How can we facilitate online disclosure of safeguarding concerns in under 18s to support transition from online to face-to-face care?

Abstract

Sexual health services (SHSs) routinely screen service users aged 17 years and under for safeguarding concerns and provide support after disclosure. SHSs are increasingly available online to 16–17 year olds. However, evidence is limited on translation of established face-to-face safeguarding procedures to online services, challenging service innovation. We aimed to establish factors that would encourage users to disclose a safeguarding concern online and facilitate appropriate response. Four semi-structured interviews were completed by young people (YP) aged 16–21 years (n = 2) and safeguarding experts (n = 2). These complemented a workshop attended by YP aged 16–18 years (n = 7) and key stakeholders (n = 9), both exploring factors that would encourage or inhibit disclosure. Results were analysed using matrix-based ‘framework’ approach. Four key themes emerged: (1) YP lack understanding about ‘normal’ sexual relationships and may not know they are being exploited. (2) Confidentiality is a key concern and clarification around limitations of confidentiality and consequences of disclosure are required. (3) YP feel online services may be convenient and avoid embarrassment, providing control, but fear online disclosure might set off an uncontrollable chain of events. (4) After disclosure, YP want certainty of help. To facilitate online disclosure, we recommend SHSs provide: (1) Information to assist YP to recognise concerns. (2) Clarification that confidentiality cannot be assured. (3) Transparency about processes following disclosure. (4) Examples of the benefits of disclosure. Further collaborative work to test and refine improvements are required.