Question: Is it possible to reduce the risk of harm when using CSE resources such as short films and theatre in education performances?Answer: Yes.This article highlights how the risk can be reduced by providing a harm reduction framework, sharing testimonials from experienced practitioners, and highlighting feedback from clients, service users and children and young people.

Whilst exploring this issue I believe it's important to adopt a balanced approach that makes use of common sense and highlights not only the potential risks of using such resources, but also the potential benefits.

What are the potential risks?
Arguably the biggest risk when it comes to using CSE resources is that the viewer may a) experience significantly distressing emotions and physical sensations (often referred to as trauma) and/or b) be triggered intore-experiencingsignificantly distressing emotions, thoughts and physical sensations that occurred at, or around the time of any previously experienced trauma (often referred to as re-traumatisation).These triggers can, and should, be managed!subsequently reducing the risk of harm.

Triggers
A trigger is often referred to as something that that causes trauma or re-trauma and can come in all shapes and sizes.The reality is that there's no such thing as a risk-free intervention and there are no therapeutic approaches that are absolutely guaranteed not to trigger.Anything we do or say with a victim of abuse has the potential to trigger re-trauma!a particular smell, a certain image, a specific sound etc.There are many things.However, in my experience re-trauma is more likely to be triggered by something unexpected rather than a carefully introduced and appropriately used CSE resource.

I once worked with a man who was sexually abused as a child.When he attended his first counselling session, he knocked on the door and when I answered, I immediately noticed the look of horror on his face."No," he quivered, shaking his head, "Sorry.No.Just no." He then turned around and quickly left.It transpired that I was wearing something that reminded him of what his perpetrator wore at the time of the abuse.The client returned, we explored this issue, and once the therapeutic relationship was established and we were a few sessions into counselling the client viewed a CSE resource.He explicitly said that seeing me in my jumper was significantly more traumatising than watching a ten-minute film.This is one of many examples that perhaps highlight how abuse victims are more likely to be triggered by something unexpected rather than a carefully introduced and appropriately used CSE resource.

I have worked with clients who had a panic attack when they started talking about their abuse but didn't have a panic attack when they watched a CSE resource.I have worked with those whose trauma was triggered by the sound of a door slamming, bins being collected and belts being buckled, all of which were linked in some way to their experience of abuse.They never felt distressed when watching a CSE resource.

Different triggers for different people
It's important to highlight that what triggers one person won't trigger another.Not all viewers of CSE resources will experience them as traumatic and not all CSE victims will experience re-traumatisation.We are all different.What one person experiences as traumatic, another person may experience in a completely different way.Of the CSE victims who do experience re-traumatisation, many, depending on the severity of the experience, are able to self-manage their reactions.Whilst some victims will suffer with stress, anxiety, panic and depression etc.many more individuals will exhibit resilient responses.The impact of trauma can be subtle, insidious, or outright destructive.How a traumatic event affects an individualdepends on many factors, including characteristics of the individual, the type and characteristics of the event(s), developmental processes, the meaning of the trauma, and sociocultural factors.

In the mid-nineties when I was in my early teens, I remember watching an episode of EastEnders where the character of Grant Mitchell was visited by his friend Dougie who developed an unhealthy interest in Grant's wife Sharon.The scenes that followed included Dougie going through Sharon's drawers, touching her underwear, smelling her perfume and watching her while she was napping on the sofa.Further scenes showed Dougie giving Sharon a menacing look and locking the living room door as Sharon looked scared.We then saw Sharon's friend Michelle, bursting into the living room to find Dougie on top of Sharon as she screamed and tried to get free.I remember thinking, ‘Oh my God, he's trying to rape her.' Grant then appeared, and a fight broke out between him and Dougie which led to Dougie holding Grant, Sharon and Michelle hostage at gunpoint.Grant had blood running down the back of his neck, Sharon had ladders in her tights and all three hostages looked terrified.As the scenes progressed, Dougie shot Michelle who was quickly taken to hospital by Grant and Sharon.Whilst some may describe the scenes as traumatic, did I feel traumatised?No.I remember thinking how awful it must be for Sharon who was nearly raped, and for Michelle who was shot.

A 2018 articlehighlights how the nineties cartoon ‘The Animals of Farthing Wood' "traumatised us for life." I was a huge fan of this show and I still have the Hornby figures that I received one Christmas when I was a child.Yes, the show certainly didn't shy away from violent encounters between the cartoon foxes or from brutal deaths such as the baby field mice being impaled, but I never once felt traumatised or distressed to a level that was concerning.In fact, I remember when the hedgehogs were run over, and when the character of Badger died of old age, I wasn't traumatised!I was sad.

These examples highlight how it's possible for children to watch scenes that could be described as traumatic, without experiencing a concerning level of distress.Is my experience unique?Unlikely.There are arguably a lot more people who watched ‘The Animals of Farthing Wood' who weren't significantly distressed by watching the show, compared to those who were.We need to stop bandying the word "trauma" around when it would sometimes be more appropriate to use other words such as "upset" or "sad," and we shouldn't assume all children will respond traumatically to potentially traumatising material.

Now to be fair, I have never been held hostage, shot, impaled or run over unlike the characters highlighted above.Would I have felt differently watching those programmes if I'd have experienced what the characters in the shows had experienced?Possibly, but it's not a guarantee.In 2003 I was raped on a night out in Leeds.A few weeks later I moved to Coventry and rented a house with my partner at the time.I remember one evening we were at home with some friends watching a film.The film showed a female character being raped by a number of men.I remember feeling upset and thinking about what happened to me but I did not experience a concerning level of re-trauma.There were similarities between how the character in the film was raped and how I was raped, but there were also significant differences.Whilst some abuse victims experience significant distress when seeing something that reminds them of their abuse!some don't.We are all different.

Significant distress is not guaranteed
Colleagues and I, along with many other professionals have used CSE resources for many years, delivering them to tens of thousands of children and young people via one-to-one support and in educational settings across the country.The overwhelming majority of children have not expressed or reported any significant distress.If the risk of children experiencing such distress as a result of watching a CSE resource was high then we'd all know about it.Large amounts of children would be expressing distress, teachers en masse would be sharing their concerns, huge numbers of parents and carers would be complaining and the media would be highlighting how thousands of children across the country are becoming traumatised.This is simply not happening.

In nine years of using CSE resources in schools, and in twelve years of using them during one-to-one work I have never been informed of a viewer experiencing significant distress.I have delivered CSE sessions to thousands of children across dozens of schools, and not once has a teacher contacted me after, to say the children were traumatised or significantly distressed.I have worked with large numbers of children and adults who experienced recent and/or historic abuse, and of those who viewed a CSE resource not one has ever told me they felt traumatised or significantly distressed as a result of watching the resource.Not one.Clients have explicitly told me that watching the resource didn't trigger any distress as they knew it wasn't real and/or the story was slightly, or in some cases very different to their own experience.I've known of more children wetting themselves and passing out during biology lessons when teachers have talked about the inside of the human body, than I've heard of children passing out when they've watched an educational CSE resources.My experience is not unique.Many practitioners across the country have used CSE resources for a number of years and report similar experiences.

I have seen children becoming upset and expressing sadness and mild discomfort but this is not significant distress and it is certainly not trauma.If you see something that makes you feel sad, it is perfectly normal to express that sadness.

Whilst it is of course possible that when watching a CSE resource someone can become distressed, and a victim can become re-traumatised, the above anecdotes perhaps highlight how this possibility is rather low.This possibility is reduced further when the resources are used carefully.

In the small number of examples where I have heard of children watching a CSE resources and becoming significantly distressed, this has usually been due to an inexperienced practitioner not using the resources appropriately, and harm reduction methods being implemented poorly or not at all.It's the inappropriate use of the resources that cause harm rather than the resource itself.

We can't and shouldn't stop using interventions, resources and therapeutic approaches because they have the possibility of triggering re-trauma.That's not reasonable.If we do that there won't be any interventions, resources or therapeutic approaches left.However, what is reasonable is to promote the safe and appropriate use of resources in a way that manages triggers and reduces the risk of harm.

A useful comparison?
Eye Movement Desensitisation and Reprocessing (EMDR) therapyhas been empirically supported by randomised control trials, is internationally recognised as an effective treatment for trauma (Shapiro, 2018)[1], and is recommended bythe National Institute for Health and Care Excellence (NICE)who also highlight its effectiveness in treating trauma.During EMDR therapy it is not uncommon for clients to experience distress, however Francine Shaprio, the founder of EMDR, highlights thatEMDR does not cause the client's distress – it simply releases it(Shapiro, 2018).With this in mind it is perhaps reasonable to say that for many people, viewing a CSE resource does notcausedistress, it simplyreleasesexisting distress that may be suppressed and unprocessed.

While there are situations where it would of course be inappropriate for someone's unresolved and suppressed trauma to be released, there are other circumstances where the release of such trauma can be beneficial and worked with effectively.Can or should someone with unprocessed trauma keep it suppressed until their dying day?Can or should they really spend the rest of their life avoiding potential triggers?I'm not sure it's possible or realistic for someone to always avoid triggers, but I certainly think it's possible and a lot more realistic to explore triggers, manage responses and utilise safety strategies to reduce the risk of harm.

During EMDR therapy (in fact during any therapy) clients may experience the same or similar distressing emotions, thoughts and/or physical sensations that they experienced at or around the time of their abuse.EMDR therapy refers to these responses as abreactions (Shapiro, 2018).So, why do we allow therapy that has the potential to re-traumatise clients to still exist?There are three points to remember.First of all, re-traumatisation and abreactions aretemporary.Shapiro (2018) highlights that an abreaction will certainly not last as long as the original traumatic experience, and I often tell clients who suffer from panic attacks that while they are distressing at the time, they are temporary.No one is having a panic attack today who started having one yesterday.The brain eventually figures out that the response is not needed.Second of all, trauma and re-trauma aremanageable.There are plenty of proven strategies that can help manage and reduce the intensity of re-traumatisation and traumatic responses!bilateral stimulation, breathing exercises, left brain thinking exercises and mindfulness.Potential traumatic responses can be managed and should be worked with and focused on, not avoided. Third of all, if we provide psycho-education around trauma and re-trauma, it cannormalisethe client's situation.Isn't it normal to feel distressed when you panic?While I do not want to minimise the effects trauma can have on a person, I think it's important to remember that traumatic responses are temporary, manageable and normal.

Simply put, the reason EMDR and other therapeutic approaches are still used is because they work.The risks of harm are managed, the positives arguably often outweigh the negatives and any traumatic responses (if they occur at all) are responded to with proven safety strategies via an established therapeutic relationship.This practice can be duplicated when using CSE resources.

Fear, misunderstanding and assumptions
While discussing and exploring this topic I have found that a number of professionals are scared.They are not necessarily scared of using the resources, they are scared of working with trauma, specifically in-the-moment traumatic reactions.It is important that any professional working with trauma is appropriately experienced and competent to do so.Trauma should not be labelled as bad or as a good.Black-and-white thinking should not be applied.Trauma, instead should be viewed as something that can be worked with.Many people who have experienced sexual trauma are often triggered by various factors.If practitioners are scared of working with trauma, they may require further training, support and supervision.

I once attended a conference as a keynote speaker where I shared my own experience of CSE and adult rape.While the presentation is rather hard-hitting (which professionals are warned about beforehand) I remember one practitioner who approached me after I delivered my presentation and told me how it was too "full on" and that she experienced trauma.I asked her to tell me a little more about what she experienced.It became clear that she hadn't experienced trauma at all!she'd experienced sadness and upset.This left me wondering how many other professionals could be labelling such experiences as trauma?

If professionals (who may be the first person a child discloses to) feel significantly affected by an adult sharing his experience of CSE and adult rape, years after it occurred at a professional conference, perhaps they should reflect on how they may feel and respond if a child discloses abuse and goes on to give a detailed account of what they experienced.

It's also important that assumptions are not made.Just because an adult may feel uncomfortable watching a CSE resource does not mean a child or young person will.There is great psychological and neurobiological variability in how people respond to traumatic events.While a significant minority of trauma victims develop symptoms that markedly interfere with their capacity to function,the majority of people are largely psychologically resistant or resilient to the negative consequences of trauma.

What are the potential benefits?
While it may be difficult to evidence a long-term positive outcome as a result of using a CSE resource (especially with large groups of children) the truth is that the use of CSE resources can and does contribute towards something positive, and we can certainly more readily and perhaps more effectively measure and assess the immediate impact that viewing the resource has had on the viewer/audience.

First of all, a number of disclosures have been made as a direct result of children and young people watching abuse storylines in soaps and viewing CSE resources.A 2012 articlehighlights how a rape victim stayed silent about his abuse for over a decade but decided to seek help after watching a storyline in Coronation Street featuring the character of Carla Connor who was raped by her jilted ex-lover.

In 2016 I was involved in the development of CSE resource‘Alright Charlie'!a 15-minute video funded by the Department of Education (DfE), aimed at primary school children in years five and six.Primary schools in Derby successfully used the film with both pupils and parents.Feedback illustrated that the resources were found to have been effective not only with pupils but also with some groups of parents who had found the film and accompanying resources had helped them understand the risks and challenges their children faced online and in the real world.A short video highlighting feedback from children, teachers, parents and carers can be foundhere.

In 2017 pupils from one Derby school actively protected their friend, worked as a group to stay safe and sought out staff to disclose the inappropriate behaviour of a male in a local park.They explained that they knew what to do as a result of seeing CSE resource ‘Alright Charlie.' A sex offender was subsequently recalled to prison for breach of license, andthe school was commended by the Independent Chair of the Derby Safeguarding Children Board.Local press later highlighted thatfour men who exploited vulnerable girls for sexual gratification were caught when one of their victims saw a filmwarning how children can be groomed without realising it is happening.

Following the 2018 Coronation Street male rape storyline, theNational Male Survivor Helpline saw a 1700% increase in calls.A 2019 articlehighlights the benefits of soaps addressing issues such as rape, and includes one survivor who commends how soaps challenge the myths surrounding sexual violence, and how they can help to reduce the shame and stigma felt by survivors.The survivor goes on to say that even though some scenes are uncomfortable to watch, if it helps just one youngster and leads them to speaking up and getting help, then surely, it's worth it.

A 2019 articlealso highlighted how a boy told his friends about the abuse he suffered after attending sex education lessons at school which made him realise that he was the victim and that the man who raped him was the offender.The boy's friends persuaded him to tell his parents, who called the police.

All Things Considered Theatre!a theatre in education company, have created‘Tomorrow Night'!an interactive performance funded by The Big Lottery Awards for All aimed at engaging young people in debate and conversations about CSE and grooming.I spoke to Artistic Director Emma Bramley, who told me that numerous disclosures have been made by those who engaged with the piece.

When a CSE resource is used to aid (rather than replace) discussion it can not only provide young people with the facts, but also challenge beliefs and dispel myths around CSE.A 2019 report by the Victims' Commissioner for England and Waleshighlights how a play addressing CSE and coercion was not an easy watch but was viewed with keen interest by children.Emma Bramley also told me how the discussions that took place around the theatre in education piece also addressed myths.Emma highlights that many young people thought CSE involved being snatched and taken away in a white van and that others wondered if a boy being abused by a man made the boy gay.Emma also told me that a large number of young people believed "the two-year rule" (where a young person can have a partner as long as the age gap is not larger than two years) was law.

I have used visual CSE resources since 2009 in a variety of settings.I have found that they not only help to dispel myths, increase understanding of grooming, and aid discussion around CSE and other related issues, they can also help children recognise inappropriate behaviour displayed by adults.I have used resources in a way that contributes to increasing children's empathy, reducing their feelings of guilt and increasing their ability to process their emotions.See feedback from clients and young people at the end of this article.

Whilst the appropriate use of CSE resources can contribute to achieving a positive outcome and the inappropriate use can contribute to a harmful outcome, it's important to remember that the use of CSE resources can also have zero effect on children and young people with some not experiencing a positive or negative impact.

How should wenotuse CSE resources?
One way we should absolutely not be using CSE resources is to give children the message that they are to blame for their abuse.I've heard examples of children who have experienced CSE being shown a CSE resource and being asked by a professional what the victim in the film could have done differently to "prevent their abuse." While language like this is clearly inappropriate it could be argued that practitioners who use such language and work in such a way will do so with or without a resource to aid them.Nevertheless, we should not be using resources to directly or indirectly give victims the message that they are responsible for their abuse.Blame for the abuse should sit solely with the perpetrator and the appropriate use of resources can emphasise this.Thankfully many resources include characters explicitly saying that the victim has done nothing wrong, such as‘Alright Charlie'by The BLAST Project and ‘Sick Party' by Basis.

Using resources to explore different choices available to children should not be something that is automatically viewed as inappropriate.The context should be considered and appropriate language should be used.If, through one-to-one work and the use of a CSE resource a child decides to stop visiting the house of an adult who police have serious concerns about, this is a choice the child has made that increases their safety.If the work around this has been done sensitively with the appropriate use of language and in a way that avoids blaming or judging the child, how could this ever be viewed as something bad?A boy once told me that he believed the world would always have "dirty old men" in it who would be willing to pay boys like him for sex.This boy was offering sexual acts to men in exchange for money on a weekly basis.While of course we need to understand this boy's background and what led him to this point in life, focusing on just the perpetrator(s) was never going to work but using a resource within a trusting relationship to focus on other options available to the boy, did work.A resource cannot be blamed for poor practice or good practice.It can be used toaidgood and sadly poor practice.

Howshouldwe use CSE resources?
Notice that the heading here doesn't sayshouldwe use CSE resources, it sayshowshould we use them, clearly implying that they can be used appropriately, which I hope this article has highlighted.The DfE's 2019 statutory guidance on relationships and sex education(RSE) states that pupilsshouldknow the concepts of, and laws relating to, sexual consent, sexual exploitation, abuse, grooming, coercion, harassment, rape etc.It goes on to say that grooming, sexual exploitation and domestic abuse, including coercive and controlling behaviour, should also be addressedsensitivelyandclearly.While children can be educated on these issues without the use of CSE resources, a visual resource can arguably be used in a way that addresses these issues sensitively and clearly.

Practitioners should consider how such resources may, or may not be appropriate to use to highlight certain points and to aid discussion.In a 2019 articleJim Gamble, Chief Executive ofIneqe Safeguarding Groupand former Chief Executive ofthe Child Exploitation and Online Protection Command (CEOP)highlights that when it comes to abuse we need to educate and empower children, giving them the right information.Used appropriately CSE resources can be used to educate and empower, and a visual resource arguably helps to explain

When educating young people on CSE, consideration should be given to methods used.Anecdotal feedback from professionals suggests that young people like something visual to engage with.A 2017 reporthighlights how we can better protect children and young people through awareness-raising and resilience building work, and goes on to highlight that when educating children around CSE the evidence base highlights important principles, including making use of all potential avenues of communication.

The use of CSE resources can be likened to soap storylines that also highlight various aspects of abuse.Commenting on the 2019 Emmerdale storylinewhere the character of Maya groomed and abused her boyfriend's teenage son, Barnardo's CEO, Javed Khan highlighted:

"Addressing these topics in the classroom will help keep children safe and healthy, and prepare them for challenges on and offline.We know from our specialist work on child sexual abuse across the country how important it is to teach children and young people about consent, healthy relationships, how to spot the signs of abuse and how to ask for help."

Fans of Emmerdale expressed concern over the grooming storyline butJaved explained that the plot was vital to raise awarenessof the reality of the situation for many young children in the UK, highlighting:

"This storyline about an adult woman grooming and abusing a boy may be uncomfortable viewing, but the issue is very serious and often misunderstood."

It's important to highlight that considerable thought should go into the creation and development of CSE resources.Artistic Director Emma Bramley from All Things Considered Theatre told me that before the launch ofCSE play ‘Tomorrow Night'one and a half years of research took place which included talking to a number of young people affected by CSE.Emma reports that young people who have viewed the play said that the interactive method was helpful and made it "real".When making CSE resource‘Alright Charlie'children, primary school teachers, experienced CSE practitioners and child psychologists were involved in the consultation process, and many other CSE resources have been developed in consultation with victims and trauma informed professionals.

It's also important that professionals have the relevant knowledge needed when using CSE resources.Scott et al (2019)highlight that it is crucial that practitioners undertaking direct work with exploited young people have a thorough understanding of attachment and trauma.They also highlight that long before the term "trauma-informed," was used, professionals in a range of services were instinctively acting in a trauma-informed manner.However, those who are not trauma informed should ensure they undergo appropriate training and increase their knowledge prior to using CSE resources and delivering any trauma focused work.In some cases, it may be appropriate for other, more experienced professionals to deliver such work.

Consideration should also be given to the establishment and maintenance of the therapeutic relationship when using CSE resources during one-to-one work.Much has been written about the importance of the therapeutic relationship in counselling and psychotherapy.The principles underlying a good therapeutic relationship (realness, acceptance, empathic understanding and trust)[2]can be applied during one-to-one work with children and young people who have experienced CSE.

A vast amount of research and reports addressing various aspects of CSE have highlighted the importance of a good professional relationship between practitioner and child.A 2019 report by The Centre of Expertise in Child Sexual Abusehighlights that features of effective practice include providing trauma-informed services that are sensitive to the needs of children and offering a range of age appropriate interventions.The same report states that service users highlight a number of important factors including being given clear information, feeling valued and listened to without judgement and having access to long-term support, with time to build atrusting relationshipso that full engagement and participation was achieved.

Bovarnick et al (2017)highlight that CSE work with young people tends to involve six core elements of direct work, one of which includes engagement andrelationship building.They also highlight that CBT and EMDR have a robust evidence base in effectively addressing the treatment of trauma symptoms in children and adolescents and thatrelationshipsare key to engagement which contributes to the foundation of direct work.

Hallett et al (2019)highlight that positive outcomes can be achieved through ensuring young people have arelationshipwith a significant adult and through ‘direct work'.Regarding the impact of interventions used with young people, Hallett et al (2019) also highlight that having a supportive adult had the most positive results, with a positive impact for the young person in 66% of cases.

If a therapeutic relationship is established and maintained during one-to-one work, this can be used as the foundation on which further work, including the use of CSE resources, if appropriate, can be built upon.

What about using resources with groups and large audiences?
There are differences between how a resource can be used with a child/young person during one-to-one work and with young people in groups and large audiences.One of the biggest differences when using CSE resources with groups and large audiences is that it's unlikely that the facilitator will be able to establish a therapeutic relationship with every audience member due to time restraints and large numbers.This may be possible when using CSE resources with smaller groups that engage in weekly sessions but it's more or less impossible when delivering a one-off session to a large audience.However, this doesn't mean a CSE resource can't and shouldn't be used!it just means that additional care needs to be taken and that more thought is needed regarding delivery and safety measures.ThePREPAREDframework below will provide guidance in how to lower the risk of harm when using CSE resources and also address how to manage the differences between using CSE resources during one-to-one work and with large audiences.

A rapid evidence assessment released by The University of Bedfordshire et alhighlights that a whole school approach, integrating CSE prevention across the curriculum, is shown to be an effective model for school-based prevention, andSharp-Jeffs et al (2017)highlight that an educational environment where there is a ‘whole-school' approach to addressing gender inequality, sexual consent, and relationships built on respect should be developed.Beckett et al (2017)also highlight the need for adopting a holistic approach:

"Risk of child sexual exploitation should be addressed as part of a wider programme of work on sexuality and sexual development, choice and consent, healthy relationships, harmful social norms, abusive behaviours and online safety.This should build on existing initiatives (around online safety, for example) and ensure messages dovetail across these different programmes of work.Educative work should engage both boys and girls and should address both risk of perpetration and risk of victimisation (and the potential for overlap)."

It's clear that children need to be educated around CSE and other associated issues and while there are various methods that can be used to provide such education, anecdotes, feedback and the number of disclosures suggest that the use of visual aids such as educational CSE films and resources can be an effective method for engaging children and young people in discussions around these issues.

When using CSE resources as an external practitioner with large audiences in educational settings it is important to have the full cooperation of those who have requested the input (usually a teacher within the educational setting).Be clear on what you are offering and have a mutual understanding of what will and will not be delivered.If it is not possible for the teacher to view the resource prior to the children viewing it, spend some time explaining the content of the resource to the teacher, with particular focus on what some may refer to as the more uncomfortable moments.I would recommend having a written agreement between the external practitioner and the teacher who requested the input.The written agreement should contain important terms including what the external practitioner expects of the school such as the need for all students to be clearly informed of the session topic and the "uncomfortable" content of any resources used a number of days prior to the session taking place.An agreement should also highlight the importance of students being given the option to decline attending the session.Discussions should also take place between the external practitioner and the teacher requesting the intervention regarding student safety including what harm reduction strategies and supportive measures are in place during and after the intervention.See ‘PREPARED framework' below.

PREPARED framework

Scott et al (2019)highlight that trauma-informed care is an approach to service delivery that weaves trauma knowledge and sensitivity into existing actions and models in a way that minimises negative effects of the intervention, and increases the likelihood of meaningful engagement and effective implementation of other models.Scott et al (2019)also highlight that all trauma-informed practice is grounded in creating safety and trust, promoting control, building resilience and empowerment, and prioritising self-empathy and self-care.The aim is to provide young people with a sense of control and hope.The PREPARED framework also adopts the principles of this approach.I have used this framework during one-to-one work with children and young people in counselling and other therapeutic/supportive settings and also when using resources with groups and large audiences of young people.

I developed the framework based on CSE research (some of which has been referenced in this article), knowledge from significantly experienced practitioners, my own experience of using CSE resources with children and young people for over ten years, ethical guidelines and most importantly common sense.Whilethis framework has not been academically researched or empirically tested,I have found it to be a useful and effective tool in the preparation and delivery of using CSE resources.

Purpose
Resilience
Ensure suitability
Provide safety
Agreement
Robust introduction
Educate appropriately/Ensure appropriate use
Debrief

Purpose

Know the reason why you're using the resource, and the outcome you are hoping it will achieve.

Important questions to ask before using a CSE resource are!what are you hoping to achieve by using it?What is the purpose?What is the outcome that you hope it will achieve or contribute towards achieving, and how will you measure this?It's important to identify an outcome that isrealistic,appropriateand ideallymeasurable.Increased knowledge about CSE, grooming behaviours, safe relationships, the laws surrounding CSE, local support services and the effects of CSE could all be classed as appropriate outcomes.

An Independent evaluation of Rape Crisis Scotland's sexual violence prevention projectdelivered in schools showed that as a result of attending workshops, the vast majority of young people increased their knowledge of how sexual violence and abuse can affect people, what the law says sexual violence is and where people who have been raped or sexually assaulted can go for support.Whilst increased knowledge can be measured via the use of evaluation forms, it is argued that increased knowledge is not a true outcome as it does not evidence a behaviour change and that increased knowledgecontributestowards achieving an outcome but in itself is not an outcome.

Even if this is the case, it doesn't mean we shouldn't be giving children this knowledge.They may use the knowledge that very day, they may use it later in life, they may never use it at all and we may never find out whether or not they have used it.Surely, it's better to give children the knowledge and never know the difference it might make, rather than not give children the knowledge at all simply because it's difficult to measure the impact?Let's think about subjects taught in school.Most of us are taught subjects like Maths, English and Science.Some aspects of these subjects are never retained in detail and may never be used in later life, but it doesn't mean we shouldn't be taught them.Surely the purpose of being taught these subjects is to have as much knowledge as possible to increase our future prospects.Perhaps it's the same regarding CSE awareness sessions and the use of CSE resources?

Perhaps a more measurable outcome can be the number of disclosures made as a consequence of using CSE resources, something that has occurred as a direct result of using short educational films and theatre in education pieces.Whilst this outcome will only apply to a number of children, other outcomes could include changes made to social media settings, and increased communication with parents/carers about whereabouts etc.Whilst these outcomes are more realistically quantifiable and applicable to more children, they are still not easy to measure, especially when working with groups and large audiences.Perhaps a more realistic and measurable outcome would not be children making these changes, but howlikelythey are to make these changes and, as highlighted previously, how much their knowledge has increased.

The purpose for using a CSE resource should be appropriate, realistic and ideally measurable and achievable under the circumstances e.g.a resource could be used to increase a child's awareness of inappropriate behaviour displayed by adults.This is an immediate outcome that is appropriate, realistic, measurable and achievable.This can also be achieved during one-to-one work, group work and CSE awareness sessions to large audiences.This immediate outcome can also contribute to other long-term outcomes later in the child's life such as avoiding adults displaying unsafe behaviours and making disclosures.You may be able to measure these outcomes if you are still working with the child.It is also important to clearly tell the viewer/audience what the purpose is of showing them the resource and what you're hoping it will achieve.See‘Robust Introduction'below.

Notice, the title of this article is ‘Reducing The Risk Of Harm When Using CSE Resources' not ‘Achieving positive outcomes when using CSE resources'.Whilst this is an area that needs to be explored further and has been touched upon here, it is not within the remit of this article to explore this in detail.

CSE awareness work often comes under the heading of prevention and whilst it is difficult to evidence that something has been prevented, it is not difficult to evidence that we care.This is perhaps arguably one of the most important outcomes to achieve.

Resilience

Ensure the viewer/audience is resilient enough to deal with the more uncomfortable parts of the resource.

The practitioner who is showing the CSE resource should always ask themselves if the viewer/audience is able to cope with what could be described as the more uncomfortable parts of the resource e.g.a perpetrator approaching a child as the music starts to sound more sinister!men unbuckling their belts as they approach an unconscious boy.During one-to-one work the practitioner should ensure they have established a good therapeutic relationship with the child ensuring they have enough knowledge about the young person to make an informed decision about how well the child can cope with the more uncomfortable parts of the resource.What does the practitioner know about the child's history and background?What support networks have they got in place?What coping strategies do they utilise?A discussion should also take place between practitioner and child.

It is much easier and much more achievable to assess the resilience of one child during one-to-one work than it is to assess the resilience of dozens of children who are attending a CSE session and watching a CSE resource as part of a large audience.In this instance the practitioner should discuss the issue of resilience with those who requested the intervention.In the absence of being able to establish a therapeutic relationship with all audience members the practitioner should spend time with the person who requested the intervention discussing the implementation of robust safety strategies, harm reduction methods and access to support.See ‘What about using resources with groups and large audiences?' above and‘Provide safety'below.

Ensure suitability

Make sure the resource is suitable for the viewer/audience.

We should not lump all CSE resources together.They are all developed in different ways by different people.The content contained within one CSE resource can vary significantly to the content contained within another.Some theatre in education plays contain aggressive shouting whilst others do not, and whilst there are no educational CSE films that show illegal sexual imagery, there are some films which contain content that is more hard-hitting than others.e.g.footage of a topless man from behind persistently thrusting himself into a girl he has pinned up against a wall.Personally, that's not something I would use with children who are in primary school as I would deem that content to be inappropriate for that age group but I would certainly use a resource such as‘Alright Charlie'with children who are in primary school.The only part of the resource that could come close to being called hard hitting is when a topless Danny (the perpetrator) approaches the camera with a towel around his neck, a menacing look in his eye and an intimidating tone in his voice as the music begins to sound slightly more sinister.Primary school children certainly watch a lot worse on TV shows and YouTube channels that are actually aimed at children and young people.

In recent years soaps have highlighted various rape and sexual abuse storylines, and just like the vast amount of CSE resources, the scenes do notshowactual abuse occurring, theyimplythat abuse has occurred or will occur.In a 2018 articleKate Oates, producer of Coronation Street made the following comment about the storyline where the character of David Platt was raped;

"If you actually watched the episode it wasn't shocking at all, what you saw was David Platt who has had a complicated life, become friends with someone, put his trust in somebody, who put a drug in his drink, and then you saw a door closing."

What we interpret as adults, is not necessary the same interpretation a young audience will have.When making CSE resource‘Alright Charlie'children were showed the scene where, after grooming Charlie, the perpetrator, Danny approaches Charlie in, what many professionals have described as, a rather sinister way.After this scene children were asked what they thought happened and the responses varied.Some thought Danny was going to sit down and have a pizza with Charlie because that's why Danny invited Charlie round to his.

Practitioners using a CSE resource with a child during one-to-one work should ensure they are familiar with the content and watch it before showing it to children.They should consider if the content of the resource is similar to the child's situation and whether or not the child is likely to respond to this in a positive or significantly distressing way.

Anecdotal feedback from boys has suggested that when using an educational CSE film containing a female victim, boys disengage, but when using a resource containing a male character, both boysandgirls engaged.See‘A note on boys and young men'below.

Practitioners should assess if the resource is appropriate for the child's age, developmental age and the situation they're in e.g.It would clearly be inappropriate to show a 10-year-old child who was recently sexually abused and who you have only just met, a short film showing hard hitting scenes.There would be no clear purpose to do so and it's unlikely that a therapeutic relationship would have been established.

If the resource is being used with larger audiences in a school, the external practitioner should ideally show the resource to the professionals such as the safeguarding lead and/or the teacher who has requested the session.These professionals are likely to know the audience a lot better than the external practitioner and will be able to provide information that can help in making an informed choice about the suitability of the resource.If the resource cannot be viewed by the safeguarding lead or the relevant teacher, the practitioner should give them an overview of the resource and explain to them what might be considered to be the more uncomfortable parts.

If you are ever unsure about the suitability of a resource, speak to colleagues and get advice from experienced practitioners and also professionals who know the child/children you are planning on using the resource with.

Provide safety

Have safety strategies in place to reduce the risk of harm, and manage any traumatic responses.

Increasing safety and reducing the risk of harm come under the heading of ‘Providing safety' which is one of the most important part of the framework.Certain safety strategies may never need to be used but it is important to have them in place.Large children's charities are regularly using CSE resources but are doing so in a way that makes use of safety checklists.I have seen such checklists and have been informed of how CSE workers are using them when working with educational CSE films.

Shapiro (2018) highlights the importance of safety factors being present whilst EMDR therapy takes place and also when assessing the client's readiness and ability to uncover and withstand the information before the processing of the trauma begins.

During one-to-one work the practitioner should assess what coping strategies the young person already has and makes use of when things become too much, as well as including the young person in discussions about what else might help them manage any potential distressing responses.When introducing an educational CSE resource I generally find that most young people say "I'll just tell you to turn it off if I don't like it." A young person has never asked me to turn off an educational CSE film but they should always have the option.Some young people use words to inform us they feel uncomfortable and others use a signal such as raising their hand or tapping their shoulder.If children can't or won't use a signal, the practitioner should look out for any signs that the child may be experiencing significant distress.

EMDR makes use of safe places which are used to help the client feel safe if they become distressed.Before EMDR processing begins the therapist asks the client to imagine a safe place and then invites them to close their eyes, imagine the safe place and notice how their senses respond to it.The therapist asks the client to come up with a word that represents the safe place such as "home" or "bedroom".If the client says this word out loud or says or signals ‘stop' during the processing of trauma, this lets the therapist know that the client wants to stop, prompting the therapist to ask the client to close their eyes and imagine their safe place.Encouraging children to imagine a safe place can also be used if the child is becoming distressed when viewing an educational CSE film.

Another safety technique is the use of a ‘safe object' where a young person simply holds on to an object that helps them to relax and feel safe.This technique is also used during EMDR and can also be used when using CSE resources in one-to-one work.Mindfulness techniques, bilateral stimulation and breathing exercises can also help to make young people feel calm and safe and it can be useful for the practitioner to be familiar with these methods prior to using a CSE resource.One session with a young person could even explore safety techniques, harm reduction methods and coping strategies before any decision is made as to whether or not to use a CSE resource.

The establishment and implementation of safety strategies and harm reductions methods are arguably even more important when using CSE resources with large audiences.The number of individuals present make it difficult to build a therapeutic relationship with each child and, as highlighted previously, assess their resilience.Before an educational CSE resource is shown to a large audience, the facilitating practitioner should engage in detailed discussions with those requesting the intervention.As highlighted previously it can be useful to have a written agreement in place that contains important terms and conditions and is signed by those requesting the session.The external practitioner may find it useful to explicitly discuss elements of the agreement specifically concerned with safety.This ensures those requesting the intervention fully understand the importance of the need for these elements to be implemented.Such elements can include giving students a clear explanation of what the session is about and the content of the resource (including the more uncomfortable parts), a clear option to decline attending and details about immediate access to support during and after the session.See ‘Agreement', ‘Robust introduction'and ‘Debrief' below.Spending some time talking with the teachers can be incredibly useful as they are more likely to know the audience a lot more than the external practitioner, and  are more likely to be able to provide guidance on the most appropriate approach to take, possibly including which CSE resource to use and how to use it.

I have worked with schools where they have signed the agreement but implemented none of the safety strategies, harm reductions methods or support plans.The sad reality is that some schools will sign agreements and not always read them so the external practitioner delivering the CSE session should always ensure that the person requesting the intervention has explicitly confirmed that all strategies around increasing safety, reducing harm and providing support contained within the agreement will be actioned and in place.In the unlikely event that a child watches a CSE resource and becomes significantly distressed the facilitating practitioner and/or another appropriate professional should immediately and competently make use of such strategies.

Agreement

Make sure the viewer/audience has consented to view the resource.

Informed consent should always be obtained from the viewer/audience before showing the resource.If a child doesn't want to watch a resource and they are forced/pressured to watch it, after they have explicitly said "no", this highlights a problem with the practitioner, not the resource.

The viewer/audience should be informed of why the resource is being shown (see ‘Purpose'), the nature and content of the more ‘uncomfortable' scenes (see ‘Robust Introduction') and they should be given a clear option to grant or refuse consent to watching the resource.

Many children who have experienced CSE often feel that they have never had a choice, so giving them a choice now, after a therapeutic relationship has been established can be incredibly empowering.A 2017 reporthighlights that research has found that the voluntary sector effectively engages with children and young people by building trusting relationships and giving them choices about what support they received, resulting in abused children and young people feeling a sense of control.

Simply put, if factors highlighted in this article are present and the child has been given all of the relevant information, and they consent to viewing the resource, use it.If factors highlighted in this article are present and the child has been given all of the relevant information, and they do not consent to viewing the resource, do not use it.

It's important to let the child know that even though they may have given consent, they can change their mind at any time and say that they no longer wish to view the resource, even if viewing of the resource has already started.

It's also worth noting that if a child declines to view the resource this may be an indicator that something has occurred or is occurring in the child's life that may need further exploration with a view to the child being offered appropriate support.

When using a CSE resource with a large audience, participants should also be informed of why the resource is being shown (see‘Purpose'), the nature and content of the more ‘uncomfortable' scenes (see‘Robust Introduction') and they should be given a clear option to grant or refuse consent to watching the resource, but unlike during one-to-one work, this should be donedaysprior to the session taking place.This gives the young people time to think about how they might feel viewing the resource and to decide if they can manage any potentially distressing reactions they might experience.Due to time restraints, practicalities and the likely absence of a therapeutic relationship between the external practitioner and the young people who make up the audience, the external practitioner cannot appropriately obtain consent from each individual child, but the school can.It is arguably easier for young people to say they don't want to watch a resource with a practitioner they have built a good relationship with during on-to-one work than it is during an assembly in front of their peers with an external practitioner they don't know.

Working with the school to give the children all relevant information, along with an easy ‘opt out' or ‘opt in' option can help children make an informed choice whilst also making it easier for them to decide whether or not to take part.It's arguably easier for young people to refuse consent days before the resource is shown than it is to stand up during the viewing of the resource and walk out.Some young people have however stated that even if they did feel significantly distressed watching the resource, being in a large audience made it easier to hide their distress.Whether this is seen as something positive or negative depends on your perspective.Either way, whilst the resource is being used in schools with large audiences, a number of teachers should be on hand to help manage any unexpected responses, and notice any reactions displayed by children that may require support and/or further exploration.

Whilst it is unlikely that children in large audiences will stand up and leave if they are told that it is OK to do so, they should still be given this option just before the resource is about to be shown on the day, along with the easy ‘opt out' or ‘opt in' option, a number of days prior.

Robust introduction

Ensure a clear and robust introduction of the resource takes place, including the explanation of the more uncomfortable parts, prior to showing the resource.

Whilsttrigger warnings have been highlighted as being trivially helpfulat reducing negative mood and intrusive thoughts, the use of a robust introduction can help young people make an informed choice as to whether or not to view the resource.Some practitioners introduce CSE resources clearly and carefully whilst others sadly give little or no thought to the introduction or use of resources at all.

Prior to showing the resource it should be introduced to the viewer/audience in a clear and robust manner which includes a number of elements.As highlighted under‘Purpose'the practitioner should inform the viewer/audiencewhythe resource is being shown to them along with theoutcomethey hope it will achieve or contribute towards achieving.Contentshould be explained, especially content that could be described as uncomfortable and/or distressing to watch.Supportshould be made available during and after the session (see‘Debrief') and the viewer/audience should be made aware of this.Safetystrategies should be highlighted and explored, and the viewer/audience should be encouraged to make use of existing safety strategies that may already use when things get tough.It's also important that the viewer/audience knows that they can change their mind at any time and inform the practitioner that they want to stop viewing the resource.

As already highlighted, children and young people who are watching a CSE resource as part of a large assembly are unlikely to stand up half way through the resource and walk out as this will perhaps draw unwanted attention, although they should still be given this option.For this and other reasons mentioned in this article, it is important that when using CSE resources with groups and large audiences, the above elements of a robust introduction should feature in apre-introductionphase.This should occur a number of days prior the scheduled CSE session and can take place as a small part of an assembly, during registration in class and/or via a letter that is sent home.The pre-introduction phase gives children the opportunity to ask questions and address any concerns before deciding whether to not to attend the session.

Before showing the resource I usually tell young people that they have the right to this information, and the right to feel safe.I explain that people value and care about them which is why the session is taking place.I find that this usually elicits a positive response.Sometimes the only thing a child may take away from a CSE awareness session is knowing that people care about them, and perhaps sometimes that's enough.

Educate appropriately/Ensure appropriate use

Make sure the resource is used appropriately and that the message conveyed is also appropriate.

I was once told how a professional used one particular CSE resource with a child and asked her if she thought the character in the short educational film would have been raped if she'd have worn a longer skirt.I am sure we can all agree that this is rather poor practice but the blame sits firmly with the professional here, not the resource.

When using CSE resources we should ensure we are using them appropriately.What does this mean?It means using them to aid discussion not replace discussion!it means using them to give children the message that they are never to blame for their abuse and that the blame always sits with the perpetrator!it means using them to focus on the perpetrator's behaviour not the choices made by the victim!it means using them to inform abused children that they've done nothing wrong.Scott et al (2019)highlight that facilitators need to be prepared for possible disclosures and to keep in mind that the message about not being to blame is particularly pertinent for children who have been or are being abused.

During my discussion with Emma Bramley, Artistic Director from All Things Considered Theatre, she highlighted that all plays should not be lumped together, highlighting that CSE play ‘Tomorrow Night' includes 20 minutes of performance and 40 minutes of discussion, providing an opportunity for debate and for young people's beliefs to be challenged.Emma believes that there's no point in giving young people information if you can't talk about it which is why she questions how valuable the information is if it can't be discussed and explored.

Thought should also be given to practicalities around how the resources is used.Sometimes when showing an educational CSE film the stop-start method is used where the film is paused at certain points and the practitioner asks relevant questions.Sometimes the film is played from start to finish with a discussion taking place after, and sometimes a number of young people who have viewed the resource can become characters who featured in the resource and answer questions put to them by other young people and answer as though they were the character.This method is often referred to as ‘hot-seating'.Practitioners should ensure they are appropriately experience and competent to facilitate the chosen method.

Debrief

Ensure a debrief takes place with the viewer/audience after the resource is shown.

Debrief means ensuring that the viewer/audience has access to information and support after the resource has been shown.Whilst, in my own experience, many will not make use of such support, it is important that it is available.

During one-to-one work this can include discussing the resource with the young person after they have viewed it to see how it has left them feeling and/or signposting them to websites, services and other places where support and information can be accessed.

Scott et al (2019)highlight that resources need to be carefully considered for their potential to trigger distress and that sessions should only be delivered when follow up support is easily available for children.A decent amount of time should be made available for a debrief to take place.This is even more important when using a CSE resource with groups and large audiences.A debrief can take many forms!the provision of a room where practitioners are placed to offer information and support to young people, and a period of time where questions can be asked and information on other sources of support and information can be shared etc.

Teachers and other professionals can also be included in the debrief.Emma Bramley, Artistic Director from All Things Considered Theatre, told me that once she and her team have delivered the CSE play ‘Tomorrow Night' a debrief takes place a) immediately after the session where feedback is given to teachers and b) at a later date where a return visit is made offering a debrief and support.

A note on boys and young men
As someone who specialises in working with males it would be remiss of me not to briefly mention resources in regards to boys and young men.

In 2019Barnardo's commissioned researchwhich found one in five UK adults thought an older woman sexually abusing a boy was less serious than a girl being groomed by a man.When I spoke to Emma Bramley of All Things Considered Theatre she told me that an emerging theme from the CSE play ‘Tomorrow Night' was that there was mass confusion regarding the fact that women can groom and abuse boys with not one young person (and some teachers) knowing that boys can also be groomed  and abused.Young people thought that boys could and would physically fight back and some asked how it was physically possible for boys to be abused.Interestingly, young people believed that women who groomed and abused boys did so because they were lonely, perhaps highlighting that young people don't perceive female perpetrators in the same way they perceive male perpetrators!something that could be addressed using CSE resource‘Brandon's Story'which depicts a woman grooming and sexually abusing a boy.The use of visual aids such as educational CSE films, resources and theatre in education plays can be used in a way that aids discussion around gender stereotypes and myths associated with male victims, and female perpetrators.

WhilstScott et al (2019)state that CSE education programmes need to make clear that boys and young men can experience sexual abuse and exploitation, and that it's not only something that girls experience it, they also highlight how research suggests that children may feel more vulnerable in mixed sex classes and that content needs to challenge attitudes around gender and relationships that underpin harmful behaviour, in ways which involve, rather than alienate boys.

Scott et al (2019)also highlight that some evaluations have found lower levels of engagement from boys where materials were inappropriate or assumed boys had problematic attitudes.Interestingly the ‘Excellence for Boys' Project (The BLAST Project, Yorkshire MESMAC)[3]showed that boys preferred CSE awareness sessions to be delivered by specialist workers rather than teachers they already knew in school.The project also highlighted that case studies and examples used within CSE awareness sessions should include both boys and girls.Findings from the project also showed that when sessions were delivered to mixed groups using a resource with a female character, boys disengaged, however, when the resource had a male character, both girlsandboys engaged.

Conclusions
Whilst it may be difficult to evidence a long-term outcome of using CSE resources there is no denying that such resources have contributed towards positive outcomes such as offenders being identified, children being supported and knowledge being increased.It is hoped that this article has not only highlighted how it is possible to use CSE resources in a way that significantly reduces the risk of harm to the viewer, but has also provided enough information for practitioners to make an informed choice about the use of CSE resources and consider making use of the PREPARED framework.

Feedback from children and young people

Below are comments from children and young people who have viewed resources.

"My social worker made me watch that film and I really didn't want to see it.I told her no but she just wouldn't listen.It was strange cos she told me how important it was for me to say no if I didn't want to do something, but I thought, what's the point in saying no if you're not going to listen.The film was alright but I didn't really want to see it."
Client JB

"Watching that film didn't traumatise me.I knew it wasn't real.It was a film!It was being raped by all those men – the real stuff.That's what traumatised me.I supposed the film helped me realise that this can happen to anyone and that it doesn't mean there's anything wrong or abnormal about me."
Client BP

"It's like when you watch Comic Relief and see all those children dying of starvation.You feel sad when you watch it but you're more affected when you're actually there.Seeing that film was a good thing cos it meant I could talk about what happened without being in it."
Client JT

"Just listening to someone gets really boring.If we watch a film or play it's like watching YouTube and then you can talk about it after."
‘Milo'

"Watching the videos did help me see the wider scenario when, at that time, I was more focused on my own mind set and my own view.As I progressed through the various stages of legal and personal development of the cases, some of the videos helped me be more vigilant with future relationships, flagging warning signs and helping me think about my safety.Some videos didn't connect with me, purely because I didn't personally relate to the situation.But overall I did find them helpful and was never distressed or aggravated by any of the videos I was shown.I think that they should be shown and are very useful in cases where it is appropriate and the young person or persons are in a good mind set and have that resilience to start considering other scenarios and are ready to be made more aware."‘Jack' highlighted in the‘Jack CSE Serious Case Review

"If I hadn't have seen that film and if you hadn't have explained things like you did I think I'd have probably killed myself.I'd definitely still be struggling"
‘Tom H'

"I liked that it showed real people.It was a real story but it was like you knew it wasn't real at the same time.So it was OK to watch"
Client JP

"I don't suppose it was the film itself that helped me, but stopping and starting it like we did and talking about what was going on made me look at things in my own life differently."
‘LM'

Feedback from professionals

Whilst some professionals provided feedback on how they thought the use of CSE resources was not best practice and would/could cause harm, the overwhelming majority responded with examples highlighting how they were used positively in a way that reduced the risk of harm.It is these comments that are provided below, as this article has already acknowledged and highlighted that the inappropriate use of resources can contribute towards triggering trauma, re-trauma and significant distress.

Some of the quotes below have been provided by social workers, charity CEOs, safer schools officers, child psychologists, sexual health workers, CSE support workers from charities such as Barnardo's, youth workers, child protection leads and more. A number of professionals have asked to remain anonymous.

CSE play ‘Chelsea's Choice' by Alter Ego.Feedback from professionals

"My handsome teenaged son Breck was groomed online by a ‘friend of a friend' from school through his passion for gaming and computing.  Breck and his friends had never been given education on the signs of grooming and exploitation, had never been told that boys can be groomed too, or been made aware that predators can be any age or gender. My words of warning meant nothing to the boys as they were so ‘tech savvy' and didn't realise the real dangers that exist online. Sadly, Breck was lured to his death at the predators flat after a year of grooming despite my efforts and reports to the police. Through my work with the Breck Foundation, we use Breck's and other children's real-life stories as a platform to engage young people in empowering discussions.Unfortunately for Breck, he and his friends were numb to the potential dangers they faced online as they were given the same boring lessons and rules they had heard repeatedly from primary school.These soft and outdated messages did not resonate with intelligent and confident young men. Whilst we don't want to alarm young people, we strive to be honest and open with them so that they can navigate their online world safely, look after each other and reach their full potential. The positive response and testimonials we have received from teens, parents, teachers and police show how by collaborating together, we can encourage young people to think through their actions in relation to their ‘online friends'."
Lorin LaFave, Founder and Head of Education & External Affairs, Breck Foundation

"As a psychologist who works with children and young people, I find the appropriate use of resources can be key in supporting them to make sense of their experience, process and manage it.   In working with those who have experienced sexual abuse, exploitation or grooming, the use of appropriate CSE resources within a safe, supported, therapeutic relationship with a trauma informed practitioner can be beneficial, promoting recovery.  There is always a risk of re-traumatisation in any therapy, but this is minimised when trust is established, there is appropriate preparatory work and a collaborative approach to the therapeutic journey.There is also a place for the appropriate use of CSE resources within a group setting.  Before becoming a psychologist, I was a secondary school teacher required to teach sex and relationship education.Some of the excellent CSE resources such as Alright Charlie and My New Friend would have been ideal resources for enabling a more open discussion about exploitation and grooming within my tutor group."
Dr Sue Whitcombe, Counselling Psychologist

"I have been using the Alright Charlie resource for years five and six.The kids find the story interesting and it gives us an opportunity to have open and honest discussions about exploitation, grooming (online and offline).A primary school had a disclosure from a child after my session.The children from the school wrote me a letter to thank me for showing them the film, saying how much they enjoyed watching it."
Andri Nicolaou, Child Exploitation Prevention Officer, Topaz team, Avon and Somerset Constabulary

"I'm a social worker and I worked with those subject to CSE from 2011-2015.For me, choosing which resources to use in direct work was guided by the young person.My relationship with the young person was key to assessing what might be helpful and what could be damaging.This was done with the young person, as after all, they knew themselves best.Before introducing any resources, I spent time developing a relationship with the young person to try and develop a trusting relationship, where the young person felt able to explore the topic.Different resources worked for certain young people at different times.Of the resources developed specifically for CSE, I often used those produced by Barnardo's and CEOP's Think You Know.I also acquired resources from other areas, for example, domestic abuse.I believe there is a huge overlap between the boyfriend/ girlfriend model of CSE and domestic abuse.My personal opinion regarding the use of educational CSE films is that it should be down to professional judgement.However, I found some resources to be better than others.I used them as part of a piece of work where the young person had an opportunity to explore what they'd seen, ask questions and debrief.For one young person I worked with, a video by CEOP was the lightbulb moment that led to her, many months later, disclosing abuse.I worked at the young person's pace.When I started to work with a young person, often they were still involved with a perpetrator.I would wait for them to make connections between their own experiences and exploitation, and then support them to explore and understand what happened to them.On one occasion, I jumped in too soon because of my own anxieties, and it didn't work.Sometimes it won't go right!talk to the young person, and apologise if you've made a bad call.Letting a young person know you're human, let's them know it's OK to make mistakes."
Emma Stephens, social worker and academic

"I do a lot of short term work with adults and children and some have viewed educational CSE films and they've found them useful.I've never received any negative feedback.Not once"
Children and families therapeutic intervention worker

"I provided CSE group work to small and large groups of children for over 15 years.I worked in nearly 40 youth and educational settings with thousands and thousands of children.I never received any negative or concerning feedback from the young people or the teachers and used a variety of resources. I would say that resources need to be used in a sensitive way, with awareness of the groups you are working with and their varying needs. Evaluation by young people of the resources can obviously improve their efficacy.Feedback from young people included comments such as "I understand grooming now".I believe it's wise to have a deep understanding and familiarity with your resources and the confidence to use them."
Former CSE education worker from a large children's charity

"I used to work as a CSE practitioner for a children's charity.I have used films over the years to support one-to-one and group work.I occasionally had young people asking if their friends could watch the films (specifically written to raise awareness of CSE, made by professional organisations such as the UKHTC etc.), and as long as they were shown in a supportive, age-appropriate environment with trained professionals to discuss trigger warnings, and support what they were viewing, I found them to be a useful resource.I don't think that the majority were more explicit or traumatic than a related episode of EastEnders or Coronation Street, both of which have covered CSE-related storylines.I appreciate that these soap opera storylines could be triggering for young people and adults who had experienced sexual abuse, so should always come with an accompanying warning and the choice not to watch the episode or film.I used the resources in a mixed range of settings and with many young people.I also think the resources were really good for inspiring me to think of other activities and to initiate conversations around consent and healthy relationships etc.I have to add that my work involved supporting young people in a variety of ways and that the conversations that ensued were of the utmost importance, so the use of resources supported my work with them, but certainly wasn't the only way of engagement."
Former CSE project worker and PhD student researching CSE

"We are using CSE resources which are chosen to the individual young person to ensure we offer a bespoke and age appropriate intervention.We use resources in group and also in one-to-one sessions.There are a wide range of resources available so it's important they are from a reliable, credible source and are checked and measured, trialled and tested.Using resources doesn't mean that we can necessarily prevent harm but it will support and help to educate, raise awareness of the dangers/risks and to develop protective behaviours.Realistically using CSE resources won't stop CSE but hopefully can reduce and treat the impact."
Claudia Slabon, Chief Executive, Service Six

"We have used ‘Kayleigh's Love Story' with tutor groups at a sixth form college, delivered over a week's period covering the whole of year 12 (approx.800 pupils).We do this every year.This is part of a longer lesson where we look at CSE, grooming, indicators, what they would do if it was happening to someone they knew and where to go to for help locally, as well as national support.We inform the college to let the young people know in advance what we will be covering and that it is sensitive so that anyone can opt out.We reiterate this when we start the lesson.Some young people have been upset watching the resource and others have said that whilst it is upsetting they think it's appropriate for younger people (for example 12 year olds) to watch and wished their younger siblings could have seen it.Some young people have made disclosures to college staff after the lessons and can therefore be supported/safeguarded.This resource has been useful to use in Nottingham as it is fairly local and as the perpetrators were tried at Nottingham Crown Court, students have said this ‘brings it home' to them rather than thinking it happens to people a long way away and not in their world.We have also used ‘Kayleigh's Love Story' with 16-25 year old FE students with learning disabilities, but did so in a way that made use of additional safety measures including cutting out the more hard-hitting scenes.We once showed ‘Kayleigh's Love Story' to a group of excluded pupils who shared information about areas of concern which was passed as intelligence to the police.Boys who were normally very challenging and disruptive engaged well and sat in silence when watching ‘Ryan's Story' which was followed by them taking part in a thoughtful discussion about how it might be difficult for boys to make a disclosure of exploitation and abuse.Again this was part of a short RSE course that had already covered relationships and consent etc.We have used other resources with young people such as ‘Matt thought he knew', ‘Jigsaw' and ‘Exploited' all of which were received well.We have used ‘Alright Charlie' with young people, mainly boys in year seven, and they fed back that they liked it and could easily pick out risk factors.Overall, I would say the resources we have used have all been useful when used in the context of a wider RSE package that covers relationships and issues of consent.Different resources have been used to match the age group and specific issues pertinent to each group or cohort."
Judith Green,Outreach and Health Promotion Lead,NUH Sexual Health Services,Victoria Health Centre

"As an experienced psychiatrist with over 20 years' experience under my belt in working with traumatised children, I am equipped to say that the use of visual aids can not only help in increasing a patient's understanding of trauma, but also recover from it.Children are visual learners.The use of visual aids should be accompanied with substantial thought and careful planning.If used sensitively and safely, harm is extremely unlikely.
Clinical psychiatrist

"In 2017, I used ‘Alright Charlie' in primary schools to explore themes of relationships and risk.All children who explored this resource were engaging in one-to-one support with myself over a minimum of a 12 week period.Prior to delivering this piece, other activities and conversations took place to assess each child's confidence, ability and resilience to exploring this content.Parental consent was also received prior to this work and all parents and schools were advised on how they could support this session and its aftercare further within education settings and the home.For various reasons, on numerous occasions it was deemed that this resource was not appropriate to deliver and was therefore was not used.The children who did access this resource however were inquisitive, engaged and provided positive feedback.Numerous children informed me they were aware of strangers grooming online but not aware this method could be used by adults they already knew and therefore considered ‘safe'.The majority of children also shared stories of peers who they knew were in contact with older people but previously felt this was ‘cool' and was a sign of popularity.I have always been very clear that this resource is not about victim blaming or about what Charlie should or shouldn't have done differently.The blame lies solely with the perpetrator!fact.For me, the aim of this resource is to help young people recognise power imbalances, question relationships and identify their positive support networks in a way which appeals to children and encourages participation."
Hannah Allen, former CSE worker

"As a CSE worker for boys and young men I used a range resources.These were chosen depending on the issues and I took into consideration how the boy or young man was feeling.I used films that were appropriate and these were especially useful as we could pause and discuss what was happening.Seeing appropriate films in groups also works in prevention work with children and young people."
Shirley Durham, former CSE worker

"I found the resources really supportive when working with children, some of which have been incorporated into our curriculum to help young people understand grooming and exploitation."
Franky Boyland, Assistant Head/Designated Safeguarding Lead, Kingsmead School

"The old adage is ‘knowledge is power'.In the case of the sexual abuse of young people this is particularly true.Knowledge for them to know what's inappropriate, and facilitating the awareness to spot the ways in which it can be misrepresented as ‘kind' behaviour, is invaluable.Invaluable in providing young people with the means to know who to go to in times of concern.Such tuition carried out sensitively and non-threateningly by experienced practitioners could not be more protectively helpful."
Dr Julian Boon – Chartered Forensic Psychologist

"Over twenty years as a CSE worker I have used educational CSE films with young people and professionals and they have always been received positively.Both young people and professionals have stated in their feedback that watching these films has raised their awareness and understanding of CSE."
Former Barnardo's CSE Worker

"For approximately 12 years I managed a number of projects that worked with and supported young people who were involved in or who were vulnerable to grooming for sexual exploitation.As part of the support we offered we also had a remit for working with schools, alternative education providers and other youth focussed settings to raise awareness regarding risk.One of the tools we used with young people were CSE resources – short films that had been produced by a number of local and national organisations.Whilst I can really appreciate how the use of these films may trigger trauma or re-trauma, my experience of using these resources was that if the practitioner was confident and knowledgeable with the content of the resource and with the subject matter, and that significant pre work had been done with the school, pupil referral unit or youth focussed setting (as well as, most importantly, with the young people in the group) then many, if not all, of the concerns may be mitigated.Some of the pre work may include staff watching the resource before the session so they are aware of the content and so they can also ask any questions they may have, this also allows for them to be aware of the young people they know about who the resource may impact on (I appreciate we don't always know what is going on for all young people)!a follow up session for the staff to deliver to the young people if the practitioners from the service were only around for one session!a significant introduction to the content of the resource as well as making it safe and ok for anyone in the class to leave at any point was essential for the young people!ensuring language and terminology was understood and allowing time to explore that.Using a CSE resource (film) in isolation, without context, in a rushed way, as a tick box exercise and without significant pre work I would say is not good, safe practice."
Emma Holmes CEO, The Market Place

"I was part of the development of the ‘Alright Charlie' resource, which I still champion to this day.It was an eye opening experience and I use many examples of the children I met (nearly 1000 of them) when I deliver training in my current role.For me the resource highlights in an age appropriate manner how easy it is to groom a young child. Most of the 1000 we consulted/delivered the resource with said how their perception of what an "unsafe adult" is, was a bald fat man, who hangs around in parks and guess what he drives…..you got it, a white van!  This project was about educating children that perpetrators can be anyone!male/female/young or old and that victims can be boys or girls. I now make it part of my training to highlight the "take out the gender" theory when looking at referrals as most young men would rather be seen as criminal behaviour and not a victim of child sexual abuse.The Alright Charlie resource, and other educational CSE films are received well by children and are a great tool in aiding discussion."
Sarah Hutchinson, Children's Home Manager and Freelance Safeguarding Trainer

"The use of any resource should not be executed unless there is a clear reason to do so, safety measures are used and the resource is introduced to the child appropriately.If these steps are followed by a practitioner who is capable of responding efficiently to any traumatic reactions the likelihood of the child enduring a traumatic reaction is extremely unlikely."
Child psychologist with over 15 years' experience

"In 2017 I worked for a CSE service.Part of my role was to train other professionals in the area.I used CSE resources with professionals and children and found them to be useful, easy to use and also very thought provoking, especially the short films which resulted in exceptional feedback and a disclosure when using ‘Alright Charlie' with a young boy I was working with at the time.I would highly recommend these resources and feel they contributed enormously in obtaining a positive outcome for children I worked with."
Tracy Farnhill, former CSE worker

"I have worked with children at risk of exploitation for over 25 years.In the course of that work I have practiced as a social worker, an outreach worker, a 1-1 support worker and a manager of CSE services.  I have championed the use of resources if they are relevant to the child's circumstances and delivered sensitively with good preparation of the child and materials.  It is imperative that the worker using the resource understands the issues and can respond to any questions that may be generated from the session.All resources should be used carefully after consideration of the child's capacity, emotional and mental health and ability to relate to the issues depicted.  If used appropriately videos and other resources can be a very helpful tool to support a child's understanding of professional concerns and identified risks related to their own circumstances. There have only been rare occasions when I have not used a resource and usually that pertains to the age of the child and capacity issues and in one case a child stating they did not want to watch anything.In my work most of the feedback given after sessions has been positive and appropriate and in several cases disclosures have been made directly after watching a video, due to the child's realisation of being groomed or exploited.  None of the resources I have used show explicit child abuse, they tend to hint at the risk rather than expose children to explicit content.Given how broad ranging the issues of exploitation are, it is very important to have access to a range of resources to explain the related risks to both children and adults because individuals learn in different ways and visual tools are just one of a range of methods used by professionals to educate them about the risks. At no time in my career has a child disclosed to me that they have been traumatised by watching a video depicting the risks of exploitation. I don't doubt that if resources are used insensitively or without proper risk assessments and preparation, children could be shocked about some content.If resources are used when they are not age appropriate or relatable for children that would suggest poor practice.Any child suffering secondary trauma after watching a resource would no doubt have already been suffering a level of trauma they were unable to reconcile.When used sensitively with good preparation any child focussed, age approved resources are useful in educating children about the many risks of exploitation."
Dr Mandy MacDonald, Child Protection Manager

"CSE resources can play a useful part in awareness raising & prevention strategies if used appropriately as part of carefully planned sessions, developed and delivered in liaison with specialist services or professionals and which enable referral access to support for any young people who need it."
Dr Rosie Campbell, former CEO of Children's CSE Service

[1]Shapiro, F.(2018).Working with Abreactions and Blocks.Eye movement desensitization and reprocessing (EMDR): basic principles, protocols, and procedures.New York, Guilford Press.(pp162-190)

[2]Rogers, C.R., Kirschenbaum, H.and Henderson, V.L.(1990).A client centred/Person centred Approach to Therapy.The Carl Rogers reader.London, Constable.(pp135-152)

[3]The BLAST Project (part of Yorkshire MESMAC Group of Services) (2017) Excellence for Boys.Developing Child Sexual Exploitation (CSE) Services for Boys and Young Men and Increasing the Identification of Males at Risk of CSE.Two Year Pilot Project.Final Report.Leeds