http://www.kirklees.nhs.uk/uploads/tx_galileodocuments/Relationship_and_sexual_health_eduction_polic by NHS Kirklees

Relationship and Sexual Health Education [RSHE] Policy for Social Care Practitioners and foster carers working with Looked after Children in Kirklees

Approval Information:

Lindsay Andrews Health advisor LAC and Erika Farey Public health associate specialist risk taking behaviours. Looked After Children and Young People â&#x20AC;&#x201C; safeguarding services. Date Approved: May 2007 COMMITTEE:-PEC Committee - PEC

Lead Director:

Sheila Dilks

Prepared by:

Responsible Area:

Reference to Standards for Better Health Domain Core/Development standard

Version No. Approved:

Review Date:

May 2008

First domain Safety Fourth domain Patient focused Fifth domain Accessible and responsive care Seventh domain Public Health

C2 D1 C13b C16 D9 C18 C19 C22 a and c C24 1. Reduction in unwanted pregnancy among young people in care 2. Training plan for foseter carers and social care practitioners

Performance indicators History of Document

3. Supervsion strategy within safeguarding services includes relationship and sexual health education.

CONTENTS Section No.

Page Noâ&#x20AC;&#x2122;s 2

Introduction/Overview

Associated Policies and Procedures

Aims & Objectives

References & Bibliography

Main policy

Appendices

NICE Guidance Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgement. However, NICE Guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.

Approval Committee: Version No: Date Approved:

Introduction/Overview We know from research that all young people want to talk about sex and relationships with some one they can trust. As a social care practitioner or carer you are in the privileged position to proactively offer support and guidance on relationships and sexual health issues and become that trusted adult for children and young people who are looked after. This policy is intended to support social care practitioners and carers to promote the sexual health and wellbeing of children and young people who are looked after by Kirklees Children and Young People’s Service. This policy has been developed in direct response to national guidance from DOH and DFES including the Teenage Pregnancy unit guidance ‘Enabling young people to access contraception and sexual health information and advice’ [2004]. The policy is also intended to clarify the important role social care practitioners and foster carers have in promoting the sexual health and wellbeing of children and young people who are looked after. This policy does not advocate or promote sexual experimentation nor condone any breaches of the law. Foster carers must continue to adhere to Kirklees Children and Young People’s family placement unit safe care policies at all times.

Associated Policies and Procedures The Law, regulations and guidance United Nations convention on the rights of the child [ratified 1991]. The UN convention on the Rights of the Child was passed on the 20th November 1929 and ratified by over a 150 countries, including the UK. It states that children up to the age of 18 have the right to; • • •

•

Protection from harm and neglect Provision of services to help them survive and develop Participation in decisions which effect them Enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. In particular ‘Parties shall pursue full implementation of this right and in particular, shall take appropriate measures; 2[f] ‘To develop preventative health care, guidance for parents, and family planning education and services’.

The Children Act 1989 The duty of Councils with social services responsibilities to safeguard and promote the health of children and young people is enshrined within the Children Act 1989. Guidance accompanying the act states that the experience of being cared for should also include the sexual education of the young person in order to help them acquire information about their bodies, sex and sexual health, and to develop relevant skills.

not as objects to be used.[1991b, vol.4sect 7.47]. The Guidance and Regulations also emphasise that the particular needs of different groups of young people must be recognised. This includes young people with physical or learning difficulties; young people who have been abused and young gay men and lesbians. The parents of a looked after child or young person may express wishes about the relationships or contraceptive advice they want provided. Whilst every effort should be made to respect these wishes, the overriding principle for the social care practitioner is to safeguard the health and welfare of the young person in their care.

Promoting the health of Looked after Children [DOH 2002] This guidance sets out a framework for the delivery of services from health agencies and social services to more effectively promote the health and wellbeing of children and young people in the care system. The guidance explicitly outlines the health promotion role of social care staff: Children [Leaving Care] Act 2000 This amendment to the Children Act was implemented in October 2001. The amendment arose out of widespread concern that young people left care too early , were not given the appropriate support , guidance and assistance and that the outcomes for this group of young people were very poor indeed. The amendment and the associated regulations and guidance ensures that all careleavers must have their need assessed , have a pathway plan up to age 21 [24 if they are in education/training at 21] and a personal advisor to help and support them. There are specific expectations that health and education needs are covered within the assessment and plan, and young parents who are careleavers must be supported. Sexual Offences Act 2003 Section 14 [2] and [3] of the Sexual Offences Act clearly states that a person does not commit an offence of arranging or facilitating commission of a child sex offence if he/she acts to; a/ Protect the child from sexually acquired infection. b/ protect the physical safety of the child A child under the age of 13 years c/ prevent the child from becoming pregnant; or d/ promote the childâ&#x20AC;&#x2122;s emotional well-being by the giving of advice providing this is not done for the purpose of obtaining sexual gratification or the purpose of causing or encouraging the sexual activity. Under the Sexual Offences Act young people under the age of 16 years are still entitled to receive confidential advice on contraception, condoms, pregnancy and abortion.

The Sexual Offences Act does not intend to prosecute mutually agreed sexually activity between two young people of a similar age, regardless of their sexual orientation, provided there is no evidence of abuse or exploitation. Guidelines relating to underage sexual activity A child under the age of 13 years is not legally capable of consenting to sexual activity. Any offence under the Sexual Offences Act 2003 relating to a child under the age of 13 years is very serious. Staff and carers must adhere to the Kirklees safeguarding board child protection Page 3 of 41

procedures. Sexual activity of a child aged 13-15 years is still classed as an offence however where the activity is consensual it may be seen as less serious than if the child is less than 13 years old. Never the less staff and carers must still adhere to the Kirklees safeguarding board child protection procedures and seek advice from their line manager in all cases. Every Child Matters; Change for Children [Children Act 2004] The central aim of the act is to shift the work with children and young people from reacting to the consequences of difficulties as they arise to a proactive approach attempting to prevent things from going wrong. The five outcomes for children and young people are; •

Being healthy

•

Staying safe Enjoying and achieving

•

Make a positive contribution

•

Enjoying economic wellbeing

Fraser guidelines

Guidelines on providing contraceptive advice and treatment to under 16s were issued in 1985, as part of Lord Fraser’s judgement, following the House of Lords’ ruling in the case of Victoria Gillick v West Norfolk and Wisbech Health Authority. The Fraser Guidelines specifically refer to contraception but the principles also apply to other treatments, including abortion. The legal ruling applied specifically to Health Professionals, but the Fraser Guidelines represent good practice guidelines for other professionals working with young people. A young person under 16 is competent to consent to contraceptive advice or treatment if: •

The young person understands the health professional’s advice;

•

The health professional cannot persuade the young person to inform his or her parents or allow them to inform the parents that he or she is seeking contraceptive advice;

•

The young person is very likely to begin or continue having intercourse with or without contraceptive treatment;

•

Unless he or she receives contraceptive advice or treatment , the young person’s physical and/or mental health or both are likely to suffer; and

•

The young person’s best interests require the health professional to give contraceptive advice and /or treatment without parental consent.

When providing condoms for contraceptive purposes and the prevention of sexually acquired infections, it is essential that social care practitioners follow the Fraser Guidelines.

Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children HM Government 2006.

Allegations of harm arising from underage sexual activity. Page 4 of 41

5.23 Cases of underage sexual activity which present cause for concern are likely to raise difficult issues and should be handled particularly sensitively. 5.24 A child under 13 is not legally capable of consenting to sexual activity. Any offence under the Sexual Offences Act 2003 involving a child under 13 is very serious and should be taken to indicate a risk of significant harm to the child. 5.25 Cases involving under 13s should always be discussed with a nominated child protection leader in the organisation. Under the Sexual Offences Act, penetrative sex with a child under 13 is classed as rape. Where the allegation concerns penetrative sex, or other intimate sexual activity occurs, there would always be reasonable cause to suspect that a child, whether a girl or boy, is suffering or is likely to suffer significant harm. There should be a presumption that the cause will be reported children’s social care and that a strategy discussion will be held in accordance with the guidance set out. This should involve children’s social care, police and relevant agencies, to discuss appropriate next steps with the professional. All cases involving under 13s should be fully documented including detailed reasons where a decision is taken not to share information. 5.26 Sexual activity with a child under 16 is also an offence. Where it is consensual it may be less serious than if the child were under 13, but may nonetheless have serious consequences for the welfare of the young person. Consideration should be given in every case of sexual activity involving a child aged 13-15 as to whether there should be a discussion with other agencies and whether a referral should be made to children’s social care. The professional should make this assessment using the considerations below. Within this age range, the younger the child, the stronger the presumption must be that sexual activity will be a matter of concern. Cases of concern should be discussed with the nominated child protection lead and subsequently with other agencies if required. Where confidentiality needs to be preserved, a discussion can still place as long as it does not identify the child (directly or indirectly). Where there is reasonable cause to suspect that significant harm to a child has occurred or might occur, there would be a presumption that the case is reported to children’s social care and a strategy discussion should be held to discuss appropriate next steps. Again, all cases should be carefully documented including where a decision is taken not to share information. 5.27 The considerations in the following checklist should be taken into account when assessing the extent to which a child (or other children) may be suffering or at risk of harm, and therefore the need to hold a strategy discussion in order to share information: • The age of the child. Sexual activity at a young age is a very strong indicator that there are risks to the welfare of the child (whether a boy or a girl) and, possibly, others. • The level of maturity and understanding of the child. • What is known about the child’s living circumstances or background. • Age imbalance, in particular where there is a significant age difference. • Overt aggression or power imbalance. • Coercion or bribery. • Familial child sex offences. • The behaviour of the child, i.e. withdrawn, anxious. • The misuse of substances as a disinhibitor. • Whether the child’s own behaviour, because of the misuse of substances, places him/her at risk of harm so that he/she is unable to make an informed choice about any activity. • Whether any attempts to secure secrecy have been made by the sexual partner, beyond what would be considered usual in a teenage relationship. • Whether the child denies, minimises or accepts concerns. • Whether the methods used are consistent with grooming. • Whether the sexual partners is known by one of the agencies. 5.28 Page 5 of 41

In cases of concern, when sufficient information is known about the sexual partner/s

the agency concerned with other agencies, including the police, to establish whatever information is known bout that person/s. The police should normally share the received information without beginning a full investigation if the agency making the check requests this. 5.29 Sexual activity involving a 16 or 17 year old, although unlikely to involve an offence, may still involve harm or the risk of harm. Professionals should still bear in mind the considerations and processes outlined in this guidance in assessing that risk, and should share information as appropriate. It is an offence for a person to have a sexual relationship with a 16 or 17 year old if they hold a position of trust or authority in relation to them.

Aims & Objectives 3.1 Aim To provide a clear framework enabling social care practitioners and carers to effectively support young people who are looked after on issues related to relationships and sexual health. To reduce the rate of teenage pregnancy and sexually acquired infection amongst looked after young people and careleavers. To inform young people in care of their entitlement regarding sexual health issues. To inform birth parents and carers of how Kirklees Children and Young People’s Service will meet the relationship and sexual health needs of their children and young people whilst they are in care. 3.2 Objectives To clarify the role and responsibilities of carers and social care practitioners with regard to providing relationship and sexual health advice and support to young people in their care. To raise self esteem, self awareness, a sense of moral responsibility of young people in care and provide them with the skills to avoid and resist unwanted sexual experience. To enable young people to gain the skills and confidence in dealing appropriately with sexual health issues and making informed choices. To support young people to access contraception and sexual health services in a timely and appropriate way.

References & Bibliography Enabling young people to Access Contraception and sexual health information and advice [DFES 2004] Kirklees condom distribution for young people [Kirklees PCT 2005] Teenage Pregnancy. A report from the Social Exclusion Unit 1999. Talking about sex and relationships-a factsheet for foster cares. Sex Education forum and National Foster Care Association. 2001. Healthy Care. National Children’s Bureau.2002 Teenage Pregnancy and Looked After Children /Careleavers. A resource for teenage pregnancy co-ordinators. Barnardo’s 2003.

Page 6 of 41

MAIN POLICY 1. 1 Introduction

‘The staff thought school were teaching me, school thought staff or my mum would be doing it – and as a result no-one told me anything’ Quote from a looked after young person [Let’s make it Happen FPA 2003]. We know from research that all young people want to talk about sex and relationships with some one they can trust. As a social care practitioner or carer you are in the privileged position to proactively offer support and guidance on relationships and sexual health issues and become that trusted adult for children and young people who are looked after. This policy is intended to support social care practitioners and carers to promote the sexual health and wellbeing of children and young people who are looked after by Kirklees Safeguarding and Specialist Provision. This policy has been developed in direct response to national guidance from DOH and DFES including the Teenage Pregnancy unit guidance ‘Enabling Young People to Access Contraception and Sexual Health Information and Advice’ [2004], which states that the duty of a social care practitioner, irrespective of their personal views, is to safeguard the health and welfare of all young people. This includes giving age appropriate Relationships and Sexual Health Education, tailored to meet the individual sexual health needs of each young person. This includes supporting a young person’s early uptake of contraception and access to confidential sexual health advice if and when they become, or are thinking of becoming, sexually active. This policy has been developed to support Kirklees Safeguarding and Specialist Provision staff and foster carers to effectively achieve this important aspect of their role. This policy does not advocate or promote sexual experimentation nor condone any breaches of the law. Foster carers must continue to adhere to family placement unit safe care policies at all times.

This Relationships and Sexual Health Education policy is underpinned by key legislation and guidance relating to the Children Act 1989, The Sexual Offences Act 2003, Fraser Guidelines, UN Convention on the rights of the child, Leaving Care Act, Promoting Health of Looked after Children and Working together to safeguard children. (For summary of the relevant documents see appendix 1). 1.2 Accountability This policy has been developed by Kirklees Primary Health Care Trust professionals working in very close partnership with Kirklees Safeguarding and Specialist provision professionals. Accountability for information provided in the policy lies jointly with the 2 named organisations:Kirklees Safeguarding & Specialist Provision Services, Unit Manager for the Looked After Children’s Service, working to the Director of Children & Young People’s Services. And:Kirklees Primary Care Trust, Assistant Director for Safeguarding working to the Director of Patient Care and Professions.

1.3 Aims and Objectives To provide a clear framework enabling social care practitioners and carers to effectively support young people who are looked after on issues related to relationships and sexual health. Objectives •

To clarify the role and responsibilities of carers and social care practitioners with regard to providing Relationships and Sexual Health Education, advice and support to young people in their care.

Page 7 of 41

•

To inform young people in care of their entitlement regarding sexual health issues.

•

To inform birth parents and carers of how Kirklees safeguarding and specialist support service will meet the relationship and sexual health needs of their children and young people whilst they are in care.

•

To raise self esteem, self awareness, a sense of moral responsibility of young people in care and provide them with the skills to avoid and resist unwanted sexual experience.

•

To enable young people to gain the skills and confidence in dealing appropriately with sexual health issues and making informed choices.

•

To support young people to access contraception and sexual health services in a timely and appropriate way.

•

To reduce the rate of teenage pregnancy and sexually acquired infection amongst looked after young people and care leavers.

1.4 Context ‘Looked after Child’ is a generic term introduced in the Children Act 1989 to describe children and young people subject to care orders (placed into the care of local authorities by order of a court) and children accommodated under Section 20 of the Children Act 1989. Looked after children may live in foster homes, residential placements or with family members. Children and young people who are ‘looked after’ may have experienced traumatic events including neglect, sexual, physical and/or emotional abuse. This may affect their understanding of personal relationships, sex and sexuality, and result in low self esteem and inappropriate sexual behaviour. Research has shown that almost a quarter of young women were mothers by the time they ceased to be looked after compared with the national figure of 3% of young women aged 16-19 years old. Young people in public care are more likely to become sex workers. Two thirds of male sex workers interviewed for a survey had been in local authority care or accommodation. (McMullen et al, 1986) It is vital that as corporate parents we meet our responsibility in effectively addressing the relationship and sexual health education needs of young people in our care. Research suggests that young people who grow up in families where relationships and sexual health are discussed openly and without embarrassment are more able to resist peer pressure, express their beliefs and opinions, challenge bullying and are more able to understand negative messages about sex and relationships [National Children’s Bureau 2003]. Talking openly with a trusted adult can enable young people to delay first sex and use contraception when they do decide to become sexually active. Young people cite parents as their preferred source of support about sex and relationships. Young people in care are less likely than other young people to receive consistent guidance and support about relationships and sexual health from their carers or parents or other significant adults. Young people in care may experience different placements, changes in schools and have more frequent exclusions from school, so are more likely therefore to have missed school based sex education sessions. They may also have missed the opportunity to build long term relationships with their peers, leaving them vulnerable to unwanted sexual pressure. 1.5 Principles and Values of Delivering Effective Relationship and Sexual Health Education ‘Sex and Relationship Education [SRE] is lifelong learning about sex, sexuality, emotions, relationships and sexual health. Through SRE children and young people acquire accurate information, develop skills and develop positive values, which will guide their decision-making, judgements, relationships Page 8 of 41

and behaviour throughout their life. SRE can happen in a variety of settings and contexts, within groups or on a one to one basis. [Sex Education Forum, National Children’s Bureau 2003.] Delivering effective Relationships and Sexual Health Education should;

1.6

•

Demonstrate and promote respect for the self and for others as it core value.

•

Be an integral part of growing up, beginning in childhood and continuing into adult life.

•

Be delivered within an inclusive framework and should be made accessible to and meet the needs of all young people in our service.

•

Be delivered in an environment that is both supportive and safe.

•

Mean that a young person has early access to information, support and guidance on relationships and sexual health as and when they need it.

•

Not impose on a young person the individual moral, ethical ,or religious stance nor the personal views regards sexuality and sexual behaviour of their carers

•

Will take into account the wishes of birth parents however the needs of the young person will remain paramount The Role of Social Care Practitioners in Providing Relationships and Sexual Health Education and Referring Young People to Sexual Health Services.

The Teenage Pregnancy Unit publication, ‘Enabling Young People to Access Contraceptive and Sexual Health Information and Advice: Legal and Policy Framework for Social Workers, Residential Social Workers, Foster Carers, Social Care Practitioners and Youth Support Workers.’

[Department for Education and Skills/Teenage Pregnancy Unit 2004] outlines the role of social care practitioners on providing information and referring young people to contraceptive and sexual health services. It specifies that social care practitioners:-

•

Can and should provide young people with accurate and up to date information on contraceptive methods and Sexually Transmitted Infection’s. However, advising a young person of the suitability of a particular method of contraception is the responsibility of a health professional.

•

Can and should provide young people with accurate and up to date information on local Contraceptive and Sexual Health (CASH) Services. This information can be given in response to a question from the young person, or given pro-actively by the professional if they believe the young person is already sexually active or likely to become so.

•

If a young person is apprehensive about contacting/attending a CASH service and cannot be persuaded to talk to a parent/carer for support, then the social care practitioner can support them to do so.

Page 9 of 41

•

Can and should support a young person to rapidly access emergency contraception in the event of unprotected sexual intercourse.

•

Can as part of a Relationship and Sexual Health Education programme take a group of young people to visit CASH clinic.

•

Can provide a young person with a single condom as part of an information session.

•

Can provide condoms with advice to a young person who requires a condom for sexual activity, including to under 16’s. Condom Distribution should form part of a wider RSHE programme and Practitioner’s will have completed appropriate sexual health training and adhere to their organisations Condom Distribution Policy as agreed with Management and understood by young people.

•

Can support a young person to undertake a home pregnancy test if the young person is unwilling to involve parent/carer or to access a pregnancy testing service.

•

Can support a young person to access pregnancy counselling services, encouraging the young person to involve parents/carers or another trusted adult.

•

Maintain confidentiality regarding sexual health issues for a young person providing there are no child protection concerns.

•

Share written information on a strictly needs to know basis.

Full document available at the Teenage Pregnancy Unit Website: www.teenagepregnancyunit.gov.uk 1.7 Confidentiality ‘It would have been nice to have discussed sex with someone without everyone else getting to hear about it –and there needs to be some one you can trust’ Quote from young person [Let’s make it Happen FPA 2003] Confidentiality is an issue that causes great anxiety for young people, staff and foster carers alike. Lack of information regarding confidentiality can hinder a young person from seeking advice or support on issues relating to sexual health. It is essential that the boundaries of confidentiality are clearly understood by all from the outset.

All service users have the right to expect that all their personal information is kept in confidence. However in cases where a child protection issue is disclosed, carers and staff must follow the safeguarding procedure and report their child protection concern to their child protection lead professional.

Personal information regarding sex, sexuality and personal relationships should not be shared by social care practitioners and foster carers without prior knowledge and preferably the consent of the young person involved.

Social care practitioners and carers do not have a duty to inform parents of evidence or suspicion of sexual activity, but the Children Act [1989] makes it clear that they should work in partnership with parents whenever possible and appropriate.

Young people who are 16 years old or under 16 and deemed ‘Competent to Consent’ under the Fraser Guidelines are within their rights to access Sexual Health Services completely confidentially to seek sexual health information, advice and treatment [see appendix 3.1).

Page 10 of 41

1.8 Working with Sexually Active Young People Under the Age of 18 The Legal Age for Consent to Sexual Activity is 16 for both Heterosexual and Homosexual sex. The law is not intended to prosecute mutually agreed teenage sexual activity between two young people of a similar age, unless it involves abuse or exploitation. All staff working with sexually active young people under the age of 18 have an obligation to identify where these sexual relationships may be abusive and the young person may need the provision of protection or additional services. Assessing whether a young person is at risk of harm from a sexual relationship can be a complex issue, and should be undertaken sensitively. Information may have to be gained over a period of time as the young person builds up trust with the worker. In most cases there will need to be a process of information gathering from the young person in question, discussion with the named Child Protection lead within the organisation followed by a possible enquiry to the Initial Assessment Unit for an appropriate plan to be formulated. In order to assess whether the sexual relationship poses a risk to the young person, the following factors need to be considered:

Whether the young person is competent to understand and consent to the sexual activity they are involved in.

If there is a power in-balance due to one partner having a learning, communication or physical disability, where differences in age, gender, race, sexuality or sexual knowledge are used to exert power, or one partner is in a position of trust such as teacher or mentor.

Where overt aggression, coercion or bribery is involved, such as sex being ‘traded’ for gifts, money, lifts etc

Misuse of alcohol/substances as a disinhibitor.

Attempts to secure secrecy by the sexual partner.

The sexual partner is known by the agency as having other concerning relationships.

Behaviour of the young person, i.e. withdrawn, anxious, afraid.

Whether the methods used are consistent with ‘grooming’. (For a definition see Procedures).

Young People Under the Age of 13 In all cases where a young person under the age of 13 is or is likely to become sexually active there must be a discussion held with the Named Child Protection Lead within your own organisation. Each case should be assessed individually and enquiry made to the Initial Assessment Team who can then check the Child Protection Register and consult with partner agencies, including the Police. A decision not to refer onto the Initial Assessment Team can only be made following a discussion with the Named Child Protection Lead within your own organisation and should be fully documented.

In all cases where the young person is under 13, or over 13 and there is suspected harm, it is essential that the Named Child Protection Lead for that organisation is involved in discussions as soon as possible and that all information is carefully documented. In cases where there is significant and immediate risk for the young person then urgent action should be taken to safeguard their welfare. Page 11 of 41

1.9 Working with birth parents and families The Children Act [1989] emphasises the importance of working in partnership with parents. Whilst the act states that parents have shared responsibility with the local authority, decisions that are made should be in the best interest of the child. •

Social workers will inform parents of the RSHE Policy and explain the local authority’s procedures on Relationships and Sexual Health Education.

•

Parents will be given the opportunity to discuss the information provided about the policy and any concerns they have regarding the policy should be documented.

•

All discussions with parents relating to Relationships and Sexual Health Education should be accurately recorded.

•

If parents do not agree to their child receiving Relationships and Sexual Health Education, the local authority should make a decision on how the best interests of the child/young person are served.

•

Where a decision has been reached to overrule the parents’ wishes relating to Relationships and Sexual Health Education and advice for their child, a clear rational for the decision must be provided to the parents and clearly recorded.

1.10 Staff Development and Training The effective implementation of this policy and practice guidance is dependant upon access to a rigorous training and development programme. A 2 day initial training programme will address: • • • •

Legal framework and introduction to this policy Attitudes and values related to sexuality A holistic view of sexuality Effective Relationships and Sexual Health Education for children and young people in public care

The two day training should be an integral part of any induction programme for all social care practitioners and carers working with looked after children and young people. Staff and carers should attend a refresher course every 2 years. This will be managed by the Children and Young People learning and development unit. Condoms should only be provided by social care practitioners and carers who have completed a Kirklees Safeguarding and Specialist Provision approved training course on condom distribution. Pregnancy testing should only be undertaken by social care practitioners and carers who have attended a Kirklees Safeguarding and Specialist Provision approved training course on pregnancy testing. Line managers as supervisors should make decisions and endorse actions and act as a resource for support on specific issues relating to Relationships and Sexual Health Education issues for looked after children and young people. In the event of public controversy or adverse publicity, providing that staff have acted within the policy guidelines management will support staff and carers. Supervision should provide an opportunity for staff and carers to discuss practice issues relating to Relationships and Sexual Health Education. Page 12 of 41

Section 2 Practice Guidance 2.1 Confidentiality •

Social care practitioners and carers can enable young people to access confidential sexual health services for advice and treatment from qualified health professionals, even if the young person is less than 16 years of age.

•

Personal information relating to young person’s relationship and sexual health should only be shared on a need to know basis, i.e. in the case of a child protection concern relating to the young person or other young people involved.

•

Young people need to be informed of any information relating to their sexual health and wellbeing that is to be documented. All written documents relating to the sexual health and wellbeing of a young person must be securely stored.

•

Staff and carers need to inform young people of the rules about confidentiality at the soonest opportunity pre-empting any personal disclosure from a young person.

•

Any information relating to a young person’s relationships and sexual health should NOT be automatically shared with parents. A discussion should take place between carers, social care practitioner and senior managers to ascertain if sharing information with birth parents is in the best interests of the child.

2.2 Talking about relationships and sexual health with young people

Children and young people need accurate information about relationships and sexual health; they also need the opportunity to develop social skills. It is important that social care practitioners and carers acknowledge that the lack of confidence, embarrassment and low self esteem of some young people making it especially difficult for them to ask for help, to negotiate in relationships and to confidently access contraception and sexual health services. Social care practitioners and carers should therefore proactively provide support and information on such issues. Social care practitioners should learn about the world in which young people live, by looking at the problem pages of teenage magazines and websites designed specifically for young people [see section 3 for web addresses]. NB Access to some of the recommended web sites may be regulated and may contravene council’s policy on the use of electronic equipment. It is therefore advisable to seek guidance from line management on accessing websites. When talking about relationships and sexual health issues social care practitioners and carers should; •

Attempt to make conversations about relationships and sexual health relaxed, realistic and relevant to young people’s life experiences.

•

Think about the things that young people will need to learn if they are to make safe positive choices about sex and relationships.

•

Do not give sexual information about yourself. If asked a direct question such as ‘How old were you when you first had sex?’ A positive answer might be ‘People have sex for the first time at different ages I don’t think there is a right age , I think it is important that

Page 13 of 41

the person feels ready , feels as though they trust their partner and that they are able to talk about it together beforehand.’ •

Provide age appropriate, easy to understand books, leaflets or watch a video about relationship and sexual health issues together with children and young people in your care.

•

Understand the risk factors for young people who may be sexually active and ensure they have accurate and up to date information about Sexually Acquired Infections including HIV and AIDS, and unintended pregnancy.

•

Understand and accept that you need the ability to respond sensitively and respectfully to a young person who may tell you that they are gay, lesbian, bisexual, or that they are confused about their sexuality and are not sure how they would identify themselves.

•

Understand that young people may have very different attitudes and values to sexual behaviour from your own. It is your role to promote positive values and attitudes towards relationship and sexual behaviour without negatively labelling the behaviour of that young person. Messages about the benefits of delaying first sexual intercourse to a later age and clearly understanding what safe sex means are vital.

•

Understand that religion and culture may be important influences in the lives of children and young people who are looked after and that this can affect their values and beliefs.

•

Peer pressure is a major influence in the lives of all children and young people, but can be especially significant for those young people who lack a trusted adult to discuss relationships and sexual health with. Your role is to offer opportunities to openly discuss relationships and sexual health empowering young people to resist peer pressure.

2.3 Puberty including menstruation and masturbation

‘An important message to carers is to start providing information and support about puberty and growing up well in advance of the onset of puberty.’ [ Who Carers Trust ‘remember my message.’] Girls 95% of girls commence their periods between the ages of 8 and 13 years. The first bodily change in 80% of girls is breast development. Pubic and underarm hair growth is the first sign of puberty in about 20% of girls. Onset of periods (Menarche) usually starts following the growth of pubic hair and breast development. The average age of the onset of periods is 13 years. Women living together often find that they have their periods at the same time. The age at which menarche occurs is closely correlated with the skeletal maturity and it is very unusual for a girl to have not commenced her periods by the age of 15 years. Girls may start to ovulate before their period, which means they can be fertile before they have their first period. Social care practitioners and carers should; •

Seek advice from a looked after children’s health advisor/nurse or the young person’s GP if the onset of periods has not commenced by the age of 15 years.

•

Assist a young person to access contraception and sexual health services if they are, or are likely to become sexually active even before onset of periods.

Page 14 of 41

•

Ensure sanitary towels are readily available for young girls from the age of 9 years old.

•

Provide advice, and answer any questions on the correct use and disposal of sanitary products.

•

Tampons may be the choice of sanitary product for some young girls. The decisions to use tampons should be based on an individual case by case basis. Manufacturer’s instructions for use should be closely followed. Very rarely a girl can develop toxic shock syndrome as a result of having a tampon in situ. This risk can be minimised by ensuring the tampon is changed 4 hourly and tampon usage is restricted the day time usage only. If a girl develops a temperature during her period when she has a tampon in situ, she should be advised to remove the tampon immediately and medical advice from her GP should be sought.

•

Seek advice and support if a girl is experiencing painful or irregular periods from the LAC health team or the girls own GP.

Boys

The hormonal changes that occur are due to the production of testosterone and are more gradual and happen over a period of time rather than as a single event. Each male adolescent is different, in most cases the beginning of puberty is between 9.5 to 14 years of age. A boy’s body size will increase, with the feet, arms, legs, and hands sometimes growing "faster" than the rest of the body. This may cause the adolescent boy to experience a time of feeling clumsy. Some boys may get some swelling in the area of their breasts as a result of the hormonal changes that are occurring. This is common among teenage boys and is usually a temporary condition. Voice changes may occur as the voice gets deeper. Sometimes, the voice may "crack" during this time. This is a temporary condition and will improve over time. Not only will hair begin to grow in the genital area, but males will also experience hair growth on their face, under their arms, and on their legs. Growth of the genitalia may result in the adolescent male experiencing involuntary erections. This is due to hormonal changes and may occur when the boy fantasizes about sexual things or for no reason at all. This is a normal occurrence. During puberty, the male's body also begins producing sperm. Semen, which is composed of sperm and other bodily fluids, may be released during an erection. Sometimes, this may happen while the male is sleeping. This is called a nocturnal emission or "wet dream." This is a normal part of puberty and will stop as the male gets older.

The social care practitioner and carer should;

•

Seek advice from the looked after children’s health team or the young person’s GP if there are none of the above physical signs of the onset of puberty by the age of 14 years old.

•

Reassure the young person regarding physical changes they are experiencing.

Page 15 of 41

Boys and girls For both boys and girls puberty is a time of rapid growth. Increase in size can lead to fears about body image, particularly about being overweight. As the hormones of puberty increase, adolescents may experience an increase in oily skin and sweating. This is a normal part of growing up. Acne may develop. Social care practitioners and carers should; •

Sensitively advise on increased hygiene needs from the onset of puberty. information should be given early, before puberty begins

•

Encourage daily washing, including the face.

•

Encourage healthy eating and an active lifestyle.

•

Be aware of the signs and symptoms of eating disorders and seek advice from the LAC health team, Child and Adolescent mental health service [CAMHS] or GP if any concerns arise.

•

In cases where a young person has developed acne enable the young person to receive appropriate treatment from the GP where needed.

This

2.4 Masturbation Masturbation is part of normal sexual behaviour, for both males and females. It is important to ensure young people understand that masturbation is a private matter. Social care practitioners and carers should; •

Acknowledge the feelings of embarrassment and guilt a young person may have regarding masturbation.

•

Challenge the myths about masturbation being harmful.

•

Young people should be sensitively informed of the need to use safe and private places in which to masturbate.

•

Ensure that you and the young person are using the same word for masturbation, this will avoid any confusion. The young person should be informed that masturbation is the correct term, however the carer and the young person may agree on another term for discussing masturbation. The agreed term should be acceptable to carers and the young person alike.

2.5 Young People with Disabilities Young people with disabilities have the same rights to Relationships and Sexual Health Education and to explore and develop their sexuality as other young people. They may however face additional barriers and difficulties when doing so. There are many myths surrounding the sexuality of young people with disabilities, e.g. regarding young people with disabilities as ‘life-long’ children. It is important that such Page 16 of 41

views are not imposed on young people and that they are able to explore their sexuality outside of any kind of stereotyping. Social care practitioners and carers; •

Work in partnership with birth parents, schools and the looked after children health team to ensure consistent approach is being adopted to meet the individual relationship and sexual health needs of each young person with a disability.

•

Information and resource material will need to be tailored to the needs of the individual young person. This may involve the use of alternative methods of communication or specifically developed resources.

2.6 Religion, Culture and relationships and sexual health education Religious and cultural differences may affect how Relationships and Sexual Health Education is provided and delivered. This does not mean that young people should be denied the benefits of such information. This information should be provided in accordance with the moral and values framework of this policy. The Sex Education Forum suggests that: “Social care practitioners and foster carers who do not share the young person’s religion will need to inform themselves about the faith whilst trying not to make assumptions based on that information. (It is important to remember that in all religions and cultures there are a range of values and views held by carers, parents and young people).” Social care practitioners and carers should; •

Ensure that any Relationships and Sexual Health Education provided is culturally sensitive and in a language the young person and /or parents can understand, or should be interpreted into a language that the young person and their parents can understand.

•

Refer to the Kirklees Metropolitan Council publication ‘Relationships and Sexual Health Education from an Islamic Perspective’ 2006.

•

For more information relating to relationship and sexual health education issues from Christian, Roman Catholic, Rastafarian, Jewish, Sikh or Hindu perspective refer to ‘Faith, Values and Relationships Education’ written by Simon Blake and Zarine Katrak, published by the national Children’s Bureau. Contact the LAC health team to loan this book.

2.7 Sexual relationships in placement Social care practitioners and foster carers need to be mindful of the possibility of the development of a sexual relationship between young people within a residential or foster care setting. In cases where a relationship between two young people in a placement has developed social care practitioners and foster carers need to inform the allocated social worker and jointly consider the following issues; Page 17 of 41

Are both young people of a legal age to engage in a sexual relationship? Do they demonstrate the maturity and ability to make informed decisions about their sexual relationships? Does the relationship negatively impact on the social dynamics of the placement? Each case will be unique and the management response will need to be flexible. Social care practitioners and carers should apply the following principles; •

Positive relationships between young people in placement may be acceptable in the placement.

•

Discuss with the young people of the impact of their relationship in the home and agree boundaries relating their behaviour.

•

Young people have a right to confidentiality, respect and privacy when working with their relationship issues.

•

Many looked after young people may have experienced abuse of some kind in their past. It is important that carers are alert and observant of issues relating to power and abuse in looked after young people’s relationships.

2.8 Sexuality Relationships and Sexual Health Education should be supportive of and responsive to the needs of all looked after young people. This should include young people who are exploring their sexual identity and young people who identify themselves as gay, lesbian or bisexual. Young people may find it difficult to share information about same sex relationships or feelings, and staff and carers need to approach these issues sensitively. Social care practitioners should; •

Not impose their own personal views about same sex relationships on young people.

•

Deliver all Relationships and Sexual Health Education within an inclusive framework, and not presume all young people are heterosexual. Using terms such as ‘partner’ instead of girlfriend or boyfriend when working with a young person if they have not identified the gender of their partner.

•

Use resources that include and positively affirm same sex relationships as being of equal importance to heterosexual relationships.

•

Be aware of and signpost young people to specialist organisations that can be accessed as a support, advice and information resource for gay, lesbian and bisexual young people. [See appendix ]

•

Appropriately challenge issues of homophobia, prejudice and discrimination, as failing to do so can appear to be ‘colluding’ with these views.

•

Be aware of discrimination gay and lesbian young people may face and ensure adequate support is made available to help young people effectively deal with this.

Page 18 of 41

2.9 The use/misuse of alcohol, solvents and drugs The effects of alcohol, solvents and drugs can be to reduce inhibitions. This can increase the risk of unplanned sexual activity or sexual exploitation of any young person. Safeguarding the young person is the priority for social care practitioners and carers in instances where the use/misuse substances is suspected of increasing risk taking sexual behaviour. Social care practitioners should: •

Adhere to the Kirklees Safeguarding Board procedures in relation to the suspicion of substance misuse by a young person.

•

Provide support, information and guidance relating to alcohol and substance misuse.

•

Seek specialist support and advice from the children and young people’s worker at Drugsense.

2.10 Pornography Pornographic material that gives a stereotyped, distorted or exploitative view of men, women, boys and girls may be particularly damaging to young people who have been sexually abused. If a young person is found in possession of pornographic material they should be informed that many people find this type of material distasteful. It may be appropriate to have further discussions about pornography and explore the young person’s feelings and attitudes towards it. However it is important to realise that an increasing awareness, and interest in Pornography is a normal part of puberty and developing sexual feelings. If the young person wishes to retain such information, it should be stressed that this should only be viewed in private so that other children or young people are not offended or influenced by its content. Depending on the age and understanding of the young person it may be appropriate to remove the material. Under Section 160 of the Criminal Justice Act 1988 as amended by Section 84(4) of the Criminal Justice Public Order Act 1994, it is an offence for a person to have an indecent photograph or pseudo-photograph of a child in their possession. Any young person in possession of this type of pornographic material should be referred to appropriate child protection procedures. In order to prevent access to internet pornography in placements social care practitioners and carers should ensure that computers are installed in a ‘public room’. Social care practitioners and carers must supervise young people’s access to the internet physically or by installing and activating a suitable parental control package. As corporate parents, Kirklees Metropolitan Council will investigate any allegations that children/young people in authority care may be accessing pornographic material in the care setting. 2.11 Sexual Exploitation Social care practitioners and carers should be aware of the potential for vulnerable young people to be sexually exploited leading them into prostitution. Young people in care may have been subject to past or suffering current abuse and this can make them particularly vulnerable to exploitation, sexual or otherwise.

Page 19 of 41

If there are concerns that a young person is involved in or at risk of sexual exploitation, Kirklees’ Local Safeguarding Board Child Protection Procedure or Missing From Care policies must be followed. 2.12 Safer sex Provision of Condoms Condoms can only be provided by social care practitioners and carers who have completed a Kirklees Safeguarding and Specialist Provision approved training course on condom distribution. Before a decision is made to make condoms available social care practitioners and carers should ensure that the supply of condoms; • • • • • •

Forms part of a broader Relationships and Sexual Health Education programme which includes helping young people to resist any pressure to have early sex. Compliments local service arrangements for the distribution of free condoms. Condoms display the British Kite mark, a clear expiry date and are to European Commission standard. Always accompanied by verbal and written advice about the correct usage of the condom. Always accompanied by information about sexually acquired infections and sexual health services Always accompanied by information on where and how to access emergency contraception in the event of a condom breaking or failure to use the condom.

Discuss with the young person on the nature of the sexual relationship should include discussion of the following: • • • • • • • •

Are they in a relationship? How do they feel about it? Length of time together? Does their parent/carer know their partner? Can they talk to their parent/carer about becoming sexually active? Do both parties want to have a sexual relationship? Is there any pressure being exerted? [This could be physical or emotional] Is there a worrying age difference between the young person and their partner? Is there a suspicion that the young person is being sexually exploited or groomed for prostitution? Is there any alcohol/substance misuse? If the young person has already been sexually active, did they use contraception? If the young person had unprotected sex, they may be either pregnant or have acquired a sexually transmitted infection, refer on to CASH clinic.

Explain Condom Use Research demonstrates that a significant proportion of condom failure is due to incorrect use. It is vital therefore that any young person issued with condoms should be shown how to correctly use a condom by using a Condom Demonstrator, [which is a plastic object available for loan from the health team], to show how to correctly put a condom on. The young person should then be encouraged to practice the correct procedure for putting on a condom using the demonstrator whilst the social care practitioner talks them through each step. The following should be explained and check to see if the young person has understood: • • • • •

Advise the young person that condoms if used properly are 95% effective. Suggest that the young person talks to their partner, before sex, about using a condom, Condoms should be stored in a cool dry place, discuss possible consequences of condoms being found at home. Advise young person to check packaging for damage, expiry date and British Kite mark, Discuss with young person the need to take care when opening the condom, i.e. jewellery, long nails etc,

Page 20 of 41

• • • • • •

Advise young person to ensure they hold the teat upwards, squeeze air out of teat, roll condom onto erect penis. Discuss use of safe, water based lubricants only. Use of oil based lubricants such as body cream, baby oil etc will cause the condom to fail. Advise the young person on the importance of withdrawal immediately after ejaculation, holding condom in place. Advise the young person to then check the condom for splits, wrap condom is tissue and dispose of in bin. Advise the young person that a condom should never be re-used. Advise that only one condom should be used at once. Using two condoms together will cause discomfort and increase the risk of the condom failing.

2.13 Emergency Hormonal Contraception (EHC) Social care practitioners should ensure that young people are aware that if they have had sex without using contraception, or if the contraception might have failed, they can access emergency contraception to avoid an unwanted pregnancy. Young people, even those under 16, can access Free Emergency Contraception Confidentially. There are two methods – pills and an IUD. •

Social care practitioners and carers should support a young person to access emergency contraception if this is the young person’s choice.

•

Emergency Hormonal Contraceptive pills contain progesterone hormone which is similar to the natural progesterone women produce in their ovaries. They should be taken within 3 days (72 hours) of having unprotected sex. However if a young person should still be supported to access a Contraceptive and Sexual Health service even if more than 72 hours has elapsed, as the Emergency Hormonal Pill can be given up to 5 days after unprotected sexual intercourse.

•

The pills may: - stop an egg being released (ovulation). -delay ovulation. -stop a fertilised egg settling in your womb (implanting).

•

Emergency contraceptive pills are very effective. However they are more effective the sooner they are taken.

•

Emergency pills come in a packet of two. The two pills should be taken together, at the same time, and as soon as possible after unprotected sex. -If taken within 24 hours of unprotected sex, they will prevent more than 9 out of 10 (95%) pregnancies expected to occur if no emergency contraception had been used. - If taken 72 hours after unprotected sex they will prevent more than 5 out of 10 (58%) pregnancies expected to occur if no emergency contraception had been used.

•

Emergency pills will not protect you from pregnancy if you have further unprotected sex.

•

Emergency contraception pills are most likely to fail if you:

- take the pills more than 72 hours after unprotected sex. - vomit within 2 hours after taking the pills. - don’t take the pills as instructed. - have unprotected sex at another time, either since your last period or since taking the pills. •

If a young person has taken the pills correctly and their next period seems normal, it is unlikely they will be pregnant. If their next period is late, or unusually heavy or light then you should support them to Page 21 of 41

access a health setting for a pregnancy test. •

Young

people,

including

those

under

can

get

emergency

contraception

free

from:

- any GP who provides contraceptive services. - most sexual health clinics. - most GUM clinics. - most NHS walk-in centres (in England only). The Dewsbury walk-in centre is on the grounds of Dewsbury and District Hospital and is open weekdays [including bank holidays and Christmas day], 8.30am -6.30pm - some pharmacies. •

Chemists are now able to provide EHC over the counter to over 16 year olds, at a cost of £24.

•

Individual Chemists choose whether they wish to offer this service; there may be some that do and some that don’t within the same pharmacy. It will depend whether those that do provide the service are working at the time as to whether the service is available.

2.14 Pregnancy Pregnancy testing and access to services It is important that young women who think they may be pregnant or young men that think their partner may be pregnant, have access to appropriate advice and support as early as possible. The early identification of pregnancy is important, as it provides time for a woman and her partner to make less rushed informed choice about their future and plan for their well being. Only those social care practitioners and carers that have completed a Kirklees Safeguarding and Specialist Provision approved training programme should undertake pregnancy testing. Social care practitioners and carers should have the authorisation of their line manager that this procedure is part of their role. Both partners, where appropriate, should be involved in the pregnancy testing process. Including both partners will facilitate discussion regarding the couple’s relationship and their sexual health. However, this discussion should still take place if only one of the partners attends. This may occur after the initial consultation regarding the need for a pregnancy test. Information needed:• • • • • • • •

knowledge of relationship current/previous methods of contraception last menstrual period plans for future contraception support available within and outside the young person’s family. age of boyfriend Parent/carer awareness of boyfriend Fraser competence

Prior to the pregnancy test being carried out it is important to prepare the young person for the outcome. It is necessary to consider what support they need if the test is positive. • • • • •

Ensure surroundings are private and conversation cannot be overheard. A clean container should be provided. The test should ideally be done on an early morning specimen Check the expiry date on the pregnancy testing kit Follow instructions for that particular kit.

Page 22 of 41

•

Be clear about the result of the test. Young people may not understand the terms positive and negative.

A positive pregnancy test must result in referral to a Contraception & Sexual Health service, [see appendix] or GP, providing the young person agrees. The social care practitioner or carer should inform the allocated social worker of the pregnancy test. The social care practitioner and allocated social worker should encourage the young person to obtain support from parent/family member where appropriate or trusted adult. However if the young person does not want their birth parent to know then the social care practitioner should support them with this process. A negative pregnancy test should be followed up with discussion on future plans regarding contraception. This may result in referral to Contraception and sexual health service or GP. Pregnancy tests which show a faint line should result in referral to a Contraception & Sexual Health (CASH) service or GP for a further test, not on the same day as the faint test. The type of pregnancy test should be the one currently used by the local Contraception & Sexual Health (CASH) service. Ideally the pregnancy test should be carried out after the period is a week late. However, it can be done 3 days after the missed period. Whatever choice the young person makes when faced with a positive pregnancy result, the social care practitioner should support them to access a health professional for onward referral to antenatal care or an NHS funded termination of pregnancy. Individuals who have positive or negative pregnancy test results should have continuity of care offered, whether this is through the social care practitioner or Contraception & Sexual Health Service to address their on-going contraceptive needs. Any unprotected intercourse may have resulted in a Sexually Transmitted Infection and appropriate screening is recommended. Keeping the baby If the young woman chooses to keep the baby, she should be helped to tell her social worker and /or birth parents to discuss future arrangements. Comprehensive information about the young person’s entitlement to benefits and support is outlined in the ‘Maternity Alliance Resource Pack’. Social care practitioners should also ensure that young mothers have access to information and advice about future contraception. It is estimated that between a quarter and a third of births conceived to young women aged 17 and 18 are second pregnancies, many of which are unplanned. Termination of pregnancy If terminating the pregnancy is the option chosen by the young woman, the social care practitioner should support the young person in accessing a speedy referral to termination services, via the GP or Contraception & Sexual Health (CASH) Services [see appendix]. The social care practitioner or carer must ensure that the young person has support on the day of the termination and ongoing support and counselling following the procedure. The social care practitioner must discuss with the young person the benefits of informing birth parents/ carers, documenting the outcome of the discussion. If the young person does not wish to inform her birth parents then every effort must be made to ensure that young person received the ongoing support of a trusted adult. To help prevent a further unwanted pregnancy the social care practitioner should support the young person to access Contraception & Sexual Health (CASH) Services [see section 3] to address their ongoing Contraception needs. Page 23 of 41

Thinking about adoption If the young person is considering adoption, the social worker should follow the procedure for adoption requests.

Page 24 of 41

Appendices 1. The Law, regulations and guidance United Nations convention on the rights of the child [ratified 1991]. The UN convention on the Rights of the Child was passed on the 20th November 1929 and ratified by over a 150 countries, including the UK. It states that children up to the age of 18 have the right to; • • •

•

The Children Act 1989 Guidance and regulations Volume 4 Residential Care. The duty of Councils with social services responsibilities to safeguard and promote the health of children and young people is enshrined within the Children Act 1989. Guidance accompanying the act states that the experience of being cared for should also include the sexual education of the young person in order to help them acquire information about their bodies, sex and sexual health, and to develop relevant skills.

. The Guidance and Regulations to the Act, Volume 4, states that: “The experience of being cared for should also include the sexual education of the young person. Sexual education will need to cover practical issues such as contraception ….however, it must also cover emotional aspects of sexuality, such as the part sexuality plays in a young person’s sense of identity; the emotional implications of entering into a sexual relationship with another person; and the need to treat sexual partners with consideration and not as objects to be used [1991b, vol.4sect 7.487.49 [edited]. The Guidance and Regulations also emphasise that the particular needs of different groups of young people must be recognised. This includes young people with physical or learning difficulties; young people who have been abused and young gay men and lesbians. The parents of a looked after child or young person may express wishes about the relationships or contraceptive advice they want provided. Whilst every effort should be made to respect these wishes, the overriding principle for the social care practitioner is to safeguard the health and welfare of the young person in their care.

their need assessed , have a pathway plan up to age 21 [24 if they are in education/training at 21] and a personal advisor to help and support them. There are specific expectations that health and education needs are covered within the assessment and plan, and young parents who are careleavers must be supported.

Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children HM Government 2006.

Allegations of harm arising from underage sexual activity. 5.23 Cases of underage sexual activity which present cause for concern are likely to raise difficult issues and should be handled particularly sensitively. 5.24 A child under 13 is not legally capable of consenting to sexual activity. Any offence under the Sexual Offences Act 2003 involving a child under 13 is very serious and should be taken to indicate a risk of significant harm to the child. 5.25 Cases involving under 13s should always be discussed with a nominated child protection leader in the organisation. Under the Sexual Offences Act, penetrative sex with a child under 13 is classed as rape. Where the allegation concerns penetrative sex, or other intimate sexual activity occurs, there would always be reasonable cause to suspect that a child, whether a girl or boy, is suffering or is likely to suffer significant harm. There should be a presumption that the cause will be reported children’s social care and that a strategy discussion will be held in accordance with the guidance set out. This should involve children’s social care, police and relevant agencies, to discuss appropriate next steps with the professional. All cases involving under 13s should be fully documented including detailed reasons where a decision is taken not to share information. 5.26 Sexual activity with a child under 16 is also an offence. Where it is consensual it may be less serious than if the child were under 13, but may nonetheless have serious consequences for the welfare of the young person. Consideration should be given in every case of sexual activity involving a child aged 13-15 as to whether there should be a discussion with other agencies and whether a referral should be made to children’s social care. The professional should make this assessment using the considerations below. Within this age range, the younger the child, the stronger the presumption must be that sexual activity will be a matter of concern. Cases of concern should be discussed with the nominated child protection lead and subsequently with other agencies if required. Where confidentiality needs to be preserved, a discussion can still place as long as it does not identify the child (directly or indirectly). Where there is reasonable cause to suspect that significant harm to a child has occurred or might occur, there would be a presumption that the case is reported to children’s social care and a strategy discussion should be held to discuss appropriate next steps. Again, all cases should be carefully documented including where a decision is taken not to share information. 5.27 The considerations in the following checklist should be taken into account when assessing the extent to which a child (or other children) may be suffering or at risk of harm, and therefore the need to hold a strategy discussion in order to share information: • The age of the child. Sexual activity at a young age is a very strong indicator that there are risks to the welfare of the child (whether a boy or a girl) and, possibly, others. • The level of maturity and understanding of the child. • What is known about the child’s living circumstances or background? • Age imbalance, in particular where there is a significant age difference. • Overt aggression or power imbalance. • Coercion or bribery. • Familial child sex offences. • The behaviour of the child, i.e. withdrawn, anxious. • The misuse of substances as a disinhibitor. Page 26 of 41

• • • • •

Whether the child’s own behaviour, because of the misuse of substances, places him/her at risk of harm so that he/she is unable to make an informed choice about any activity. Whether any attempts to secure secrecy have been made by the sexual partner, beyond what would be considered usual in a teenage relationship. Whether the child denies, minimises or accepts concerns. Whether the methods used are consistent with grooming. Whether the sexual partners is known by one of the agencies.

5.28 In cases of concern, when sufficient information is known about the sexual partner/s the agency concerned with other agencies, including the police, to establish whatever information is known bout that person/s. The police should normally share the received information without beginning a full investigation if the agency making the check requests this. 5.29 Sexual activity involving a 16 or 17 year old, although unlikely to involve an offence, may still involve harm or the risk of harm. Professionals should still bear in mind the considerations and processes outlined in this guidance in assessing that risk, and should share information as appropriate. It is an offence for a person to have a sexual relationship with a 16 or 17 year old if they hold a position of trust or authority in relation to them.

Young People, Sex and the Law (in England & Wales). A girl must be 16 or over before it is legal for her to have sex. Her partner is breaking the law if she has sex before this. It is an offence for a male aged 14 or over to have sex with a girl under 16, even if she consents. It is an absolute offence (statutory rape) if a male aged 14 or over has sex with a girl under 13. The maximum penalty is life imprisonment, because the law assumes that a girl under 13 is unable to consent to sexual activity and does not understand the consequences of having sex. (This is at odds with the Fraser ruling, which has no lower age limit). A boy of 10 or over can be prosecuted for having sex with a girl under 13. It is no defence to say she agreed or wanted to do it. (See above). A woman who has sex with a boy under 16 could theoretically be charged with indecent assault. The age of consent for gay relationships is now 16. Sexual contact between men is allowed if both are over 16, consent, and sex takes place in private. There is nothing in the law about lesbians, other than that a girl must be 16 before she can legally have sex.

Sexual Offences Act 2003 “The legal age for young people to consent to have sex is still 16, whether they are heterosexual, gay or bisexual. Although the age of consent remains 16, the law is not intended to prosecute mutually agreed teenage sexual activity between two young people of a similar age, unless it involves abuse or exploitation. Under the Sexual Offences Act young people still have the right to confidential advice on contraception, condoms, pregnancy and abortion, even if they are under 16. Young people under the age of 13 continue to be able to consent to treatment if they are considered competent to understand the treatment proposed. The judgement of competence rests with the professional on a case by case basis related to the circumstances of the individual young person. Professionals providing contraceptive/sexual health advice or treatment to under 13s to protect them from unwanted pregnancy or STIs, to protect their physical safety or to promote their emotional well Page 27 of 41

being are not guilty of arranging or facilitating any offence. This exception applies even though, under the Act, all sexual activity with under 13’s is now considered rape. The inability under the Act for under 13’s to consent to sexual activity does not affect their competence to consent to treatment.” (Working Within the Sexual Offences Act 2003 Home Office) Fraser guidelines

Guidelines on providing contraceptive advice and treatment to under 16s were issued in 1985, as part of Lord Fraser’s judgement, following the House of Lords’ ruling in the case of Victoria Gillick v West Norfolk and Wisbech Health Authority. The Fraser Guidelines specifically refer to contraception but the principles also apply to other treatments, including termination of pregnancy. The legal ruling applied specifically to Health Professionals, but the Fraser Guidelines represent good practice guidelines for other professionals working with young people. A young person under 16 is competent to consent to contraceptive advice or treatment if: •

The young person understands the health professional’s advice;

•

The health professional cannot persuade the young person to inform his or her parents or allow them to inform the parents that he or she is seeking contraceptive advice;

•

The young person is very likely to begin or continue having intercourse with or without contraceptive treatment;

•

Unless he or she receives contraceptive advice or treatment , the young person’s physical and/or mental health or both are likely to suffer; and

•

The young person’s best interests require the health professional to give contraceptive advice and /or treatment without parental consent.

2. Contraception & Sexual Health (CASH) Services. Social care practitioners and carers should: •

Encourage and support young people who are sexually active to access Contraception & Sexual Health (CASH) services, especially designed for young people, such as ‘4U’.

•

Help a young person identify an appropriate clinic, by providing opening times and location.

•

Support a young person to attend a clinic by accompanying the young person on initial visits, if the young person chooses.

•

Ensure a young person knows that unprotected sex may result in a sexually acquired infection as well as pregnancy.

•

Be aware that Contraception & Sexual Health Services are constantly evolving. It is wise to telephone the service before hand to check that opening times are still correct.

An up to date list of services with contact telephone numbers will be dispatched regularly by the looked after children and young people health team. Contraceptive & Sexual Health (CASH) Services Page 28 of 41

HUDDERSFIELD Princess Royal Clinics Tel: (01484) 344260 Monday 1.00pm – 3.00pm 3.30pm – 4.45pm 4U (Under 20) 4.30pm – 5.30pm Tuesday

9.30am – 11.30am 5.30pm – 7.30pm

Wednesday

9.30am – 11.30am 3.30 – 4.45pm 4U (Under 20) 5.30pm – 7.30pm

Thursday

12.30pm – 3.00pm 5.30pm – 7.30pm

Friday

9.30am – 11.30am 1.00pm – 3.30pm (Drop in) 3.30 – 4.45pm 4U (Under 20)

Saturday

10.30am – 12.00pm (under 20’s)

Thornton Lodge Tel: (01484) 344260 Wednesday 1.00pm – 2.30pm

Chestnut Centre Tel: (01484) 344260 or (01484) 347867 Friday 1.15pm – 3.15pm

GU Medicine Clinic (Princess Royal) Tel: (01484) 344311 Ring on a Monday morning at 8.30am for an appointment. NORTH KIRKLEES Batley Health Centre Tel: (01924) 351550 (by appt) Monday 9.30am – 11.30am 6.30pm – 8.00pm Tuesday 9.30am – 11.30am (alternate weeks) 3.00pm – 5.00pm (Young person’s clinic) Wednesday 6.00pm – 8.00pm Friday 1.30pm – 3.30pm

Unplanned pregnancy advisory clinic (UPAC) Tel: (01924) 351551 (by appt.) Wednesday 8.45am – 2.30pm

Cleckheaton Health Centre Tel: 01924)351550 Monday 6pm – 8pm (alt. weeks) Page 29 of 41

Tuesday 9.30am – 11.30am (alt. weeks) Thursday 6pm – 8pm Young person’s drop-in clinic Thursday 3pm – 4.30pm Dewsbury Health Clinic Tel: (01924) 351550 (for appointments) Tuesday 6.15pm – 8pm Thursday 6.15pm – 8pm Chadwick Centre, Dewsbury Tel: (01924) 816120 (appts necessary) Male & female doctors available throughout the week Monday 9.30am – 12.30pm 1.30pm – 7.00pm Tuesday 9.30am – 12.30pm 1.30pm – 5.00pm Wednesday 9.30am – 12.30pm Thursday 9.30am – 12.30pm 1.30pm – 7.00pm Friday 9.30am – 12.30pm The Walk-in centre. Dewsbury and District Hospital. Open Weekdays 8.30am-6.30pm. No appointment necessary. YOUNG PEOPLE’S CLINICS (No appointment needed – drop in) Netherton Surgery Tel: (01484) 666050 Friday 3.30pm – 4.30pm You don’t have to be registered with this practice to attend Milnsbridge New Street Surgery (at rear of YMCA in a portacabin) Tel: (01484) 651622 Wednesday 3.30pm – 4.30pm You don’t have to be registered with this practice to attend Kirkburton Health Centre Tel: (01484) 602040 Tuesday 3.30pm – 4.30pm You don’t have to be registered with this practice to attend (Huddersfield) New College Tel: (01484) 652341 or 652249 Dr Joe Schembri Tuesday 12.30pm – 1.15pm School nurses Thursday 12.30 – 1.15pm College nurse Monday 9.00am – 12.30pm Thursday 9.00am – 12.30pm Friday 9.00am – 12.30pm College student’s condoms and pregnancy testing available. (College academic year) Time 4 Teens, Fieldhead Surgery, Golcar Tel: (01484) 654504 Monday 4.00pm – 4.40pm Young people do have to be registered at Fieldhead to attend Chestnut Centre, Chestnut Street, Deighton Tel: (01484) 234234 Friday 3.15pm – 4.45pm Page 30 of 41

Drop–In for young people Cleckheaton Health Centre Tel: (01924) 351550 (for appts. or advice) Thursday 3.00pm – 4.30pm Thornhill Young Persons Drop-in Sure Start Building Tel: (01924) 325334 Tuesday 3.00pm – 5.00pm Young people to drop in to reception; they will call a worker as young people arrive.

Page 31 of 41

3. Types of Contraception Contraceptive Method

Benefits/Downside

Condom A condom is a thin rubber balloon that fits over the penis when erect and physically prevents sperm from entering the vagina. The female condom is slightly wider, made from polyurethane plastic, and fitted inside the vagina.

Easily available, simple to use, and only form of contraceptive that also protects against STIs. Some claim the male condom interferes with sex, because it has to be rolled on carefully just as things are hotting up. But there’s no excuse for not using it – it’s the only thing that protects against STIs. Does not interrupt sex. Protects against cancer of the ovary and womb. Bleeding may be lighter and period pain or pre-menstrual tension (PMT) is less likely. Does not protect against STIs In a small number of women it can cause serious side-affects such as blood clots and caner of the breast of cervix. Can cause weight gain and/or skin problems. Does not interrupt sex Can be taken by some women who can not use the combined pill Can be used when breastfeeding Does not protect against STIs Periods may be irregular

Combined Oral Contraceptive Pill Tablets containing two types of synthetic hormone: oestrogen and progestogen (usually taken for 21 days followed by a 7 day break). This prevents ovaries from releasing an egg each month – and provides round-theclock protection against pregnancy.

Progestogen-only pill Oestrogen-free alternative to the combined pill that affects the cervical mucus so sperm can’t reach the womb. For some women, the progestogen-only pill can stop ovulation, which means it prevents the ovaries from releasing an egg. Implants One small progestogen-primed tube inserted under the skin of the upper arm. The protects against pregnancy for up to 3 years.

Injection Progestogen-based contraceptive injection that lasts for 8 or 12 weeks (depending on which brand you chose to use).

Page 32 of 41

Does not interrupt sex Works for up to 3 years Fertility returns immediately after implant is removed. Does not protect against STIs Periods may be irregular or stop altogether Can cause headaches and skin problems. Does not interrupt sex Women to not have to remember to take the pill May protect against cancer of the womb Does not protect against STIs Periods may be irregular or stop altogether Can cause headaches and skin problems

Intra-Uterine System (IUS) Fitted in the womb, this tiny plastic Tshaped device slowly releases progestogen to protect against pregnancy for up to 5 years.

Contraceptive Patch Small patch, releasing the same hormones as the combined pill, applied to the skin like a sticky plaster.

Diaphragms and Caps Diaphragms are dome-shaped rubber devices that fit into the vagina and over the cervix. Caps are smaller, but both form a barrier preventing sperm from reaching the female egg.

Intra-Uterine Device (IUD or ‘the coil’) Range of small devices made from copper/polyethylene. When fitted in the uterus an IUD prevents sperm meeting an egg or may stop an egg settling in the uterus.

Natural Family Planning This is a difficult method of Page 33 of 41

Can take a year or more after stopping the injection for regular periods to return As the hormone is injected into the body, any side-affects may continue for as long as the injection lasts, and sometimes longer. Depo-Provera works by lowering levels of the female hormone oestrogen and this can cause slight thinning of the bones by reducing bone mineral density. Does not interrupt sex Works for 5 years Periods may be lighter or may stop completely, until the IUS is removed. Does not protect against STIs Can cause irregular bleeding at first Can cause temporary side-affects such as skin problems or breast tenderness. Does not interrupt sex Can be worn while swimming, having a bath or exercising Women do not have to remember to take the pill Does not protect against STIs Can cause headaches and skin problems Contains the same hormones as the combined pill, which in a small number of women can cause serious side-affects such as blood clots and breast cancer. May protect against some STIs and cancer of the cervix. Only needs to be used when having sex Can be put in before sex Putting it in can interrupt sex Must be fitted by a doctor or nurse in the first place to make sure it’s the right size. Can cause cystitis Does not interrupt sex Works immediately Works for between 3 – 10 years depending on the type of IUD fitted Does not protect against STIs Periods may be heavier, more painful or last longer If it fails, there is a risk that a pregnancy will develop in the fallopian tube (known as ectopic pregnancy) No side affects Can be used to plan pregnancy or

contraception to use and needs to be taught properly to be affective. Natural metho9ds of contraception involve working out when a woman is at the fertile phase of her monthly cycle and avoiding unprotected sex during this time. Be warned – this is a difficult method to get right.

avoid pregnancy Does not protect against STIs Need to avoid sex, or use a barrier method of contraception if you have sex, during fertile times. Must be taught properly to be affective Needs high level of commitment from both partners Need to keep daily records.

4. Sexually Acquired Infections Infection and Treatment

Gonorrhoea Bacterial infection Antibiotics

Symptoms may include Yellow or white discharge from vagina or penis. Pain or ‘burning’ when urinating, anal irritation or discharge. Inflammation of testicles and prostate gland. May be asymptomatic.

Untreated: can lead to pelvic inflammatory disease and infertility.

Chlamydia Bacterial Infection

Often no symptoms but sometimes: discharge from penis or vagina, pain when urinating, abdominal pain, pain during sex, painful swelling/irritation in the eyes if infected.

Antibiotics Untreated: can lead to pelvic inflammatory disease and infertility. Inflammation of the fallopian tubes. Pelvic Inflammatory Disease (PID) Caused by a range of bacterial infections, Abdominal pain, weakness, painful commonly Chlamydia and Gonorrhoea periods, pain during sex, bleeding between periods. Sometimes symptom Antibiotics less. Untreated: increased risk of ectopic pregnancy and infertility due to damaged fallopian tubes.

Genital Herpes (Herpes Simplex Virus ii)

Blisters and sores around the genital and anal areas, pain when urinating, flu-like illness, headache. Virus remains in the body and can result in further attacks. Highly infectious during an attack.

Viral Infection Antiviral treatment and measures to reduce/prevent further attacks Genital Warts (Human Papilloma Virus) Viral infection Lotions, creams or warts frozen or cut off. Page 34 of 41

Growths or warts anywhere on genital or anal areas. These may itch and are usually painless. Recurrence of warts can happen. Some types of wart virus can cause changes in the cervical cells.

Hepatitis B Viral infection Treatment will depend on severity of inflammation of liver. Prevention with vaccine (up to five years).

Hepatitis C Viral infection Treatment will depend on severity of liver damage. Less often sexually transmitted than Hepatitis B Human Immunodeficiency Virus (HIV) Retrovirus

Flu-like symptoms, tiredness, joint pains, weight loss, jaundice. Can result in permanent liver damage or cancer. Most adults recover fully. 2-10% will remain chronic carriers.

Symptoms are uncommon. If present they are similar to those of Hepatitis B. 20% of those infected will appear to clean the virus. 80% will remain infected and infectious.

From no symptoms to a range of opportunistic infections that can lead to an Aids diagnosis.

No cure but management of virus with combination therapies. Thrush (Candida Albicans) Yeast Infection

If infected will remain infectious. In women: thick, white discharge, itching, and pain when urinating.

Pessaries and cream for women Cream for men

In men: rash and/or soreness under the foreskin.

Not always acquired through sexual intercourse. Trichomoniasis (TV) Small Parasite Antibiotics

Pubic Lice Parasites

Yellow, green or white smelly discharge from vagina or penis. Pain when urinating, pain during sex. Often symptomless. Severe itching around the genitals. Small nits (eggs) on pubic hairs. Black powder (lice droppings) in underwear.

Lotions (as for head)

5 .Useful Organisations & Websites YOUNG PEOPLE SITES

Page 35 of 41

These sites are young people friendly. Some are general sites which cover a range of health issues including sexual health and others are more specifically focussed. Whilst we have looked at them we are not in a position to give absolute assurances about the quality of the sites and would recommend you check them out to ensure they are appropriate for the use intended. The Kirklees council policy on use of electronic equipment and access to the internet must be adhered to, some sites may be blocked by the council internet protection mechanism. Management advice should be sought in order to gain access the sites.

Sexual health and well being www.ruthinking.co.uk www.lets-talk-about-sex.co.uk www.gayyouth.org.uk/index.phtml www.regard.org.uk www.stonewall.org.uk www.akt.org.uk www.lgbtyouth.org.uk www.queeryouth.org.uk www.likeitis.org.uk www.lovelife.uk.com www.avert.org www.brook.org.uk

Other health issues www.youthinformation.com www.connect.to/voyagerhouse www.teenagehealthfreak.org www.wiredforhealth.gov.uk www.bullying.co.uk www.alcoholconcern.org.uk www.talktofrank.com www.givingupsmoking.co.uk www.childline.org.uk www.edauk.com www.youthfax.org/rights/kirklees.html www.thecalmzone.net/

WORKER SITES The worker sites offer information, facts and figures in relation to health, some are focussed on general health and some specifically on sexual health. www.kirkleeshealthyschools.org.uk www.sexplained.com www.childpolicy.org.uk www.hda-online.org.uk/yphn www.durex.co.uk www.sexualhealthsheffield.co.uk www.dfes.gov.uk www.parentlineplus.org.uk www.teenagepregnancyunit.gov.uk www.hpa.org.uk/default.htm Page 36 of 41

www.ncb.org.uk/sef www.fpa.org.uk/www saferschoolpartnerships.org/citizenship/homophobia/addressing_homo_transphobia_page4.ht m

Teenage Pregnancy Unit Department for Education and Skills, Caxton House, 6-12 Tothill Street, London SW1H 9NA Tel: 020 7273 4839 www.teenagepregnancyunit.gov.uk Kirklees Teenage Pregnancy Strategy Contact: Marianne McLeod-Hill National Childrenâ&#x20AC;&#x2122;s Centre, Brian Jackson House, New North Parade, Huddersfield, HD1 5JP Telephone 01484 223393 Sex Education Forum 8 Wakley Street London EC1V 7QE Tel: 020 7843 6052 www.ncb.org.uk/sef Provides publications and resources, as well as an information help line for professionals involved in sex and relationship education. FPA (formerly the Family Planning Association) 50 Featherstone Street, London, EC1Y 8QU Tel: 020 7837 5432 www.fpa.org.uk FPA runs an information service, including a national telephone helpline (0845 310 1334), provides training & consultancy services and runs community based projects. FPA produces publications and leaflets for the public and professionals, including a range of leaflets for young people. Sheffield Centre for HIV & Sexual Health 22 Collegiate Crescent Sheffield S10 2BA Tel: 0114 226 1900 www.sexualhealthsheffield.co.uk The Sheffield Centre for HIV & Sexual Health offer training, consultancy and resources on a range of sexual health issues as well as running Lesbian Information Service www.lesbianinformationservice.org PO Box 8, Todmorden, Lancashire, OL14 5TZ Telephone 01706 817235 A research and training organisation challenging homophobia. Page 37 of 41

Teenage Health Freak www.teenagehealthfreak.co.uk Website for teenagers. Can email questions on a wide range of medical and sexual issues. Brook 421 Highgate Studios 53-79 Highgate Road London NW5 1TL Tel: 020 7284 6040 www.brook.org.uk Brook advisory centres provide free and confidential sexual health advice and services specifically for young people under 25. Brook also provide a free helpline for young people, 0800 0185 023 (mon-fri, 9am-5pm). There is also a confidential text messaging service, text: BROOK INFO to 81222. Yorkshire MESMAC Contact: Andy Mullen, PO Box 267, Bradford, BD1 5XT Tel: 01274 395815 MESMAC offer a range of support services to men who have sex with men. Barnadoâ&#x20AC;&#x2122;s Missing In Yorkshire Project, Kirklees Contact: Helen West Room F1, Westfields, Minfield, WF14 9PW Tel: 01924 483754 Freephone number for girls and young women: 0800 0725070 This organisation provides a support service for girls aged 16 and under in the Kirklees area who have gone missing from home or a care base. Childline www.childline.org.uk National helpline - 0800 1111. Open 24 hours a day, 365 days a year. Provides a free, confidential telephone counselling service for children or young people with any problem. Information for children and young people, as well as professionals, is also available via the website. A textphone service provides confidential support and advice for the deaf or hard of hearing. Call on 0800 400 222 (weekdays, 9.30am-9.30pm and weekends, 11am-8pm). Department of Health www.doh.gov.uk A website that shows the latest information on the work of the Department, as well as health and social care guidance, publications and policy (including the National Strategy for Sexual Health and HIV). Education of Choice www.efc.org.uk The Print House, 18 Ashwin Street, London, E8 3DL Page 38 of 41

Telephone 020 7837 7221 Education for Choice is a pro-choice organisation that works to enable young people to make informed choices, around pregnancy and abortion and also facilitates workshops in these areas. Has a national training programme for health and education professionals; produces resources for those working with young people. National AIDS Helpline Telephone 0800 567 123 A free, confidential 24 hour help line for information on HIV and other sexually transmitted infections. Marie Stopes www.mariestopes.org.uk Marie Stopes International 153-157 Cleveland Street, London, W1T 6QW Telephone 0845 300 8090 Online sexual health information and advice on issues such as abortion, pregnancy and STD’s. NHS Direct www.nhsdirect.nhs.uk Help line 0845 46 47. Open 24 hours a day, 7 days a week. To find out more about an illness or condition, a self-help guide and advice for healthy living. Need 2 Know www.need2know.co.uk Information portal for teenagers with an online magazine and signposting to other useful websites. Sections include health, relationships, money, travel and law. NSPCC www.nspcc.org.uk Child Protection Helpline 0800 800 5000 The UK’s leading charity specialising in child protection and prevention of cruelty to children. The website contains comprehensive information on the NSPCC’s work. Sexwise www.ruthinking.co.uk Helpline 0800 28 29 30. Open from 7 am – 12 am every day. For young people aged 12 – 18. The website gives information on contraception, sex and relationships. It allows you to search for services anywhere in the UK. The Site www.thesite.org.uk General information and lifestyle website for young people, ‘your guide to the real world’. Has a section on sex and relationships, including STI’s, contraception and sexual health. He Say You Say www.hesayyousay.co.uk Interactive site, helping young women persuade their partner to wear a condom. Hosted by Durex. Page 39 of 41

EACH www.eachaction.org.uk Free Helpline 0800 1000 143 Educational Action Challenging Homophobia. EACH is a service supporting young people, parents/carers or adults being affected by homophobic bullying.

GALYIC www.galyic.org.uk Gay And Lesbian Youth In Calderdale. GALYIC is a group designed to support lesbian/gay/bisexual people aged 25 years and below. Although based in Calderdale they take referrals from Kirklees. Young people can self-refer.

Page 40 of 41