4. Spotting the signs of child sexual exploitation
If a practitioner spots the signs of child sexual exploitation, although this does not necessarily mean abuse is taking place, it should raise a degree of suspicion and lead to further enquiry .
Child sexual exploitation can present across a range of different health settings, and may be spotted by health practitioners working with children but also those working with adults who have dependent children. Health practitioners likely to be interacting with children at risk of or affected by child sexual exploitation, and who should therefore consider and suspect child sexual exploitation, include  ;
- Addiction services;
- Dental professionals;
- Emergency health services;
- Family nurses;
- GP and practice nurses;
- Health Visitors
- Homeless services;
- Mental health services;
- Paediatric services;
- Paramedics and ambulance staff;
- School nurses and LAC;(looked after children) specialist health staff;
- Sexual Health services;
- The 'gatekeepers', e.g. reception staff.
This list is not exhaustive and any health practitioner may be in a position to identify or suspect child sexual exploitation.
A 15 year old approaches a pharmacist for the morning after pill. She says she does not need to go through all the advice as she has been through it before. She keeps her mobile phone on all the time that she is talking to the pharmacist and reacts to messages arriving with fear. She has a large amount of cash available to pay for the medication. An older man is present in the pharmacy while she is talking to the pharmacist and leaves with her. 
Many indicators of child sexual exploitation may be visible to health practitioners; examples can include  ;
1. What you might notice in their circumstances:
- Presence of a controlling or older adult or 'boyfriend/girlfriend';
- Evidence that a young person is being monitored through their mobile phone;
- Young person with unexplained amounts of money or expensive presents or possessions;
- Young people who fail to attend follow-up appointments and disengage from health services or school;
- Changes in behaviour, including changes in eating habits;
- Inappropriate sexualised behaviour.
2. What you might notice in what they say:
- Young people who describe peers or friends as involved in sexual exploitation;
- Young people who have been staying out late or have unexplained absences from home or school;
- Young people with multiple sexual partners;
- Young people who describe being in or taken to (or who were found in) houses/flats/hotel rooms where they engaged in sexual activity with multiple or older adults.
3. What you might notice in their health needs:
- Young people repeatedly seeking emergency contraception or terminations, or with repeat STIs;
- Young people expressing despair (e.g. challenging behaviour, aggression, self-harm);
- Young people presenting intoxicated or misusing alcohol or drugs;
- Late presentation of or unexplained injuries or symptoms;
- Disclosure of sexual/physical assault, followed by withdrawal of allegation;
- Evidence of physical abuse associated with sexual contact.
There are resources available to health practitioners to support identification of young people at risk of or affected by child sexual exploitation, some of which are outlined in Appendix 1.
Email: Katrina McDonald
Phone: 0300 244 4000 - Central Enquiry Unit
The Scottish Government
St Andrew's House