Within the entire data set we identified 13 critical incidents. Of these, nine had a direct or indirect relationship with PHN practice, while four related to personal, rather than professional experiences. To retain the integrity of data, we have presented the nine critical incidents in full in this section. For the sake of readability, critical incidents have been subject to minor editing and ‘cleaned’ for grammatical clarity. In addition seven participants gave valuable insights into the issue of sexting as a hypothetical concern (reported elsewhere) but they were unable to relate the issue directly to practice by way of example. As an important finding in its own right, this reveals a gap in many PHNs’ role in dealing with the issue.
Normalisation and trust
The first four incidents capture how a ‘normalisation’ of sexting takes place in what young people considered trusting relationships (Participants 3, 5, 6 & 9). PHNs also discuss the impact of national media reports on their knowledge acquisition in this regard.
Participant 3
This is how little I know! But I do remember there was a case [published in the press] and he was charged with the offence… It’s probably something I’ve only heard on the news; a few cases that have made my ears prick up. When you first mentioned it, I don’t think I’d heard of it and I’m probably more aware of it because you’ve been doing a study on it. As a family nurse I think I should be. I don’t think I’ve ever talked about sexting.
Interviewer: If you think back to the case that you mentioned in the press, what was your reaction when you first heard about it?
It was quite shocking to be honest… I thought you could see how young people could get into this without really realising the extent of how it could end up and not understanding it really. That’s where the education comes in from the teachers and professionals because [to young people] it’s all a bit of a laugh… We don’t want to normalise it do we? It’s interesting. We were talking about sexting earlier with colleagues and some had never heard of it at all. My knowledge feels very scant, but I think, only because probably you’re doing this study and I’ve heard it also mentioned a couple of times on the news, that it made me really think about it, so it’s been a good, positive outcome really.
In contrast to Participant 3, who felt that young people might trivialise the issue of sexting as a normalised feature of their intimate relationships, Participant 5 used discussions about trust and relationships to discuss sexting with one of her female clients. For her, the risks associated with sexting were around being let down within a relationship, and exploring power and control within intimate relationships.
Participant 5
[One young girl] shared with me when we were talking about trust, I think, or relationship stuff, she was able to say, ‘well actually I did have a partner who I thought I could trust and… he shared these pictures with his friends and what have you’. She didn’t do anything about it so it never went anywhere. She’s never done anything about it. I guess I empathised with her in the first instance and then said, ‘That’s not right’, and tried to get her to think about if it was an equitable relationship or whether there was power and control in there. But she didn’t want to do anything formally about it… but she was talking about it, ‘Yes it was really rubbish… why would he do that if he said he loved me?’ … She’s one of my least complicated clients but she just trusted this chap who let her down big time.
Interviewer: When you reflect on it now, would you have done anything differently when she told you?
I don’t think so… I left it with her, left it open that if she wanted to talk about it again we could explore it further if she felt the need. But she hasn’t done. No I don’t think I would do anything different other than maybe knowing what to do: To be able to say: ‘Actually if X happens, you go to Y’, or those sorts of things because really, when talking about that bit, I was just blagging [making it up].
Similarly, Participant 6 also discussed the risks of sexting as being about a genuine relationship going wrong, with young people not foreseeing the potential outcomes when this occurs. This participant suggested sexting is a normalised ‘culture’ among young people and educational interventions need to deliver strong messages that convey how sexting can ruin lives.
Participant 6
We’ve had quite a lot of child protection cases going on where young people who have been 16 years old have texted something to somebody who was 15 and this has led them to be on a child protection plan… when actually, it was just a genuine relationship that has gone wrong with sending images of each other and parents have seen those images... I think that because they were so young it was like, ‘Oh, really? You complete idiots! Fancy doing that to yourselves’. But it’s their culture isn’t it? In this day and age this is how they feel they have to communicate. I haven’t had any real conversations with him [the boy involved] because he’s been dealing with other agencies…They [young people] don’t understand the consequences even though you talk about somebody being of a legal age and somebody not, it doesn’t come to the front of their minds, [they think] ‘that’s my girlfriend, we are in the same year at school, what can be so different about us?’ You can’t do a lesson plan for an hour because they’ll switch off after 10 min. We need something that they’ll pick up on at the beginning that says: ‘It could ruin your life if you do x, y and z’.
Participant 6 had some experiences of child protection involving sexting that had led her to think about best practice. She made some judgments about how harms could have been avoided although she had not spoken with those involved. She suggested a need for tailored educational interventions, although she had not yet followed through. On the other hand, participant 9 had undertaken direct conversations with the young people involved:
Participant 9
It’s not just been one family I’ve worked with, it’s happened a few times: One of the first families that I came across… it was an opportunity to really talk to the client [young girl] about the importance of not having these images to start with and how dangerous they can be. She was able to reflect on the impact it already had on her life and her circle of friends and her family, all from enabling pictures to be taken and that kind of involved, you know sexting. It was an opportunity to get the client’s understanding of what it was and how severe things can go and she had quite close friends and they all started to kind of realise how important it is not to allow partners or whatever to have these images of them to start with, so that they’re not in that situation. But other people may well think this is still quite normal. It’s definitely - she [young girl] certainly told me at the time that it’s really made her think very differently to how she uses pictures.
This report of a conversation in practice demonstrates shared learning that led to a change in a young person’s perspective of harms involved. A further important theme links to young girls described here as being particularly 'vulnerable' to child sexual exploitation. This finding was perceived by PHNs to be due to the girls’ having additional learning difficulties (Participants 14 & 17) or learning disability (Participants 7 & 13).
Vulnerability and child sexual exploitation
Child sexual exploitation (CSE) is associated here with sexting behaviour. Two PHNs identified child protection needs which suggested a normalisation of high risk sexual behaviour among vulnerable, young, learning disabled girls. This was expressed to the point of PHNs being ‘unsurprised’ by the girls’ graphic sexual detail of encounters with men who they perceive as boyfriends. Participant 14 identified her educative role in supporting a vulnerable 13 year-old girl to stop sharing intimate selfies, while participant 17 describes the feeling of helplessness in addressing the issue.
Participant 14
There was a family where the children would always come back into Child Protection [the attention of social services] through neglect. The daughter in that family, she probably had borderline learning difficulties. My involvement with her began when it came to light that she was using Facebook and sharing everything and she had requests to show pictures of herself in her underwear… and she did. She was 13. Thankfully it came to light at school and school involved everybody appropriately. I became involved around educating her about how to protect herself; how to help her with understanding about relationships and what’s appropriate to share and what isn’t appropriate to share.
Interviewer: When you first heard about that what was your initial reaction?
Horror really! I thought she’s really at risk… I was really frightened for this girl because I knew the parents didn’t have the wherewithal [to educate and protect her]. I was very worried about her safety really… In some ways this girl was in a good position because her family were definitely on the radar with school because her parents were well-known to school…. My worry would be for a child whose family aren’t on the radar… So my worry would be for another child.
Participant 17
A young person disclosed to one of the members of staff that she had some explicit images of herself and she’d sent them to somebody. And an image had obviously been shared by lots of people so we were involved at that stage with kind of child protection issues… I was surprised a little bit but.... You get used to what they’re telling you… you get to the stage where perhaps nothing surprises you quite so much. We had another young girl. She’s got learning disabilities and she was going on the internet and she was meeting… well, she thought they were her boyfriends, she thought she was in a relationship… It’s very difficult, you know. We’re supporting her and trying to advise her and also school were aware of what she was doing and they were trying to support her about not doing it. But she thought she’d met the love of her life and it was like, you know, ‘this is my boyfriend’. But she hadn’t even seen him face-to-face… But she had got some learning needs so we were involved with her on the edge of the child protection arena you know? [Unfortunately, when she was 17] she disappeared and they didn’t know where she’d gone and she did actually go to meet one of these men down in London. So… she hasn’t actually learnt and she’s obviously a very vulnerable young lady.
The predatory nature of sexting and the grooming that can take place was evident in the incidents reported by the following three participants (Participants 7, 10 & 13):
Participant 7
I’m aware that I don’t know an awful lot about it and I haven’t had an awful lot to do with it, but I have had a couple of incidents with indecent images of girls being, for want of a better word, blackmailed. One incident I’m particularly thinking about it was like a young girl, sort of year 8 [12–13 year-old] and she had a year 10 boyfriend [14–15 year old], who wasn’t a particularly nice guy and who said to her, if I remember this to be correct that, unless she took a photograph of her genitals and sent them to him on Facebook, he was going to tell everyone that she had sex with him. So of course she did that. But he felt the need to pass it on to other people anyway. One particular young man who was year 11 [15–16 year-old] then said to her, ‘I know where you live and unless you agree to have sex with me, I will come round to your house and tell your mum’. This girl, fortunately for her had a really good friend and her friend took it into her own hands and went to the head teacher and then of course it was taken up from there and the parents were involved. It might come across as sounding naive but you would hope that they wouldn’t be so cruel at that age wouldn’t you? At first, I thought, ‘Hold on a minute’, because I didn’t expect it in one so young. I thought they’d pick on girls who were maybe aged 14, you know? I was shocked. I was angry. It was a little bit odd because she didn’t seem too worried about it. Her friend seemed to be more worried about it than she was. I don’t know whether that was something to do with her learning abilities or not, to be honest. But I just thought how vulnerable did that make that girl or, ‘you’ve done this now’, you know, she’s allowed herself to be blackmailed... It scares me because we try and protect them but I’m thinking it’s so difficult to protect them from this sort of thing, isn’t it? If you tell some young people about these sorts of dangers it’s all, ‘Yeah, we know about that’. They all feel that they know a little bit about it. I think sometimes it’s done so insidiously, it’s grooming isn’t it? I feel that there must be something that we can do to protect them from this and I don’t know what that is, you know? It makes me cross because it makes you feel helpless doesn’t it so far as that’s concerned.
Participant 10
It’s something I haven’t really thought about a lot until recently. One of my caseloads involved with CSE (child sexual exploitation), made me start thinking of sexting, because at a meeting it was brought up that this young girl was actually sending photos of herself and being videoed, so I think I’ve only really become aware of it in the last few months.
Interviewer: How did you react, what was your reaction when you heard about what this young person was doing?
Quite shocked! The police were saying they’d seen the videos and that she obviously was giving consent and in the other videos they feel that she wasn’t, so the police said that they struggle whether they can prosecute because they don’t know where they stand and that’s really hard, because to me, that girl needs support and help. It’s grooming, isn’t it?
Interviewer: So how do you think you can best take it forward or support that client?
Discussing with her what she was thinking when she sent them. Was she aware that they could be passed on? The girl’s saying that she didn’t know some of them were taken, so I would try to find out what she means and explore it more and I think to me, trying to make our clients aware that they might be in a relationship, they are sending these texts out, but what happens if that relationship breaks down? Where are they going to go then?
Participant 13
I’ve had one [young girl] where he was getting her to send pictures of herself and he was actually a paedophile and he was grooming her… it is all exploitation… It’s a massive issue and with these girls or even boys, they’ll carry that with them for the rest of their lives, so it could start triggering depression, anxiety, suicidal thoughts, it’s a massive mental health issue…It’s awful. I was really angry because I knew the family fairly well and she’s clearly got a disability, a learning disability, so she’d been exploited… I knew that she had quite a high sex drive, so she was frequenting sex telephone lines and other things, so I was horrified by the fact that this man could happily exploit this girl to get her to send images of herself … To this day, I wouldn’t know whether she is aware that what she did was wrong… She is 14, maybe 15 years old and she’s got a very high sex drive, which is very common within this group. She was seeking out her sexual fantasies through these chat lines… These men will pick them out, they just know. They, they can see the vulnerability and they just draw them [young girls] in and he gave her a lot of attention, because she was very attention seeking. [The problem is] we don’t want them [young girls] getting pregnant, we don’t want them making relationships with these men, that creates trouble for them and they end up getting into violent relationships and that sort of thing.
In these latter critical incidents, while talking about the grooming of young girls with learning disabilities, the PHNs’ discourse of normalisation shifts to talking about sexual harm in a way that could be construed as blaming. Some of the judgments about normalisation and vulnerability relating to sexual behaviour reflected PHN beliefs and attitudes about sexting as a feature of youth culture. The focus on the predators is relatively absent or abstracted, except when young boys were involved, perhaps reflecting PHNs’ lack of knowledge about the harmful intimate relationships the girls were involved in outside of school or in their local communities. In considering best practice these incidents raise questions about perceived vulnerability to child sexual exploitation and the PHN role in identifying and responding appropriately to sexting as a signifier of harmful sexual behaviour. The incidents demonstrate occasional PHN attempts to address the issue, and suggests the limited capacity of PHNs to raise their concerns about sexual predators identified or associated with children and young people’s sexting.