County Lines Awareness Training for Care and Healthcare Staff

A teenager who suddenly has a second phone and unexplained cash. A care home resident whose flat is being used by unfamiliar visitors at odd hours. A young person in supported living who goes missing overnight and comes back with injuries they won't explain. On their own, each of these can look like nothing much. Put together, they can be the clearest signs a person is being drawn into county lines exploitation — and care and healthcare staff are very often the first professionals in a position to notice.

What "county lines" actually means

County lines is the name given to a model of drug dealing in which criminal networks based in one area extend their supply into other towns, coastal areas or rural communities, using a dedicated mobile phone "line" to take orders from local drug users. What makes it a safeguarding issue rather than purely a policing one is how the networks operate: they deliberately recruit and coerce children and vulnerable adults to store drugs and cash, carry weapons, and transport drugs between locations, often travelling considerable distances on trains, buses or in taxis to do so. Understanding this distinction is a core part of any safeguarding vulnerable adults training programme, because the people being exploited are legally victims of criminal exploitation, not simply willing participants in criminal activity.

Cuckooing

A related and increasingly common tactic is "cuckooing" — where a dealer or gang takes over a person's home, typically someone who is isolated, has a substance dependency, a learning disability, a mental health condition, or reduced mobility, and uses that property as a base for dealing, storing drugs, or exploiting others. Care and support workers who visit people in their own homes are often uniquely placed to notice the tell-tale signs: unfamiliar visitors coming and going at unusual hours, a change in who is answering the door, new locks or damaged doors, or a service user who suddenly seems frightened, anxious, or reluctant to let staff in.

How children and vulnerable adults are targeted and groomed

Exploitation rarely starts with force. Grooming for county lines typically follows a recognisable pattern, and understanding it helps staff spot it earlier.

Identifying vulnerability

Perpetrators actively look for people with unmet needs — a young person who feels they don't belong, someone experiencing poverty, a care leaver with limited support, an adult with a learning disability who is socially isolated, or a looked-after child who has recently changed placement. According to NSPCC guidance, gangs observe and identify what a young person is lacking, whether that's money, status, a sense of belonging, or protection.

Building trust, then dependency

Once a vulnerability is identified, exploiters offer something that appears to meet it: gifts, cash, alcohol, drugs, attention, or the promise of friendship and protection. This is often framed as a favour rather than a transaction, which makes it harder for the person being groomed to recognise what is happening.

Control through fear and debt

Once a person is drawn in, the relationship shifts. Debts are manufactured ("you owe us for what you lost/damaged"), threats are made against the person or their family, and violence or the threat of it is used to enforce compliance. People are often told that going to the police or a professional for help is itself a betrayal, which is why disclosure can be extremely difficult to secure. This same dynamic of coercive control, secrecy, and manufactured loyalty appears across other forms of exploitation covered in trauma-informed care in practice, and staff trained in one often recognise it faster in the other.

Who is most at risk

While any child or adult can be targeted, those in the care system are disproportionately at risk. This includes looked-after children, particularly those in residential care or placements a long way from their home area; care leavers with limited family support; adults with learning disabilities or autism who may find social cues harder to read and be more trusting of people who show them attention; people with substance dependency; and anyone who is socially isolated, in unstable housing, or has previously experienced abuse or neglect. Staff who have completed learning disability and autism awareness training are often better equipped to recognise when a person's trust is being exploited rather than genuinely reciprocated.

Warning signs and indicators to watch for

No single sign confirms exploitation, but a cluster of these should prompt a safeguarding conversation and, where appropriate, a referral.

Changes in behaviour and routine

• Going missing repeatedly, for longer periods, or to unexplained locations, sometimes out of the local area
• Unexplained absences from a service, school, day centre or placement
• New, unexplained money, clothing, phones or other possessions
• Carrying more than one mobile phone, especially a cheap "burner" handset
• Unexplained or frequent travel, or possession of train or bus tickets to unfamiliar destinations
• Increased secrecy about who they are with or where they are going

Physical and emotional signs

• Unexplained injuries, or reluctance to explain how injuries occurred
• Signs of physical assault, weapons, or drug paraphernalia
• New or unexplained relationships with older individuals or groups
• Sudden changes in mood, increased anxiety, fearfulness, or withdrawal
• Self-harm, substance misuse, or a marked decline in wellbeing

Signs specific to care settings

• Unfamiliar visitors, particularly at unusual hours, in a service user's home or a residential setting
• A resident or service user becoming a go-between, passing messages or items to others
• Reluctance to allow staff into a property, or a change in who answers the door
• A service user appearing to be controlled or coached by someone else present

The role of care and healthcare staff

Care and healthcare workers are not expected to investigate or confront exploitation directly. Your role is to notice, record, and report. That means observing changes over time rather than dismissing a single odd detail, documenting concerns factually and promptly in line with your organisation's procedures, and raising concerns through your safeguarding lead rather than sitting on them. Good documentation matters here just as much as in any other safeguarding concern, because a clear, timely record can make the difference in a later referral or investigation.

It also means building the kind of trusted relationship that makes disclosure possible. People being exploited are frequently too frightened, ashamed, or controlled to say so directly. A calm, non-judgemental, consistent approach — one that treats the person as a victim rather than an offender — is often what allows a disclosure to happen at all.

Referral pathways

If a child or adult is in immediate danger, call 999. Where there is no immediate danger but you have a safeguarding concern, escalate through your organisation's designated safeguarding lead and follow your local authority's multi-agency safeguarding procedures — this typically means a referral to children's social care or adult social care, alongside a police referral where a crime may have taken place.

Where a person, whether a child or an adult, may be a victim of criminal exploitation or modern slavery, they may be eligible for referral into the National Referral Mechanism (NRM), the UK's official framework for identifying and supporting victims of modern slavery and trafficking, including county lines exploitation. First responder organisations — which include local authorities and certain NHS bodies — can make an NRM referral, and care and healthcare staff should know who their organisation's first responder or safeguarding lead is so a referral can be made without delay. Home Office data for 2024 recorded 1,845 county lines-flagged referrals into the NRM, around 10% of all referrals that year, with the large majority involving male children (Home Office, National Referral Mechanism and Duty to Notify statistics, UK: end of year summary 2024).

Why this is now core safeguarding training

The scale of the problem is why county lines awareness now sits alongside other mandatory safeguarding modules for the sector. Home Office figures show 19,125 potential victims of modern slavery and trafficking were referred into the NRM in 2024, a 13% rise on 2023 and the highest annual total since the mechanism began, with children accounting for 5,999 of those referrals — 31% of the total — and criminal exploitation the single most common reason for a child referral, making up 48% of child cases (Home Office, NRM end of year summary 2024). Care providers, domiciliary care agencies and healthcare settings work daily with the groups most likely to be targeted: children in care, adults with learning disabilities, people experiencing homelessness or substance dependency, and isolated older or disabled adults at risk of cuckooing. That contact gives frontline staff a genuine opportunity to intervene early, which is exactly why regulators and safeguarding boards increasingly expect it to be covered in induction and refresher training rather than treated as a specialist add-on.

Frequently asked questions

Is county lines exploitation only a risk for teenagers?

No. While the majority of identified victims are children and young people, adults — particularly those with learning disabilities, mental health conditions, substance dependency, or who are socially isolated — are also targeted, often through cuckooing of their home.

What should I do if a service user discloses exploitation to me?

Listen without judgement, do not promise confidentiality, reassure them they are not in trouble, record what was said as accurately as possible using their own words, and pass this immediately to your designated safeguarding lead following your organisation's procedures.

Do I need consent from the person before making a safeguarding referral?

Where there is a risk of serious harm, especially to a child, you should raise the concern regardless of consent, following your organisation's safeguarding policy. For adults with capacity, you should generally seek to involve them, but immediate risk to life always overrides this — call 999 if anyone is in danger.

How is county lines different from other forms of exploitation staff are trained on?

The grooming and coercive control patterns overlap significantly with other forms of exploitation and abuse, but county lines specifically involves criminal drug supply networks using victims to move drugs and cash across geographic areas, and often includes cuckooing of a person's home as a base of operations.

County lines exploitation depends on victims staying hidden, and care and healthcare staff are often the people best placed to bring it into view. Building this awareness into your team's regular safeguarding training helps everyone recognise the signs earlier and respond with confidence. Explore Learnsignal's CPD training courses to see how county lines and wider safeguarding awareness can be built into your team's ongoing training plan.