Identifying young people who are experiencing criminal and sexual exploitation

James is a 16 year old boy who lives in a residential (children’s) home. Over the past two months, he has regularly gone missing, returning with new clothes and a new smartphone and laptop. He has been dropped off by different cars late at night. His reluctance to offer explanations for his absences and new possessions raised concerns among care workers.

He presents to the emergency department with an arm injury and is found to have a fracture. He seems withdrawn and provides only limited details about how the injury occurred. He is in a rush to leave and hesitant to stay for review by the orthopaedic team, saying that his friend is waiting for him outside.

Exploitation of young people is an important public health concern. In England and Wales, it occurs across all parts of the country, with more than 17 000 crimes related to child sexual exploitation reported yearly, and at least 27 000 young people at risk of exploitation by criminal organisations.12 The numbers affected increase each year; 10% more in 2022 than in 2021.2

As with other crimes, rates are likely underestimated, and this type of abuse is under-recognised and underreported.34 Because of this, and a lack of a gold standard definition, estimating global prevalence is difficult.5 Recent estimates suggest 300 million children are victims of online sexual exploitation and abuse, meaning the total number affected by any form of criminal and sexual exploitation will be even greater.6

There is …