Greater Manchester Sexual Health Network CSE Risk Indicator Tool
Please note:
(i)This form should be completed following GM training and in line with support guidance pack
(ii) Questions to be asked to young person/vulnerable adult on their own
(iii)Confidentiality discussed Yes / No
(iv) Explain that if young person /vulnerable adult identified as potentially being at risk then information will be shared
Unique identifier:(e.g. Blither or other clinic identifier)
Name: / Age: / DOB: / M / F
Under 18 years old: / Yes / No / Education establishment:
Attending regularly? Yes / No
Vulnerable adult: / Yes / No
Sexually active: / Yes / No
Comments on –
low risk or risk of exploitation
Family and Social Relationships
Who do you live with?
Can you talk to your parents about sex and relationships? / Yes / No
Is there anyone you feel you can talk to?
you can talk to? / Yes / Who?
No / Refer for help
Any problems at home? / Yes / No
If yes – social worker involvement Yes / No
Any other support service? e.g. YOT, CAMHS, YW, school nurse, teacher, social worker / Yes / No
If yes - who
Relationships
How old were you when you first had sex?
How many partners in total have you had?
How many partners in the last 12 months?
How long have you known your partner?
Are you happy in your relationship? / Yes / No
Is you partner know to friends / family? / Yes / No
Where did you meet?
How old is he/she? / Male / Female
Consent
Current partner’s name?
What does he / she do?
Are you pressured to have sex by current partner? / Yes / No
Do you feel you could say no to your partner? / Yes / No
Do you feel ready to have sex? / Yes / No
Previous partner(s) names?
Were you pressured to have sex
by previous partner(s) / friends? / Yes / No
If yes refer to CSE assessment form or refer to
specialist CSE lead / team in own organisation
Has anyone given you money or gifts for sex? / Yes / No
If yes, who
Unique identifier:(e.g. Blither or other clinic identifier)
Name: / Age: / DOB: / M / F
Contraception
Do you use contraception? / Yes / No / What type?
STIs
Have you had an STI test? / Yes / No / If yes, how many in last 6 mths?
Have you ever had an STI? / Yes / No
Drugs and Alcohol
Do you every use drugs and / or alcohol? / Yes / No
How often do you drink? / p/w / Take drugs? / p/w
Where do you get the alcohol / drugs from?
How do you feel after you have taken alcohol/drugs?
Do you think alcohol/drugs affect your decisions? / Yes / No
Have you ever tried to harm or hurt yourself? / Yes / No
Professional analysis of the assessment
Is there any evidence of the following in their relationship with partner(s)?
Coercion or bribery / Over aggression (sexual assault) / Age or power imbalance
Suspicion of sexual exploitation abuse or grooming for prostitution / Any other vulnerability
Low risk
Risk / If risk referred to CSE / Safeguarding lead on …………….………….. [date]
following service’s Safeguarding policy
Any additional information:
Signed: / Print: / Date: / Time:
Status:
Fraser Guidelines
The health professional cannot persuade the young person to inform his/her parent or allow the doctor/healthcare worker/professional to inform the parents that he/she is seeking sexual health advice/care.
The young person is very likely to begin or continue having intercourse with or without sexual health treatment.
Unless he/she receives sexual health advice or treatment, without parental consent, the young person’s physical or mental health, or both are likely to suffer.
The young person’s best interests require the health professional to give sexual health advice, treatment or both without parental consent.
The young person understands the health professional’s advice
Adapted from Trafford Youth Service’s Safeguarding under18s form
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