Youth-produced sexual images: A victim-centred consensus approach

Edinburgh Research Explorer Youth-produced sexual images Citation for published version: Quayle, E & Cariola, L 2017, Youth-produced sexual images: A victim-centred consensus approach. University of Edinburgh. Link: Link to publication record in Edinburgh Research Explorer Document Version: Publisher's PDF, also known as Version of record General rights Copyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s) and / or other copyright owners and it is a condition of accessing these publications that users recognise and abide by the legal requirements associated with these rights. Take down policy The University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorer content complies with UK legislation. If you believe that the public display of this file breaches copyright please contact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately and investigate your claim. Download date: 05. Dec. 2021 YOUTH-PRODUCED SEXUAL IMAGES: A VICTIM-CENTRED CONSENSUS APPROACH 1 Acknowledgements This study is a continuation of the previous SPIRTO project which was funded by the European Safer Internet Programme as a Knowledge Enhancement Project. The SPIRTO project, which was completed in 2015, resulted in a series of training materials, reports and educational films on sexting for practitioners and parents (http://www.spirto.health.ed.ac.uk/). The current project is funded by the ESRC Impact Accelerator Account to promote Knowledge Exchange and Impact Activities across the social sciences. Our thanks to the young people who completed the Delphi Study, and those who facilitated contact with them, and to the participants in the three symposia who shared their expertise with us. We are grateful for the engagement of representatives of the Scottish Government in this research. Particular thanks go to staff from NCA CEOP Command, Police Scotland, Norfolk Constabulary and Marie Collins Foundation who offered invaluable input and support throughout. Authors Ethel Quayle, Reader in Clinical Psychology, School of Health in Social Science, University of Edinburgh. Laura Cariola, Post-doctoral research assistant, School of Health in Social Science, University of Edinburgh. June, 2017. 2 Foreword Cases of youth produced sexual imagery or sexting are increasingly being reported to the police as new and current technologies become accessible to a greater number of children and young people. Whilst it is important to not forget the positive benefits of this, it is clear that this can also present significant safeguarding challenges and new opportunities for exploitation by those persons with a motivation to do so. I welcome this valuable research and the insights it provides from a child’s perspective as well as the challenges faced by professionals when responding to this issue. We are clear that primarily these cases should be treated as a safeguarding issue. We are also clear that we should seek to avoid unnecessarily criminalising children and young people and only pursue a criminal justice response when aggravating circumstances require it. To this end, in conjunction with the College of Policing we issued updated advice for all police forces in England and Wales in November 2016. This was developed in parallel with UKCCIS who produced interlinked advice for schools. We will continue to invest in this area and welcome new research to ensure that our responses are evidence driven and that ultimately all victims receive the best possible service. Clearly along with an effective investigation more needs to be done from a prevention and education perspective to ensure the risks are understood and places of support highlighted. This should be alongside more investment by industry to prevent imagery from being further distributed and delete content where it has not been consensually taken or shared. Chief Constable Simon Bailey (QPM)– Norfolk constabulary & national policing lead for Child Protection Abuse Investigation (CPAI) and Violence & Public Protection (VPP). 3 Executive summary The report reflects the views of a sample of young people who have taken and shared sexual images of themselves, and three groups of professionals whose work exposes them to the challenges of managing these cases if, and when, they come to light. The aim was to complement existing UK procedural guidelines for Schools and Colleges (UKCCIS, 2016) and Police (College of Policing, 2016) through explicitly seeking the involvement of adolescents (Study 1) alongside those of multiple stakeholders across three sites (Study 2). This work is supported by ESRC Impact Accelerator funding and follows the earlier work from the SPIRTO project. • Both adolescents and professionals recognised the importance of maintaining a child-focused approach, which showed sensitivity to the social, cultural and personal needs of the child, and that embraced both the range of professionals involved as well as parents or caregivers. This inter-agency working requires not only a recording of the case upon discovery or disclosure, but a mapping of who should be involved in the child’s social system, and a plan for how information can be shared and managed. This in turn necessitates an understanding of the significance, and recognition, of behavioural and attitudinal signs, which may indicate that images have been exchanged, either within a relationship or the wider social system. • Potential tensions between the roles of parents, caring professionals and those who represent the legal process need to be made explicit and managed in a proportional way. This should acknowledge the shifting purpose and function of youth-produced images and the consequences for the child of loss of ownership, and the challenges of managing a breach of trust that this probably implies. This sits alongside the difficulties in understanding whether these images meet the criteria for indecency and the degree to which coercion in their production or sharing has taken place. • Both groups expressed the need for support of the child through all elements of the process, an avoidance of a judgemental stance and sensitivity by parents and involved professionals to the potential shame and humiliation felt by the child. This also means working with the child, providing information about the procedures that will be followed (including the management of the images) and keeping the child, as well as other key individuals, informed at each stage. • Working with children requires patience and sensitivity. There is a need to avoid inappropriate social and cultural stereotypes and an acceptance that the child may need help to develop effective coping strategies to deal with the responses from family, friends and acquaintances after sharing self-produced images becomes public knowledge. It is important to note that this may also be the case where digital devices, such as smart phones and laptops, have been confiscated as part of the inquiry process. • Concerns were expressed about the difficulties of involving professionals and parents in educational and training events that increase knowledge of technological change and the opportunities and risks that this brings. A lack of awareness about differences in the age of consent for sexual activity and the taking and sharing of sexual images needs to be addressed. For children and parents, educational strategies, with a focus on healthy and respectful relationships, might best be delivered by and with children, rather than to them. Ways of providing peer support should also be explored. 4 INTRODUCTION In June 2015 we completed the final work on the SPIRTO Project (Self-produced Images Risk Taking Online: www.spirto.health.ed.ac.uk) which was an EU project funded by the Safer Internet Programme. The goal was to build an evidence base of the risks associated for adolescents with the move to merged technology, particularly in relation to hand-held devices. Our focus was on risk related to the capacity to generate sexual content (often described as sexting). We wished to understand the different contexts behind the creation and sharing of these sexual images and the consequences for the young people involved. The final aim of the project was to develop training materials for professionals working with young people and parents. This would seek to provide information, enable further discussion with young people about risk, and examine effective ways of sharing knowledge. This work followed from an earlier EU-funded project (ROBERT: http://childcentre.info/robert/), which concerned online behavior that resulted in sexual abuse. The results of interviews with young people who had been sexually abused by someone met online indicated that images were often created as part of that abusive relationship, either through the use of a webcam or handheld device (mobile phone) which, in part, may have resulted in further coercion and limited the likelihood of disclosure. These results coincided with reports from organisations such as the US National Center for Missing and Exploited Children that high numbers of identified children were associated with self-produced sexual content and an influential study by Wolak, Finkelhor and Mitchell (2012) who had collected arrest data for online sexual offences at three time points (2000, 2006, 2009). Between 2000 and 2009 there was a substantial increase in the number of arrests, with approximately half of these for possession of ‘child pornography’ only (the term used in these reports). The increase in arrests for production of ‘child pornography’ was largely driven by ‘youth-produced sexual images’ which were taken by children 17 years or under and which met the legal definitions in the US for ‘child pornography’. In most of these cases the person arrested was an adult who had solicited images from a minor, also reflected in that there were more adolescent victims and ones where they were face-to-face acquaintances with the person arrested. The large number of academic publications (across multiple disciplines) over the last 10 years, alongside reports from government and civil society organisations, is a good indicator of concerns about the recent phenomenon of ‘sexting’. Self-produced digital content appears to capture a sexual ‘private moment’ and potentially turn it into a public one. Increased opportunities for this to happen coincided with the availability of inexpensive web cameras and camera phones (subsequently smart phones) and the possibility (and encouragement) to create digital content. The, at times, heated debates that followed reflected what Rollins (2015) called ‘the vexing issue’ for parents, schools, legislation and criminal justice and, given that whatever role self-produced images are serving seems to be as important now as when it first came to our attention, raises questions for some as to whether this is a social issue that we should be investing in changing (Strassberg, Cann & Velarde, 2017). The term sexting became associated both with ‘self-produced child pornography’ (Leary, 2010) and an expression of the adolescent’s sexual identity and thus protected by Articles 8 and 10 of the European Convention on Human Rights (Gilliespie, 2013). As part of the SPIRTO research we completed a systematic review of the literature (Cooper, Quayle, Jonsson & Svedin, 2016) which examined the motivational, lifestyle and personality factors that influenced adolescent ‘sexting’ practices and which explored the research evidence within the wider context of contemporary social and visual media cultures and gender. Not surprisingly, the results indicated remarkable variation in terms of context, meaning and intention 5 and noted the potential for consensual and non-consensual aspects of this activity (also indicated in the framework developed by Lee & Crofts, 2015). The evidence indicated that while youth-produced sexual images may be a means of flirting, or enhancing a sexual relationship, it could also highlight potential vulnerabilities to sexual victimisation or to participation in risky sexual behaviours. The review also noted the link between ‘sexting’ and social expectations of gendered sexual behaviours. Females often derived less pleasure from their experiences and were more likely than males to be seen in a negative way by their peers. Ricketts, Maloney, Marcum and Higgins (2015) noted that ‘deviant’ peer association (including associating with others who ‘sext’) and Internetrelated problems (similar to what has been called Internet addiction) were also associated with sexting by adolescents. This compares to the results of a large qualitative study by Stanley, Barter, Wood, Aghtaie, Larkins, Lanau and Överlien (2016) which indicated that although youth-produced sexual images were normalised and seen as positive by most young people in their sample, it also had the potential to reproduce ‘sexist’ features of pornography, such as control and humiliation. A willingness to engage in ‘sexting’ by Dutch adolescent females (but not males) was also associated with ‘sexy selfrepresentations’ on social media (Van Oosten & Vandenbosch, 2017). The results from the EU Kids Online II project, with 17,016 11-16-year-olds, also reported an association between sexting and emotional problems, although paradoxically they noted that younger boys with higher self-efficacy were more likely to send sexts than those with lower selfefficacy (Ševčíková, 2016). Other reviews have noted a relationship between adolescent sexting, peer pressure and a range of emotional difficulties (Van Ouytsel, Walrave, Ponnet & Heirman, 2015). Cooper et al.’s (2016) review highlighted some of the negative assumptions about youthproduced sexual images, but also acknowledged that it (in all its definitional complexities) reflected practices that could be thought of as existing on a continuum of coercion, from adolescent expectations of it being a ‘normal’ thing to do, through to aggressive activity by peers or adults. This echoes the findings of Wolak and Finkelhor (2011) whose typology of ‘sexting’ from US law-enforcement cases differentiated between experimental and romantic activity between peers and aggravated incidents with the intention of harming, harassing or embarrassing others through behaviours that included deception, exploitation and abuse. Such aggravated incidents were also seen in an analysis of public reports to the Canadian hotline (Quayle & Newman, 2016). A further study examining the association between sexting and sexual coercion among female adolescents (Choi, van Ouytsel & Temple, 2016) found that offline sexual coercion was significantly associated with sending and being asked for naked images, as well as receiving a naked image without giving permission. These results suggested that youth-produced images could function as an online dimension of offline sexual coercion and are similar to the results of Wood, Barter, Stanley, Aghtaie and Larkins (2016) who found that adolescents who reported victimisation in their relationships were more likely to have sent a ‘sext’ than those who had not. What can be seen from many of these studies is confusion as to whether self-produced images by adolescents should be treated as problematic, or even criminal, or whether it is simply reflects exposure to, and consumption of sexual media. Bobowski, Shafer and Ortiz’s (2016) study suggest that adolescents are inspired by sexual media to create and distribute sexual media of their own (this is also likely to be the case with adults who are more likely than adolescents to send and share sexual self-produced images: Klettke, Halford & Mellor, 2014). While this is likely to be the case, it still leaves challenges as to how we might balance the tensions between accepting that sexual self-produced images may be an expression of sexual development (or even rights), and the need to protect adolescents from both intentional, and unintentional, problematic outcomes. 6 Regardless of the intentions and context for the creation of sexual youth-produced images, the ability of the individual to control what happens to those images is limited, and where the production and dissemination of images is done by adolescents, the resulting media may be illegal in most jurisdictions, even though the sexual activity portrayed may not be. We have little meaningful information about how many of these scenarios ‘go wrong’, although inevitably we pay a lot of attention to the rare cases that result in self-harm or suicide. We know that in the US the number of cases that result in prosecution is relatively low (Wolak, Finkelhor & Mitchell, 2011). In their national sample of police cases 2008 and 2009, 675 cases involved youth-produced sexual images. Two-thirds of the cases involved an aggravated element involving either an adult (36% of cases) or a minor engaged in malicious, nonconsensual, or abusive behavior (31% of cases). An arrest took place in 62% of cases that involved an adult, 36% of the aggravated youth-only cases, and in 18% of the “experimental” cases (involving only adolescents and with and no aggravating elements). This sample is now 8 years old, and it is likely that the number of cases has increased. It was not possible to identify parallel research outside of the US, nor could we identify studies that had analysed the content of these images to understand what proportion would meet the criteria for illegality in a given jurisdiction. This report reflects two studies aimed at creating a consensus approach to the management of instances youth-produced sexual images when they are identified. The aim was to complement existing UK procedural guidelines for Schools and Colleges (UKCCIS, 2016) and Police (College of Policing, 2016) through explicitly seeking the involvement of adolescents (Study 1) alongside those of multiple stakeholders across three sites (Study 2). This work is timely in that it coincided with the launch of advice that will impact on changing professional practice and address many of the concerns raised in this report. The current studies are supported by ESRC Impact Accelerator funding and follows the earlier work from the SPIRTO project. 7 Part 1 – Delphi Study with Young People 8 Key Findings Youth-produced sexual images which are shared with others and often called selfies, or sexts) are often seen as problematic, and sometimes illegal, yet little is known about how adolescents feel about these incidents, and how they should be managed when ‘things go wrong’. Young people who had self-identified as having sent youth-produced images were recruited as ‘experts’ in a Delphi study, and provided their opinions and views of what constitutes an appropriate response by parents, schools, police and other agencies when dealing with coercive youth-produced image-taking. This study also aimed to identify indicators of distress and ways to facilitate disclosure where the sharing of images causes anxiety or is associated with bullying, harassment or victimisation. Responses to a vignette-based questionnaire (a short scenario, with questions linked to it as seen in Appendix 1) revealed what young people considered important indicators of, and responses to, situations where sexting had ‘gone wrong’. These are clustered around different scenarios and illustrated with examples from the responses. • Most participants saw the following to be important signs that selfies were shared without permission: … spread rumours and gossip … post insulting messages or her nude images on social media • Participants identified what the boyfriend might do or say that suggests selfies had been shared: … avoids letting her see or use his mobile phone … does not give a clear answer when asked about nude photos • Important first steps to seeking help by the young person included: … speaks to police to report that photos were shared without permission … speaks to a person they trust (a friend, youth worker) to seek help • Parents or carers were seen to be supportive if they: … supports the young person (being reassuring and respecting privacy) and offers to resolve the problem together … talks to others about the situation with the young person’s permission • The young person dealing with others in ways that might reduce and minimize the stressful effects of bullying and harassment included: … does not isolate herself from others … reports and speaks about others’ disrespectful behaviour to a trusted person (family, teacher or police) • What all professionals could do and say to help included: … informs about procedures, important information and explains what is going to happen next … tries to understand and listens to the young person, and is aware of the social context of photo sharing • What teachers could say or do to help included: … speaks with boyfriend and his parents to discuss the seriousness of the situation … does not draw attention to individual affected through preferential treatment • What police could say or do to help included: … reassures that the matter is dealt with appropriately and safely … deals with the situation appropriately, fast and with little repercussion 9 Abstract The ability to create and share digital content has increased the availability of child abuse images, a proportion of which is created by young people in the context of both coercive and non-coercive relationships and is often associated with self-produced images (sexting). This poses considerable resource challenges to law enforcement and creates ambiguity as to what constitutes a proportionate response. The aim of this Delphi study was to use the opinions of young people who had taken and shared images as ‘experts’ to explore how their experiences of self-produced images may inform the development of evidence-based guidelines for good practice, for police and child protection agencies, in relation to a victim-centred management of coercive and non-coercive self-produced sexual image-taking. A two-round Delphi method was completed by 23 young people. 60 items were identified that endorsed their views of problem identification, facilitation of disclosure, proportionate responding by professionals, and problem management. Moreover, this study represents an inclusive approach by the formation of expert panels of young people that should be explored further in future research. Introduction The ability to create and share digital content has increased the availability of child abuse images. Technology has enabled these crimes and afforded opportunities for people with a sexual interest in children to rapidly acquire expertise in the location and manipulation of young people, achieved through the creation and sharing of sexual images (Quayle & Newman, 2015; Quayle & Cooper, 2015). Although previous research has identified that image-creation may be part of developmentally appropriate sexual behaviour in young people (Döring, 2014), it can be also be exploited by both adults and peers. This poses considerable resource challenges to law enforcement and creates ambiguity as to what constitutes a proportionate response. To date, no consensus exists that informs good practice with particular attention to the need to protect young people while respecting agency and the right to assert their sexual identity. Evidently there is need to develop victim-centred guidelines and resources that enable practitioners to confidently and appropriately respond to these cases being mindful of the systems in which the child operates. 10 Youth Produced Sexual Imagery and its Management The management of coercive and non-coercive sexual imagery in the online exploitation of children is a critical and largely an unexplored area, possibly because of its inherent challenges. For example, victims are often adolescents who have taken sexual images, through their web cam or hand held device, which is a challenge to law enforcement as well as child protection agencies (Englander, 2016). The UK Council for Child Internet Safety Report (UKCCIS, 2016) was an important development in providing advice for designated safeguarding leads (DSLs), their deputies, head teachers and senior leadership teams in schools and educational establishments in England. The report noted that the availability of internet-connected devices for young people, and the corresponding ease and speed of sharing images, has raised concerns about the self-producing and sharing of sexual images and videos. These concerns reflected the potential risks involved, especially where these images were shared with another person. These risks included feelings of embarrassment, but also the risk of bullying by peers and greater vulnerability to sexual exploitation. The larger context for these concerns in the UK is that for young people under the age of 18 producing and sharing of sexual images may be illegal depending on whether the content meets the relevant criteria. The report acknowledges that these images are likely to be taken outside of schools and colleges (many in young peoples’ bedrooms and bathrooms), but the reality is that those images that have been taken and shared will often manifest in schools and colleges, as well as organisations who work with children and young people. The UKCCIS report is a response to the fact that organisations working with children need to be able to respond both confidently and swiftly when this activity is identified or disclosed in order to safeguard, support and educate young people. This report is in response to the need to support such organisations to develop procedures, and identify resources, to respond to incidents that involve sexual images produced and shared by young people. These procedures are seen as part of an organisation’s safeguarding arrangements where all incidents of youth-produced sexual images are seen as safeguarding concerns. The UKCCIS report is an important resource and emphasises that responding to incidents should be guided by principles of proportionality and the need to be mindful of the welfare and protection of the young people involved. In the same year, the College of Policing in England and Wales brought out a briefing note. “Police Action in Response to Youth Produced Sexual Imagery (‘Sexting’)” to “support law enforcement professionals to respond in a proportionate way to reports of children (under 18 year olds) possessing, sharing or generating indecent imagery of themselves or other children”. This was produced in parallel with the UKCCIS report through a process of continuous consultation. The report identifies the contexts in which such activity may be an offence under the Protection of Children Act 1978 and Criminal Justice Act 1998. Both reports express a need for proportionality, and a consideration of the potential impact on the young person/s of investigation and prosecution, although the terminology ‘youthproduced sexual images’ and ‘indecent imagery of themselves’ is markedly different. The briefing note concerns the initial response to a report of youth produced sexual imagery and what might constitute a proportionate response, within the bounds of the law, where producing and sharing the images does not involve aggravating factors (such as adult involvement or the presence of violence). Our attention is also drawn to the fact that in England and Wales, “All reported offences of youth produced sexual imagery must be 11 recorded as a crime in line with Home Office Counting Rules (HOCR)” (p. 3), although in 2016 the Home Office launched outcome 21 which states that ‘‘Further investigation, resulting from the crime report, which could provide evidence sufficient to support formal action being taken against the suspect is not in the public interest – police decision”. This is the likely outcome for cases where there is no evidence of, “exploitation, grooming, profit motive, malicious intent (e.g. extensive or inappropriate sharing (e.g. uploading onto a pornographic website) or it being persistent behaviour. Where these factors are present, outcome 21 would not apply”. While the College of Policing advice was written for forces in England and Wales, the UKCCIS advice is wider, although mostly focussed on England due to jurisdictional issues and the fact that the legal powers of schools in England regarding seizure are different to the other devolved nations. However, the advice has been widely disseminated and is available for use by other countries, a fact which may encourage greater consistency of responses. These two important reports offer clear advice about the management of cases involving youth-produced sexual images by children, particularly from educators and law enforcement. What the reports also reflect is that the young person exists within multiple, overlapping social systems that may influence not only the creation and sharing of sexual media but the experience of the child when one or more of these systems becomes overtly involved. Martin and Alaggia (2013) have argued that Cyberspace has added a new dimension to the ecology of childhood. Their focus was on children made the subject of sexual abuse images, and clearly overlaps with issues of youth-produced content. Their model allows us to simultaneously think about the child and family context, the larger social systems of influence in which the child and family are embedded, and overarching cultural values and belief systems and how these may change over time. This provides a useful framework for thinking not only about proximal and distal forces that influence a young person’s decision to take and share images, but how the wider system may respond to them consequently. Voices of Young People This study focuses on identifying voices of young people. In research, policy and practice regarding children and young people, the question of participation needs to be understood in relation to questions of inequality and inclusion. Many societal processes marginalise children’s experiences, treating them as spoken for or dealt with by their parents or child protection agencies, and this has traditionally been the case with, for example, child sexual abuse (Gilligan, 2016). For example, early research, policy and practice regarding children’s safety began with an adult agenda (particularly within a legal context) and it is only belatedly that the voices of children began to be heard. Children themselves are often critical of politics, policy and services, assuming that even if they do speak out, they will not be heard or respected as valid contributors to deliberation or decision-making. Early opportunities to protect (rather than judge or restrict) them are often missed by parents, teachers and policy makers (Mendelson & Letrourneau, 2015). It is also evident that when specific efforts are made to include children in matters that concern them (required by the UN Convention on the Rights of the Child), these often result in further inequalities, as children from already-advantaged backgrounds tend to take up such opportunities disproportionately while the alreadydisadvantaged become further marginalised in a vicious cycle of exclusion. This study is an attempt to include young people in a meaningful way that gives the opportunity for their views to be heard. 12 Rationale for this Study Very little is known of the views of young people who have engaged in self-produced sexual images, and their experiences of involvement with professionals, including law enforcement and child protection agencies. To address this gap in the literature, this Delphi study identified the opinions and views of young people as ‘experts’ on what constitutes an appropriate response when dealing with what starts out as non-coercive self-produced image-taking, but where images are subsequently shared without consent. This study also aimed to identify indicators of distress and ways to facilitate disclosure when the sharing of images causes anxiety or is associated with bullying, harassment or victimisation. Such indicators facilitate rapid assessment of cases, on the one hand, and provision of information, protection and support to vulnerable and potentially intimidated victims on the other. Method Delphi Method The Delphi method is a consensus technique that involves a group of anonymous experts who are given questionnaires and controlled feedback to obtain consensus on a topic (Dalkey & Helmer, 1963; Rowe, Wright, & Bolger, 1991; Ziglio, 1996). Delphi is a tool for knowledge-building, to explore critical ideas and to support informed decision-making that is grounded on a collective basis (Linstone & Turoff, 1975). It can be a particularly beneficial application to identify options to solve problems under conditions of uncertainty and inadequate information. The Delphi method enables the researcher to gather the intuitive insights of experts that provide the basis of new insights and problem-solving (Dalkey, 1967; Hasson, Keeney, & McKenna, 2000;). Within this context, the Delphi method represents a suitable approach to explore the opinions of young people who have engaged in youth-produced image-taking to aid professionals in evaluating and responding to cases with a victim-centred approach. The Delphi method is a structured technique that consists of several parts, or so-called ‘rounds’. In the first round of the study, participants are typically being asked to answer a set of open-ended survey questions. The second round is informed by the data of the first round to the extent that it involves a summary of themes that were most frequently mentioned in the survey. The themes are presented in the form of statements, which participants are asked to rank in relation to their importance (Ziglio, 1996). Delphi studies often require up to three rounds to reach consensus where participants are then asked to adjust their initial ratings of statements in relation to responses of other participants where agreement was not reached. Although consensus is often reached after two or three rounds, further rounds may be required until consensus has been obtained. As pointed out by Earley (2015), the Delphi method is characterized by four key features: Anonymity, controlled feedback, iteration and statistical group response. The use of questionnaires is used to protect the anonymity of panellists. Due to this feature, the Delphi method avoids many disadvantages associated with the dynamics of direct face-to-face group interactions, such as the “band-wagon effect” or the “halo effect” (Dalkey, 1969; Turoff & Hiltz, 1996) where participants may feel pressured into agreeing with others within the group. It enables researchers to reach participants that are geographically dispersed in a cost- and time-efficient manner (Becker & Roberts, 2009; Ziglio, 1996). The controlled feedback involves accumulating feedback in a series 13 of iterations; and finally, statistical group response ensures each panellist’s opinion is included in the final response (Earley, 2015). The Delphi method has also been shown to produce sufficient reliability and validity when results are based on both qualitative and quantitative measurement (Hasson & Keeney, 2011). There is no agreement on the required samples for Delphi studies, with samples typically ranging from 10-100 (Akins, Tolson, & Cole, 2005). Participants The research was reviewed by the School of Health in Social Science Research Ethics Committee. In total, 124 participants all of whom had self-identified as taking and sharing youth-produced sexual images (sexts) took part in the Delphi study, of which 45 provided full survey responses, which included the disclosure of a mobile phone number (to LC) to be contacted for the second round of the survey (this was a dedicated mobile and numbers were deleted post data collection). Of these full responses, 10 were male and 33 were female (two participants did not disclose their gender) with a mean of 16.24 years (range 14-19). Round 2 was completed by 23 (51.11%) individuals. Participant Recruitment Participants, that formed part of the panel of ‘experts’, were young people recruited over three different time-periods (or “recruitment waves”) between May to September 2016. The use of different “recruitment waves” enabled comparison of response propensity across participant recruitment procedure – such as networks of professionals working with young people, including police, child-protection agencies, child therapy units, youth workers and schools. Participants were recruited through two methods that protected participants’ anonymity – 1) advertisement on online-platforms, email bulletins and social media, and 2) pupils at high school. All participants were offered a £10 gift voucher for volunteering their time to complete the study. Procedure Young people as participants were provided with a web-link to access the survey platform. By following the web-link, participants were also given information about the purpose of the study, as well as access to the consent form and the questionnaire, which were designed using the secure web-based software ‘Bristol Online Survey Tool’. The information package and consent form explained clearly that anonymity between participants was ensured, and that participating in this study was anonymous to the extent that only one researcher had access to their email address or mobile phone numbers, which were used to contact participants as a part of this study and deleted once this had been completed. Participants had two to three weeks to complete each round. After participants had completed the Round 1 questionnaire, reminder emails and text messages were sent out with a web-link to access and complete the Round 2 questionnaire. In particular, this study employed a vignette approach that has been also used in other Delphi studies (e.g. Wainwright, Gallagher, Tompsett, & Atkins, 2010). To assess consensus of responses given to the vignettes-based questionnaire, a defined average percentage of agreement with an 80% cut-off was used (Langlands, Jorm, Kelly, & Kitchener, 2008). The following consensus criteria were used: 1. If at least 80% of participants rated an item as “very important”, “important’ or “moderately important”, the item was included. 2. Any items that did not meet condition 1 were excluded from significant findings. 3. Excluded items were still considered to provide relevant information. 14 Round 1 Questionnaire Round 1 was an open-ended vignette-based questionnaire consisting of a series of eight questions that inquired about participants’ opinions and advice of youth-produced imagetaking (Appendix 1). Vignette-based approaches have been used in other Delphi studies and this approach was considered appropriate by the Educational Unit of the National Crime Agency CEOP command as a way of making the questions more accessible to the participants. The questionnaire also adhered to principles of questionnaire design. An initial pilot testing was carried out that assessed the clarity of the wording of the questions and time frame of completion. The questionnaire items were divided into four separate sections. The first section was concerned with the identification of problems and it included one question; the second section presented participants with five questions in relation to the facilitation of disclosure, and involvement with parents and professionals; and the third section revolved around the involvement of other third parties associated with bullying, harassment or victimisation. An additional question was content-free and allowed participants to add any other relevant information. Content Analysis Qualitative content analysis was used to identify relevant themes as meaning units of the responses of the Round 1 questionnaire. Content analysis enables the researcher to develop theoretical and conceptual models of a phenomenon by objectively and systematically describing the manifest content, such as words and phrases, of communication (Krippendorff, 1980, p. 19). It does this by categorising words, phrases and paragraphs into fewer meaning units that convey a similar central meaning (Graneheim & Lundman, 2004). To conduct the content analysis of the Round 1 questionnaires, all responses were transferred to a standard word document and carefully read by the researcher to obtain a general insight of the data content. The unit of analysis was participants’ responses to the open-ended questions in relation to the five main themes – 1) identification of problems; 2) first steps to seeking help; 3) supportive behaviour by parents; 4) supportive behaviour by professionals, and 5) involvement of other third parties associated with bullying, harassment or victimisation. The responses varied in their quantity ranging from short phrases to longer segments that contained several meaning units. The identified meaning units were condensed and collapsed into smaller meaning units, which were then grouped into broader themes and categorised into sub-categories and higher-order categories. A total of 60 sub-categories were identified and grouped into the following eight higher-order categories: 1) What people did or said that suggests nude or semi-nude images were shared without permission 2) What the boyfriend might do or say that suggests ‘selfies’ were shared without permission 3) First steps to seeking help 4) Parent or carer doing and saying things that are supportive 5) Dealing with others 6) Professionals doing and saying things that may be supportive 7) Teachers doing and saying things that may be supportive 8) Police doing and saying things that may be supportive 15 Round 2 Questionnaire The results of the content analysis were used to develop the items for the Round 2 questionnaire. Consistent with the aim of this study, the Round 2 questionnaire items revolved around observable behaviours and attitudes relevant to the identification of problems, facilitation of disclosure and involvement of third parties in cases of nonconsensual image sharing. These items were presented in the form of declarative statements with prefaced verbs that relate to the category heading and followed by verbatim excerpts taken from the Round 1 questionnaire responses – for example, the sub-category “people’s indirect comment about nude selfies” was prefaced with the word “make” and completed with the verbatim example “people making jokes about it around her”. All items in the Round 2 questionnaire were listed under the category heading as identified using content analysis of the Round 1 questionnaire responses. A total of 8 categories were constructed with a total of 60 items. Participants were asked to rate their strength of agreement for each item on a 5-point Likert scale, where ‘1’ indicated “not important” and ‘5’ indicated “very important”. Eight open-ended questionnaires provided an opportunity for participants to provide further comments and supplementary information. All the 45 participants who provided full responses in the Round 1 questionnaire, were invited to complete the Round 2 questionnaire. Once all the responses of the Round 2 questionnaire were collected, the consensus-criteria were applied to identify which items were included or excluded. Results The Round 1 questionnaire was completed by 45 participants. The meaning units of these responses were grouped into 60 sub-categories and 8 higher-order categories that matched to the five broad themes: 1) identification of problems; 2) first steps to seeking help; 3) supportive behaviour by parents; 4) supportive behaviour by professionals, and 5) involvement of other third parties associated with bullying, harassment or victimisation. Identification of problems This theme related to codes and categories associated with the identification of behaviour and attitudes that signal nude or semi-nude images have been shared without consent. The categories in this theme were “what people did or said that suggests ‘selfies’ were shared without permission” and “what the boyfriend might do or say that suggests ‘selfies’ were shared without permission”. In relation to people’s behaviours and attitudes, most participants perceived the following to be important sign that ‘selfies’ were shared without permission: • spread rumours and gossip (100%) • post insulting messages or her nude images on social media (100%) • make direct comments, such as confronting her about the nude selfie, or asking for a nude selfie (95.65%) • suddenly behaving differently, for example avoiding her (95.65%) • make indirect comments about the nude selfie (e.g., laugh, make jokes and call her nasty names) (86.96%) 16 Although not at a significant level, nearly two-thirds of participants rated that “giving strange looks when walking by” (65.22%) was also an important sign that images were non-consensually shared with others. Participants’ comments in Round 2 further proposed that other signs could be indicative of non-consensual image sharing, such as other boys taking a greater interest in her and girls being inclined to suddenly keep their distance from the victim to engage in gossip, as well as receiving others’ sympathetic looks or trolling behaviour. Based on participants’ ratings, important behaviours and attitudes of the boyfriend that signal nude ‘selfies’ were shared without permission included: • avoids letting her see or use his mobile phone (100%) • does not give a clear answer when asked about nude photos (100%) • compares her to other girls who he says freely share pictures (91.30%) • behaves distant and avoids her (86.96%) Although not at a significant level, the boyfriend’s inquiry for more nude photos “asks for more nude pictures” (69.57%), “being persistent when she refused to send more photos and steers conversations to nude images” (78.26%) and “shows his phone to others who start laughing and show great interest” (78.26%), were also perceived to be an important sign to indicate images were shared without permission. Participants’ comments in Round 2 further suggested that other signs could indicate that images are being shared without permission, such as the boyfriend exhibiting aggressive and annoying behaviour when the victim refuses to provide more nude ‘selfies’, as well as the use of password protected picture-storing mobile phone apps. Another suggestion put forward was that the boyfriend might experience anxiety that his friends would disclose to the victim that images have been shared without her consent. First steps to seeking help The theme of “first steps to seeking help” relates to codes and categories associated with helpful actions when the victim suspects or is aware that nude or semi-nude images have been shared without permission. In relation to this theme, the majority of participants reached consensus about the importance of the following help-seeking behaviours: • speaks to police to report that photos were shared without permission (95.65%) • speaks to a person they trust (a friend, youth worker) to seek help (95.65%) • confronts the boyfriend about the situation (95.65%) • discusses the situation with a parent or carer or another family member (91.30%) • speaks to trusted teacher to try and sort out the problem (86.96%) • speaks to ChildLine to seek support (86.96%) • speaking to a trusted person outside of the family (82.16%) 17 Consistent with the helpful behaviours rated to be important, most participants did not rate the following behaviours: • avoids retaliating with similar behaviour (e.g., sharing nude image of boyfriend (73.91%) • pretends to others that she’s not being hurt or affected (39.13%) • avoids speaking to the police (30.43%) This may indicate that avoidance strategies were not considered to be important when seeking help. Participants’ comments in Round 2 also indicated that speaking to another victim who has experienced a similar situation and changing social media settings to private-mode might be helpful actions. Parents or carers doing and saying things that are supportive This theme relates to codes and categories associated with parental behaviours that support the young person whose nude ‘selfies’ have been shared without permission. In relation to this theme, the majority of participants perceived the following behaviour to be supportive: • supports the young person (being reassuring and respecting privacy) and offers to resolve the problem together (95.65%) • talks to others about the situation with the young person’s permission (95.65%) • is non-judgemental and does not blame the young person (95.65%) • parent / carer talks to a teacher about the situation to minimise damage and resolve the problem (91.30%) • confronts the boyfriend or approaches his parents about the image (82.61%) In contrast, participants thought it less important for parents to contact the police about the incident or to advise against sending nude images again: • contacts the police to report that photos were shared without permission (78.26%) • advises the young person not to send images again (73.91%) Consistent with the results, most participants did not rate “does not confront boyfriend or approaches boyfriend’s parents about image” (47.83%) to be an important parental behaviour. A participant also commented in Round 2 that the parent / carer should try to come to an agreement with the young person how to proceed in resolving the problem situation. 18 Professionals doing and saying things that may be supportive The theme of “supportive behaviour by professionals” relates to code and categories associated with professionals’ behaviours that support the young person whose nude ‘selfies’ have been shared without permission. In relation to this theme, the majority of participants perceived the following behaviour to be supportive: • informs about procedures, important information and explains what is going to happen next (100%) • tries to understand and listens to the young person, and is aware of the social context of photo sharing (100%) • does not breach privacy by mentioning names to others who do not need to know (100%) • avoids making the situation worse (100%) • confronts the boyfriend and those involved to stop sharing and delete the image from the mobile phone (95.65%) • deals with the situation confidentially, discreetly and sensitively (95.65%) • is supportive and reassuring, offers help to resolve the problem together (95.6%) • offers supportive reporting processes (95.65%) • punishes those involved who have shared images without permission, such as school suspension or a criminal fine (91.30%) • educates those involved about the consequences and seriousness of sending and sharing nude pictures, and also informs about safe-sexting (90.90%) • avoids judgment, blaming and victimisation (86.86%) Participants’ comments in Round 2 provided various suggestions of other supportive behaviours. For example, teachers should try to stop the victim being bullied, and reduce tension by introducing a seating plan where the victim is not sitting with anyone who has been involved with bullying her. It was also thought that teachers should raise awareness of the implications of sharing nude ‘selfies’ and warn pupils not to ostracise or bully any victims. Although one comment stated that the risk and dangers of sharing nude ‘selfies’ should be addressed in large school assemblies, another comment indicated that large school assemblies, even without mentioning any names, would infringe the victim’s privacy and therefore result in further problems, such as bullying and harassment. 19 Teachers doing and saying things that may be supportive This sub-theme relates to the main theme of “professionals doing and saying things that may be supportive” with specific focus on teachers and the management of cases within the educational context. In relation to this theme, the majority of participants perceived the following behaviour to be supportive: • speaks with boyfriend and his parents to discuss the seriousness of the situation (100%) • does not draw attention to individual affected through preferential treatment (95.65%) • contacts the police to report non-consensually shared image (95.65%) • speaks with other pupils about appropriate behaviour and attitude (91.30%) Conversely, participants did not perceive the ban of mobile phones at schools and allowing the victim to take time off school to be important supportive behaviours: • introduction of policies to ban mobile phones from schools (52.17%) • allows to take time off school (26.09%) Participants’ comments in Round 2 also suggested that the risks of sharing nude images should be discussed and explored as a part of a set curriculum to explore solutions to situations of non-consensually shared nude images. On the other hand, the discussion of these topics as a response to an incident of non-consensual shared images at the school would promote gossip. Teachers should also discuss with a group of pupils, including the boyfriend and his friends, the underlying reasons of their bullying of the victim. Police doing and saying things that may be supportive This sub-theme relates to the main theme of “professionals doing and saying things that may be supportive” with specific focus on the management of cases within the context of law enforcement. In relation to this theme, the majority of participants perceived the following behaviour to be supportive: • reassures that the matter is dealt with appropriately and safely (95.65%) • deals with the situation appropriately, fast and with little repercussion (91.30%) • having access to speak to a female police officer (91.30%) A participant’s comment in Round 2 also stated that police should make the victim feel comfortable and not to surround the young person with too many different people. 20 Dealing with others’ behaviours and attitudes This theme relates to coping strategies in response to others’ negative and disruptive behaviours, such as bullying, when non-consensually shared images become public knowledge within small-knit communities, such as schools. The majority of participants reached consensus that the following coping strategies would be important to reduce and minimize the stressful effects of bullying and harassment: • does not isolate herself from others (100%) • reports and speaks about others’ disrespectful behaviour to a trusted person (family, teacher or police) (95.65%) • surrounds herself with supportive friends and focuses on positive activities (91.30%) • accepts and learns from experience (91.30%) • refuses to feel bad for having made a bad decision (91.30%) • joins a support group to better deal with the situation (86.96%) • remains confident, assertive and holds ‘head up high’ (82.61%) • seeks distance and ignores others who are disrespectful (82.61%) Participants, however, did not perceive confrontational behaviour to be an important coping strategy: • confronts others about their disrespectful behaviour (47.83%) Participants also commented in Round 2 that the victim should not retaliate in response to others’ bullying behaviour. Another comment suggested that the victim should engage in altruistic activities to increase a self-worth. Discussion This study explored the opinions and views of young people of what constitute helpful behaviours and attitudes in cases where nude or semi-nude images have been shared without consent. Overall, participants agreed that the clear majority of statements identified in the Round 1 questionnaire were important and thus achieved consensus. The findings demonstrated that the participants reached consensus over several helpful and supportive behaviours. Such helpful behaviours and attitudes related to themselves, parents and professionals working with young people, including teachers and the police. The first theme provided insight of what behavioural signs by others and the boyfriend might indicate that images have been shared without permission, for example, the spreading of rumours and insulting behaviour. The second theme related to participants rating of immediate helpful behaviour in cases of non-consensual image sharing. One of the highly-rated behaviours included reporting to the police that images have been shared without permission, and speaking to a trusted person to seek help and advice. Interestingly, the same participants rated it less important for parents to report the incident to the police. In contrast, young people preferred parents to approach a teacher or boyfriend and his parents. Parents’ non-judgmental attitude and avoidance of blaming were also rated highly. High ratings were also given to professionals’ ability to listen to the 21 young person, respect of privacy as well as providing information about procedures and other important information. Although a few items did not achieve consensus, they were still deemed to provide important information. For example, the item “giving strange looks when walking by” (65.22%) was rated by over two-thirds of the participants to signal that images have been shared. Noteworthy, this study is also the first study that focused on identifying the views of young people who are framed as ‘experts by experience’. Such a focus on young people as ‘experts’ is of importance for the development of evidence-based policies and guidelines that ensure good practice in relation to the management of coercive and noncoercive youth-produced sexual image-taking. Implications for research and practice This study was the first of its kind by including young people as ‘experts by experience’. Such a focus on young people is important to inform appropriate victim-centred management of cases where images have been shared without permission. Limitations of study There are several limitations that, to some extent, may interfere with validity of the results obtained in this study. Although this study is based on a sufficient sample size, it must be taken into consideration that a larger data set could have produced slightly different results. In this study, it was not possible to differentiate between participants who have direct or indirect experiences of sexting, from those who do not have such experiences. Of those, who may have experience, it was not possible to infer who had experience of their own images being shared non-consensually, and of these cases having escalated to law enforcement. In this sense, future studies should include a data set based on a more diverse demographic. In particular, this should make reference to gender, ethnic and socio-economic diversity and LGBTQ youth as well as other groups who are often marginalised. 22 23 Part 2 – Collaborative Symposia: Edinburgh, Norfolk and London 24 Introduction Professional confidence in responding to all forms of technology-mediated abuse and exploitation seems lacking (Quayle & Cooper, 2016). This is not to say that organisations are failing children, or that there are not examples of good practice across many disciplines. The limited academic literature has largely focused on the challenges professionals face when responding to children abused and exploited online. To date, there is very little research or practice-based work in this area to help us understand the needs of child involved in either coercive or non-coercive youthproduced sexual images. However, there are resonances for this group of young people with studies examining the management of cases involving online child sexual abuse and exploitation images. Here there is a recognition that the introduction of the internet has created a new type of victim experience that needs to be explored to fully understand the implications for that child victim (Leonard, 2010), and highlights the necessity to explore professionals’ opinions regarding the needs of child victims and the challenges and difficulties they face in meeting these needs. Quayle and Cooper’s (2016) review of the literature suggests a general agreement amongst professionals, including social workers and other mental health professionals, that child online sexual exploitation cases are extremely challenging and poorly understood. A German study by von Weiler, Haardt-Becker and Schulte, (2010) found that child pornographic exploitation (CPE) cases were seen as more complex than offline abuse and were more demanding for professionals in terms of the multiple and potentially on-going traumatising aspects of the abuse. Online abuse and exploitation victims may share some characteristics of traditional sexual abuse victims, but they also demonstrate several unique characteristics (Wells & Mitchell, 2007). One particular challenge is the issue of permanence regarding abuse images, leading to a lack of closure, or non-resolution of the abuse experience (Wells & Mitchell, 2007; von Weiler, Haardt-Becker & Schulte, 2010; Leonard, 2010). Specifically, professionals report that children often feel helpless about the lack of closure, leading to additional psychological stress and heightening feelings of shame, fear and guilt. A second challenge concerns the harms arising from victims knowing that their images can continually be publically distributed and viewed by innumerable others. The feelings of loss of control in turn may lead to anger, self-blame and humiliation (Martin 2014; 2014a; Slane, 2015; Cooper, 2011). However, there is limited empirical evidence or evidence-based guidelines about how professionals might to respond to the victims. Martin highlights how practitioners differ in their conceptualisation of what constitutes online child sexual abuse images, their levels of concern about the issue, and their understanding of the potential effects on the child (Martin, 2014; 2014a; 2015). For Cooper (2011), it is imperative that professionals, especially healthcare providers, learn to understand the significance of abuse images alongside the experience of caring for victims. This means acquiring the experience to feel comfortable in discussing the images during interviews, thereby enabling professionals to transfer their understanding of the experiences both to the victims themselves and to the authorities. As cases involving child online sexual exploitation victims are more likely to involve multiple other authorities, e.g. law enforcement officers or child protection services, there is a need to develop guidance about collaborative working between authorities that will enable practitioners to draw upon the expertise of other professionals in order to provide comprehensive treatment and care (Wells and Mitchell, 2007). 25 Jansen (2011) suggests that the needs of these young people are different from offline cases in a number of ways. Feelings of connectedness, responsibility and shame may be more persistent in online CSA cases as the young people may have presented themselves online in a sexualised way and as a willing participant. They may also have ignored opportunities to disconnect from online interactions, thus creating feelings of responsibility for enabling the abuse. This may surely be the case in relation to youth-produced sexual images, particularly where they have been shared as well as where coercion has taken place. It is also likely to be the case that as most these cases involve adolescents, as opposed to younger children, there are perceived issues about agency and adolescent risk-taking that may influence our attitudes and behaviour towards these young people. Adolescent sexuality when evidenced in digital media is challenging, possibly embarrassing, and an unwelcome disruption of our sense of order. For law enforcement, it can be a time-consuming distraction from cases where children are more apparently at risk. What Problem is Being Addressed? Our original research had resulted in the development of a series of short films, commissioned by our partners in NCA - CEOP Command, which targeted parents and professional groups. Our pilot workshops which accompanied the launch of these materials indicated a generally positive response from parents in their confidence levels about talking to their children about ‘sexting’, but professionals felt less certain about their ability to manage these cases. This prompted us to work with NCA – CEOP Command, Police Scotland, Norfolk Constabulary and the Marie Collins Foundation to develop a consensus study across stakeholder professional groups to address concerns about the management of youth-produced sexual images and to provide examples of what might be seen as good practice. The bid was to address the perceived gaps about how professionals may work together and draw upon each other’s expertise in order to increase cross-disciplinary confidence in working with young people. How was the Problem Approached? We worked with partners to identify professionals who would be interested in attending one of three symposia. We wished to have small groups (approximately 20 people) to facilitate engagement and maximise our outputs. The meetings were structured (three short presentations) before working in groups to address previously identified questions. Prior to the symposia, our partners distributed the Delphi report that had already been completed with young people who had self-produced and shared sexual images. Confidentiality was assured in that while we had requested that the content of these meetings could be collated for this report, no attributions would be made to any individuals. 26 Overview of the consensus study with professionals Locations The collaborative symposia with diverse groups of professionals were held across three sites in the UK (i.e., Edinburgh, Norfolk and London) between November and December 2016. These symposia were organized in collaboration with partners of the project, which included Police Scotland, Norfolk Constabulary and NCA-CEOP Command. The symposia were held in informal settings at three different locations – i.e., the University of Edinburgh, Norfolk Constabulary, and the offices of NCA-CEOP Command. Attendees At total of 70 individuals attended the three collaborative symposia – of which 26 individuals attended the symposium in Edinburgh, 17 attended the symposium in Norfolk and 26 attended the symposium in London. Although the highest percentage of attendants at all three collaborative symposia were police officers, each symposium also had a distinctive distribution of professions (see Tables 1-3). For example, the symposium in Edinburgh had a stronger attendance of government employees whereas the symposium in London featured the greatest percentage of teachers. Although the symposium in London had an overall greater diversity of professionals and organisations (such as health and wellbeing advisor an academic), the symposia in London and Norfolk had a similar distribution of individuals working for the government, charities and NHS. 27 Table 1: Overview of attendees at the Edinburgh symposium Table 2: Overview of attendees at the Norwich symposium Table 3: Overview of attendees at the London symposium A closer examination of the attendees’ professional focus (regardless of professional group) reflected a strong emphasis on child protection in all three symposia (see Tables 4-6). 28 Table 4: Professional focus of attendees at the Edinburgh symposium Table 5: Professional focus of attendees at the Norfolk symposium Table 6: Professional focus of attendees at the London symposium 29 Discussion Groups Following a series of brief presentations by stakeholders relevant to the topic of online sexual exploitation and youth-produced sexual images, all attendees were divided into equally-sized discussion groups of approximately 5-7 people. In each of the three symposia, attendees were given a set of five questions that were critically discussed in each discussion group. The five questions were the following: 1. What are the main challenges associated with youth-produced images? 2. How do we differentiate between coercive and non-coercive youth-produced images? 3. What facilitates the management of these cases? 4. What inhibits their management? 5. What recommendations would you make for how these cases can be managed that maintains a child-focused perspective? Each group nominated a note-taker who wrote down the main discussion points on flip-chart paper for later discussion. After the discussions ended, the summary of the responses was then presented by one representative of each group to the whole of attendees, and then further examined and debated by the larger group. At the end of each symposium, all attendees were asked to write down three recommendations on “what changes should be made to better manage cases of non-consensually shared images?”. These recommendations aimed to identify and pull together the attendees’ impact-orientated insights and opinions that were formed because of the group discussions. Analysis All responses were transferred to a standard word document and carefully read by the researchers to obtain a general insight of the data content. Responses varied in their quantity ranging from simple keywords to short phrases and sentences. Qualitative content analysis was then used to identify themes that were frequently mentioned in responses to the questions, in addition salient responses were identified and included in the result section. Researchers’ notes that were taken during the open group discussions were also used to provide further details and complement the responses. 30 Results Responses to the Five Questions Responses to the five questions related to “identification of main challenges”, “differentiation between coercive and non-coercive youth-produced images”, “facilitation of case management”, “inhibitors of case management”, and “recommendation for child-focussed management” were grouped into thematic categories. Q1: Main challenges associated with youth-produced images? In relation to the management and conceptualisation of images, attendees identified that the “shifting purpose and function of images” as they are shared between different audiences makes it difficult to decide upon appropriate interventions. The “unspecified ownership and inherent loss of images” indicates challenge in the “categorisation of images as nudes or selfies”. In addition, attendees mentioned a lack of awareness and insight by young people, parents and professionals concerning the implied risks of sharing and producing nude images. It highlights the importance to introduce educational schemes that inform young people, parents and professionals about the risk and consequences of image sharing. Educational schemes should also “raise awareness about technology and the Internet”, and the implications of the “longevity of pictures”. In particular, education content should be highly “relevant to young people who are using images as part of their culture”. As pointed out by attendees at the symposium in Edinburgh, young people should have access to “peer support” as a means to avoid peer pressure and cultural expectations that normalise the sharing of images and possibly undermine reporting. Attendees also identified that young people’s limited ability “to understand the consequences and risks of sending images” and their understanding of interpersonal relationships, such as “young people’s naïve understanding of interpersonal trust” and “understanding the risk of sharing of images during a relationship, and its consequence after the relationship breaks down” has been identified as a challenge. This can serve to create “a barrier to find dialogue” between young people and “professionals who are dependent on the experiences of young people who have very different values regarding healthy relationships”. Young people are also often under the influence of “peer pressure on silencing, such as fear of reporting and blackmailing” which represents a challenge to professionals to offer ways of reporting that are in the best interest of the young person. As pointed out at the symposium in Edinburgh, professionals are also challenged to identify and respond in a child-focussed way when “dealing with the perpetrator as a teenager”. Attendees in London identified that tensions between parents and schools and an apparent lack of active parental engagement indicate challenges in the management of cases. For example, “parents defer responsibility to school to manage problem, which blurs the boundaries of problem ownership”. In relation to parenting, there is “not sufficient communication between parents and young people” and “a lack of parental interventions, such as restricting young people’s access to affordances (e.g., mobile phones)”. “Young people against disclosing to the teacher out of fear of losing their smart phone” and “escalation of young people’s risky behaviour represents an additional barrier to disclosing to a parent or teacher”. 31 Attendees at the symposium in Edinburgh identified challenges of the legal processes in the management of cases. It was stated that there is a “need for a legislative framework to assess criminal threshold” and that a “balanced legal framework should emphasise activities that are in the best interest of young people”. In relation to the best interest of young people, it was also mentioned that “police should focus on victims to come forward” and once a report has been made, “young people should be informed about the legal process”. Differences between guidelines across agencies “represent a barrier to reporting”, and “inconsistency of information, risk assessment and decision-making processes” as well as a “lack of clear definitions” hinder and delay processes. Although external interruptions can also delay the timely processing of cases, such as “young people doing exams”, the use of guidelines that promote a consistent approach are particularly important to “how cases are managed, developed, and influence the experience of a young person”. It was also suggested that there is a need to carry out “more research to support, understand and influence government in relation to evidence proportionality”. Most importantly, as stated by attendees at the symposium in Norfolk, “once reported to the police, an investigation has to be followed through”. It was also mentioned that the rapidly advancing technology and its risks to young people represents an additional challenge, thus attendees pointed out the importance to better “understand the nature of the Internet”. In particular, professionals might “come from different contexts might have a different understanding of technological norms” and “be overwhelmed by technology”. Users of technology, including young people and parents, need to better understand the risks of sharing images and “the tension between the easiness of taking a picture and its longevity on the Internet”, which highlights also an existing “generational gap of parents to understand the implications of young people growing up with technology”. The cultural context and its wider social implications represent a challenge, which partly reflects the controversial topic of the nude body in society. For example, there is a sense of a “normalisation of sexting” that is largely consistent with the “normalisation of nudity as a part of generational upbringing (e.g., music industry)” and possibly influences “young people’s perception between rough and aesthetic pictures”. Such a normalisation of nudity and sexting distracts from perceiving “sharing of images as a risky behaviour”, and as a means to obtain “self-validation”, implies the danger of encountering “public humiliation and self-harm”. There exists also a “doublestandard of sexual consent” where young people aged 16 or over are allowed to engage in sexual activity, but it is illegal to take, possess or share nude images of anyone (including oneself) under the age of 18. As mentioned by attendees in London, the sharing and production of nude images are also relevant in relation to “implications of gang culture” as well as “victim culture where victims become perpetrators and those who were bullied become bullies”. Q2: Differentiating between coercive and non-coercive youth-produced images In relation to the differentiation between coercive and non-coercive youth-produced images, attendees consistently stated the intrinsic difficulty imposed by the changing context in which images are shared that make it difficult to determine when a situation becomes coercive. In this sense, it is “difficult to differentiate because images can start as shared consensually but then things go wrong and the relationship might change” or in situations where initially “non-coercive image sharing may turn coercive, for example, when the victim is being threatened if the sharing won’t 32 continue”. As identified by attendees at the symposium in Edinburgh, there is also “tension around the decision-making framework” to determine whether images are coercive or non-coercive, and “prejudices around the person who created the image”. With the aim to differentiate between coercive and non-coercive sharing of images, attendees provided practical suggestions. For example, it was proposed that professionals should strive to “understand the context of image sharing on an individual case assessment” and “gather sufficient information that enables proportional responding”. In relation to the victim and perpetrator, it would be important to “identify power imbalance vs. healthy relationship” by “using intelligence and evidence, such as talking to witnesses and victims to weigh up against each other” and “clarifying the intentions and motivations of the perpetrator to determine coercive sharing (e.g., blackmail, photo-shopping, hacking devices) vs. noncoercive sharing – e.g., free will and loving relationship)”. It was seen as important to focus on “consent being led by the victim”, and as pointed out by attendees at the symposium in London, for professionals to “be mindful of cultural differences”. Conversely, attendees also pointed out that there remain existing “tensions in the law to the extent that each police force has different guidelines and limits” and oftentimes the “discretion to report and to carry out appropriate risk assessment remains with school and police force”. Q3: Facilitation of case management In relation to the facilitation of case management, attendees consistently stressed the importance of inter-agency work. Such “effective inter-agency working and good relationships among agencies” would facilitate “timely and coordinated response led by professionals who can ensure joint actions, appropriate responses and completed outcomes”. There should be also a shared “professional understanding of which agencies should be included” so that there is an “effective support system that is in place when help is needed”. Agencies have an “obligation to support the police” which includes “information sharing to enable police to obtain a coherent picture”. Attendees at the symposium in Edinburgh also mentioned that an effective multi-agency approach requires “low competing interests and a focus on shared interests” and the “same decision-making process and risk assessments”. Processes and joint actions should incorporate “balance between a child friendly perspective and legal process”, emphasise “child focussed responses that are individual and implement flexibility to make decisions” and “ensure outcomes, actions and agreed joint response with input of young person”. Although a multiagency approach is needed to facilitate the management of cases, power remains with the police who carry the statutory obligation to own the problem and hold discretion about enhanced record check of reports to be mentioned. Schools, and the involvement of teachers, have been identified of utmost importance in the management of cases to the extent that schools should focus on the safeguarding of young people and carry out early interventions and risk assessments. Attendees mentioned that teachers would require “training about online safety”, “to notice and report changes in children’s behaviour”, and adhere to their “duty to report when a child is at risk” and “being aware of confidentiality”. Schools should “emphasise safe-guarding”, “maintain good relationships with police, school governance, safeguarding and parents to enable early management and prevention” and should 33 provide “good risk assessment processes at schools to decide what needs to be escalated”. By focussing on the needs of young people, the school and teachers should have sufficient “awareness of procedure to keep children involved – e.g., referral to youth engagement team”, “provide management of the psychological impact on children and involving counselling and other agencies”, as well as providing relevant education to young people by “ensuring that sexting is part of subject content at school”. Given that cases involve young people, attendees also pointed out the emphasis on a child-focussed perspective by ensuring that “young people are involved in discussions regarding procedures”, “the right person talks to the young person and maintains communication” and that professionals have a “good understanding of young person’s vocabulary” and “children based communication”. Attendees at the symposium in Edinburgh further mentioned the importance of providing young people with relevant education about “the Internet and risks” as well as the “difference between coercive and non-coercive relationships”. Given that young people typically want to be part of a group, there should be “peer support to influence positive behaviour and decision-making, such as coming forward”. The role of parents to ensure the safeguarding of their children has also been identified as an important factor in the management of cases. Parents should be “supportive to their children” and there is a need of “parental involvement and knowledge of technologies”, “parents should attend workshops about the Internet” and “discuss issues on parent online forums to identify and fill their knowledge gaps”. Q4: Inhibitors of case management In relation to factors that inhibit the management of cases, attendees identified in relation to an existing legal gap that “young people aged 16-18 years are too young in regard to a sexual offence, but the police are not able to generate a young person concern report if over the age of 16 years”. This comment was made in Edinburgh and was related to: the perceived legal framework in Scotland, what might be seen to be in the best interest of the child, reporting, and the difficulty of a legal-child-friendly perspective. There might be also a “mismatch between a young person’s maturity and development as well as their sexual experience and age” and “young people scared to come forward and engage with law enforcement”. Once a young person has come forward and a case is being processed, however, “professionals should manage the expectations of a young person in regards to the legal procedure of case”. There is also a general “lack of understanding of technology” and “differential responses by agencies” that inhibits the processing of cases. Attitudes of professionals towards cases involving sexting have also been pointed out to be a potential hindrance. An apparent “lack of communication between professionals, such as a lack of feedback from social service, one-way information but no update on cases” as well as “lack of feedback from police to reassure safe dealing”. Attendees at the symposium in London, in particular, identified that teachers show a “lack of understanding of protocol and law” and “lack of familiarity of working together with the police”. There is also a sense of “teacher’s embarrassment and fear of engaging with cases, such as viewing of evidence, confiscating of mobile phones and devices”, a “fear of professionals of viewing images and its impact on their own professional reputation” and an undercurrent of “judgmental attitudes with a focus on education rather safeguarding”. 34 Attendees at the symposium in London mentioned a lack of parental engagement with their children has also been identified to problematic to the extent that parents are “in denial of problems” and “lack sufficient understanding of the culture of young people, such as the sharing of images”. An additional “lack of parental engagement, undermines on a school level” where for example, there is a “culture where parents take children out of sex education”. While at times these comments may seem like ‘parent-blaming’, it was acknowledged that there is a need for additional parental support to empower them to safeguard their children through engaging in more active communication about relationships, including those that are made online. Q5: Recommendation for child-focussed management Attendees identified the importance of being aware and remaining focussed on the young person. For example, “a review of legislation should allow for a young person-focussed and individualized approach and response”. Such youth-focussed management requires professionals to “take into account a young person’s age, stage of development and their ability to understand the situation” and “to understand child’s perspective and language” and also of “being aware of special needs”. To provide an understanding of the young person’s specific context, professionals need to “listen to the young person in the process” and also “believe the young person at all times”. Young people should be “given a range of ways to disclose” and be “involved from the onset and kept informed” throughout the process. Professionals should also be mindful that the “process of investigation is traumatic to a young person” and there should be a “provision of ongoing support, if required, as well as the provision of peer support”. Effective and timely processing of cases and communication across agencies has also been mentioned as facilitating a child-focussed approach. This should include “multiagency screening to deal with cases appropriately and timely” and “bridging the gap of partnerships for the best need of children”. The access and sharing of information across agencies, such as “providing web-pages with information”, has been also identified to be supportive to assure the implementation of “early intervention”, “individualised interventions” and to “inform professionals about available interventions”. Responses should be also “proportional and prioritise the child vs. criminalisation”. There should be also “standardised risk assessments” and “realistic management of risk programmes in context of adolescence”. As pointed out by attendees at the symposium in London, it is important for schools to “address their mistrust towards the police” and to “emphasise their duty of pastoral care”. Attendees at the symposium in Edinburgh proposed the notion of “a triage approach” that enables “an initial screening (rather than a random process) and use of guidelines in relation with additional information, including age, diversity groups and special needs”. Professionals should be made available a “tool kit for risk assessment and decision-making processes”. Attendees further identified the importance of an “international context” in cases involving sexting, rather than considering a solely local or national context. Attendees also proposed the use of training to educate young people, professionals and parents about online safety. Thus, there is a need for “informing public and young people about online risks”, “teach about resilience and empowerment” and also to “involve child in the delivery of training”. In specific, social media can be part of the solution to the extent that “cooperation from tech-police companies and social media platforms” should prioritise safeguarding. In such cooperation, media should be used to “inform young people and the public about risks and consequences of using 35 technology and the Internet” and “empower young people”. Recommendations for Changes The responses to the question “What changes should be made to better manage cases of non-consensually shared images?” were grouped into six thematic categories – 1) focus on young people; 2) prevention and early intervention; 3) guidelines and frameworks; 4) support for professionals; 5) equality; and 6) culture. Focus on young people Theme one, “focus on young people”, relates to categories associated with the emphasis on the protection and well-being of young people during the management of cases. Attendees identified the importance to “emphasize a child focused process”, “retain a focus on specific vulnerabilities”. Prioritising the needs and concerns of young people includes “involving and listening to young people, avoiding judgment or blame, and understanding the social context of image sharing” and also “better understanding of the vocabulary of young people”. It was also suggested that professionals should “evaluate and assess cases individually”, and if appropriate, “involve social care and health care services”. Given the use of technology and online devices, professionals should also “provide additional support to young people to manage risky online behaviour” and “better understand the impact of negative online experiences on young people”, such as by “conducting longitudinal studies of impact”. Prevention and early intervention Theme two, “prevention and early intervention”, relates to importance of preventative measures involving professionals and parents to increase awareness and knowledge about sexting. Attendee’s responses highlighted the importance of offering “multipleroutes for reporting and disclosure for young people, parents and schools” and an increased “police liaison with schools to optimise engagement and facilitate disclosure”. It was also identified that there should be a greater “emphasis on a shift from investigation to prevention” that “engage parents and professionals to resolve issues together”. Such prevention includes the provision of “early education to professionals, parents and young people”, and the introduction of “preventative measures and learning material to increase awareness” about internet safety and mobile phones and by doing so “develop skills and increase awareness of risks” to “influence behaviour and prevent negative impact”. Guidelines and frameworks Theme three, “guidelines and frameworks”, relates to detailed suggestions to influence the improvement of policies and guidelines of the management of cases. Attendees identified the importance to “develop consistent guidelines across agencies” and regions, including “across Scotland”. 36 Detailed suggestions indicated the need to “improve existing frameworks and guidelines for agencies to deal appropriately with cases” and “develop clear guidance that clarify the responsibilities and role of agencies in managing cases” to ensure best practice approaches. The guidelines should also “implement clear descriptions and definitions that are useful for professionals”. Professionals and agencies should also “broaden the scope to include national and international guidelines of good-practice to promote a shared approach on censorship”. Attendees also pointed out the necessity to “develop strategies that outline how to manage report of sexting regardless of first point of contact”, “implement and develop a decision-making process, risk assessment and toolkit for best management by agencies for cases” that inform proportional responding to cases. The law surrounding sexting including “the review of legislations and polices across all agencies” was also identified to require improvement and the need for “clear guidelines for professionals around law on sexting” with the use of “accessible language and avoidance of jargon”. Schools were specifically identified as requiring attention in the implementation of guidelines and legislation to enable appropriate management of cases. Attendees mentioned the need to “introduce legislation in schools, teaching and learning about sexting” and to “develop consistent and clear national guidance across schools” that “clarify relationship between school and law”. There should be also the “use of questionnaires at schools about sexting” to identify trends, insight and opinions of both staff and students Attendees also drew attention to the involvement of media service providers to support safe use of the Internet, such as the “development of better industry control on internet risks to young people” and their “support of initiatives” to raise awareness of risks and promote safe online behaviour. This highlighted the inherent problems of privacy, loss of control of content and the need for support from industry to aid in the identification and removal of content. Attendees were aware of some of the new tools developed by industry to assist in this, and there was some discussion of the need for industry to ‘future-proof’ the development of new social media applications. Support for professionals Theme four, “support for professionals”, relates to a range of support measures ranging from improved technological support to the sharing of information between agencies, as well as the access to regular updates, workshops and training events to promote a “better understanding of technologies”. In relation to technological support, attendees mentioned the need for “better IT” such as software to track and delete images and “capabilities that do not deskill or disable professionals”. 37 Attendees also mentioned the importance of “better group work and sharing of information across agencies” which would increase trust. The development of clear policies is essential for “better clarification of responsibilities between agencies and ownership of incidents”. The notion of “better and effective cross-agency communication” or “clearer systems of communication” have been also identified of vital importance to facilitate functional cross-agency work. Agencies could be brought together through the “introduction of a web-directory” and “the development of a knowledge hub of trends, including best practices, technology and failures”. The notion of continuous professional development, “regular workshops and updates”, such as “CEOP training and other local training”, to provide support to professionals has also been consistently pointed out by the attendees. Other suggestions related specifically to police officers and their need to have improved “support to work with schools for a period of time” and for other professionals to “better understand the role of the police that does not aim to criminalise young people”. Further suggestions indicate the need for “more funding to identify underlying issues” that need to be addressed and resolved. Equality Theme five, “equality”, relates to proposed changes to promote and facilitate increased equality of LGBT young people. Attendees suggested that there is a need for “the development of guidelines that address equality issues”. Professionals should “consider LGBT young people’s experiences of sexting” and be aware of “the role of prejudices and discrimination as risk factors”. Existing social-cultural perceptions need also to be clarified and challenged, including “female victim vs. male perpetrator stereotype that hinders same sex and LGBT youth to seek support”. Culture Theme six, “culture” relates to proposed changes and increased understanding of “the wider and specific context of image sharing”, which included a better “understanding the context of gang culture”. In relation to the public and sociocultural norms, it would be beneficial to “break the societal taboo and understand normalization of the topic of sexting” to facilitate management of cases and “understand that problems around sexting are exacerbated by cultural influences”. Social media platforms and organisations should also “report and highlight the dangers of sexting”, whereas adults might benefit from “challenging stereotypes of young people having high levels of digital literacy”. 38 Executive Summary and Conclusion This study explored the opinions and views of professionals relevant to the management of cases involving adolescent youth-produced images. Based on the responses to five questions that explored the wider context of case management, a series of frequently mentioned and salient themes were identified. Examination of the responses identified consistent themes. In relation to the first question “main challenges”, the main themes related to the shifting purpose of images, a lack of awareness of risks that might impact on reporting, and young people’s limited ability to understand implied risks. Tensions between parents and schools and the legal process in the management of cases were mentioned. Rapidly advancing technologies and implications of the wider social-cultural context were also pointed out. Responses to the second question “differentiating between coercive and non-coercive images” showed that the sharing of images represent a changing context that makes decision-making difficult for professionals to differentiate between coercive and non-coercive images. Practical suggestions indicate the need to obtain a better understanding of the context of image sharing, exploring power imbalances in relationships and identifying consent. The third question “facilitation of case management” produced responses that stressed the importance of inter-agency work and the sharing of information. There is also a need to involve schools and teachers to support and safeguard young people as well as to provide information about risks and consequences. An emphasis on a childfocussed perspective was also identified, as was the need of parents to safeguard their children. In relation to the fourth question “inhibitors of case management”, responses pointed out the legal gap between sexual consent and prosecution for sexual offences was not useful. Young people’s mismatch between age and experience might impact on reporting. Existing attitudes of professionals towards self-produced sexual images and a lack of understanding of the legal framework can represent a problem. Lack of parental engagement with their children has also been shown to be problematic. The fifth and last question “recommendation for child-focussed management” showed the need for professionals to assess cases on an individual basis whilst being attuned to the needs, perspective and context of young people. Young people should also be given different ways to disclose and be provided with support. Cases should be assessed in an effective and timely manner and be based on appropriate responses, including risk assessment and standardised processes. Young people and parents also require training to understand the implications of online risks and safe Internet use, which should be supported by social media. 39 Implications for research and practice The analysis of professionals’ opinions and views of the management of cases is important to inform the development of practice frameworks and guidelines that are consistent with existing guidelines that outline action responses and practical advice to law enforcement agencies and schools. Throughout the symposia discussions (which preceded the additional advice subsequently given to law enforcement), tensions were evident between the perceived need to protect children through prevention of youthproduced sexual images, alongside an acknowledgement of the rights of children to sexual self-expression, especially where children may otherwise experience marginalisation. Practitioners talked about a lack of shared values around issues of trust and the challenges of dealing with adolescents as ‘perpetrators’, especially around sexual agency. Consideration was also given to the normalisation of nudity and the imperative of sharing content on social media which inevitably increases the possibility of illegal youth-produced sexual images. This had implications for industry to invest more heavily in the ability to identify and remove inappropriate content and to develop tools to facilitate this. Many of the professionals who attended the symposia were also parents, or had family members that were adolescents. This heightened sensitivity about the engagement of children by professionals, but also about the empowerment of parents to be more effective communicators with their children about sexuality, privacy and consent. The need for children, and their parents to be at the centre of a proportional and nonjudgmental response to youth-taken sexual images, was consistently referred to. However, this was also in the context of a need for more cross-agency training and support and the further development of consistent multi-agency guidelines. Industry were also seen as important actors in this. There was very little acknowledgement of the absence of specific guidelines towards social care for children in relation to technology and youth-produced sexual images, and specific support for children and professionals where children are out-of-home or looked after. This gap is also identified in relation to other groups of potentially marginalised children, such as those with learning or physical disabilities, although there was discussion of the specific needs of LGBTQA youth. These gaps are also reflected in the lack of research in this area. For both research and practice, the importance of meaningful engagement of young people is echoed throughout this report. This comes with challenges and, at times, seemingly competing agendas. Changing technological applications, and particularly social media, challenge many of our assumptions about privacy and control, and youth-produced images are a small part of this. Internet opportunities also bring risks, but proportionate responses to risk-taking are necessary if we wish to work collaboratively with children. 40 41 References Akins, R. B., Tolson, H., & Cole, B. R. (2005). Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. BMC Medical Research Methodology, 5. Retrieved from http://bmcmedresmethodol.biomedcentral.com/ articles/10.1186/1471-2288-5-37 Becker, G. E., & Roberts, T. (2009). Do we agree? Using a Delphi technique to develop consensus on skills of hand expression. Journal of Human Lactation, 25, 220-225. 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Your friend Shanice is seeing a new boyfriend. He’s asked her to send him some topless pictures from her mobile and she agreed. Shanice believes that her boyfriend has shown the picture to his friends at school, but she is not sure whether she is just being “paranoid”. She is asking you for your advice. What warning signs would you tell Shanice to look out for, which could mean that there is a problem? 2. Shanice is now quite sure that the situation has got out of control, and that her boyfriend has shared her pictures with his friends. She is feeling angry, embarrassed and ashamed. Shanice would like to speak to someone about her problem. She turns to you for advice. Who would you advise Shanice to talk to about her problem and why? (e.g., police, family, teacher etc.) 3. Shanice told her mother that she has sent topless images to her boyfriend, which he has probably shared with his friends. Her mother asks her what she can do to help without making it more embarrassing and difficult for Shanice. What would you suggest Shanice should say to her mother? 4. Shanice has spoken to her teacher at school. The teacher, Mrs. Smith, realizes that the situation is very difficult for Shanice and wants to help. How do you think Shanice would like the situation to be dealt with? How do you think Shanice would feel at this time? 5. Shanice noticed that a group of girls were whispering and starring at her during break-time. Shanice believes that others know about the pictures. Her concerns are confirmed when her best friend Lesley mentions that “everybody knows”. What advice would you give to Shanice to deal with the situation? 6. Because Shanice’s problem turned out to be serious, the police got involved. The police officers clearly want to help Shanice. How do you think Shanice would like the situation to be dealt with? How do you think Shanice would feel at this time? 7. What advice would you give to teachers, social workers, police and other professionals who work with teenagers when there are concerns about images being shared without consent? 8. What other helpful advice would you have given to Shanice? 46 47 YOUTH-PRODUCED SEXUAL IMAGES: A VICTIM-CENTRED CONSENSUS APPROACH Design: Graphic Design Service, LTW, ISG, The University of Edinburgh www.ed.ac.uk/is/graphic-design 48