially mediated the relationship between
childhood neglect and prostitution; in other words,
statistical testing suggested that part of the reason neglect
increases the risk of prostitution is because it raises the risk
of early sexual contact. Much of this sexual contact may
constitute abuse – dierent forms were not delineated in
these studies.
Studies exploring other relationships within this dataset
also suggest a relationship between neglect and CSE.
For example, Widom, Czaja and Dutton (2008) found
that those who had experienced physical abuse, sexual
abuse or neglect before age 11 were at higher risk of
interpersonal victimisation by the age of 40, and that
those who experienced either neglect only or multiple
forms of maltreatment were at greatest risk. One third
(33%) of those who had experienced neglect without
other maltreatment had been coerced into unwanted sex,
compared to 18% of the control group.
Turning to studies that have focused specically on either
sexual victimisation or commercial sexual exploitation
before adulthood, only a small number have delineated
specic links to neglect.
Naramore et al (2015) compared the adverse childhood
experiences reported by a sample of 102 adolescents
who had been arrested in Florida for ‘trading sex’ to
those reported by 64,227 adolescents arrested for other
oences (who might also be expected to have experienced
high rates of adversity). For the majority of adolescents
arrested for trading sex (88%), their ‘oences’12 included
or comprised solely ‘selling sex’ whilst under 18 – by UK
denitions, this means nearly all been sexually exploited.
This group reported more adverse childhood experiences
than the comparison group. They diered most in their
experience of physical neglect. The sexually exploited
young people were over 7 times more likely to report
physical neglect than the group of young oenders (41.2%
compared to 7.8%); and they were almost twice as likely to
report emotional neglect (36.3% compared to 18.6%). They
were also four times more likely to report sexual abuse.
In another US sample of 12,240 adolescents and young
adults, Kaestle (2012) found that around 2% began ‘selling
sex’ between the start point of the study (when they were
between 11 and 19 years old) and its end point (7 years
later). An unknown but likely signicant proportion of this
will have been commercial sexual exploitation of children.
Experiencing neglect in childhood predicted ‘selling sex’
in both males and females between these time points.
Although this relationship ceased to be signicant once
many other factors were entered into the statistical model,
this was not a theoretically driven model in which potential
pathways were explored. In simple statistical models such
as these, the inuence of more distal factors, such as
earlier abuse or neglect, can in eect be hidden behind the
inuence of more proximal factors;13 in other words, the
lack of signicance may simply indicate that neglect is not
related to CSE beyond its inuence on other factors such as
running away, homelessness, other forms of maltreatment,
social isolation, substance misuse and youth oending. (As
explored in Section 4, many of these factors are crucial to
any relationship between the two.)
This was also the conclusion reached by a UK study which
analysed the case les of 175 young people attending a
drop-in and outreach centre for those experiencing or at
risk of CSE (Klatt, Cavner and Egan, 2014). As expected,
the researchers found that more proximal factors such as
current poverty, homelessness and associations with adult
sex workers14 were more closely related to experiencing
CSE than prior childhood maltreatment. Emotional abuse
11 The original samples were 908 and 667 respectively, dropping to 676
and 520 by age 29.
12 As dened by US law, which does not appear to be sensitive to the
young person’s victimisation in these activities.
13 ‘Distal’ factors are those that are ‘further away’ from the CSE, in time
or social space, such as earlier abuse or neglect; ‘proximal’ factors are
those that are ‘closer’ to the experience of CSE, for example, running
away or substance misuse.
14 Use of the term ‘adult sex worker’ is not meant to obscure the fact that
for many adults ‘selling sex’ represents their abuse and exploitation. It is
used to reect the literature’s ndings.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 10
and neglect (categorised together as one factor) did increase
the risk of experiencing CSE, but this was not statistically
signicant. However, the study’s ability to detect a signicant
relationship between neglect and CSE was limited given that
it relied on case le analysis (information about childhood
adversities does not appear to have been specically
requested by workers) and it compared those experiencing
CSE with those at risk of it, many of whom may also have
been victims.
In a larger study that instead relied on interviews and
enquired about several dimensions of neglect, Reid (2011)
found that women who had experienced child commercial
sexual exploitation (12% of the female, predominantly
African American sample of 174) were signicantly more
likely to report growing up with a lack of food or a lack of
love from their parents than the rest of the group.
The evidence does not infer that by any means all CSE
victims/survivors experienced neglect. However, these
studies, considered alongside others discussed later in this
scope, suggest a relationship between neglect and CSE
though it is important to avoid assuming causality.
Evidence of a more general relationship between child
maltreatment, family diculties and CSE
Numerous studies have found a connection between general
child maltreatment, other specic forms (physical, sexual
or emotional abuse) or ‘family dysfunction’15 in childhood,
and subsequent sexual victimisation or commercial sexual
exploitation in adolescence. Although most have not
explored neglect in particular, these studies are highly
relevant because neglect substantially overlaps with other
forms of maltreatment and ‘family dysfunction’ (such as
parental substance misuse, domestic abuse and mental ill-
health - see Section 2). They suggest that neglect, when it
co-occurs with these other adversities, is a salient risk factor
for subsequent CSE.
A number of studies have explored variations in the risks
for experiencing commercial sexual exploitation according
to age of rst involvement. They have generally found that
earlier childhood maltreatment is more closely related to
child commercial sexual exploitation than commercial sexual
exploitation beginning in adulthood. In a large US sample
of 1,354 young people, Reid and Piquero (2014) found those
who had experienced commercial sexual exploitation by age
16 were more likely to report having a mother who had a
(past or current) substance misuse problem than a) young
people who experienced commercial sexual exploitation
at later ages and b) a group of young oenders. Similarly,
Clarke et al (2012) found that among a sample of 389 women
attending a ‘prostitution diversion programme’, those who
had been sexually exploited before age 18 were more likely
to have grown up with a family member who misused drugs
or alcohol.
Neglect is the form of child maltreatment most closely
entwined with parental substance misuse – DiLauro (2004)
found that parental substance misuse increases the risk of
neglect by four times – and neglect may be one of the salient
factors behind the relationship observed in these studies.
In a small-scale qualitative study involving in-depth
interviews with 40 US female ‘sex workers’, Cobbina and
Oselin (2011) found that for those women who were rst
sexually exploited as adolescents, childhood maltreatment
had played a more salient role in their pathway into
exploitation than for those who began ‘selling sex’ as
adults. Women who were sexually exploited as adolescents
also spoke about the formative role of families and
neighbourhoods that modelled ‘sex work.
Other studies (for example, Roe-Sepowitz, 2012; Loza,
2010) report similar ndings. Although a few studies do
not nd this pattern, this appears to be due to high levels
of childhood maltreatment in both the child-onset and
adult-onset groups (Clarke et al, 2012; Kramer and Berg,
2003). (None of the studies described here specically asked
participants about neglect.)
Studies comparing young people involved in commercial
sexual exploitation to other ‘at-risk’ young people (ie, those
using local youth service agencies in Austin, Texas – Bell
and Todd, 1998) and other qualitative research (for example,
Dodsworth, 2012, 2014; Rosenblatt, 2014) also document
associations between childhood entry into commercial sexual
exploitation and earlier childhood maltreatment, parental
substance misuse and ‘family dysfunction’.
However, it is also important to look beyond commercial
sexual exploitation given that not all CSE is commercial in
nature. This brings into view the sizeable literature indicating
a robust association between adolescent sexual victimisation
(a signicant proportion of which is likely to be CSE) and
earlier child maltreatment and family diculties.16
Two studies are illustrative. In a self-report study of 541
women, Miron and Orcutt (2014) found that childhood sexual
and physical abuse (neglect was not specically measured)
were both signicantly related to sexual victimisation in
adolescence. And in a longitudinal study of 1,467 children
aged 2 to 17 (assessed via telephone interviews with carers or
children themselves) in which multiple types of victimisation
were measured, Finkelhor, Ormrod and Turner (2007a) found
that children who had experienced physical neglect, physical
abuse or emotional abuse (classied as ‘maltreatment’) in
the rst year of the study were 4.3 times more likely than
other children to experience sexual victimisation in the
second year. Children who had experienced a multitude of
victimisations (‘poly-victims’) in the rst year were 6.8 times
more likely to have experienced sexual victimisation in the
second year.
15 The term ‘family dysfunction’ is used in the literature to refer to
diculties such as parental substance misuse and domestic violence;
its use is not meant to imply blame of families – such ‘dysfunction’
tends to arise in a context of signicant broader adversities.
16 This overlaps with an even wider literature exploring sexual
revictimisation (in childhood or adulthood); a review of this literature
found that two out of three people who are sexually victimised will be
revictimised sexually (Classen, Palesh and Aggarwal, 2005).
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 11
Discussion
There are a number of limitations to the evidence base,
including (albeit with some exceptions) an ongoing
‘neglect of neglect’ (Stoltenborgh, Bakermans-Kranenburg
and van IJzendoorn, 2013), a focus on commercial
manifestations of CSE, and the reliance on cross-sectional,
retrospective self-report data.
Nevertheless, this set of studies does allow a degree of
‘triangulation’ that enables tentative conclusions to be
drawn (see Section 1: ‘constraints of the current evidence
base’). Longitudinal research by Widom and colleagues
charts the signicant impact of neglect on commercial
sexual exploitation in childhood and adulthood (while
not dierentiating between the two), and cross-sectional
research17 indicates the greater relevance of neglect (and
the abuse and family diculties it coalesces with) to
childhood commercial sexual exploitation than to ‘sex
work’ in adulthood (for example, Cobbina and Oselin,
2011). Research has also found that rates of neglect are
higher among sexually exploited young people than
in other groups of young people, including others also
deemed vulnerable such as those who oend (Kaestle,
2012; Naramore et al, 2015; Reid, 2011).
A further longitudinal study (Widom, Czaja and Dutton,
2008) found that neglect predicted the experience of
sexual violence over the life-course to a similar degree
as childhood physical and sexual abuse. Other studies
that merge abuse and neglect (or focus more on abuse)
demonstrate their relevance to adolescent victimisation,
including sexual victimisation (for example, Finkelhor,
Ormrod and Turner, 2007a; Miron and Orcutt, 2014).
The next section of this scope moves to a second critical
question: what might account for any such relationship
between neglect and CSE? Or, put dierently, how might
neglect contribute to CSE (and possibly vice versa)?
Summary of key points
> Despite some limitations to the evidence base,
overall the literature demonstrates the relevance
of neglect to adolescent sexual victimisation
and adolescent commercial sexual exploitation
when it occurs in combination with other forms
of maltreatment and family diculties, and
more tentatively indicates the likely relevance of
neglect alone.
> The relationship is a complex one, however;
certainly many young people experiencing CSE
have not experienced neglect.
17 Cross-sectional research compares individuals at a certain point
in time, rather than following people as life unfolds. For example,
a cross-sectional study might compare the childhoods of adults
with depression to those without. In general, it is harder to draw
rm conclusions about causality from cross-sectional compared to
longitudinal research – see Appendix A.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 12
Section 4: What might explain the
relationship between neglect and CSE?
This section focuses on those factors that might explain
or act as potential mediators in the relationship between
neglect and vulnerability to CSE.
The rst three sub-sections explore how neglect may
contribute to increased vulnerability to subsequent CSE by
considering the evidence in relation to:
1) social, behavioural and material factors
2) psychological factors
3) system responses to neglect.
The fourth sub-section explores how neglect may
contribute to concurrent CSE and also considers ways
in which CSE may even make some young people more
vulnerable to neglect. (To some extent, these divisions
are articial, given the degree of overlap and interaction
between them (Pittenger, Huit and Hansen, 2016), but they
are made here to help conceptualisation).
As a whole, this section is necessarily speculative and is
intended to stimulate further research, as well as reection
on practice and policy.
Two diagrams are included at the end of Section 4,
illustrating the potential ways in which various mediating
factors might operate between neglect and CSE and the
strength of evidence for these conceptual connections.
Social, behavioural and material factors
Running away, ejections from home (‘thrown away’) and
homelessness
In simple terms, adolescents become homeless because
they run away or because their family is unwilling to
house them, although the distinction between the two
is oen blurred. Parental unwillingness to house young
people is the leading cause of youth homelessness in the
UK (Homeless Link, 2015) and in itself constitutes a form of
neglect. (In the American literature this group have been
termed ‘thrownaways’ in contrast to ‘runaways’). Young
people may run away from families who neglect them in
other ways (eg, by depriving them of aection or food),
in an eort to escape abuse or domestic violence, and
because they hope they can meet their social, emotional
and material needs elsewhere. Running away oen
then leads to homelessness (including hidden forms of
homelessness), which in turn pose a signicant risk factor
for CSE.
In Widom’s longitudinal studies (described in Section
3), neglect in childhood predicted running away in
adolescence to a similar degree as physical and sexual
abuse (Wilson and Widom, 2010; Kaufman and Widom,
1999). Yoder, Whitbeck and Hoyt (2001) found that physical
neglect was the strongest predictor of running away
among a sample of 602 runaway and homeless adolescents
(emotional neglect was not measured); at any given age,
neglected adolescents were 3.25 times more likely to run
away than those who had not been neglected. The results
of these studies are supported by many others;18 one
example in the UK is Craig and Hodson (1998), who found
that 69% of homeless young people surveyed in London
reported childhoods ‘lacking in aection’.
Young people who have run away may resort to ‘trading
sex’ for money, shelter or other means of survival, or they
may nd themselves in a peer culture that enables or
normalises sexual exploitation. Numerous studies attest
to the route from running away and homelessness to CSE.
Smeaton (2013) found that 12% of young people seen by
services supporting young runaways in the UK had been
sexually exploited; and all 36 teenage girls experiencing
CSE in Pearce’s (2002) study had histories of running away
from home or care.19
Edwards, Iritani and Hallfors (2006) found that running
away from home was signicantly correlated with
commercial sexual exploitation in a sample of 13,294
American adolescents. Several studies described in
Section 3 also demonstrate this link – for example, both
Roe-Sepowitz (2012) and Cobbina and Oselin (2011) found
that running away more oen played a part in the onset
of adolescent compared to adult commercial sexual
exploitation.
Signicantly, in her retrospective study of predominantly
African American women, Reid (2011) found evidence that
running away20 partly mediated the relationship between
childhood maltreatment and commercial CSE (note,
however, that mediation within a longitudinal sample
would provide the best evidence of a causal pathway).
Although Wilson and Widom (2010) did not nd that
running away mediated the relationship between neglect
and later commercial sexual exploitation, their study
did not dierentiate between child commercial sexual
exploitation and exploitation in adulthood; previously cited
studies nd running away to be of greater relevance to the
former.
18 These tended to have less robust methodologies, however.
19 In general this section explores running away from home rather
than care; Section 4.3 below explores the specic relevance of care
experiences to CSE vulnerability.
20 Alongside sexual denigration and substance misuse, factors explored
below.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 13
It is worth highlighting that in their study of 175 UK drop-
in/outreach centre case les, Klatt and colleagues (2014)
found running away reduced the chance of CSE: young
people at risk of CSE were more likely to have run away
than those actually experiencing CSE. This could be a
spurious nding (workers may record ‘running away’ in
les to support their categorisation of the young person as
‘at-risk’); however, it could also be that running away can
at times remove young people from other risk factors, such
as associations with adult sex workers, which their study
(and many others) nds is related to CSE.
This relates to a nal point – running away may be thought
of as both a risk for CSE and as an indicator of the potential
for resilience. Pearce comments on the approach to
running away she observed in her interviewees:
‘It is evident that the young women see running away as an
opportunity to “do something, a chance to make a move, to
be active and exert some self-determination over what oen
appear to be impossible situations.
(Pearce, 2002: p44)
Running away may, arguably, demonstrate a level of self-
ecacy and agency that may prove invaluable in nding
ways out of CSE (if this is not lost during the experience
of exploitation). It is uncomfortable to acknowledge that,
for some young people, it may be that running away is
preferable to remaining in an invalidating and neglectful
environment. In her extensive review of age, gender and
route-related vulnerabilities to sex tracking, Reid (2012)
found evidence of high levels of determination, ambition
and hope in victims – these qualities may have not only
enabled individuals to escape adverse conditions in the
past but to escape exploitation in the present or future.
Early or ‘risky’ sexual activity with others
A number of studies indicate that experiences of childhood
neglect heighten the likelihood of early and ‘risky’ sexual
activity (for example, Black et al, 2009; Wilson and Widom,
2008; Wilson et al, 2015; and a systematic review and
meta-analysis by Norman et al, 2012); and others suggest
that early sexual activity in turn denotes a vulnerability
to CSE (Edwards et al, 2006; Reid and Piquero, 2014; Van
Brunschot and Brannigan, 2002). In their analysis of data
from the large longitudinal study (described in Section 3.1),
Wilson and Widom (2010) found that early age of onset of
sexual activity partially mediated the relationship between
neglect and commercial sexual exploitation in childhood
and adulthood.
Such a mediating relationship might exist for a number
of reasons. Neglect might lead to a young person
experiencing low self-esteem (Hildyard and Wolfe, 2002),
a sense of disconnection from others or a reduced sense
of self. Sexual contact might be perceived by a vulnerable
young person as a ‘solution’ to any of these (see Section
4.2 below). The lack of parental monitoring and guidance
oen involved in neglect might reduce barriers to early
and/or risky sexual activity (Oberlander et al, 2011).
Perpetrators may then be more likely to come into contact
with these young people and spot their vulnerabilities and
take advantage of these in order to abuse (Cockbain and
Wortley, 2015). This is a theme further explored in Scope 2.
However, while early or risky sexual behaviour is a
plausible neglect-related risk factor for CSE, there would
appear to be an inherent aw in much of the research in
this area that limits the strength of any conclusions drawn.
Studies do not appear to have adequately dierentiated
early or risky consensual21 sexual activity in adolescence
from sexual abuse or exploitation; therefore, much of the
‘early’ or ‘risky’ sexual behaviour reported may in fact be
sexual victimisation. The research is then telling a simpler
story of neglect increasing risk for sexual abuse and
exploitation, without any mediating factor.
In summary, we cannot currently be sure that neglect
increases early or risky non-abusive sexual activity, which
then exacerbates a vulnerability to CSE. However, there
is a body of evidence indicating that neglect increases
early sexual activity, which may include sexual abuse
or exploitation, and that this activity does link to later
exploitation. This remains an important nding, as
early sexual activity may be a marker for risk, however
it contributes to it. As with all messages in this scope,
there is no suggestion it applies to all young people who
experience CSE
21 Consent is dened as agreeing by choice and having the freedom
and capacity to make that choice. A person cannot consent if certain
circumstances apply. These include the use, or fear of use, of violence
against the complainant or other person; the complainant being
unlawfully detained; being under the inuence of substances (causing
the complainant to be stupeed or overpowered); being asleep or
unconscious or unable to communicate because of physical disability
(extended to include mental disability in later case law) and being
deceived as to the defendant’s identity (Sexual Oences Act s74-76)
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 14
Substance misuse
Norman et al’s (2012) extensive systematic review and
meta-analysis of the long-term health consequences of
neglect (and other forms of non-sexual maltreatment)
found ‘robust evidence’ for a relationship between
childhood neglect and later drug use. In contrast, they
found less consistent evidence of a relationship between
neglect and subsequent alcohol misuse. Several studies
indicate that neglect interacts with genetic factors in
complex ways to increase drug use susceptibility, including
in adolescents (Gerra et al, 2010; Rovaris et al, 2015; Vaske,
Newsome and Wright, 2012).
There is also strong evidence suggesting that substance
misuse during adolescence in turn raises the risk of sexual
exploitation. Numerous studies have found a signicant
association between the two (for example, Klatt et al,
2014; Edwards et al, 2006; Reid, 2011). Although in part
this relationship may be due to CSE heightening the need
for drugs and alcohol, some studies indicate that earlier
substance misuse increases the risk of later CSE. For
example, Clarke et al (2012) found, in a sample of women
who had experienced commercial sexual exploitation as
adolescents and continued ‘selling sex’ into adulthood,
that the average age of rst drug use was younger than the
average age of CSE onset. Their statistical model indicated
that ‘for every year one delays starting drug use, he or
she delays entry into prostitution by 0.4 of a year’ (p281).
Nine of 21 teenage girls caught up in commercial sexual
exploitation interviewed by Pearce22 (2002) cited drugs as
their primary reason for involvement (it was evident that
there were a variety of interlinked factors connected to the
drug use, such as ongoing abuse and low self-esteem).
In summary there is enough evidence to suggest that drug
use may be one means by which neglect increases the
risk of CSE. In the absence of eective emotion regulation
skills developed through responsive caregiving, children
may turn to drugs to reduce dicult emotions, especially
if these are particularly intense, fuelled by negative
models of self and others and ongoing family and social
diculties. Earlier experiences of neglect may also, for a
variety of reasons explored in Section 4.2, increase some
young people’s susceptibility to exploiters’ manipulative
techniques designed to generate drug addiction (described
for example in Kennedy et al, 2007). Once young people
have become dependent on drugs, perpetrators may use
this to initiate or continue abuse.
Social isolation and peer rejection
A more hypothetical means by which neglect may heighten
risk for CSE is via its impact on isolation and peer rejection.
A wide variety of studies taken together demonstrate that
neglected children are on average less popular with their
peers, have fewer reciprocated friendships, are more
avoidant in their peer interactions than other children and
experience greater loneliness (Hildyard and Wolfe, 2002;
Appleyard, Yang and Runyon, 2010).
In a prospective longitudinal study with a community
sample of 942 children, Chapple, Tyler and Bersani (2005)
found that physical and emotional neglect, measured
when children were between ages 3 and 5 years, each
signicantly predicted rejection by their peers in early
adolescence (even when corporal punishment, a proxy
of physical abuse, was controlled for, highlighting the
role of neglect beyond that of physical abuse). Other
studies conrm that early neglect may have an especially
detrimental impact on social connection (Manly et al, 2001).
The processes involved in peer rejection and social
withdrawal are likely to be complex – children may avoid
or be rejected by peers because neglect has compromised
their cognitive and language abilities, their social skills,
their capacity to regulate their emotions, or even the
natural expectation that peers will enjoy and desire their
company (see Section 4.2).
Social isolation may in turn leave young people more
vulnerable to sexual exploitation. Perpetrators describe
targeting children who appear vulnerable and lack of
popularity may be a marker of such vulnerability (Kennedy
et al, 2007). And with less positive armation from their
peers, neglected young people may be more susceptible
to deceptive positive gestures from perpetrators (Hanna,
2002); fewer peer and family interactions may also leave
socially isolated children with a compromised ability
to discriminate between genuineness and respectful
behaviour and behaviour that is manipulative or abusive.
22 Pearce interviewed 36 girls who were experiencing CSE; 21 of the 36
were caught up in commercial sexual exploitation.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 15
Gang involvement
Both boys and girls involved in gangs are at heightened
risk of sexual exploitation, from others within the gang as
well as those outside it (Beckett et al, 2013). Gangs form
a highly conducive context for exploitation for a variety
of reasons, including the focus on displaying status and
hyper-masculinity through exploitative practices (Pitts, 2013;
Firmin, 2013). Childhood neglect is one factor that can create
vulnerability to gang involvement (Howell and Egley, 2005),
for example via its contribution to youth homelessness (Yoder,
Whitbeck and Hoyt, 2003) and a poor sense of identity, for
which gang membership may seem to oer a solution.
The plausible possibility highlighted here and in the above
sub-section is that both social isolation and some peer
relationships can create risk for sexual exploitation. This
points to the importance of socially excluded young people
being supported to develop peer relationships that are pro-
social, supportive and in at least partial view of protective
adults.
Psychological and neuropsychological factors
Cognitive and language diculties
One of the most robust ndings in the literature is the
impact of neglect on cognitive and language functioning in
childhood and across the life course (Hildyard and Wolfe,
2002; Georoy et al, 2016). Some studies suggest that
early neglect may cause more harm to cognitive abilities
than neglect experienced later in childhood (for example,
Sylvestre, Bussières and Bouchard, 2016), and that neglect
causes more damage to cognitive functioning than other
forms of maltreatment (Georoy et al, 2016).
A striking nding in the work of O’Hara et al (2015)
and Culp et al (1991), amongst others,23 is that neglect
experienced by itself may compromise some cognitive
skills to an even greater degree than neglect paired with
abuse, possibly because negative interactions (whilst highly
harmful in other ways) provide some of the stimulation and
acknowledgment necessary for cognitive development. This
somewhat challenging nding highlights the importance
of not viewing ‘just neglect’ as less harmful than neglect in
the context of other maltreatment.
While there is no robust research exploring the cognitive
and language functioning of young people who have
experienced CSE, it is well established that children with
learning diculties are at heightened risk of sexual
victimisation (Jones et al, 2012). It is plausible that young
people with lower cognitive abilities may be less able
to detect or disentangle themselves from perpetrators’
grooming and entrapment strategies. Perpetrators may
also specically target these young people. And if parents,
carers and practitioners/services are not sensitive to
these cognitive dierences, then children with diminished
cognitive and language capacities may also nd it harder to
seek help and be heard.
Dissociation, reduced awareness and PTSD
Children and young adults who have been neglected in
childhood are at increased risk of dissociation and post-
traumatic stress disorder (PTSD) (Hulette et al, 2008; Mace
et al, 2001; Nikulina, Widom and Czaja, 2011; Widom,
1999; Wright, Crawford and Del Castillo, 2009). These two
sets of psychological diculties, and the avoidant coping
mechanisms with which they are associated, in turn raise
the risk of sexual victimisation. For example, in a robust
longitudinal study of 3,604 adolescents, McCart et al (2012)
found that adolescents’ levels of PTSD predicted subsequent
interpersonal victimisation, even aer accounting for the
degree of prior victimisation; and Fortier et al (2009) found
that avoidant coping (in their study following childhood
sexual abuse) was associated with sexual victimisation in
young adulthood.
There are several reasons why PTSD and forms of
psychological avoidance may raise the risk of sexual
victimisation, potentially including CSE. McCart et al (2012)
found that PTSD appeared to prompt increased use of drugs
and alcohol, which in turn raised the risk of victimisation.
It is also suggested that hyperarousal in PTSD, and the
attention to internal threats (for example, to ashbacks and
to intrusive thoughts about the abuse), may make it harder
for individuals to discriminate real from perceived danger,
increasing the likelihood of remaining in contact with
abusive individuals (Risser et al, 2006).
Diculty in spotting threats from other people may also
result from dissociation. When people have (subconsciously)
attempted to cope with abuse and neglect by reducing their
awareness of their emotions and of social rules, they may
have fewer tools with which to recognise and move away
from abuse. Messman-Moore and Brown (2006) found that
previously victimised women were on average slower to
indicate they would leave a threatening situation, and the
women who exhibited this delayed response were more
likely to be subsequently raped. Similarly, DePrince (2005)
found that revictimisation was associated with impairments
in detecting social threat. None of this is to suggest that it is
ever the responsibility of victims to stop the abuse.
23 See Section 3 of Scope 2 for further discussion of this nding.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 16
Negative working models of self and others, and non-secure
attachment styles
Neglect can aect how a child (and subsequent adult)
perceives themselves, other people, and their relationships.
Hildyard and Wolfe’s (2002) review summarises studies
indicating that neglect can contribute to infants and
pre-school children having insecure24 or, in some cases,
disorganised attachments with their primary caregivers,
and to children across the pre-adolescent age range having
negative representations of themselves and others. Studies
found that, in comparison to others, neglected children
had fewer positive and more negative (for example,
angry and oppositional) self-representations, as well as
a more negative view of the social world characterised
by diculties in relationships and seeing others as hurt,
sad and anxious (McCrone et al, 1994; Toth et al, 1997;
Waldinger, Toth and Gerber, 2001). Although most studies
do not dierentiate between forms of neglect, there was
tentative evidence that emotional neglect posed most risk
for attachment diculties (for example, Egeland, Sroufe
and Erickson, 1983).
In a study of 301 undergraduates, Wright and colleagues
(2009) found that self-reported emotional neglect in
childhood was associated with three ‘schemas’25 or core
organising beliefs: (i) the belief that one is unable to
prevent catastrophes, which may strike at any time (termed
‘vulnerability to harm’); (ii) the belief that one is a defective
and shameful person (termed ‘defectiveness/shame’); and
(iii) the belief that one should focus on the desires, feelings
and responses of others at the expense of oneself (termed
‘self-sacrice’). In statistical analyses, these schemas were
found to partially account for the relationship between
emotional neglect and subsequent anxiety, depression and
dissociation.
It is conceivable that such schemas aect some young
people’s vulnerability to CSE. A young person who believes
they must sacrice their own needs to those of others in
order to be valued or normal, may be more likely to comply
with sexual coercion and ‘emotional manipulation’. And a
young person who believes they are shameful, or cannot
avoid harm or catastrophe, may be less able to disengage
themselves from exploitative and abusive persons –
not believing they are worthy of or can achieve better
relationships.
These hypotheses are supported by ndings from several
disparate studies. Proneness to shame and self-blame
appear to increase risk of sexual victimisation, acting as
a mediator between childhood and adult victimisation
(Classen, Palesh and Aggarwal, 2005; Kessler and Bieschke,
1999). Reid (2011) found support for a model in which
childhood maltreatment increased ‘sexual denigration of
self and others’, which in turn increased the risk of CSE
(although it should be noted that causality could not be
denitively determined). Sexual denigration represented
a cluster of beliefs such as: ‘No man26 would care for me
without a sexual relationship’; ‘Only bad, worthless guys
would be interested in me’; and ‘I use sex to get something
I want or need’.
In two UK qualitative studies exploring how childhood
experiences aected the nature and self-attributed
meanings of CSE and adult ‘sex work’, Dodsworth (2012,
2014) found that experiences of neglect and abuse le
some women feeling as if they had little control over
their lives. This sense of helplessness contributed to them
remaining in ‘sex work’. Other factors found to contribute
both to the start of CSE and continued exploitation into
adulthood, included feeling that abuse was deserved and a
desperate search for aection. Three quotes illustrate these
dynamics:
‘Mum told me she wished I wasn’t born and if I had any
contact with them [the family] she’d stab me… I can’t
remember why they didn’t want me. It ruined my life… the
way I think of it, I must deserve all I get.
‘Nothing’s coincidence – everything you do you do for a
reason. If someone tells you for so long that you’re crap, then
you believe you are crap.
‘I started seeing this man. He got me into it. I think I was
looking for a father-gure. He was abusive too. I started
prostitution at 17 and did unpaid prostitution from 15 to 17.
(Dodsworth, 2012, p9; Dodsworth, 2014, p6)
Although somewhat more tangential, the research
indicating that neglect (in particular, emotional neglect)
increases the risk of ‘borderline personality disorder’ or
BPD27 (Johnson et al, 1999; Lobbestael, Arnst and Bernstein,
2010; Widom, Czaja and Paris, 2009) is noteworthy, as this
cluster of diculties is underpinned by shame-proneness,
low self-esteem and chronic fears of rejection (see for
example Rüsch et al, 2007).
Lastly, as stated above, numerous factors discussed in this
scope interrelate – so, for example, the negative sense of
self discussed here may prompt dissociation (eg, Talbot,
Talbot and Tu, 2004), which in turn increases vulnerability
and risk.
24 It is important to note that insecure attachment is very common;
although it is not optimal, it is not in itself cause for alarm
(Shemmings, 2016).
25 The term ‘schema’ is more or less interchangeable with ‘negative
working model’ and ‘core belief’.
26 As noted earlier, the sample for this study was all female (174
predominantly African American women).
27 As with other terms in this scope, this label is used because of its
use in the literature – its use does not imply uncritical acceptance; see
Table 1.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 17
Unmet psychological needs
The idea of ‘unmet psychological needs’ is used in research
and practice to describe the dynamic (partly touched on
above) in which young people who are deprived of love,
status, approval, or a sense of belonging or identity (due
to emotional neglect, for example), search for these things
– a vulnerability which is then exploited by others (Hanna,
2002; Scott and Skidmore, 2006).28
This concept draws attention to the uncomfortable
possibility that, for some young people, living with a set of
unmet needs may feel worse than being in relationships
where they are being exploited.
Hallett found evidence of this in her interviews with nine
UK young people who had experienced sexual exploitation:
For young people who consider themselves to be vulnerable
and without care – without attention, acknowledgment and
help – ‘sexual exploitation’ can be a solution of sorts: ‘help’
and recognition, of some form, from someone.
(Hallett, 2015: p6)
The quotes below from those she interviewed are
illustrative:
‘Because no-one’s been there to help them, they, then they
just turn to what’s available.
(‘Kerry’, p5)
‘He [boyfriend who coerced her into selling sex] was there
for me and you know I just wanted someone to love me.
(‘Katie’, p8)
One implication of this is that to help a young person escape
exploitation before (or instead of) addressing their unmet
needs may be at best ineective and, at worst, contribute to
harm. Another young person interviewed by Hallett (2015),
oers this advice for practitioners:
‘Try and work on the issues that make them vulnerable to
it and then as they become, as their life becomes a bit more
stable, um, hopefully they should be able to withdraw from
what is making them turn towards that… I think that when
people try to pull them out really quickly that sometimes, if
it’s an emotional issue, it can sometimes cause them damage
as well… it can just be redirected somewhere else and cause
more issues them somewhere else.
(‘Nathan’, p9)
Depression and anxiety
Depression and anxiety, in both adolescence and
adulthood, are common consequences of childhood
emotional or physical neglect (Johnson et al, 2000;
Petrenko et al, 2012; Young, Lennie and Minnis, 2011;
Wright, Crawford and Del Castillo, 2009) and it is worth
considering their potential role in any neglect-CSE
relationship. Depression and anxiety can follow neglect
both because neglect can play a role in these diculties,
and because neglect oen co-occurs alongside other
adversities such as poverty, which themselves directly
contribute to distress (Nikulina, Widom and Czaja, 2011).
This point is true for many of the poor outcomes that
neglect can result in.
Longitudinal studies have found that, when measured
at an initial time point, depression and anxiety (oen
measured together as the construct ‘psychological distress’)
predict subsequent sexual victimisation in adolescence and
adulthood (Cuevas et al, 2010; Orcutt, Cooper and Garcia,
2005). Research has typically explored this relationship
among individuals who have previously experienced sexual
abuse, oen alongside other forms of maltreatment.
Young people experiencing CSE also have higher levels of
depression than other young people (Edwards, Iritani and
Hallfors, 2006; Tyler, 2009); and while this relationship
might be partially explained by CSE leading young people
into depression, revictimisation studies suggest depression
is also likely to be acting as a vulnerability.
System responses to neglect
Care, safeguarding responses and the impact on young
people
Neglect is the most common reason for children and young
people to become the subject of a child protection plan
(DfE, 2015), and many will become looked aer by the care
system, entering foster or residential care. Some research
suggests that children who are removed from their families
due to neglect are likely to spend more time in care than
those removed for abuse, are less likely to return home
and are more likely to re-enter care if they do return home
(Bundy-Fazioli, Winokur and DeLong-Hamilton, 2009;
Marquis et al, 2008).
Although it is important to remember that CSE by no
means only aects those in the care system, young people
living in care are disproportionately aected by CSE (CEOP,
2011; Shuker, 2013). For example, both Jago et al (2011)
and Berelowitz et al (2012) found that 21 per cent of their
large samples of young people who had experienced CSE
were in care at the time; and those living in residential or
secure care (as opposed to foster care) are at particularly
heightened risk (Jago et al, 2011; Beckett, 2013) as explored
briey on the following page.
28 This section explores this dynamic generally and Section 4.3
considers it in relation to children involved in the care system.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 18
The experiences of maltreatment, as discussed in previous
sections, may increase vulnerability to CSE as well as
leading to a child being taken into care - so it is important
to avoid the notion that care creates or causes vulnerability
to CSE. However, there may well be responses or actions
taken for and about children in care that exacerbate this
vulnerability. Research, involving interviews with UK
adolescents and young adults who have experienced CSE,
has unpicked the ways in which being looked aer by
the care system can sometimes inadvertently create or
exacerbate vulnerability to CSE. In her interviews with nine
young people who had experienced both CSE and statutory
care involvement, Hallett found that:
… the practices of social care and more specically those of
child protection, although talked about by the young people
as fundamental to solving the problem, were also talked
about as forming and reinforcing parts of the problem.
(Hallett, 2015: 8-9)
Others have reached the same conclusion (Beckett, 2013;
Coy, 2008, 2009; Shuker, 2013). Young people describe
how multiple placement moves, lack of opportunities to
contribute to decision-making, a succession of dierent
workers and practice that focuses on ‘problems’ at the
expense of seeing the whole person, all work together
to make them feel powerless, objectied, stigmatised,
lonely and without anchoring relationships or a sense of
belonging (Hallett, 2015; Coy, 2008, 2009; The Care Inquiry,
2013). This can lead to vicious spirals, as multiple moves
prompt young people to distance themselves from new
carers, test carers’ commitment and engage in distress-
fuelled aggression, prompting yet further moves and more
loss, disconnection and powerlessness (Newton, Litrownik
and Landsverk, 2000; Shuker, 2013).
In interviews with Hallett (2015) and Coy (2008, 2009),
young people described how such experiences had
le them vulnerable to CSE – at least initially, being
‘befriended’ by exploitative individuals seemed to provide
the missing sense of belonging and connection.
In these qualitative studies, there is a concerning resonance
between CSE, some safeguarding approaches and prior
experiences of maltreatment in their impact on young
people’s sense of objectication, loneliness, negative
self-concept, mistrust of others and overall lack of control.
Sexual exploitation may conrm many of these and so
provide what one young person described to Hallett (2015)
as ‘an uncomfortable comfortableness. This phrase sums
up the conict many people experience when wanting to
be free of negative feelings about themselves and others,
but nd themselves drawn to familiarity and conrmatory
experiences.29
‘I was SO lonely at the time, nobody was listening to me or
anything like that and I think part of me was like sod it, and
that’s why, stu started and I ended up in trouble.
(‘Hannah’ in Hallett, 2015: p5)
‘I was in care and I was moved around here and there and
anywhere. So I was always doing runners, and when I met
[person who was deemed exploitative] it was having someone
who was there for me you know.
(‘Katie’ in Hallett, 2015: p8)
‘When I rst went in there [children’s home] I was a good
girl… but being in them places you have to adapt to the other
kids, living to be part of the gang.
(‘Stacey’ in Coy, 2008: p1418)
An additional factor is that, when in care, young people are
more likely to meet other young people already aected
by CSE, increasing the risk that they too will experience it
(Klatt, Cavner and Egan, 2014; Cobbina and Oselin, 2011;
Coy, 2009; Tyler, 2009).
In her interviews with young people aected by CSE around
the UK, Warrington (2013) found similar themes in the
safeguarding system’s responses to CSE. She concludes that
when young people are excluded, in myriad ways, from
informing and shaping the everyday processes designed
to safeguard them, then safeguarding itself becomes
fundamentally compromised – as it also does, Shuker
(2013) argues, when responses to CSE prioritise physical
safety above relational and psychological forms of safety.
Hanson and Holmes (2014) argue that to be eective, help
and support needs to ‘go with the grain’ of young people’s
development and increasing sense of agency, rather than
work against it or simply ignore it, and should be centred
around high-quality relationships (see also The Care
Inquiry, 2013).
Limited resources and a variety of systemic factors can work
against individual practitioners and teams oering young
people care and support that is genuinely relationship-
based, participatory, responsive and person-centred.
However, when such care and support is provided – and
there are many examples of good practice in both the
statutory and voluntary sectors – young people describe the
inuential role it can play in helping them move forward
and away from abuse and towards wellbeing (Warrington,
2013; Hallett, 2015; The Care Inquiry, 2013).
However, even when care is highly attuned and young-
person-centred, being ‘looked aer’ – and being in
residential care especially – may increase a young person’s
vulnerability to CSE, because research in various parts
of the UK indicates that perpetrators selectively target
residential homes (Beckett, 2013; Munro, 2004). Moreover,
practitioners may have ‘limited tools at their disposal to
defend against the manipulative techniques employed by
abusers (Beckett, 2013, p. 79).
29 These ideas lie behind the evidence-based schema theory and
therapy – see Young, Klosko and Weishaar (2003).
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 19
The criminal justice system
Neglect, especially when experienced in the early years,
can lead to aggression problems in childhood, and
oending behaviour in adolescence and adulthood
(Brandon et al, 2014; Kotch et al, 2008). Kazemian, Widom
and Farrington’s (2011) longitudinal UK study also suggests
that when young people who have experienced neglect
do commit oences, they are more likely than other young
people to be caught. The authors suggest this is because
neglect leads to the increased involvement of statutory
systems in a young person’s life and this, in turn, results
in greater identication of any oending (compared to
the oending by young people who are not ‘on the radar’
of systems). This nding and hypothesis invites further
consideration of the possible adverse consequences of
statutory responses to neglect.
Involvement in the CJS may compound a young person’s
negative self-concept and distress, constrain their social,
emotional and academic development, reduce positive
social supports, expose them to people involved in
crime or CSE, and heighten instability and material
needs (Cesaroni and Peterson-Badali, 2005; Howard
League, 2010, 2014; Farmer, 2011). Young people may also
struggle to nd safe housing, employment and supportive
relationships following time spent in custody (Hazel and
Bateman, 2013; Howard League, 2011). All these factors
increase vulnerability to CSE, through many of the same
mechanisms as discussed in previous sections.
Reecting on the statutory denition of neglect, it could
be argued that placing adolescents in young oender
institutions can be seen as a form of societal neglect, as
this form of secure accommodation does not ‘protect a
child from physical and emotional harm or danger’, and
is unresponsive to ‘a child’s basic emotional needs (HM
Government, 2015) (see Hanson and Holmes, 2014, for a
fuller discussion of this point).
System responses to a young person’s oending do
not uniformly increase vulnerability and risk, however.
Strengths- and relationships-based approaches, as
implemented by a number of youth oending services and
youth services (Byrne and Brooks, 2014), have the potential
to be protective, for example by raising a young person’s
self-esteem, and developing their opportunities to engage
in rewarding employment and positive social networks.
Neglect concurrent with CSE
Neglect experienced during adolescence may increase the
risk of concurrent CSE in distinctive ways and these are
considered briey in this section. More specically, this
section also examines the ways in which CSE may in turn
increase risk for concurrent neglect.
Adolescent neglect may be part of a chronic long-term
pattern that began with neglect in earlier childhood.
However, some neglect can commence once children
reach adolescence – for example if the parents’ diculties
escalate over time leading to neglectful parenting, and/
or if support that was mitigating neglect is reduced as the
child grows up. Parents may struggle to respond to the
increased risk-taking that is characteristic of adolescence
as a developmental stage; neglect may follow premature
or unsupported reunication following time spent as a
looked aer child; or neglect may follow adverse life events
(Lutman and Farmer, 2013).
Neglect in adolescence can take dierent forms. As
discussed above (see page 12), these may be quite striking
in terms of the risk they present. For example, parental
unwillingness to house young people is the primary reason
for youth homelessness, which in turn is one of the most
evidenced vulnerabilities to sexual exploitation (Homeless
Link, 2015). Some homeless adolescents may be ‘taken
care of’ by, or introduced to, persons involved in crime
and sexual exploitation; associating with those involved in
‘prostitution’ is found to be a risk factor for CSE (Cobbina
and Oselin, 2011; Klatt, Cavner and Egan, 2014; Tyler, 2009).
Other manifestations may be less immediately obvious.
Risk for CSE is also increased when parents are relatively
distant and uninvolved in their children’s lives (McNeal
and Walker, 2015). Perpetrators may then have more
opportunity to spend time with young people, grooming
and manipulating them, and young people may be more
emotionally responsive to their overtures if they feel that
attention and aection is lacking.
It is important to stress that this potential manifestation
does not place the blame for CSE with young people or
with their parents, though of course where parents are
neglecting children’s basic support and supervisory needs
it is important to highlight the responsibility that parents
should exercise. As with other risk factors, the degree to
which parental under-involvement increases risk of CSE
would depend on the presence and behaviours of sexually
exploitative people.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 20
It can also be argued that sexual exploitation in turn works
to increase the challenges of parenting. Perpetrators will
frequently seek to isolate those they exploit from their
family and friends – for example, by spreading malicious
rumours, manipulating young people’s loyalty, and
blackmailing and terrorising (PACE and YouGov, 2013).
Young people may become emotionally preoccupied with
those who are exploiting them, creating distance in their
other relationships, and so nd it hard to recognise abusive
aspects. This can lead to those who love them feeling
hopeless and frustrated. Some young people may run away
to live with the people exploiting them.
The dynamics of CSE are powerful and complex and
demand a level of proactive parenting that some parents
may struggle to achieve. This could be for a number of
reasons, such as a lack of understanding about what
is happening to their child or signicant parallel life
challenges – including nancial hardship, responsibilities
towards others (including other children), social isolation
or health problems. A young person’s victimisation
may also be obscured by their perceived ‘risk-taking
behaviour’ or attachment to a perpetrator, and parents
may even feel anger towards their child or mistakenly
hold them responsible for the CSE, which can in turn lead
to inadvertently neglectful responses. There are several
examples of positive work with parents which aim to
address these challenges, these include PACE’s (Parents
Against Child Sexual Exploitation) relational safeguarding
model (PACE, 2014) and Barnardo’s FCASE (Families and
Communities Against Sexual Exploitation) project (D’Arcy et
al, 2015).
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 21
Low self-
esteem/negative
sense of self
Hypothesised model of how neglect may increase vulnerability to CSE
Developmental
impacts
Direct
eects
Theoretical
link
Child
experiences
Group of
associated
factors
Child’s
needs
Perpetrator
actions
Associated
behaviours
Potential mediating factors
Perpetrator
strategies
Poor emotional
regulation
Compromised
social skills
Inhibited
cognitive and
language
development
Psychological
diculties
Befriending
or ‘romantic’
relationship
Drug use
Gang
involvement
Running
away
Poor system
responses to
needs
Family/
placement
breakdown
Homelessness
Atttempts to
induce drug
dependency
Trading
shelter, drugs
or cash for
sex
Targeting
vulnerable
groups/
locations
Coercive and
manipulative
strategies
Neglect
Unmet emotional
physical and
social needs
Attachment
diculties
Child sexual
exploitation
Key
Prioritises the
needs of others/
desire to please
Thrill
seeking
Social
isolation
Impaired
problem-
solving ability
Diculty in
detecting threat/
discriminating
danger
Low self-
esteem/negative
sense of self
Early impacts
Hypothesised model of how neglect may increase vulnerability to CSE
Developmental
impacts
Direct
eects
Theoretical
link
Child
experiences
Group of
associated
factors
Child’s
needs
Perpetrator
actions
Associated
behaviours
Potential mediating factors
Perpetrator
strategies
Poor emotional
regulation
Compromised
social skills
Inhibited
cognitive and
language
development
Psychological
diculties
Befriending
or ‘romantic’
relationship
Drug use
Gang
involvement
Running
away
Poor system
responses to
needs
Family/
placement
breakdown
Homelessness
Atttempts to
induce drug
dependency
Trading
shelter, drugs
or cash for
sex
Targeting
vulnerable
groups/
locations
Coercive and
manipulative
strategies
Neglect
Unmet emotional
physical and
social needs
Attachment
diculties
Child sexual
exploitation
Key
Prioritises the
needs of others/
desire to please
Thrill
seeking
Social
isolation
Impaired
problem-
solving ability
Diculty in
detecting threat/
discriminating
danger
Figure 1: Hypothesised model of how neglect may increase vulnerability to CSE
22
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1
Figure 2: The nature of evidence for impacts of neglect and vulnerability to child sexual exploitation
Running
away
Homelessness
Gang
involvement
Poor
service response
Oending
Social
isolation
Cognitive
diculties
Poor
sense of self
Attachment
diculties
Early
sexual activity
Psychological
problems
Drug use
Concurrent
neglect
Risk
of CSE
Prior
neglect
Longitudinal
studies
Retrospective
studies with
victims
Cross-sectional
studies
Theoretical
link and/or
weak evidence
Key
The nature of evidence for impacts of neglect and vulnerability to child sexual exploitation
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 23
Summary of key points
> There are a range of factors that might act as
mediators in the relationship between neglect
and CSE. In other words, the evidence points to a
number of potential responses to (or impacts of)
neglect, which may increase vulnerability to CSE.
> These include running away or being ejected
from the family home (although for some young
people, running away may also be thought of as
an indicator for potential resilience) and misuse
of drugs. There is strong evidence for a link
between childhood neglect and later drug use,
and for a link between adolescent drug use and
sexual exploitation.
> Neglect increases the likelihood of early sexual
activity, which in turn is linked to subsequent
sexual exploitation. What is less clear from
current evidence is the extent to which ‘early’ or
‘risky’ sexual activity was consensual – or was in
reality abuse or exploitation; either way, early
sexual activity (whether abusive or not) is found
to be linked to later sexual exploitation.
> More hypothetically, neglect may heighten
the risk for CSE via its impact on isolation and
peer rejection. Neglected children tend to be
less popular, have fewer friends, experience
more loneliness and are more avoidant in
peer interactions. This social isolation may
leave young people more vulnerable to sexual
exploitation.
> Neglect is strongly linked with poorer cognitive
and language functioning. There is evidence
that neglect on its own may even compromise
development of cognitive skills to a greater
extent than neglect experienced alongside
other forms of abuse. It is plausible (though not
empirically established) that young people with
lower cognitive abilities may be less able to
detect or protect themselves against grooming
and entrapment strategies.
> Children and young people who have
experienced childhood neglect are at greater risk
for a range of psychological diculties, including
dissociation, post-traumatic stress disorder,
depression and anxiety, which may make them
more vulnerable to exploitation.
> Childhood neglect can contribute to the
development of negative representations of self
and others, and render young people less able
to disengage from abusive people. Young people
who have been deprived of love, approval or a
sense of belonging or identity may be drawn into
trying to meet those needs through exploitative
relationships.
> Many young people in care have experienced
neglect and young people in care are
disproportionately aected by CSE. Evidence
suggests that poorly managed systems
responses to young people’s needs – such as
multiple placement moves, lack of involvement
in decision-making, a succession of dierent
workers and a focus on ‘problems’ at the
expense of seeing the whole person – may
in some cases exacerbate young people’s
vulnerability to CSE.
> Being taken into care does not create
vulnerability to CSE, but this evidence does
highlight the need for support that is genuinely
relationship-based, participatory, responsive and
person-centred. Limited resources can make it
hard for practitioners and teams to oer such
support, but there are many examples of good
practice. And there are many testimonies from
young people describing how such approaches
helped keep them safe and to move forward.
> Neglect does not always begin in childhood.
Neglect sometimes emerges only when a young
person reaches adolescence. A young person’s
experience of CSE may itself increase the risk of
concurrent neglect – for some young people.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 24
Section 5: A resilience-focused approach:
what factors can help children and young
people who have been neglected avoid
CSE (and other adversities)?
What is resilience?
Resilience is the process by which individuals, or
families or communities, achieve positive adaptation or
development in spite of exposure to risks or adversities
(Fergus and Zimmerman, 2005). This section specically
explores the ways in which resilience against CSE (and
other adversities) might be developed within and around
neglected children and young people. Some key principles
and understandings about resilience provide a helpful
framework to this discussion (see also Newman, 2014):
> Resilience develops through a process of
interaction between a child or young person’s
‘assets’ (for example, their willingness to try new
things) and the ‘resources’ around them (for
example, educational opportunities, supportive
people).
> Resilience does not reside within a child or young
person as a character trait but across children
and young people and all the environments
and systems with which they interact. External
resources are vital, and resilience is not a
substitute for help.
> Resilience can emerge from an accumulation of
(sometimes small) positive things interacting.
Virtuous spirals develop, in which one positive
leads to others; for example, a supportive teacher
helps a child/young person develop greater self-
belief, which in turn encourages them to make
the most of extra-curricular opportunities, which
further builds their self-esteem and self-ecacy.
> Virtuous spirals can help people avoid the
adverse trajectories that oen follow childhood
maltreatment. Such trajectories can involve their
own negative spirals (Nurius et al, 2015), so it
follows that eorts to ‘grow’ resilience should start
as early as possible.
> What may be most eective at building
resilience oen varies depending on the child’s
developmental stage and social situation;
transition points may hold particular potential
(Newman, 2014).
> Negative behavioural and psychological
consequences of abuse and neglect (eg,
aggression, self-harm, dissociation and post-
traumatic stress) may be most accurately thought
of as attempts to adapt to adversity. When they are
given the support and opportunity to adapt instead
to safe and arming social worlds, children and
young people can and do develop a positive self-
concept, emotion regulation skills and wellbeing.
> Some degree of exposure to diculty and risk
helps children develop the skills to cope with
adversities further down the line (see, for example,
Tremblay et al, 2015). Resilience may develop
when young people have some carefully measured
opportunities to exercise their agency in potentially
risky situations – as bets a young person’s
developmental stage and individual needs.
> Resilience may be best thought of in relative terms;
it will look dierent following neglect of diering
severity and chronicity.
Exploring resilience is inseparable from exploring the
negative trajectories that can follow maltreatment. For
example, if self-denigration following neglect can increase
a young person’s vulnerability to sexual exploitation, then
we might reasonably work to the belief that helping a
neglected child/young person develop a positive sense
of self can increase the chance they will avoid CSE. At the
same time, the study of resilience should not be reduced
to the study of negative impact, as it draws attention to
essential but otherwise neglected areas: individual and
systemic strengths, protective factors, positive spirals and
processes of growth.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 25
Addressing neglect and associated adversities
There is some debate around whether reducing a child’s
experience of neglect is a part of promoting their resilience
(Newman, 2014), or whether it is instead a necessary
precondition or parallel process. Either way, addressing
neglect as soon as possible is an essential rst goal:
both as an end in itself, and also to increase the chances
that the child will avoid longer-term harms. As noted in
Section 2, cumulative neglect, especially when experienced
across developmental periods, leads to signicantly worse
outcomes.
Best practice in tackling neglect involves three interlocking
processes:
> identifying patterns of neglect early
> identifying and tackling the ‘root causes’ of a
particular family’s diculties and behaviours, and
identifying their strengths and motivations
> engaging them eectively in a process of change.
Early identication is improved when there are informal
routes for people who work with children to receive help
and advice from safeguarding services and also when:
there are accessible, non-stigmatising ways for families to
seek and receive help; practitioners and services prioritise
the child’s experience; and practitioners use nuanced and
sensitive assessment tools that aid professional judgment
(Daniel et al, 2014; Brandon et al, 2014). This need to
minimise stigma, elicit family engagement and balance
sensitivity to parents’ needs with child-centred decision-
making can be very challenging for practitioners.
The most eective support and intervention is likely
to be based on a constantly evolving and individual
understanding of a particular family’s patterns of neglect
– for example, what are the contributory factors for this
family (in their circumstances, history, relationships, etc)?
What are their strengths? What are the protective factors?
Depending on the answer to these questions, support and
intervention might variously include:
> support with budgeting and debt management, as
well as other forms of practical help in the home
> support and/or treatment for parents experiencing
poor mental health or substance misuse problems
> support in addressing issues such as domestic
abuse, poor or unstable housing, disabilities or
social isolation
> interventions designed to promote positive
parenting or parent-child psychotherapy (Daniel et
al, 2011; Pelton, 2015; Toth et al, 2015).
What is vital in all kinds of support to families is that
professionals (and volunteers, where they are providing
support) are able to work empathically with parents while
maintaining focus on the child. Some forms of support
combine various elements, such as voluntary sector
keyworking or intensive health visiting; both of these help
families access support from others, retain a clear focus on
the interests of the child and involve ongoing assessment in
collaboration with social care (Long et al, 2014; McIntosh et
al, 2009).
If assessment reveals that neglect is unlikely to cease (or
unlikely to cease within a timeframe that allows the child
to develop healthily) children may need to be cared for
by people other than their birth families. The next section
explores the factors that promote resilience both in these
circumstances and when children remain or reunite with
their families.
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Developing resilience through communities,
opportunities, relationships, and focused
interventions
Some communities are more able than others at helping to
protect children from the impact of neglect and associated
adversities. Communities can be an important mediating
factor – for example, Kotch et al (2014) found that
community social cohesion and trust reduced the degree to
which parental depression led to aggression and alcohol
use in adolescents who had been neglected.
Hypothesising in this vein, it may be that if neglected
children have a sense that people in their community trust
and depend upon one another, then they may develop
more positive models or representations of the world;
this in turn can encourage better relationships and lessen
the likelihood of sexual exploitation and other forms of
relational abuse.
A socially cohesive community may also make young
people more condent in seeking help if they are targeted
for exploitation, and provide them with more avenues
for seeking help. Moreover, a second form of social
capital – informal social control (ie, the degree to which a
community intervenes to interrupt anti-social behaviour) –
may make communities less conducive to exploitation.
Kaestle (2012) found that the more strongly a young
person feels connected to and happy within their
school community, the less likely they are to be sexually
exploited. (This relationship was not accounted for by other
demographic or risk factors.) When young people are
embedded within a supportive school community, they are
likely to develop a sense of belonging, stability and belief
in themselves; they may also gain a better education and
more subsequent employment options. For many young
people, these ‘assets’ and ‘resources’ may help protect
them against CSE; for others who have become caught
up in CSE, they may help them break free of it sooner
(Dodsworth, 2014; Reid, 2012; 2014; Tyler, 2009).
High-quality relationships are typically a central feature
of resilient trajectories following childhood maltreatment.
When a young person experiences patience, love,
consistency, positive role-modelling and belief from
another over time, this can go a long way towards
developing the ‘assets’ that research shows to be
protective: self-condence, a sense of security, positive
aspiration, adaptive beliefs about oneself and others, and
social and emotional regulation skills.
Peer relationships are important, as are those with adults
– whether the adult is a parent or relative, foster carer,
mentor, social worker, teacher, therapist or someone else
(Thompson, Greeson and Brunsink, 2016; DuBois et al,
2011). The relationships that make a dierence to young
people are those in which they experience being cared
for over the long term, by someone who empathises with
them and persistently works in their best interests (Ahrens
et al, 2011, 2013); one or more of these should involve
authoritative (as opposed to authoritarian or permissive)
parenting (Chan and Koo, 2011; Fuentes et al, 2015;
Oberlander et al, 2011). These relationships are likely to
be most achievable, and to have most impact, when they
combine with other sources of stability and predictability,
such as a stable long-term home and school (The Care
Inquiry, 2013; Newton, Litrownik and Landsverk, 2000; Coy,
2009).
All of this means that, particularly for young people who
have experienced fragmented or negative relationships in
childhood, there should be:
… a determination to view relationships – their extent, their
quality and their likelihood of lasting – as the cornerstone of
planning and practice.
(The Care Inquiry, 2013: p9)
Finally, there are a number of interventions that foster
resilience by specically targeting the behavioural and
psychological diculties that can emerge following neglect
and which render young people more vulnerable to sexual
exploitation and other forms of revictimisation and ongoing
adversity). (Problems such as post-traumatic stress,
dissociation, shame, aggression, social isolation, limited
relationship skills and sexual denigration do, of course, all
demand attention in their own right, beyond the risk they
confer for CSE.)
Therapies (with children and/or their families) such as
cognitive behavioural therapy (CBT), trauma-focused CBT,
attachment-based psychotherapy, EMDR (Eye Movement
Desensitisation and Reprocessing), art and drama
therapies, and systemic and narrative therapies, all hold
promise in reducing these problems (see for example
Deblinger and Runyon, 2005; Howe, 2006; Malchiodi,
2014; Smith, 2012; Taussig et al, 2013). However, what is
best suited to a young person will depend on a variety of
factors, such as their strengths, diculties, developmental
stage, personality and life circumstances.
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Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 27
Summary of key points
> Resilience is not an inherent character trait.
Rather resilience develops through an interactive
process between a child or young person’s ‘assets’
(such as a willingness to try new things) and the
‘resources’ around them (for example, educational
opportunities, supportive adults and peers). These
external resources are vital to building resilience.
> When a young person experiences patience, love,
consistency, positive role-modelling and belief
from another over time, this can go a long way
towards developing the ‘assets’ that research
shows to be protective: self-condence, a sense of
security, positive aspiration, adaptive beliefs about
oneself and others, and social and emotional
regulation skills.
> Best practice in tackling neglect involves
identifying patterns of neglect early, identifying the
root causes of a family’s diculties and also the
family’s strengths, and meaningfully engaging the
family in a process of change.
> Some communities are better than others at
protecting children from the impact of neglect
and other adversities. A strong and socially
cohesive community, including schools and
neighbourhoods, can act as a vital mediator in
negating or reducing the impact of childhood
adversity. A resilient community is also less
conducive to the development of exploitation.
> A range of interventions can foster resilience
by targeting the behavioural and psychological
diculties that can follow neglect (and may
render young people more vulnerable to
sexual exploitation). These include: cognitive
behavioural therapy with children and/or
families (CBT), trauma-focused CBT, attachment-
based psychotherapy, EMDR (Eye Movement
Desensitisation and Reprocessing), art and drama
therapies, and systemic and narrative therapies.
What is best suited to a young person will
depend on their individual strengths, diculties,
developmental stage, personality and life
circumstances.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 28
Section 6: Reflections and implications for
practice and research
Conclusions and reections
While this scope does not give reason to presume neglect
in the childhoods of the majority of young people aected
by CSE, it does urge us to think about the vulnerabilities
young people who have experienced neglect may face, and
how these may increase risk for CSE. It stimulates thought
around: a) how we might address the impact of neglect
early on so that it does not create vulnerability to CSE and
indeed other adversities in later childhood and beyond;
and b) how, when a young person who has experienced
neglect does go on to experience CSE, we might better help
them address their underlying vulnerabilities and needs.
As discussed, attention to vulnerabilities to CSE in children
and young people is justied on the basis that practitioners
and services oen have more opportunity to address these
factors; other contributors, such as perpetrator behaviour
(where responsibility clearly lies) and wider systemic
factors, such as cultural values and poverty, are harder for
practitioners to inuence. At the same time, focusing on
vulnerability does carry risks, which this scope has sought
to avoid. These include contributing to mother- or family-
blaming for CSE and for neglect, downplaying or ignoring
the inuence of communities and neighbourhoods,
providing ineective interventions (for example, where
treatments aim to tackle vulnerabilities that are assumed
but not present), and diverting attention from perpetrator
behaviour.
In summary, the research explored in this scope indicates
many avenues and opportunities to tackle the impact of
neglect and the occurrence of CSE provided nuance and
critical reection is applied along the way. This will help
to avoid the risks that might otherwise contribute to the
problems we are hoping to tackle.
Implications relating to Scope 1
1. All young people identied as being at risk of
or experiencing CSE must be oered support
that aims to understand and address any
vulnerabilities or unmet needs. Focusing
exclusively on CSE without addressing these
needs may be at best ineective and at worst
harmful.
2. In order for parents and carers to be able to
support their child, families of children at
risk of or experiencing CSE should be oered
support that helps them process and address
the impact of CSE on themselves, their child
and their family relationships.
3. Focusing on CSE above other forms of sexual
harm can create false delineations and be
unhelpful. Local leaders should ensure that
CSE policy and strategy does not inadvertently
obscure other forms of sexual harm and
is connected to wider eorts to safeguard
children and young people.
4. For children, young people and families
aected by neglect or CSE, the provision of
accessible support around housing, education
and employment, mental health, domestic
abuse and substance misuse would go a
long way towards tackling both forms of
maltreatment.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 29
Research implications
This scope has highlighted a variety of gaps in the research
literature around both neglect and sexual exploitation. It
would be of particular value to practice and prevention to
understand more fully:
1. The extent of the relationship between neglect
and sexual exploitation. This could be explored
more comprehensively through a UK longitudinal
study following maltreated (including neglected)
children’s trajectories over time.
2. How the social and psychological impacts of
neglect emerge and unfold over time, and how
they are aected by community and social factors.
This could include a focus on what increases and
reduces risk of ‘revictimisation’ including in terms
of CSE. Studies utilising various methodologies
would be ideal, including those that are
longitudinal and qualitative.
3. The social, material and psychological
vulnerabilities to various forms of CSE would be
useful areas to undertake research around. It
would be insightful to explore with CSE-aected
young people what factors they perceived played a
part, and what helped them move forward.
4. How diversities aect the impact of neglect, risk
factors for CSE and the relationship between
child maltreatment and subsequent CSE needs
further research. For example, few UK studies
have specically explored the experiences and
voices of sexually exploited or neglected boys,
LGBT, or BME young people, nor what approaches
and interventions are most eective for these
groups. Additionally, future research could help
to elucidate how poverty, and community and
neighbourhood factors might contribute to CSE.
5. It would be helpful to understand more about
entrapment within CSE, and how perpetrator
strategies achieve this. Further qualitative studies
with young people aected by CSE would be
particularly helpful here.
Practice implications relating to all three scopes
1. Neglect is the most common form of maltreatment
reported in the family, and yet arguably remains
a neglected issue. Government must prioritise
tackling the causes of neglect and ensure that
resources reect its prevalence and impact.
Resources must be sucient for local areas to
enable children and families to receive support at
an early stage so that harm can be prevented.
2. Serious consideration should be given to adopting
a public health approach to addressing neglect;
this would involve population-level activity as well
as targeted support, drawing more on data of need
and focusing on social determinants of neglect.
3. Support for families where neglect has been
identied should not focus exclusively on
parenting. Local commissioners and service
leaders should ensure therapeutic support and
interventions are also provided to help children
and young people recover from the impacts of
neglect.
4. Access to support is all too oen predicated on
thresholds, which can be a barrier to families
receiving the early help neglected children and
their families need. Service leaders should
consider redesigning service pathways and routes
to support, drawing in particular on the expertise
of family support and community-based services.
In designing pathways, attention should be paid to
the potentially inhibiting issue of stigma.
5. The care system must place the wellbeing of
looked aer children, including recovery from past
trauma, at the centre of all processes and decision-
making. This will include prioritising permanence
(love, security and a sense of belonging) and
children’s relationships with those close to them.
Including young people systematically in future
research and practice development would support
this aim.
6. Multiple placement moves for children in care
should be all but eliminated, given the long-
term harm they can cause. When moves are
unavoidable, their impact must be mitigated – for
example, by keeping the child in the same school
and making sure they retain the same key worker
(or other permanent gure).
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 30
7. Professionals across the multi-agency workforce
need support to help them identify and respond
to emotional neglect in particular, an oen hidden
form of maltreatment that can have far-reaching
impacts on a child or young person’s life. Routine
well-being checks exploring the child’s perspective
on their emotional wellbeing would support this.
8. Eorts must be made to increase the visibility of
fathers in practice, policy and research around
neglect. Too oen mothers are the focus; this can
mean the risks and protective factors that fathers
bring to a child’s life may be missed. Local service
leaders can enable this through policy review and
practice audits.
9. Local areas should ensure that there is a strategic
overview of the collective endeavours of all
agencies to address neglect. Plans should be
informed by the expertise of all relevant agencies
and by children and families themselves.
10. Policy, research and frontline practice do not
always recognise and respond to the specic
needs of particular groups aected by neglect and
sexual harm – including LGBT, BME, or disabled
young people. Local service leaders should review
whether support available needs to be tailored,
drawing on the experience of children and families
from these groups.
Research in Practice | NSPCC | Action for Children
Exploring the relationship between neglect and child sexual exploitation: Evidence Scope 1 31
Author: Elly Hanson
Edited by: Steve Flood and Dez Holmes
Thanks to the following people for their support, challenge and wisdom;
their input has been invaluable to us in producing the series of scopes:
Joanna Adler, Anna Banbury, Helen Beckett ,Martin Calder, Jane Dodsworth,
Brigid Featherstone, Carlene Firmin, Nathalie Fontenay, Ruth Gardner,
Colin Green, Sarah Harris, Nick Marsh, Kate Mulley, Donna Peach and
Lorraine Radford
Exploring the relationship
between neglect and
child sexual exploitationn:
Evidence Scope 1
www.rip.org.uk
Research in Practice
The Granary, Dartington Hall
Totnes, Devon, TQ9 6EE
tel: 01803 867 692
email: ask@rip.org.uk
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Totnes TQ9 6EL
... And it can also push girls to seek this praise through 'initiating' sexually explicit conversation or images. When a girl's self-esteem has been already been undermined by earlier childhood experiences, such as neglect or abuse, her need for affirmation is likely to be further heightened, which may lead to more serious or risky attempts to meet it, such as offering sex for money which is made much easier online (Hanson 2016;Jonsson et al., 2014;Svensson et al., 2013). More generally, a variety of mainstream social media platforms make it straightforward for children and adolescents to have sexual communication with people they have met or become familiar with online, placing no or only minor obstacles in the way of vulnerability meeting exploitation. ...
... Further discussion of adolescent-centred practice, that understands and works with their agency, can be found inHanson and Holmes (2014). Also for discussion of therapeutic work with victims of CSE where there is an online element, seeHanson (2017b), and where there might be risk of further revictimization seeHanson (2016). ...
Chapter
Full-text available
The central theory presented in this chapter is as follows: the ideology of cyber-libertarianism, combined with organizational social processes and the impact of power, have contributed to tech corporations acting in ways that facilitate child sexual exploitation (both directly and indirectly), and relatedly, have contributed to online spaces and processes being understood and approached as freer from social and moral concerns than others. Four key (interrelated) online routes to increased CSE are highlighted involving: a) online sex offending psychology, b) the online porn industry, c) online ‘escort’ agencies, and d) the interaction of social media and gaming platforms with adolescent developmental proclivities.
... This result may be reflecting the fact that this type of sexual abuse is more probable among children and adolescents who lack supervision from an adult. It has been stated that neglected children, due to unmet needs for affection or basic physical needs -such as shelter or food-, are at risk of getting involved in dangerous relationships (Hanson, 2016). ...
Article
Most adolescents in residential care have been through severe forms of victimization within their household. However, it is frequent to experience multiple forms of violence, and peer victimization is one of the most prevalent during adolescence. Trauma caused by interpersonal violence can have damaging effects on children and adolescents' health and psychosocial wellbeing. The present study aimed to measure lifetime prevalence and frequency rates of child physical and emotional abuse, neglect, domestic violence, and several types of sexual and peer victimization among adolescents in residential care. Additionally, victimization across contexts and effects of gender, age and immigrant status of the family (local vs. immigrant) were analyzed. Participants were 107 adolescents in Spanish residential care, aged 12–17 (Mage=15.16 years). Data was collected using thirteen items of the Juvenile Victimization Questionnaire self-report. Results indicate that over 75% of adolescents have suffered victimization by peers and siblings, over 65% have suffered child maltreatment, over 50% have witnessed family violence, and over 40% have suffered sexual victimization. Gender and immigrant status correlates show females and immigrant-family females reported higher prevalence of sexual victimization than their counterparts, and that immigrant-family adolescents reported higher rates of physical abuse, domestic violence, and peer assaults. Remarkably, few age effects were found. Moderate associations were found between child maltreatment, and peer and sibling and sexual victimization.
... Many of the above forms might also be termed 'technology-assisted child sexual exploitation'. There are ongoing debates and complexities involved in the definition of sexual exploitation and how it can be differentiated from other forms of sexual abuse (Hanson, 2016a). However, this report is focused on the broader issue of child sexual abuse (CSA), incorporating CSE. ...
Research
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- Impact of child sexual abuse - Impact of online sexual abuse - also known as technology-assisted sexual abuse - Young people's views of professional responses to abuse - Young people's views on how sexual abuse could be better prevented and responded to - Dynamics of online sexual abuse
... Various models attempt to account for the inter-relationship between the resulting mediating variables such as isolation, withdrawal from education, low self-esteem, depression, anxiety, drug/alcohol use, post-traumatic stress disorder (PTSD) and distorted sexual development (Hanson, 2016;Allnock, 2016;Lalor and McElvaney, 2010;SBNI, 2014;Chase and Statham, 2005). ...
Research
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This is the latest evidence scope in child sexual exploitation, originally written and published in 2015 by RiP. It was revised by Jessica Eaton in September 2017 and published by RiP in October 2017 to reflect the evolving understanding and evidence in child sexual exploitation practice and theory. It is open access and owned by RiP.
Article
There is ample evidence that neglect is the most commonly experienced form of maltreatment for children and young people of all ages, but practice and research on neglect have tended to focus on younger children. New research studies have begun to highlight the particularly harmful effects of neglect between the ages of 11 and 17, suggesting that there should be a greater emphasis on improving understanding and responses for this age-group. This paper outlines research findings, including from recently-published work, and explains how fresh insights can support better policy and practice. It will be of interest to professionals in operational and strategic safeguarding roles.
Chapter
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This chapter considers risk factors and contexts for children and young people experiencing abuse and significant harm, with a focus on clinical approaches to understanding and preventing re-victimisation following childhood sexual abuse. Processes contributing to re-victimisation are discussed, including psychological, systemic and societal factors. Assessment approaches and clinical interventions to prevent further sexual abuse and exploitation are suggested, in line with the evidence-base and clinical practice developments that support individual children and young people, parents and caregivers and their wider systems.
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