Online sexual exploitation and image-based abuse — formative SAQs

SAQ 1 (10 marks)

A 15-year-old boy is brought to the emergency department at midnight after taking an overdose of paracetamol. He is medically stable. In a private moment he tells you that a "girl" he met on a gaming platform sent him a sexual video, he sent one back, and was then told to transfer money or the video would be sent to all his contacts. He has not told his parents. He is terrified and believes there is no way out. [3] [2]

1. Give your immediate assessment and safety actions, and the further steps you would arrange before he leaves the department. (4) [2] [3]
2. Outline how you would take the history and preserve the digital evidence without destroying it. (3) [1] [6]
3. Describe your mandatory-reporting and online-safety reporting duties, and how you would communicate with the family. (3) [4] [6]

Model answer — SAQ 1

(1) Immediate assessment and safety (4). Acute safety comes before everything else: perform a structured suicide-risk assessment (ideation, intent, plan, means, protective factors), because financial sextortion carries a high acute-suicide risk — the young man perceives no exit that does not involve humiliation. If he is acutely suicidal he cannot be discharged without a safety plan and supervision; remove access to means and ensure a safe, supervised environment. Assess the perpetrator's current access — whether the offender has his location, is actively demanding payment, or has already distributed the image — because a live threat is a safeguarding emergency that may need police involvement in real time. Inform your consultant and the child-protection team from the first minute, and arrange a formal mental-health assessment to determine disposition. [2] [3]

(2) History and evidence preservation (3). Take a careful, non-leading history using a HEADSS framework adapted to include online life — who he talks to, which platforms, whether he has met the contact, what was shared, and the nature of the threats and any financial demands. Record his exact words in quotation marks and note dates, platforms, usernames and payment methods; do not conduct a forensic interview, which is for the specialist and the authority, but capture what arises faithfully and contemporaneously. On evidence: advise him (and his parent, where appropriate) to keep the device, screenshot the threats, and record usernames and URLs — and critically, do not delete or wipe the device, and do not view, download, or forward the image yourself, because doing so can constitute further distribution and destroy the forensic material. Frame keeping the phone safe as part of the plan, not a punishment. [1] [6]

(3) Reporting and family communication (3). Two reports in parallel, not in sequence: notify the statutory child-protection authority on the basis of a reasonable belief of harm (not proof), and report to the designated online-safety or cybertipline body for image removal and offender identification (the eSafety Commissioner in Australia, the Revenge Porn Helpline in the UK, the NCMEC CyberTipline in the US, Cybertip.ca in Canada). Share relevant clinical information with the authority — statutory reporting protections generally override common-law confidentiality for the purpose of protecting a child — and document what you shared and why; do not transmit the image itself. To the family, be honest and non-blame: explain that their son is the victim of a crime, that images will be pursued for removal, and that punishing or confiscating his autonomy in anger can worsen the harm; a supportive family response gives the best chance of recovery. [4] [6]

SAQ 2 (10 marks)

A 14-year-old girl is referred by her school nurse after an intimate image she had sent to her boyfriend was forwarded around her year group when the relationship ended. She is withdrawn, has missed two weeks of school, and has begun cutting. She tells you she feels "ruined" and that "everyone has seen it." [3] [6]

1. Explain the classification of this presentation and the clinical principle that defines the harm. (3) [4] [6]
2. Describe your assessment of acute safety and the workup you would arrange. (4) [2] [3]
3. Discuss how your approach would differ if, instead of a peer, the contact had been an adult stranger who coerced the image and is now threatening to expose it. (3) [1] [7]

Model answer — SAQ 2

(1) Classification and the defining principle (3). This is image-based abuse — the non-consensual sharing (or threat of sharing) of an intimate image — perpetrated by a peer. The critical clinical principle, established by Henry, Flynn and Powell, is that the harm flows from the non-consensual distribution, not from the original image or from the young person's decision to send it. The young woman is unequivocally the victim of a crime, regardless of whether the original sext was consensual. Distinguish this peer-driven image-based abuse from offender-driven subtypes (grooming, sextortion, solicitation, CSAM): here there is no adult, no age gap, and no ongoing extortion lever — though the same image could become a lever if an offender later obtained it. [4] [6]

(2) Acute safety assessment and workup (4). Screen for suicidal ideation, intent and plan first — image-based abuse carries an elevated acute-suicide risk, and the self-harm already signals severe distress. Assess the severity and recency of the cutting, her access to means, and her support network. Perform a structured mental-health assessment for depression, anxiety and post-traumatic stress using age-appropriate tools, and determine disposition: admission or intensive supervision if acutely suicidal, or discharge with a safety plan and urgent follow-up if the risk is contained. Map the digital evidence — whether the image is still circulating, on which platforms — and advise preservation of any messages and screenshots for the image-removal report. Engage the school, because the social context is part of the harm, and arrange proactive mental-health follow-up rather than reactive crisis care. [2] [3]

(3) If the contact had been a coercive adult (3). The presentation would shift from peer-driven image-based abuse to offender-driven sextortion, and the risk profile changes substantially. An adult stranger who coerced the image and is threatening exposure is running the grooming-to-sextortion spiral described by Kloess and colleagues: the image is now the lever, and the offender may demand more content, a meeting, or money under threat of exposure to family or school. The immediate priorities change — assess perpetrator access (does the offender have her location or contact details?), treat a live threat as a safeguarding emergency potentially requiring real-time police involvement, and arrange a forensic and sexual-health examination if there is any possibility of contact abuse or a meeting, because Mitchell, Finkelhor and Wolak showed that online and offline abuse frequently co-occur. The dual reporting pathway is unchanged in structure (child protection plus the online-safety body) but the urgency and the forensic dimension rise markedly. [1] [7]