1. Julia Waters, Public Health Principal Kingston Public Health
Commissioning SH services (clinical and SRE) for people with learning disabilities following a Needs Assessment London Public Health Knowledge and Intelligence Network meeting   Monday 27th June 2016
Julia Waters,
Public Health Principal
Kingston Public Health

2. Sample Profiles & Methodology of the 3 NAs:
Needs Assessment Group
Sample Profile
Methodology
YP with learning disabilities FPA
year olds with learning difficulties.
Survey of providers; Focus Groups with service users, non-users
Sample Profiles & Methodology of the 3 NAs:

3. Young People with Learning Difficulties
More than one million people living in England with learning disability, but YP with learning disabilities do not have good access to SRE or information (Talking about sex & relationships: the views of young people with learning disabilities, CHANGE, 2010).
Recommended more accessible information / support for YP with learning difficulties & their parents. Needs to include information about sexuality, abuse, consent & practical information about contraception & safer sex where appropriate.

4. Needs Assessment of Young People, FPA 2013
FINDINGS

5. The majority of YP with disabilities stated that they had not attended the existing YP’s SH drop-ins nor heard what they were

6. The majority of YP with disabilities stated that they would like a clinic:
that allows confidentiality, privacy, not too noisy (so that communication could be highly audible)
that had other people with disabilities accessing
where help can be offered in understanding questions

7. The majority of YP with disabilities stated that they would like a clinic where staff:
were familiar & friendly
listen & do not interrupt
do not ask too many questions
offer choice e.g. over type of contraception & offer of a female health care professional,
were familiar with needs of people with disabilities & preferably dedicated to YP with disabilities.

8. health seeking behaviours,
Communities do not want to be regarded as a homogeneous group but have a diverse range of risks & outcomes:
risk behaviours (e.g. age of sexual debut, sexual practices, number of partners, sexual mixing)
health seeking behaviours,
barriers to accessing services e.g. perceived stigma, lack of confidentiality.
levels of economic disadvantage
levels of social exclusion

9. Recommendations
1. To develop a service to address the concerns about confidentiality & privacy, embarrassment, and discrimination in accessing sexual health services.
2. To address the lack of services promotion information for specific groups e.g. Parents.
3. Training –
specialised training.
generalist (e.g. induction) training of all local authority staff

10. Outcomes of PLD Needs Assessment
Level 2 service specification for sexual health clinic (Connect Clinic) developed for Moor Lane Centre (Integrated Service for Children with Learning Disabilities) for people with leaning disabilities under 25 years once a month for 5 hours.
To engage a specialist Provider to train & assist parents & staff (educational, health, social care) who support YP with learning difficulties in sexual health and SRE and to improve services access through the development of appropriately tailored SRE & services promotion materials.

11. Changes to Connect Clinic after 1st year
PLD accessing the monthly Connect Clinic were not only under 25s
Change venue from Moor Lane Centre to Wolverton SH Centre, Kingston Hospital.
Change from monthly to weekly appts with a Dr & Nurse. 4 Hrs/week sessions.
Concurrent Connect sex education/advice sessions: to change venues in similar fashion to above or alternative venue as requested by client. 2 Hrs/month sessions.
Connect patient follow-up admin time: to take place outside of the sessions (referrals/liaison with external agencies/ partner notification). 1-3 Hrs/month sessions.

12. Some Objectives for the SRE service :
will demonstrate increased awareness of good & bad relationships, friendships as well as one to one.
will demonstrate increased awareness of public & private behaviours including affection & touch.
their support staff, parents & carers shall understand rights & responsibilities of the young people & the law in respect of relationships & sex.
will demonstrate increased awareness of SH, STIs & contraception
will increase skills relating to communication & assertiveness; in particular making decisions, saying ‘no’ & asking for support.
will demonstrate increased confidence & raised self-esteem in respect of relationships & sex.

13. Outputs from SRE work
2 types of leaflets: ‘Relationships, the internet, and You’ for adults and for year olds
Schemes of work for a Special School (for Years 7-11 with mild to moderate learning disabilities) covering:
Personal information on-line,
Social media and sharing
Sexting
Grooming
Pornography

14. Objectives for the dedicated SH Clinic (Connect):
Uphold the relevant principles of the policies and directives
provide a high quality, evidence-based service which represents good value and is responsive to local needs & national guidance & policy across Kingston;
work collaboratively with the acute sector, voluntary sector providers, general practice & other primary care providers;
work with commissioners to further develop high quality local services;
as requested, work with Sector and pan-London Health organisations.
Improve young people’s knowledge of local sexual health services & increase their confidence to access these by:
Using national, regional, local services information e.g. services leaflets to inform young people of relevant services.
Using national, regional, local resources e.g. toolkits to support best practice learning in accordance with most up-to-date policies, directives, recommended guidance.

15. Challenges
Ensure inclusivity and clarify ethics in collecting information from vulnerable groups
Under 16s
importance of including transition years into adulthood for YPLD.
complex needs – extended appointment time with assessing capacity to consent and responding to disclosure and accurately assessing and acting on safeguarding needs
ensure focus on one vulnerable group is not excluding to another
Young People vs Older People.
severe learning disabilities vs those possibly undiagnosed and in mainstream education (eg who are SEND)
Challenges accessing parents and carers of YPLD – more lead time required to optimise engagement and utilise existing networks
Challenges with sustainability of competency of those staff who are received SRE training

16. Benefits
Improve safeguarding of PLD including preventing and intervening in any CSE (by direct work with young people & with people working with this population)
Improves integrated pathways between education, social care, and healthcare.
Improved confidence among population and their parents and carers in accessing SH services

17. Further Benefits Knowledge (Information / Facts):
Awareness of the law and their rights
Awareness of risk, including on/off line sexual exploitation
Awareness of different types of contraception including LARC
Awareness of appropriate local, regional, and national services
Attitudes:
Awareness of what constitutes a healthy, respectful relationship
Attitudes to delaying sex and saying no
Attitudes to condom use

18. Further Benefits Behaviours:
Raised confidence reported by young people in negotiating respectful relationships
Increased resilience: assertiveness and decision making skills
Increased contraception / condom use, where applicable

19. THANK YOU
ANY QUESTIONS?