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sexually exploited children are among
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the most vulnerable people in our
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society yet we're still not doing enough
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to identify and prevent exploitation
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from happening Healthcare professionals
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need to be aware of the indicators of
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child sexual exploitation then use their
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professional curiosity to explore
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whether intervention is needed
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child sexual exploitation more commonly
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referred to as CSE which is what health
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professionals may hear more commonly is
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a form of child sexual abuse it's a
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contact or non-contact with a child and
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there are various models of CSE and so
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you may read in the papers about CSE
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Rings taxi drivers and employees those
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sorts of things but also there is the
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boyfriend Model A lot of research is is
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focusing on sort of the teenage age
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group from about 13 to 15 16 but I think
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we actually really don't know the true
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size of the children young people that
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could be at risk of CSE it can affect
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boys or girls it's um not relevant to an
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ethnic background or a religious
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background it's pretty much any child or
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young person could be at risk of CSE
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Nikki was a victim of CSE for many years
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the impact on her life has been
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devastating
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it was um very violent towards me there
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was many times when I tried to get away
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from him you're cut off from from
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everybody else whether it be your family
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your friends my abuser got me involved
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in a lot of criminal activities so I
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couldn't tell the police what was going
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on
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I have tried to take my own life I've
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got an eating disorder it's affected my
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parenting you know the amount of damage
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it's done and it'll it'll never be
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undone
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Healthcare professionals have the power
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to prevent a situation like mine ever
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happening again that one phone call that
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I take a few minutes could actually save
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a child's life
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children who are being sexually
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exploited almost invariably have contact
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with Healthcare professionals however
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they rarely complain of the abuse that
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they're being subjected to
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the following scenarios are all
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fictional they'll help you identify
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indicators of CSE and recognize when
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they might be part of a more serious
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picture I need them on an afterpill
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please we got a bit carried away last
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night okay do you want to go through
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into the consultation room it's fine I'm
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in a bit of a rush actually I've heard
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it all before cannot just fill the forms
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out here no I'm afraid we need to have a
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talk in private it won't take long this
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is ridiculous I really am in a rush it
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won't take long if you could make your
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way through please thank you
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so it's been 12 hours since you had
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unprotected sex
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how old are you
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16. well 16 next week actually
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do your parents know you've been having
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unprotected sex
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you really ought to discuss it with them
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you know tell my parents are you having
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a laugh
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first off they're not my real parents
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they're my foster parents and I can't
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tell them this happened a couple of
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months ago and they went nuts they said
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they kicked me out if it happened again
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look we're usually really careful made a
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mistake you know
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In the Heat of the Moment
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I just need that
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um elephant
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I can't have a baby look before I can
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prescribe you anything I need to make
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sure that you understand the advice that
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I've given you
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and you really should be more careful I
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know I'm not a baby look I've got the
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money I can pay can we just hurry up
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with this please
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we're nearly finished
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what a waste of time just to get a pill
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right take that straight away
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and I'd like you to read this please
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that'll be 34.99 please
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what
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yeah
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there you go nice phone
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yeah mint in it my boyfriend got it for
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me
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thanks a lot I'm sure I'll be more
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careful
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this situation would leave many people
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feeling uncomfortable
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but how many of the indicators of CSE
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did you see
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who is the older man with Claire
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why didn't she want to go into the
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Consulting room
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how can you be sure how old she is
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she's taken the morning after pill
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before
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living with foster parents indicates
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that she is vulnerable
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The Knowing look to the pharmacist is
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inappropriate for her age why did the
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text cause Claire so much concern her
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boyfriend has given her an expensive
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present and phones are often used to
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control victims she clearly has easy
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access to cash for a 15 year old girl
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and why isn't she at school
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we wasn't aware that we was actually
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being groomed we just thought these
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people our boyfriends but there was a
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lot of professionals that looked at it
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as a it was my boyfriend and I was just
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a naughty school girl that that wanted
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it and what professionals need to be
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doing is asking children questions you
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know if they would have said to me have
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you got a boyfriend I'd have said yeah
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how old is it he's 24 and our audio I'm
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14. so straight to it that that should
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be acted on it should be reported
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professional curiosity is something that
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Health practitioners have innately
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within them if for some reason you feel
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uncomfortable or suspect that something
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is going on it is your duty as that
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practitioner to ensure that you seek
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advice and guidance on the next steps
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come
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hi Claire been a while hasn't this
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two years and look at you now
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well we need to do your booster jab you
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missed it last month when I was here
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I was off sick I kept getting tummy ache
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but I'm better now so they said I had to
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come back into school
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that doesn't sound too good what was
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causing it I don't know it just went
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away by itself
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sometimes I wish I still had it so I
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didn't have to have stupid injections
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and new pointless exams where you might
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not like this but I can promise you that
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dip theory of polio and tetanus are far
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worse than exams you don't have any
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allergies
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okay pop your sleeve off for me please
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what you're going to do after your gcses
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to now moving in with my boyfriend now
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let's promise to take care of me
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but you didn't give a damn about GCSE
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how did you get that
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oh it was calicato she was slagging my
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boyfriend off and I just wasn't standing
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for it
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she's a right [ __ ] she won't be doing
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it again
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well you may be older but not any wiser
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small scratch the school nurse is busy
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and frustrated by Claire missing her
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appointment she also knows that Claire
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has been in trouble in the past however
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she may have missed a number of CSE
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indicators what's the real cause of
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Claire's tummy ache
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he seems to look very grown up all of a
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sudden those look like track marks that
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Claire was hiding when she was rolling
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up her sleeve
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could there be another reason for the
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bruising on her arm and what's the real
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cause of her rebellious disruptive
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behavior
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I think for for me professionals would
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have been able to spot it quite easily
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and what they need to be looking out for
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is changes in Behavior you know it could
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be a person withdrawn themselves
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skipping school gifts for markings
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because I was beating you know had
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bruises and things that's all things
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that they need to be looking out for
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it's unlikely and when a child or young
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person is accessing services that they
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are going to disclose straight away that
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they are either suffering or at risk of
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CSE often children young people don't
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realize they're being exploited it's
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about building the relationship with the
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child or young person to gain their
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confidence so that they feel able to
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disclose to you potentially what's
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happening to them and they're trusting
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you that you will be able to help
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protect and support them
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foreign
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looks like you've had a good night
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have you been drinking taking any drugs
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oh I do like commenting uniform
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what are you doing next time
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I could be your nurse ambulance
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she already
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well it's safe to say she's overdone it
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mate do you know where or what she's
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been drinking what she's been taking I
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haven't got a clue I was just passing I
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was worried I could see she was
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unconscious nasty
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he was like that water didn't you
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'll give us some more snack baby and
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I'll do anything you want me to
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take a photo yeah yeah
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going from Good Samaritan to Smart
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dealer in two seconds
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she looks just like that girl we picked
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up do you know outside the block of
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flats and the Dempsey estate last week
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I guess you best leave this one's the
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professionals I
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swear guys
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I'll try and get any ID on there and the
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phone's locked but I mean it's not been
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a good night's sleep well so
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I'm just worried about these cups on
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their arm
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I'll have to take her in then
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these kids don't know how much they cost
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the NHS for their binge drinking I
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reckon we should charge them then they
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think twice if I die in a bottle of
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vodka and a load of ecstasy
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paramedics treat drunk teenagers
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regularly and it's easy to think of them
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all as being the same but remaining
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Vigilant is crucial in spotting CSE
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why is Claire so inappropriately
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sexually aware for her age is Andrew all
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he appears to be and why was he so quick
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to leave
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why was Andrew's photo on the home page
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of Claire's phone
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she's clearly drinking heavily and is
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taking drugs the second paramedic has
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seen her recently and she appears to be
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self-harming
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there were times when I used to slit my
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wrist just for Relief I think really it
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just feels like you're kind of getting
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away off of your shoulders I was
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provided with drugs and alcohol so I
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think you know any of those signs a
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professional needs to be picking up on
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that what we need to ensure from a
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health perspective is that all staff are
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equipped to be able to recognize the
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indicators of CSE and when a child is at
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risk of CSE particularly for staff
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working in emergency services Sexual
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Health Services School nursing and GP
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practices and pharmacies because these
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staff are potentially more likely to
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come into contact with children
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experiencing or at risk of CSA
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hi Claire how are you I'm Rachel what
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can I do for you today
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I need some condoms please I can't keep
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taking the morning after Bill how many
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times have you taken it and why are you
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having unprotected sex it can be really
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dangerous you know
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if I've taken it three times now I think
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it might be making me ill
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I keep getting tummy ache you know
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down there
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is there all the time
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it's really getting me down
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have you been tested for STIs
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no
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my boyfriend says he's clean and he
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doesn't want me to
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it dumped me if you knew I had an STI or
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couldn't have sex with him you really
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should be on your phone in here Claire
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would you mind switching it off and
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putting it away I really need to know
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that you concentrating I'm listening
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right what does it matter if my phone is
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on or off
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it's on silent
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I'm worried about you
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will you let us test you for STIs look I
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just want some condoms I didn't come
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here for a lecture if I'd wanted that to
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gone home okay Claire
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I know you're upset and of course you
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can have some condoms
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but you really need to think about being
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safe yeah and here's another leaflet
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again just giving me the condoms will
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you
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the clinician is finding it hard to
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remain patient with someone who doesn't
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seem to want to help herself
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CSE victims can be very challenging so
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you should see this frustration as an
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indicator in itself why is Claire's
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self-esteem so low what's the real cause
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of Claire's pain and why isn't she
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getting it treated why is the phone such
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a big issue could there be someone
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listening in her moods are swinging
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alarmingly quickly
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and she appears to be unstable and very
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vulnerable
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there was a lot of occasions when I'd
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use that phone so he could hear
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everything that was going off in the
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rooms when I was 14 and 15 and being
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abused I was an absolute [ __ ] now I
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went from this this young girl that was
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confident but kind polite and had
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manners to all of a sudden wanting to to
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kill anyone that came near me and I
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think professionals when they they see
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this naughty kid and you know a kid that
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they can't handle it's easier just to
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say do you know what I can't deal with
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it and walk away from it and you can't
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do that it can be frustrating to a
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Frontline practitioner if this childhood
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young person is continuing to present
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and not listen to their advice or take
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on board their support it's our role as
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health practitioners to see beyond that
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stroppy teenager and actually see the
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child and young person behind that and
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what's causing that behavior if you're
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concerned about a child you're treating
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you must contact your local safeguarding
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team
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to my knowledge in in the UK a
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professional has never lost their job
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for reporting child abuse but there's
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been many that have lost their jobs for
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not reporting it if somebody would have
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spotted it earlier on it could have
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prevented such a lot I wouldn't have had
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the sexual and physical violence of
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things my family would have been ripped
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apart I would have had an education I
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wouldn't have any any sort of my entire
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life would have been different
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if you're dealing with children as a
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healthcare professional always remember
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the child and look beyond their behavior
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consider why they're behaving like this
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always listen to what the child is
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telling you
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don't dismiss what a child does tell you
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be professionally curious if the
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situation doesn't look or feel right to
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you then it probably isn't
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if in doubt always seek advice and
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support from your line manager or
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safeguarding lead
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and share information
