From playground to bedroom. Balancing acute and community sexual health services for young people Richard West Health Adviser lead for Young People’s Services

Aim To focus on the sexual health needs of young people and the role the health adviser plays both in health promotion within GUM and facilitating access in the community

The sexual health needs of young people from professionals ● advice ● counselling ● advocacy ● ● education ● pregnancy tests ● fraser competent ● ● chlamydia screens ● support ● condom demos ● the pill ● sexual health screens ● flavoured condoms ● ● protection ● self confidence ● dating skills ● ● terminations ● empowerment ● careers advice ● ● talking to parents ● emergency contraception ● peer pressure ● information ● lube ● identity issues ● ● mental health ● drugs and alcohol ● attitude ● ● parenting skills ● self esteem ● symptoms ●

The sexual health needs of young people, help at hand? Sex and Relationships Education at School “SRE aims to inform children and young people about relationships, emotions, sex, sexuality and sexual health. It enables them to develop personal and social skills and a positive attitude to sexual health and well- being” (SEF, Guidance and training activities for school governors, 2003)

The sexual health needs of young people, help at hand? KNOWLEDGESKILLS ATTITUDES BELIEFS IDENTITY SELF ESTEEM

The sexual health needs of young people, help at hand? So most SRE is delivered at school? Know and understand the physical and emotional changes that take place during adolescence STATUTORY Key stage 3 (age 11 to 14 years)

The sexual health needs of young people, help at hand? So most SRE is delivered at school? Know and understand about medical uses of hormones including the control and promotion of fertility STATUTORY Key stage 4 (age 15 to 16 years)

Will have considered the benefits of sexual behaviour within a committed relationship NON STATUTORY Key stage 3 (age 11 to 14 years) The sexual health needs of young people, help at hand? So most SRE is delivered at school?

The sexual health needs of young people, help at hand? So most SRE is delivered at school? Know and understand how HIV and other sexually transmitted infections affect the body NON STATUTORY Key stage 4 (age 15 to 16 years)

The sexual health needs of young people, help at hand? So most SRE is delivered at school? Be able to have the confidence to assert themselves and challenge offending behaviour NON STATUTORY Key stage 4 (age 15 to 16 years)

The sexual health needs of young people, help at hand? So most SRE is delivered at school? Know and understand when and where to get help from places such as the genitourinary medicine clinic NON STATUTORY Key stage 3 (age 11 to 14 years)

The sexual health needs of young people, help at hand? 40% said SRE poor or very poor 57% of girls aged not shown condom demonstration 49%don’t know where to find their local clinic National Survey (UK Youth Parliament, 2007) 34%said they didn’t receive any 33% said what they did receive was poor Audit (West Mid, 2007)

The sexual health needs of young people, help at hand? KNOWLEDGESKILLS ATTITUDES BELIEFS IDENTITY SELF ESTEEM Know and understand the physical and emotional changes that take place during adolescence Know and understand about medical uses of hormones including the control and promotion of fertility Will have considered the benefits of sexual behaviour within a committed relationship Know and understand how HIV and other sexually transmitted infections affect the body Be able to have the confidence to assert themselves and challenge offending behaviour Know and understand when and where to get help from places such as the genitourinary medicine clinic NON STATUTORYSTATUTORY

Barriers to young people in acute sexual health clinics Knowledge base is much lower then we expect Young people are not ideal patients Very little experience of formal medical services Sexual health clinics are busy places Taking negative attitudes towards sex Staff resistance They are acute services!

Barriers to young people in community sexual health services Often one person/ small team dependent Can be difficult to set up clinics High turn over of staff in young people’s roles Staff working in the community may not have level of knowledge required No speedy referral Young people may suddenly be too old

Overcoming Barriers: Working in the Community Setting up a clinic Strategic involvement –Teenage Pregnancy Board –Chlamydia Screening –Sexual Health Board –Young people groups/ Youth Councils –Regular meetings with other service providers (housing/ youth work/ LAC nurse/ YOT/ D&A)

Overcoming Barriers: Working in the Community Involvement in Schools –Class –Assemblies –Health Drop-ins Involvement with high risk young people –Pupil referral units –Looked after children centres –Adolescent drugs and alcohol services –Child and Adolescent Mental Health (CAMHS)

Overcoming Barriers: Working in the Community 3 levels of sexual health with young people Level one –Individuals that work with YP with a range of needs but primary role not sexual health Level two –Work with YP in a variety of health roles but not specifically sexual health Level three –Role with YP specifically relating to sexual health

Overcoming Barriers: Working in the clinic Young persons clinic health adviser lead Involvement of specialist nurse practitioner HA sees all under 18’s for assessment Not just about Fraser Competency Workers also seen in the community

Has this lead to an increase of YP? Number of new YP

Ages of YP attending %of age

Number of partners %of YP

Ethnicity Differences Hounslow AverageClinic Average 2007

Schools YP attend Schools young people come from –Have seen a drop in numbers whose schools do not have contact with the clinic –Have seen an increase in numbers from schools with established contact –When asked how they found out in 2008, 11% were told at school, 6% came as a direct result of a talk by GU in school, 7% were from community referrals.

Drugs and Alcohol Alcohol –64%Admitted trying alcohol –19% Regularly drank (one a week) –21%Had alcohol in the last 7 days (nationally) Drugs –19%used cannabis (5% regularly) –3% used other recreational drugs (coke) –10%taken cannabis in last year (nationally) –4%taken class A drugs in the past Smoking, Drinking and Drug Use among Young People in England in 2006

Drugs and Alcohol Smoking –41%admitted smoking (32% daily) –18%smoked more then ten a day –39% have tried smoking (nationally) –9%smoke regularly (more than once a week)

What is the point of collecting this? Confidentiality Position of trust talking about other sensitive things Get a better picture of the risks to young people Enable community referrals Reciprocal with other agencies

Case studies 12 year old girl attending clinic after learning about the YP session at school. Referred back to school nurse and on to CAMHS 15 year old girl sent by school for pregnancy test, worked with school for TOP referral after DV fears Outreach session in PRU lead to a 15 year old girl with symptoms accessing the clinic

Summary Need to put the sexual health clinic out into the community more This can range from anything from doing “tours” to sessions in schools Benefits from working with the community Political and Financial Break down barriers Improve on the SRE provided to young people Building a link and transition between services