This article originally appeared in the Journal of School & Public Health Nursing, now the Journal of School Health. Click here for your free digital subscription.

girloninternetModern technology and modern lifestyles mean that most young people, including children as young as five, have unsupervised access to the internet. While this brings great opportunities for education and entertainment it also carries dangers of exploitation and abuse, warns Barbara Richardson Todd who advises school nurses on some key indicators.

We live in a world where technology is part of everyday life. Accessing the internet via computers or smart phones is easy, and once logged on, it is easy to enter a virtual world comprised of emails, social networking sites, instant messaging and chat. Gaming sites, consoles and virtual worlds not only have the potential to become addictive, but offer people the opportunity to compete with strangers, who may become instant “friends”. These quick, easily accessible, but often hidden technologies provide an effortless way of communication.

However the downside of all of this is that social media and games can also act as a conduit for abusers – and children especially are at risk of being exposed to abuse or bullying in this way. This article considers the ways in which children and young people may be abused via their use of technology, the impact this abuse may have on them, and the subsequent need for school nurses to identify and address this impact to help the young person’s recovery.

Communication risks
Technology means that many more young people are potentially placing themselves in dangerous situations, often without realising the danger. Risky scenarios include engaging with online “friends” who may not be who they say they are. Children are also at far greater risk of leaving themselves open to being bullied or abused via the internet.

Fantasy world
“The internet is possibly the greatest social experiment of all time but one in which children can be the sacrificial guinea pigs. I use the analogy of a loaded gun. No one warned us about it yet they blamed us when the kids started to shoot themselves.” (Mary Kozakiewicz, in an interview with Mary Wark).

Although the internet is a wonderful resource and can be a great way to meet and talk to other people, it can also be a fantasy world where anyone can escape from reality. Internet users can pretend to be anyone they like; they can lie about their age, their interests and whether they’re male or female.

Children, can act like adults to feel “mature”, and groomers (or internet seducers) don’t need to worry about being suspicious. Both can build any online persona they wish. According to the UK Council for Child Internet Safety, 18% of children have come across inappropriate or harmful material online and 33% of children stated that their parents don’t know what they are accessing on the internet. It is important that school nurses reinforce key internet safety messages. Young people should be warned never to pass on any personal details online and also be under no illusion that even long-term internet “friends” are still strangers in reality and therefore an unknown quantity.

Who is at risk?
Abuse can affect children of any age, sex and ethnicity and often the risks are from people known to them. There are few common indicators of vulnerability, but it is often linked to the stage of development of a child, starting around 11 to 12 years of age. This is also the age that children can start to use social networking sites such as Facebook, which can expose them to risk.

Rather worryingly, according to Tink Palmer, “Only half of children encountering harmful or inappropriate online content say they did something about it”.

Palmer offers a plausible reason why this may be so, explaining that children depend for their survival on the adults who are close to them and are taught that “adults know best”. “They [also] look to their family for clues to what is OK and not OK”5. Children experiencing online abuse may hide their feelings and instead display difficult behaviours. It takes a skilled and receptive school nurse to link such behaviours with online use. Girls aged between 12 to 14 years of age are most vulnerable in terms of online abuse, according to Palmer.

Bad new world
In our new technological age, words and actions are entering the English language, which just a decade or so ago simply didn’t exist.

Examples include:
• Cyberbullying can be unwanted or upsetting text or email messages or images, bullying messages or the posting of malicious details about others. It varies from direct bullying in that it is anonymous, can occur at any time and often takes place off school premises. It is more hidden and emotional reactions cannot be determined.
• Sexting is the act of sending sexually explicit messages or intimate photos electronically, primarily between mobile phones, and is becoming increasingly popular among young people. Although their motives might be innocent – for example, sending an image to a friend – it can be used to embarrass and humiliate someone and can be a bullying tool.

Worryingly, this behaviour is not often reported. According to the NSPCC 25% of parents who discovered sexually explicit messages on their child’s mobile phone, secretly snooped.

Becoming secretive about where they are going or who they are meeting Will not let you see what they are accessing online using a webcam in a closed area, away from other people accessing the web or using a mobile or tablet for long periods and at all hour clearing the computer history every time they use it in receipt of unexpected money or gifts from people who are unknown.

Denial is common
Even when abuse is strongly suspected, it can be difficult for school nurses and other adults to reach out to offer help and support to that young person. The children may themselves be in denial about the abuse and often display a complex range of emotions, from shame, guilt, fear and anger to betrayal. With young girls especially, multi-faceted reasons can prolong the denial stage.

According to Palmer, these may include:
• Feelings of complicity
• Perhaps they have lied about their age, They feel “in love” or have an emotional dependency on their online “boyfriend” They are waiting for their boyfriend to get back in touch with them,
• The young women have used highly sexualised language, so feel embarrassed.
• There is a fear of peer group and family responses to what they had done
• They are hurt by being conned or feel broken-hearted

When abuse turns deadly…
The tragic death of 13 year old Chevonea Kendall-Bryan in March 2011 illustrates the serious consequences of sexual bullying in relation to social media.
Chevonea was seen begging a teenage boy to delete a tape of her being sexually abused when she plunged 60ft from her bedroom window in Battersea, South London.

He had threatened to widely share the mobile phone footage with fellow pupils. The coroner’s court heard that Chevonea had been bullied mercilessly by fellow pupils at St Cecilia’s School in Wandsworth, south London, from the age of 11. She self-harmed, cut herself with scissors in class and on one occasion was said to have swallowed a handful of paracetamol tablets.

The abuse became worse after she accused a boy, known as TG, of raping her at a party in February 2011. Chevona told her school she had been raped and they passed the information to social services. It was recommended that she should see a mental health professional, but the referral was never followed up by the school.

The coroner concluded Chevona’s fall was a tragic accident but criticised Saint Cecilia’s School and Wandsworth Council’s children’s services team for “a catalogue of failings”.

Effective interventions
School nurses can, alongside school staff and parents, play an effective role in teaching children about the risks of being online and how to stay safe. They need to learn how people behave online and how they themselves should behave to avoid these risks. Children should be helped to deal with what they may come across online and they need the knowledge and skills to build up resilience to the things they find online.

A young person going through the transitional and development stage of adolescence is neither child nor adult (but sometimes a bit of both), so therapeutic interventions should be provided within this context. One of the most important strategies is to acknowledge all the feelings and emotions which may be felt by the young person. The conflicting dynamics of the young person being a child offline, but an adult online need to be understood3. On the one hand they may feel as though they have been used and abused, but on the other hand may “love” the seducer/groomer.

Online safety tips for children
School nurses should advise young people to:
• Treat online space with respect. Only allow your real life friends to link to you, i.e if you haven’t met them in real life don’t link to them.
• Use a nickname online (not your real name) and a nickname that is not going to attract the wrong type of attention!
• Be aware that meeting up with an online friend can be dangerous. If you really have to meet up with them speak to an adult and make sure that they go along with you.
• ALWAYS have a good look at the privacy settings of any sites you post personal information on and make sure you know who can see or copy your stuff!
• Look out for your friends online and inform a teacher or the school nurse if you think they are at risk.

Online safety tips for parents
School nurses should advise parents to:
• Talk to their children about online safety
• Only allow them to use the internet in a certain location/room
• Supervising internet sessions and make sure sites are “age appropiate”
• Regularly check what children are doing online
• Ensure younger children do not use the internet on their own
• Only allowing use of certain websites
• Checking the use of social networking sites
• Stipulating that computers can only be used for a certain amount of time
• Not allowing the use of ‘chat’ programmes
• Only allow use at certain times of the day
• Use special software to filter/block access
• Ensure access is password protected.

Fear of disclosure
Fran Henry, founder of the charity Stop it Now! Explains that abuse “breaks something sacred inside us”. He adds: “… the most important harm I have wrestled with is one that complicates how we solve the problem of sexual abuse. It is the problem of a broken heart. Adults can better bear a broken heart, but it doesn’t work that way for children. When children are betrayed and they get no help for the wound, they develop a pinched outlook on love and on life”.

Henry alleges that girls who are abused may want the abuse to stop, yet also want to keep the relationship with the perpetrator. They may be fearful of the consequences of telling someone about what is occurring, especially if that person is a close attachment figure. Children wonder what will happen or will not happen if they tell.

Supporting victims of abuse
If a child discloses abuse to a school nurse, teacher or other adult, or abuse is discovered, it is imperative that she (or he) needs to be believed; be in a safe place and protected from contact with the perpetrator. Young people need to be offered therapy and support, especially through the witness process while the abuse is investigated. Continuity and consistency of key workers is essential and a school nurse can play a key role in either being that support or facilitating that support with designated specialists.

Emotional help and support
Children need to live in an environment where they know that they will be heard if they disclose abuse. If they were close to the person who caused the abuse (for example, if it is a trusted adult in their lives) they need to know that the person will be answerable for what they have done, but will receive help. School nurses can offer reassuring support to children, explaining that they will not have to spend periods of their childhood in emotional and physical pain without
receiving help and that they will not be labelled troublesome or difficult.

School nurses also need to be aware that other adults close to the child who has experienced abuse may have barriers to effective listening and to asking the relevant questions about a child who has experienced love even though they may never have met the other person. Permission needs to be given to them to talk about what has happened and express these feelings. They should also be given time and space to come to terms with what they have experienced.

Long-term effects of abuse
The effects of abuse can be long-lasting as abuse related stress can seriously damage development, including the pattern of the brain. Survivors often say “It’s not what was done to me but what it did to me”. Early detection and intervention by professionals, including school nurses, is vital to drastically reduce harmful effects. Viewing pornographic material online may be dismissed as being another “rite of passage”. However there is a correlation between ”viewing” and “doing” which may colour future relationships. School nurses can educate young people to understand that what they may have seen in porn is not necessarily regarded as acceptable in a healthy and loving relationship.

Acknowledgement
The content of this article is based on a presentation given by Tink Palmer, then director of Stop it Now! at the School and Public Health Nurses’ Association (SAPHNA) Conference, 2009. It has been reviewed by Tink Palmer and is included here with her kind co-operation.